Congenital heart diseaseResearch article
Valvular involvement, phenotypic heterogeneity and outcomes in adults with left-to-right shunt congenital heart disease
- retrospectively studied
- consecutive adults
- factor analysis of mixed data followed by hierarchical clustering
Authors' conclusion
Valvular involvement was common and showed shunt location-specific associations with haemodynamics and cardiac remodelling. Integrated assessment of valve status, chamber remodelling and haemodynamics may enhance phenotypic characterisation beyond shunt magnitude alone, although its prognostic and clinical relevance requires further validation.
Study context
- Population
- Adults with non-complex, unrepaired left-to-right shunt congenital heart disease (CHD), pulmonary-to-systemic flow ratio >1.5 on right heart catheterisation and available echocardiographic data, 2015–2019pre-tricuspid shunts 351 · post-tricuspid shunts 101
- Participants
- 452 adults
- Comparison
- Left-sided, right-sided and bilateral valvular involvement in relation to invasive haemodynamics, cardiac remodelling and survival, by pre-tricuspid or post-tricuspid shunt location
- pre-tricuspid shuntsn = 351
- post-tricuspid shuntsn = 101
Main finding
As reported in the abstract
Valvular involvement (left-sided, right-sided, bilateral)
Left-sided
Right-sided
Bilateral
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Mortality by cluster · higher in high-burden pre-tricuspid cluster | 17.5% vs 4.3% | false discovery rate-adjusted log-rank p<0.001 |
- Mortality by cluster — Did not differ significantly across post-tricuspid clusters
- p=0.260
Haemodynamic and remodelling associations in pre-tricuspid shunts
- Right-sided involvement associated with greater pulmonary vascular load and right-heart enlargement
- Left-sided and bilateral involvement associated with higher filling pressures, lower estimated mixed venous oxygen saturation and multichamber remodelling
Haemodynamic and remodelling associations in post-tricuspid shunts
- Less consistent associations, mainly involving mixed venous oxygen saturation and chamber enlargement
Survival
- Left-sided and bilateral involvement associated with lower survival in pre-tricuspid shunts
- No significant survival differences in post-tricuspid shunts
Clustering phenotypes
- Two pre-tricuspid and three post-tricuspid phenotypes identified
Original publication
Valvular involvement, phenotypic heterogeneity and outcomes in adults with left-to-right shunt congenital heart disease. Heart. Published 21 August 2026. doi:10.1136/heartjnl-2026-328500
Summarised from the published abstract; every number is checked against it