Partial Anomalous Pulmonary Venous Drainage Research Articles

Echocardiogram Diagnosis of Complex Congenital Cardiac Malformations

Background: Complex congenital cardiac malformations rarely reported in literature Objective: Study was undertaken to define complex congenital cardiac malformations by Echocardiogram Materials and Methods: Prospective study included 101 children aged 2 to14 years, both male and female during March 2004 to February 2005 and July 2006 who attended in-patients & outpatient departments at Vyedhi Institute of Medical Sciences and Research Centre (VIMS & RC) and Sri Jayadeva Institute of Cardio-vascular Sciences and Research of Cardiology (SJICR), Bangalore, India. Clinical diagnosis was confirmed by relevant investigations and Echocardiography. Results: Complex congenital cardiac malformations presented in 16 (15.99%) of 101 children raising the total number of cardiac defects to 121. Majority 77 (76.2%) acyanotic cardiac malformations comprised of 29 (28.72%) Atrial Septal Defects (ASD) had 11 complex cardiac malformations. Three cases ASD + Partial Anomalous Pulmonary Venous Drainage (PAPVC), 2 cases ASD + Patent Ductus Arteriosus (PDA) + Mitral Valve prolapse (MVP), 2 cases ASD + Pulmonary Stenosis (PS,) 1 case ASD + PDA + PS, 1 case ASD + Ventricular Septal Defect (VSD), 1 case ASD + Coarctation of Aorta (CoA) and 1 case ASD + MVP. Next 23 (22.77%) VSD had 4 complex cardiac malformation cases, 3 cases of VSD + Aortic Stenosis (AS) of which one case had dextrocardia and 1 case VSD + PS. Followed by AS 8 (7.9%) with 1 case of AS + CoA, another case had VSD + AS. Among 24 (23.76%) cyanotic defects, TOF18 (17.8%) was the commonest, other rare variants included Double Outlet Right Ventricle (DORV) 4(3.96%) one case with dextrocardia. Pentalogy of Fallot 1 (0.99%) and Triology of Fallot 1 (0.99%). The age distribution revealed most 30(29.8%) were young children aged 2-4 years with overall male predominance Male:Female::1.3:1, observed contrasted to female predominance noted in ASD and TOF, M:F::1:2 and M:F::1:1.3 respectively Conclusion: Complex congenital cardiac malformations presented in 16(15.99%) of 101 children raising the total number of cardiac defects to 121

Virtual reality modelling for planning of percutaneous first step palliation in a newborn with heterotaxy syndrome.

We report the first-stage percutaneous palliation in a newborn with a rare heterotaxy syndrome variant including interrupted inferior vena cava, partial anomalous pulmonary venous drainage, and restrictive interatrial communication. Virtual reality imaging aided visualisation, decision-making, and planning. Successful atrial septoplasty performed via the internal jugular vein and anomalous pulmonary vein was followed by stenting of ductus arteriosus.

Scimitar Syndrome with Acquired Cardiac Disease: A Once-in-a-blue-moon Occurrence

Abstract Scimitar syndrome (SS) is a rare congenital anomaly characterized by various abnormalities observed in both children and adults, primarily involving partial anomalous pulmonary venous drainage from the right lung to the inferior vena cava and right lung hypoplasia. It is also known by alternative names such as congenital venolobar syndrome, Halasz syndrome, mirror-image lung syndrome, hypogenetic lung syndrome, and vena cava bronchovascular syndrome. The clinical presentation of this syndrome varies widely, ranging from asymptomatic cases to severe forms. Surgical intervention is typically required for severe cases, and the diagnosis relies predominantly on imaging studies. We present two instances of SS: one involving a patient with underlying rheumatic heart disease scheduled for valve replacement surgery and the other as an incidental finding in an asymptomatic individual, managed through medical means.

Diagnosis and treatment of neonatal machete syndrome

Aim: To provide suggestions for clinical diagnosis, treatment and eugenics through the retrospective analysis of a case of neonatal machete syndrome.Methods: The clinical data of a newborn with machete syndrome admitted to the pediatrics department of Baogang Hospital of Inner Mongolia were analyzed, and suggestions of eugenics were provided based on the literatures.Results: The child, male, natural conception, G2P2, gestational age 38+4 weeks, was born by cesarean section (at am 09:24 on November 13th, 2021). He was hospitalized in our department for 9 days and given NCPAP positive pressure ventilation to give oxygen and anti-infection symptomatic treatment. The dyspnea of the child was not significantly alleviated, and the heart murmurs became increasingly obvious. The child was transferred to the neonatology Department of the Seventh Medical Center of the PLA General Hospital for further treatment on 9 days after birth. After admission, piperacillin and tazobactam were treated with anti-infection, high-frequency oscillation mode of invasive ventilator, limited fluid volume and other symptomatic treatments. Fiberbronchoscopy showed atelectasis of right lung and tracheomalacia of left lung. Echocardiography showed partial anomalous pulmonary venous drainage, atrial septal defect (secondary foramina), inferior vena cava dilatation, pulmonary hypertension, initial coronary artery dilatation, and patent ductus arteriosus. CT 3D imaging of pulmonary veins showed: Congenital heart disease: partial anomalous pulmonary venous drainage (subcardial), consideration of "machete syndrome," atrial septal defect, consideration of pulmonary hypertension, right pulmonary artery stenosis, right lower lung receiving abdominal aorta blood supply, right lung tissue dysplasia, and widening of inferior vena cava pulmonary veins. Therefore, the comprehensive diagnosis was "machete syndrome." Considering the high surgical risk of the child, conservative symptomatic treatment was recommended, and the family requested discharge after 22 days of treatment. The patient died at home at 3 months follow-up after discharge.Conclusions: Machete syndrome is a rare congenital property of abnormal partial or complete pulmonary venous drainage from the right or left lung to the inferior vena cava. With an incidence of approximately 2 in 100,000 live births, the syndrome is commonly associated with right lung dysplasia, pulmonary sequestration, persistent left superior vena cava, and right tilt of the heart. In this case, the child had these syndromes after birth, since the primary hospital did not recognize the disease, the child was clearly diagnosed in the higher hospital. Children with machete syndrome can be treated with surgery in the early neonatal period, but the indication of surgical treatment is still controversial, and the need for surgery is evaluated according to the severity of the patient's symptoms and pulmonary circulation blood flow.

Kiosk 1Q-FA-07 - Partial Anomalous Pulmonary Venous Drainage in an Operated Adolescent with Tetralogy of Fallot, Is This Significant? Role of 4-dimensional (4D) Flow

Kiosk 1Q-FA-07 - Partial Anomalous Pulmonary Venous Drainage in an Operated Adolescent with Tetralogy of Fallot, Is This Significant? Role of 4-dimensional (4D) Flow

Kiosk 2Q-TA-05 - Transcatheter Treatment of Superior Sinus Venosus Atrial Septal Defect (SVASD) with Partial Anomalous Pulmonary Venous Drainage (PAPVD): The Critical Role of 3D Modelling

Kiosk 2Q-TA-05 - Transcatheter Treatment of Superior Sinus Venosus Atrial Septal Defect (SVASD) with Partial Anomalous Pulmonary Venous Drainage (PAPVD): The Critical Role of 3D Modelling

Determination of Stenosis and Arrhythmia After Surgical Operation of Partial Anomalous Pulmonary Venous Drainage in Mid & Longterm (Comparison of Double/Single Patch and Warden Operation in Partial Anomalous Pulmonary Venous Drainage): A Comparative Study of Two Different Time Intervals

We retrospectively investigated 20 patients who underwent partial anomalous pulmonary venous drainage (PAPVD) surgery with single-double patch, and Warden operation after surgical treatment in Hacettepe Medical School, department of cardiovascular surgery (group A) and 62 patients who underwent surgery with double patch in Eskişehir Osmangazi Medical School and 10 patients in Muğla Sıtkı Koçman Medical School (group B including 72 patients) at different time intervals. We compared postoperative v. cava superior stenosis, pulmonary vein stenosis and arrhythmia in regards of different techniques. We constituted 2 groups: 20 patients of Hacettepe Medical School between 2005-2011 (group A) and 72 patients of Muğla Sıtkı Koçman and Eskişehir Osmangazi Medical School between 2015-2022 (group B). Group A included 12 females, 8 males, the mean age was 5.7±3 years, ranging between 0.42 and 11 years, the mean weight was 18.67±9.01 kg, ranging between 5.50 and 41 kg. Group B included 39 females, 33 males, the mean age was 6.68±3.70 years, ranging between 1 and 17 years, mean weight was 23.58±14.75 kg, ranging between 8 and 80 kg. Clinical findings, electrocardiographic, echocardiographic evaluations were obtained. We found neither early nor late mortality in both groups. The mean follow-up duration were 39.73 months and 49.82 months respectively. No pulmonary venous or v. cava superior stenosis occurred in both groups. Reoperation for residual atrial septal defects required in 1 patient who underwent Warden procedure,1 patient who underwent double patch technique in group A. It didn’t require reoperation in group B. In group A, 6 patients presented rhythm disturbance in early postoperative period, as well as 4 patients in group B. In follow-up all patient recovered to sinus rhythm in both groups. Pacemaker wasn’t required. PAPVD can be safely operated using different procedures. Meticulous dissection nearby sinus node (SN) should be emphasized to avoid injury of SN for all techniques.

Device Closure of Superior Sinus Venosus Atrial Septal Defects: A single centre experience.

Sinus venosus atrial septal defects present a wide variety of anatomical features and are frequently associated with partial anomalous pulmonary venous drainage of one or more right pulmonary veins. Surgical correction used to be the standard treatment. In recent times, transcatheter correction of superior sinus venosus atrial septal defects has come into vogue. The transcatheter closure of these defects with covered stents at a tertiary care centre in Oman between 2018 and 2023 is reported.

Case Report: Removal of septal occluder device and closure of atrial septal defect with pulmonary vein flow redirection

BACKGROUND: Atrial septal defect represents 10 to 15% of congenital heart disease and is more frequent in women with a 2:1 ratio. Sinus venosus atrial septal defect is usually associated with partial anomalous pulmonary venous drainage from the right superior pulmonary vein to the right atrium directly or indirectly through the superior vena cava. Rarer still, is the inferior sinus venosus, which may be associated with partial anomalous venous drainage from the right inferior pulmonary vein. CASE REPORT: 13-year-old patient with a history of intervention for interatrial defect closure with Amplatzer occluder at the age of six. He was brought to receive medical attention for fatigue and dyspnea that had been progressing for 2 years. Cardiac CT reported partial anomalous connection of pulmonary veins and echocardiogram reported a residual atrial septal defect of 10 mm and mild to moderate pulmonary hypertension. Based on the findings, surgical treatment was decided. EVOLUTION: In correction surgery, we observed Amplatzer occluder incorrectly positioned, the device was removed and flow was redirected from right pulmonary veins to left atrium with bovine pericardium patch. After the surgical intervention, the patient had a favorable evolution without no post-surgical complications. At follow-up, 15 days after medical discharge, the patient was asymptomatic, and a cardiac CT scan showed the corrected interatrial defect. CONCLUSION: The treatment of atrial septal defect should be individualized, since it will depend on the size of the defect, the age at the time of diagnosis, the magnitude of the shunt, the severity of the symptoms and the presence of other conditions. If the defect requires repair, it is important to weigh the benefits of choosing percutaneous closure vs. surgical intervention to avoid the need for reintervention, as in the present case. Closure and redirection of pulmonary vein flow with bovine patch is a safe and effective option.

Minimally Invasive Surgery for Septal Defects Inchild: Literature Review

Nowadays a minimally invasive approach is a rapidly evolving strategy in particular in the field of congenital heart surgery. The main advantage of minimally invasive approaches is less trauma to a patient which positively effects early postoperative period and recovery after surgery. Own to continuous technological progress and growing experience minimally invasive approaches become widely used in cardiac surgery as well as in treatments of congenital heart defects. This review highlights the main problems and their potential solutions in using minimally invasive approaches in surgical treatment of atrial septal defect, ventricular septal defect, partial atrioventricular canal, partial anomalous pulmonary venous drainage. We describe specific considerations of cardiopulmonary bypass, operative techniques and results of minimally invasive approanes.

An uncommon variant of partial anomalous pulmonary venous drainage causing right chamber dilatation

An uncommon variant of partial anomalous pulmonary venous drainage causing right chamber dilatation

Transcatheter versus surgical treatment for isolated superior sinus venosus atrial septal defect.

The superior sinus venosus atrial septal defect is a congenital communication between the left and right atria. Open surgical approach by patch closure has historically been the only treatment option. Recently, a transcatheter approach has been developed. This study aims to compare the efficacy and safety of surgical and transcatheter approach in treatment of sinus venosus atrial septal defect. Between March 2010 and December 2020, 58patients (median age: 45.4, range 14.8-73.8) underwent either surgical or transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. Twenty-four patients (median age: 35.4, range 14.8-66.8) underwent surgery while 34patients (median age: 46.8, range 15.5-73.8) had a transcatheter treatment. During the catheterization era, 41patients was considered suitable for a transcatheter closure. In 5 patients, surgery was the patient's or referring physician's choice. In 2cases, the procedure was unsuccessful; the remaining 34were successfully closed (94.4% of cases). Intensive care unit stay (median of 1 day, range 0.5-4, vs. 0, range 0-2, p < 0.0001) and hospital stay (median 7 days, range 2-15 vs. 2 days, range 1-12, p < 0.0001), were significantly longer in the surgery group. Total early complication rate, consisted on procedural and in-hospital complication, were higher in the surgical group (62.5% vs. 23.5%; p = 0.005). However, complications in both groups were clinically mild. At follow-up, a small residual shunt was present in 6patients (surgery group: 2 pts; catheterization group: 4 pts; p: NS). Imaging studies showed significant improvement of right ventricular size and unobstructed pulmonary venous return in all patients. No late complications occurred at follow-up. Transcatheter correction of sinus venosus atrial septal defect is effective and safe in selected patients and may be considered as a valid alternative to surgery.

Midline crossing right pulmonary veins with dual drainage to the left atrium.

We report the exceptional case of transcatheter treatment of a partial anomalous pulmonary venous drainage of the right lung to the innominate vein and dual drainage to the left atrium.

Complex Adult Congenital Heart Disease: A Rare Case of Dextrocardia with Double-outlet Right Ventricle

Abstract Double-outlet right ventricle (DORV) is a complex and rare congenital heart disease (CHD), which is usually symptomatic early in childhood and thus diagnosed early. Dextrocardia is another rare CHD that can occur either as an isolated cardiac abnormality or may be associated with other complex cardiac defects. However, the co-occurrence of DORV and dextrocardia is rare, especially in adult life. We present a 35-year-old Nigerian lady with situs inversus totalis and complex CHD, which included dextrocardia with multiple congenital intracardiac shunts, DORV occurring with L-malpositioning of the great vessels, atrial septal defect, and ventricular septal defect with partial anomalous pulmonary venous drainage, persistent left superior vena cava as well as severe pulmonary stenosis.

MODIFIED DEEP TRANSGASTRIC TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING OF SUPERIOR VENA CAVA

<h3>Background</h3> Superior vena cava is usually interrogated intraoperatively by a standard bi-caval view as suggested by American Society of Echocardiography. A modified deep transgastric transesophageal echocardiography view is suggested that will superior interrogation of the superior vena cava intraoperatively. <h3>Objective</h3> Evaluation of a modified deep transgastric imaging of superior vena cava in patients undergoing cardiac surgery. <h3>Methods and material</h3> A modified deep transgastric imaging of superior vena cava was performed in children undergoing cardiac surgery. The deep transgastric interrogation with color Doppler blood flow map showed the venous return pattern. A pulse wave Doppler signal analysis was also feasible. The position of the tip of a central venous catheter tip that was inserted through the internal jugular vein could be seen. An agitated saline contrast injected into the left upper limb could exclude the presence of a left superior vena cava. In patients undergoing a undergoing a bi-directional Glenn shunt, considerable length of superior vena cava was visualized. In a child with a partial anomalous pulmonary venous drainage and a superior sinus venosus ASD, a point of the pulmonary vein joining the superior vena cava could be identified as it was possible to interrogate a considerable length of superior vena cava compared to the standard mid esophageal bi-caval view. The deep transgastric TEE interrogation of superior vena cava revealed a residual gradient in the superior vena cava following a sinus venosus atrial septal defect repair that was corrected at the same sitting. A color Doppler blood flow map across the superior vena cava following removal of a directly inserted venous cannula showed turbulence and a continuous-wave Doppler signal analysis revealed a residual gradient that was immediately corrected by the surgeon in another patient. <h3>Conclusion</h3> In conclusion, the deep transgastric TEE view of the superior vena cava is clinically useful. The doppler alignment is parallel to SVC flow (less than 20 degree) which is superior to bi caval view, where the doppler alignment is almost perpendicular to the flow. The probable difficulties that may be encountered that would interfere with proper visualization are: (i) poor contact of the probe with cephalad aspect of the stomach, (ii) air in the stomach, (iii) use of inadequate contact jelly, and (iv) lack of experience. There is a deep learning curve that can be a practical impediment but once honed, it could be a really useful adjunct to our routine trans-esophageal views.

Septum Primum Malposition: An Uncommon Cause of Right Ventricular Volume Overload.

A 24-year-old woman was hospitalised for a systolic murmur with exertional fatigue. Transthoracic echocardiography found an enlarged right heart, mild pulmonary hypertension (39 mmHg systolic pressure), and an interatrial septum exhibiting a leftward deviation of its dorsocranial insertion (Figure 1A; Supplementary Video 1). On Doppler examination, partial anomalous pulmonary venous drainage (PAPVD) to the right atrium (RA) was suspected (Figure 1B; Supplementary Video 2). Transoesophageal echocardiography demonstrated an interatrial septum aneurysm and a patent foramen ovale with a right-to-left shunt (Figure 1C; Supplementary Video 3).

Conduction system pacing in the adult congenital population; feasibility and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle pacing (LBP) is an evolving pacing method designed to capture the intrinsic conduction and minimise ventricular dys- synchrony. Anatomical complexity, scars of previous corrective surgeries and haemodynamic properties of adult congenital heart disease (ACHD) population could increase challenges of LBP. We describe our experience in LBP in ACHD patients and different patient groups. Purpose To compare the feasibility of LBP in ACHD patient population and non-ACHD patients. Methods We included all patients who had LBP at our institution in 2020 and 2021. Demographic data, imaging data, procedural parameters and follow up data were collected and analysed. Results A total of 36 patients were included and divided into two groups: ACHD (n=8, mean age, 54 years, 38% females) and non-ACHD (n=28, mean age, 74 years, 43% females). ACHD anatomy included simple lesions (4) as atrial and ventricular septal defects, partial anomalous pulmonary venous drainage, bicuspid aortic valve and Shone’s syndrome, moderate (3), as Tetralogy of Fallot with surgical repair, and complex (1), as transposition of great arteries with Mustard repair. Non-ACHD included patients with structurally normal heart, dilated cardiomyopathy, and those who underwent mitral and aortic valve interventions. Mean left ventricular ejection fraction in ACHD group was 59.5%, and 57.5% in non-ACHD. Late gadolinium enhancement in basal septal area was present in 5 patients in ACHD group. Acute success rate, defined as capture of left bundle branch, was 100% in ACHD group, and 88% in non-ACHD. No acute complications were recorded in both groups. Mean pre-procedural QRS duration was longer in ACHD group (170 ms, vs, 120, p=&amp;lt;0.001). Mean reduction in QRS duration in ACHD group was 27 ms, vs, 15, p= 0.856. Mean procedural and fluoroscopy times were similar in both groups (ACHD, 75.5 minutes, vs, 70, p= 0.26, and ACHD, 9 minutes, vs 7.13, respectively, p= 0.46). Pacing parameters at implantation and after 2 months were satisfactory in both groups (Fig 1). Conclusion Left bundle pacing is feasible in ACHD population as compared to non-ACHD patients, with low incidence of complications. Procedural and fluoroscopic times were similar in both groups. Pacing parameters were satisfactory and stable over 2 month-follow up.

Prenatal Diagnosis and Outcome of Scimitar Syndrome: A Case Series of Six Patients.

Scimitar syndrome is a rare disease characterized by hypoplasia of the right lung and partial anomalous pulmonary venous drainage to the inferior vena cava. All cases with a prenatal diagnosis of scimitar syndrome with or without associated malformations in an 18-year period (2000–2018) in two large tertiary referral centers (University of Bonn and University of Cologne, Germany) were retrospectively reviewed for the intrauterine course and postnatal outcome. Six cases were diagnosed in the study period. All presented with hypoplasia of the right lung, right-sided mediastinal shift, and abnormal pulmonary venous drainage to the inferior vena cava. Systemic arterial blood supply to the right lung, albeit postnatally present in all cases, could not be detected prenatally. Major associated anomalies were present in all cases and included atrial septal defect (n = 5), coarctation (n = 3), diaphragmatic hernia (n = 2), and VACTERL association (n = 1). Half of the cohort died within 6 months after birth and all three survivors suffer from long-term pulmonary sequelae. The primary hint to the prenatal diagnosis of scimitar syndrome is the abnormal position of the heart in the chest. If searched for, abnormal venous drainage can be identified prenatally and confirms the diagnosis. The prognosis depends on the presence of associated major anomalies and the need for neonatal intervention.

Multi-spectrum robotic cardiac surgery: Early outcomes.

ObjectiveThe robotic cardiac surgery program at our current institution began in 2013 with an experienced and dedicated team. This review analyzes early outcomes in the first 1103 patients.MethodsWe reviewed all robotic procedures between July 2013 and February 2021. Primary outcomes were mortality and perioperative morbidity. Our robotic approach is totally endoscopic for all cases: off-pump for coronary and epicardial procedures, and on-pump with the endoballoon for mitral valve and other intracardiac procedures.ResultsThere were 1103 robotic-assisted cardiac surgeries over 7 years. A total of 585 (53%) were off-pump totally endoscopic coronary artery bypasses, 399 (36%) intracardiac cases (including isolated and concomitant mitral valve procedures, isolated tricuspid valve repair, CryoMaze, atrial or ventricular septal defect repair, benign cardiac tumor, septal myectomy, partial anomalous pulmonary venous drainage, and aortic valve replacement); 80 (7%) epicardial electrophysiology-related procedures (epicardial atrial fibrillation ablation, left atrial appendage ligation, lead placement, and ventricular tachycardia ablation); and 39 (4%) other epicardial procedures (pericardiectomy, unroofing myocardial bridge). Mortality was 1.2% (observed/expected ratio, 0.7). In the totally endoscopic coronary artery bypass and intracardiac groups, mortality was 1.0% (observed/expected, 0.6) and 1.5% (observed/expected, 0.87), respectively. There were 8 conversions to sternotomy (0.7%) and 24 (2.2%) take-backs for bleeding. Mean hospital and intensive care unit lengths of stay were 2.74 ± 1.26 days and 1.28 ± 0.57 days, respectively.ConclusionsThis experience demonstrates that a robotic endoscopic approach can safely be used in a multitude of cardiac surgical procedures both on- and off-pump with excellent early outcomes. An experienced surgeon and team are necessary. Longer-term follow-up is warranted.

Right ventricular volume and its relationship to functional tricuspid regurgitation

BackgroundSignificant right ventricular (RV) dilatation has long been considered integral to the pathogenesis of functional tricuspid regurgitation (FTR).ObjectivesTo explore the relationship of RV dilatation and FTR in patients with ‘pure’ RV volume overload.MethodsPatients (>17yrs) with RV dilatation due to pre-tricuspid shunts (atrial septal defect; ASD and/or partial anomalous pulmonary venous drainage; PAPVD) referred to our service (2000–2019) were retrospectively identified. Those with pulmonary hypertension, primum ASD or left-heart disease were excluded. Using standard cardiac MRI protocols, RV, right atrial and TV parameters were measured and compared.ResultsOf 52 consecutively eligible patients (42 ± 15yrs, 25 males), 25 had ASDs, 13 had PAPVD and 14 had both conditions. All were in sinus rhythm and none had pulmonary regurgitation. Left and right ventricular ejection fractions were normal (LVEF 63 ± 8%, RVEF 56 ± 8%). Indexed RV end-diastolic volumes (RVEDVi) were moderately increased (males 148 ± 33 mL/m2 and females 141 ± 42 mL/m2, range 95–267 mL/m2). Despite substantial RV volume overload, no patients had severe tricuspid regurgitation (TR). Only two had > mild TR. There was a weak correlation between tricuspid annular diameter and both degree of RV dilatation (r = 0.37; p = 0.01) and degree of TR (r = 0.38; p = 0.006). There was a similarly poor correlation between right atrial dimensions and the degree of TR (r = 0.34; p = 0.02).ConclusionWhen RV dilatation is simply due to volume overload, we find that significant TR is extremely rare. This gives an important and novel insight; that RV dilatation per se does not result in FTR.