Tricuspid Regurgitation in Ostium Secundum Atrial Septal Defects: Repair or Not?

Authors

  • Chirag Sumithra Prasanna Kumar, MCh Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Bineesh K. Radhakrishnan, MCh Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Remya Sudevan, MPH Department of Health Sciences Research, Amrita Institute of Medical Sciences, Kochi. Kerala, India
  • Jayakumar Karunakaran, MCh Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

DOI:

https://doi.org/10.1532/hsf.2859

Keywords:

Tricuspid regurgitation, ostium secundum atrial septal defects, repair

Abstract

Background: Longstanding ostium secundum atrial septal defects lead to functional tricuspid regurgitation. Significant functional tricuspid regurgitation associated with left heart valve disease is addressed at the time of primary left heart valve surgery. In contrast, there is no global recommendation for tricuspid regurgitation associated with atrial septal defects. This study assesses changes in tricuspid regurgitation after isolated atrial septal defect closure.

Methods: Retrospectively, records were examined of 100 patients who underwent isolated ostium secundum atrial septal defect closure without tricuspid valve repair. Echocardiograms were done preoperatively and 3 days, 3 months, and 1 year after surgery. Data on tricuspid regurgitation status, right ventricle dimensions, and pulmonary artery hypertension status were collected and analyzed.

Results: After surgical closure, echocardiography showed a regression of tricuspid regurgitation to mild or less in 76% of patients at 3 days, 89% at 3 months, and 93% at 1 year. Severe pulmonary artery hypertension (32% patients preoperatively) showed statistically significant regression: 14% at 3 days, 10% at 3 months, and 2% at 1 year. Preoperatively, the mean right ventricular internal diameter was 37.9 mm, which decreased to 34 ± 5.5 mm (mean ± standard deviation) at 3 days, 32.3 ± 5.3 mm at 3 months, and 31.3 ± 5.4 mm at 1 year. It was also noted that regression favored patients who were <25 years old.

Conclusion: Tricuspid valve repair may not be required in patients with ostium secundum atrial septal defect with functional tricuspid regurgitation.

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Published

2020-04-23

How to Cite

Prasanna Kumar, C. S., Radhakrishnan, B. K., Sudevan, R., & Karunakaran, J. (2020). Tricuspid Regurgitation in Ostium Secundum Atrial Septal Defects: Repair or Not?. The Heart Surgery Forum, 23(2), E239-E244. https://doi.org/10.1532/hsf.2859

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Articles