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The Pediatric Heart Network\u2019s (PHN) Single Ventricle Reconstruction trial followed children with single RV to age 6 years. This study compared serial echocardiographic measures of TR during staged palliations and determine the impact of TR and tricuspid valve (TV) intervention on transplant-free survival in the PHN cohort.\u00a0Study echocardiograms were performed at 6 pre-determined times: baseline, post-Norwood, pre-stage II, age 14 months, pre-Fontan, and age 6 years. TR was categorized as\n                    <jats:italic>\u2264<\/jats:italic>\n                    \u2009mild or &gt; mild. McNemar\u2019s test compared TR across time; t-tests compared RV size\/function by TR category; and survival analysis assessed the effect of &gt;\u2009mild TR on transplant-free survival.\u00a0TR was assessed in 543 participants prior to Norwood. From baseline to post-Norwood, those with &gt;\u2009mild TR increased from 12 to 24% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Thereafter, the proportion of surviving participants with &gt;\u2009mild TR was stable. Participants with &gt;\u2009mild TR had increased baseline TV annular area, and increased RV volume but not decreased function. Transplant-free survival at 6 years was lower with &gt;\u2009mild TR at any time except pre-Fontan. 78 TV interventions occurred in 66 participants. Those with TV intervention at the Norwood and\/or Stage II had a higher rate of death\/transplant than those without or those who had a later intervention.\u00a0At baseline, post Norwood and pre-stage II, &gt; mild TR is associated with decreased transplant-free survival. TV intervention at the Norwood or Stage II operations was not associated with improved survival.\n                  <\/jats:p>\n                  <jats:p>Clinical Trial Registration: NCT00115934<\/jats:p>","DOI":"10.1007\/s00246-025-04122-x","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T06:53:30Z","timestamp":1771397610000},"page":"3354-3361","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tricuspid Regurgitation and Impact of Surgical Valve Intervention in the Single Ventricle Reconstruction Trial"],"prefix":"10.1007","volume":"47","clinical-trial-number":[{"clinical-trial-number":"nct00115934","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"J. F.","family":"Cnota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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