Factors associated with the presence of tricuspid valve regurgitation in patients with systemic right ventricles following atrial switch.

Background: The development of significant tricuspid regurgitation (TR) is associated with an unfavorable clinical outcome in patients with systemic right ventricles. Increased knowledge about the factors contributing to its presence would help prevent its progression.

Methods: This was a retrospective analysis of the factors predictive of significant TR in 60 patients with systemic right ventricles following an atrial switch procedure for complete transposition of the great arteries. Data from echocardiographic examinations, exercise radionuclide angiography, and myocardial perfusion imaging were analyzed.

Results: Significant TR was present in 20% of patients. Compared to patients without significant TR, patients with significant TR were older at the time of surgery (p < or = 0.001), with a higher body mass index (p < or = 0.005), lower right ventricular ejection fraction (RVEF; p < or = 0.01), higher exercise perfusion abnormalities score on radionuclide angiography (p < or = 0.03), and higher systolic blood pressure (p < or = 0.02). At univariate logistic regression analysis systolic blood pressure (p = 0.03), increasing age at surgery (p = 0.01), and RVEF (p = 0.02), were predictors of significant tricuspid regurgitation. The latter two remained significant at multivariate analysis.

Conclusions: Patients operated upon later in life, with decreased RVEF and higher blood pressure, are at risk of significant tricuspid regurgitation and therefore warrant special attention. Prospective studies are needed to ascertain whether appropriate pharmacological intervention would prevent the development and/or progression of TR in these patients.