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Prevalence and determinants of tricuspid regurgitation after repair of tetralogy of Fallot

Published:November 24, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.039

      Highlights

      • Prevalence and determinants of tricuspid regurgitation (TR) in patients with repaired Tetralogy of Fallot (rTOF) remain incompletely understood.
      • Despite substantial RV volume overload, there was very little TR in patients following ToF repair (78% had none or mild TR).
      • RV volume, RA volume and tricuspid annular diameter correlated poorly with TR severity in rTOF.
      • Only rTOF was independently associated with higher TR fraction in a pooled cohort analysis including patients with significant RV dilatation due to pre-tricuspid shunt.
      • Our findings challenge commonly held notions regarding the pathophysiology of FTR with RV dilatation.

      Abstract

      Background

      The prevalence and determinants of tricuspid regurgitation (TR) in patients with repaired Tetralogy of Fallot (rTOF) remain incompletely understood.

      Objectives

      To explore the prevalence of and factors associated with TR in patients with rTOF, specifically, the relationship of right ventricular (RV) dilatation with TR severity.

      Methods

      Patients (≥17 yrs) with rTOF referred to our service (2000–2019) were identified. Those with severe pulmonary stenosis, significant shunt, or previous tricuspid valve surgery were excluded. Using standard cardiac MRI protocols, RV, right atrial (RA) and tricuspid valve (TV) parameters were measured and compared.

      Results

      68 consecutively eligible patients with rTOF were included in the study (27 ± 9 yrs., 35% female). Despite substantial RV volume overload (mean RVEDVi 153 mL/m2), the majority of the cohort (78%) had no or only mild TR. RA volumes, tenting height/area and annular diameter were normal (4.9 ± 2.0 mm, 1.1 ± 1.0 cm2 and 32.4 ± 6.2 mm, respectively). There was no significant correlation of TR fraction with RVEDVi (r = 0.13; p = 0.30), RVEF (r = 0.09; p = 0.44) or tricuspid annular diameter (r = 0.07; p = 0.62). Only RAVi showed a weak but significant correlation with TR fraction (0.29; p = 0.03). In a pooled cohort analysis, including both rTOF patients and adults with a dilated RV from pre-tricuspid shunt lesions, rTOF was independently associated with higher TR fraction (p = 0.017).

      Conclusion

      Despite substantial RV dilatation in a cohort with rTOF, there was surprisingly little TR. We found poor correlation between RVEDVi, RA volumes, tricuspid annular dilatation and the presence of significant TR. These findings question commonly held notions regarding the pathophysiology of functional TR in these patients.

      Keywords

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