Tricuspid Valve Dilation in a Case of Ostium Secundum Atrial Septal Defect: Therapeutic Dilemmas in the Perioperative Period and a Call for Building the Evidence

The adult literature on managing tricuspid regurgitation (TR) in left heart disease is in evolution. Tricuspid valve repair in pediatrics, on the other hand has more or less been restricted to disease subsets, such as children developing TR secondary to right ventricular disease or tricuspid valve anomalies. The pediatric literature on ‘acquired’ TR [as in congenital heart diseases, such as atrial septal defect (ASD)] is sparse. Some of the concerns that need to be addressed are thresholds for intervention, optimal annular reduction and methods of surgical reduction (DeVega vs ring annuloplasty). We present a case of a 5 years old female child who primarily presented for closure of her ostium secundum ASD. However, intraoperative transesophageal echocardiography (TEE) revealed TR and a tricuspid annular dimension beyond z +3 for her size. The surgeon chose to perform a DeVega annuloplasty and both the ASD closure and the annuloplasty were uneventful, postoperative TEE revealed no residual defect, no TR or stenosis. We seek to highlight this case in order to urge a more systematic study of such patients with a local focus since patients in our country present later than usual with asymptomatic heart disease and are more likely to undergo progressive right heart enlargement for a given shunt.