Tricuspid Regurgitation and Impact of Surgical Valve Intervention in the Single Ventricle Reconstruction Trial
By
J. F. Cnota
S. M. Chowdhury
A. Floh
R. Gongwer
B. H. Goot
J. P. Jacobs
M. A. Jolley
S. Kirmani
D. J. LaPar
J. C. Levine
A. B. Lewis
R. H. Pignatelli
C. Pizarro
T. C. Slesnick
T. Thorsson
F. Trachtenberg
D. T. Truong
J. W. Newburger
P. C. Frommelt
February 18, 2026
Clinical Scorecard: The Role of Surgical Valve Intervention on Tricuspid Regurgitation in Patients Undergoing Single Ventricle Reconstruction Trial
At a Glance
Category Detail
Condition Tricuspid valve regurgitation in single right ventricle anomalies Key Mechanisms Tethering of septal leaflet, cleft leaflets, annular dilation, leaflet prolapse Target Population Infants with single right ventricle anomalies undergoing staged surgical palliation Care Setting Pediatric cardiac surgery and longitudinal echocardiographic follow-up
Key Highlights
Moderate or greater tricuspid regurgitation prior to Norwood procedure is associated with worse transplant-free survival at 6 years (HR 1.77). The proportion of patients with > mild TR increases significantly post-Norwood and remains stable through 6 years. Right ventricular size and function show modest association with TR severity only at the post-Norwood time point. Guideline-Based Recommendations
Diagnosis
Use serial 2D/Doppler echocardiography at predefined time points to assess TR severity qualitatively by vena contracta size. Categorize TR as none, mild, moderate, or severe; dichotomize as ≤ mild or > mild for clinical decision-making. Management
Consider surgical tricuspid valve intervention during staged palliation, though effective long-term strategies remain elusive. Monitor TR severity closely after Norwood procedure to identify patients at higher risk for adverse outcomes. Monitoring & Follow-up
Perform echocardiograms at baseline, early post-Norwood, pre-stage II, 14 months, pre-Fontan, and post-Fontan (6 years). Assess right ventricular size and function alongside TR severity to guide prognosis. Risks
Presence of > mild TR is associated with increased risk of death or cardiac transplantation. Surgical intervention timing and impact on long-term outcomes require careful consideration due to variable results. Patient & Prescribing Data
Infants with single right ventricle anomalies undergoing Norwood procedure and staged palliation
TR severity prior to and following Norwood procedure is a prognostic marker; surgical intervention impact on survival is under investigation.
Clinical Best Practices
Perform comprehensive echocardiographic assessment of TR at standardized intervals during staged palliation. Use TR severity as a dynamic marker to stratify risk and guide timing of potential surgical valve interventions. Incorporate RV size and function measurements to contextualize TR severity and patient prognosis. Exclude patients with conversion to biventricular physiology from TR outcome analyses to maintain cohort consistency. References
