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


  • 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



Tricuspid regurgitation, ostium secundum atrial septal defects, repair


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.


Baumgartner H, Falk V, Bax JJ, et al. 2017. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739-2791.

Berbarie RF, Anwar A, Dockery WD, et al. 2007. Measurement of right ventricular volumes before and after atrial septal defect closure using multi slice CT. Am J Cardiol 99:1458-1461.

Dehghani H, Boyle AJ. 2012. Percutaneous device closure of secundum atrial septal defect in older adults. Am J Cardiovasc Dis 2:133-142.

Gatzoulis MA, Rodington AN, Somerville J et al. 1996. Should atrial septal defects in adults be closed? Ann Thorac Surg 61:657-659.

Ghosh S, Chatterjee S, Black E, Firmin RK. 2002. Surgical closure of atrial septal defects in adults: Effect of age at operation on outcome. Heart 88:485-487.

Hamer JPM. 1990. Practical Echocardiography in the Adult. Springer Netherlands, Dordrecht. 238 pp.

Hoashi T, Yazaki S, Kagisaki K, et al. 2015. Management of ostium secundum atrial septal defect in the era of percutaneous trans-catheter device closure: 7-Year experience at a single institution. J Cardiol 65:418-422.

Humenberger M Rosenhek R, Gabriel H, et al. 2011. Benefits of atrial septal defect closure in adults: Impact of age. Eur Heart J 32:553-560.

Jemielity M, Dyszkiewicz W, Paluszkiewicz L, et al. 2001. Do patients over 40 years of age benefit from surgical closure of atrial septal defects? Heart 85:300-303.

Kotowycz MA, Therrien J, Ionescu-Ittu R, et al. 2013. Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 6:497-503.

Krovetz LJ. Normal standards for cardiovascular data. II. Pressure and vascular resistances. 1972. John Hopkins Med J 130:187-195.

Lang RM, Bierig M, Devereux RB, et al. 2005. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Eur J Echocardiogr 7:79-108.

Levin AR, Levin AR, Spach MS, et al. 1968. Atrial pressure-flow dynamics in atrial septal defects (secundum type). Circulation 37:476-488.

Liberthson RR, Boucher CA, Strauss HW, Dinsmore RE, McKusick KA, Pohost GM. 1981. Right ventricular function in adult atrial septal defect: Preoperative and postoperative assessment and clinical implications. Am J Cardiol 47:56-60.

Maatouk F, Ben Farhat M, Betbout F, et al. 2001. Right ventricular dilatation and intraventricular septal motion after surgical closure of atrial septal defect. Arch Mal Coeur Vaiss 94:204-210.

Mohanan Nair KK, Pillai HS, Thajudeen A, et al. 2012. Immediate and long-term results following balloon mitral valvotomy in patients with atrial fibrillation. Clin Cardiol 35:35-39.

Moodie D, Sterba R. 2000. Long term outcomes excellent for atrial septal defect repair in adults. Cleve Clin J Med 67:657.

Nishimura RA, Otto CM, Bonow RO, et al. 2014. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:2440-2492.

Oakley C. 1996. Closure of atrial septal defects in adult life. Cardiologia 41:31.

Rao PS, Harris AD. 2017. Recent advances in managing septal defects: Atrial septal defects. F1000Res 6:2042.

Rosas M, Attie F, Sandoval J, et al. 2004. Atrial septal defects in adults ≥40 years old: Negative impact of low arterial saturation. Int J Cardiol 93:145-155.

Webb G, Gatzolius MA. 2006. Atrial septal defects in the adult: Recent progress and overview. Circulation 114:1645-1653.

Weyman AE. 1994. Principles and Practice of Echocardiography, Second Edition. Lippincott Williams & Wilkins; Philadelphia. 1335 pp.

Zoghbi WA, Enriquez-Sarano M, Foster E, et al. 2003. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777-802.



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.