+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Predictors of residual tricuspid regurgitation after percutaneous closure of atrial septal defect



Predictors of residual tricuspid regurgitation after percutaneous closure of atrial septal defect



European Heart Journal Cardiovascular Imaging 20(2): 225-232



Functional tricuspid regurgitation (TR) associated with atrial septal defects (ASDs) is frequently present due to right-sided volume-overload. Tricuspid valve (TV) repair is often considered in candidates for surgical ASD closure, and percutaneous TV repair is currently under clinical investigation. In this study, we develop a prediction model to identify patients with residual moderate/severe TR after percutaneous ASD closure. In this observational study, 172 adult patients (26% male, age 49 ± 17 years) with successful percutaneous ASD closure had pre- and post-procedural echocardiography. Right heart dimensions/function were measured. TR was assessed semi-quantitatively. A prediction model for 6-month post-procedural moderate/severe TR was derived from uni-and multi-variable logistic regression. Clinical follow-up (FU) was updated and adverse events were defined as cardiovascular death or hospitalization for heart failure. Pre-procedural TR was present in 130 (76%) patients (moderate/severe: n = 64) of which 72 (55%) had ≥1 grade reduction post-closure. Independent predictors of post-procedural moderate/severe TR (n = 36) were age ≥60 years [odds ratio (OR) 2.57; P = 0.095], right atrial end-diastolic area ≥10cm2/m2 (OR 3.36; P = 0.032), right ventricular systolic pressure ≥44 mmHg (OR 6.44; P = 0.001), and tricuspid annular plane systolic excursion ≤2.3 cm (OR 3.29; P = 0.037), producing a model with optimism-corrected C-index = 0.82 (P < 0.001). Sensitivity analysis excluding baseline none/mild TR yielded similar results. Patients with moderate/severe TR at 6-month FU had higher adverse event rates [hazard ratio = 6.2 (95% confidence interval 1.5-26); log-rank P = 0.004] across a median of 45 (30-76) months clinical FU. This study shows that parallel to reduction of volume-overload and reverse remodelling after percutaneous ASD closure, TR improved substantially despite significant TR at baseline. Our proposed risk model helps identify ASD patients in whom TR regression is unlikely after successful percutaneous closure.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 065425009

Download citation: RISBibTeXText

PMID: 29905827

DOI: 10.1093/ehjci/jey080


Related references

Predictors of mid-term functional tricuspid regurgitation after device closure of atrial septal defect in adults: Impact of pre-operative tricuspid valve remodeling. International Journal of Cardiology 187: 447-452, 2015

Persistent tricuspid regurgitation and its predictor in adults after percutaneous and isolated surgical closure of secundum atrial septal defect. American Journal of Cardiology 104(6): 856-861, 2009

Different Determinants of Residual Tricuspid Regurgitation after Tricuspid Annuloplasty: Comparison of Atrial Septal Defect and Mitral Valve Prolapse. Yearbook of Cardiology 2010: 269-270, 2010

Different determinants of residual tricuspid regurgitation after tricuspid annuloplasty: comparison of atrial septal defect and mitral valve prolapse. Journal of the American Society of Echocardiography 22(8): 899-903, 2009

Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation. Catheterization and Cardiovascular Interventions 82(6): E817, 2013

Robotic-assisted removal of an Amplatzer atrial septal occluder device for residual shunting, closure of septal defect and simultaneous tricuspid annuloplasty. Journal of Robotic Surgery 12(1): 185-188, 2018

Late complete atrioventricular block and tricuspid regurgitation after percutaneous closure of a perimembranous ventricular septal defect. Journal of Thoracic and Cardiovascular Surgery 140(3): E60, 2010

Device fracture and severe tricuspid regurgitation after percutaneous closure of perimembranous ventricular septal defect: a case report. Catheterization and Cardiovascular Interventions 70(5): 749-753, 2007

Decreased tricuspid regurgitation following percutaneous closure of congenital perimembranous ventricular septal defect: immediate and 6-month echocardiographic assessment. Heart and Vessels 30(5): 611-617, 2015

Increased pulmonary artery pressures during exercise are related to persistent tricuspid regurgitation after atrial septal defect closure. Acta Cardiologica 68(4): 365-372, 2013

Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adult Patients: Long-Term Follow-Up. Jacc. Cardiovascular Interventions 10(21): 2211-2218, 2017

Atrial septal defect with tricuspid valve regurgitation and heart failure in early childhood: report of a case with successful surgical management consisting of special patch closure technique and use of polydioxanone suture for the tricuspid annuloplasty. Rinsho Kyobu Geka 9(3): 301-304, 1989

Incidence and Predictors of Aggravation of Mitral Regurgitation After Atrial Septal Defect Closure. Annals of Thoracic Surgery 104(1): 205-210, 2017

Comparative changes of pulmonary artery pressure values and tricuspid valve regurgitation following transcatheter atrial septal defect closure in adults and the elderly. Congenital Heart Disease 4(1): 17-20, 2009

Residual atrial septal defect after percutaneous closure with an Amplatzer device. EuropeanJournalofCardio-ThoracicSurgery37(2):489, 2010