Clinical Analysis On Tricuspid Regurgitation In Patients With Atrial Septal Defect

Objective:To investigate the clinical features and influence factors of tricuspid regurgitation (TR) in patients with atrial septal defect (ASD).Methods:We retrospectively enrolled 246 secundum ASD patients in the First Affiliated Hospital of Guangxi Medical University from January 2013 to September 2015. The clinical manifestations, electrocardiogram, right heart catheterization and transthoracic echocardiography parameters were collected. Groups were made and compared according to the age, the severity of TR, the size of right ventricular and the size of right atrium to picture out the clinical features and the influence factors of TR.Results:(1) Females occupied 69.5% of patients with ASD. The average age when patients underwent interventional closure was 26.6±15.7.62.6% of patients with ASD were free of overt symptoms and 98% of patients were considered to have New York Heart Association (NYHA) class Ⅰ or Ⅱ.89.0% of ASD patients were free of pulmonary hypertension. (2) 97.6% of patients with ASD have TR. The percentage of patients whose TR<10ml,10ml< TR< 20ml, TR≥20ml was 84.2%(202/240),11.2%(27/240),4.6%(11/240), respectively. Three cases were diagnosed with severe TR. The worse TR volume was up to 67ml. (3) Patients whose TR volume≥10ml were older and had greater left atrium diameter (LAD), right atrium diameter (RAD), right ventricular diameter (RVD) than those whose TR volume< 10ml (all P< 0.05). (4) The TR volume, LAD, RAD and RVD were greater in middle-age and senior patients than those in young patients. (5) The TR volume in patients who had dilated right ventricular or dilated right atrium was significantly greater than that in normal patients (6.8±6.8ml vs 1.4±1.3ml, P<0.05,8.3±7.6ml vs 3.7±3.4ml, P<0.05, respectively). (6) In linear correlation analysis, age, LAD, RAD, RVD, left ventricular ejection fraction, pulmonary arterial systolic pressure were significantly correlated to TR volume (r=0.273, r=0.207, r= 0.408, r= 0.371, r= 0.129, r= 0.128, respectively, all P< 0.05), while RAD was identified as the influence factor of TR (P< 0.05).Conclusion:(1) ASD was more common in female. Most of patients were free of overt symptoms with NYHA class I or II. Only a few patients with ASD had mild to moderate pulmonary hypertension. (2) The majority of ASD patients complicated with functional TR, but commonly, the TR volume were less than 10ml. Very few patients had severe TR. (3) Not only did the LAD, RAD, RVD were greater, but the TR was more severe in middle-age and senior patients than those in young patients. (4) The dilation of the right ventricular and right atrium were closely related to TR, and RAD was the influence factor of TR.