Background: Functional TR occurs in adults with congenital atrial septal defect (ASD) due to left-to-right interatrial shunting and enlarged right heart. The prevalence and the predictors of TR following ASD closure in adults remain unknown. Moreover, whether preoperative anatomical parameters of tricuspid valve related to TR after ASD closure is understudied. Methods: Comprehensive transthoracic echocardiography was performed in 64 consecutive secundum ASD patients before and at 3 months after device closure. Tricuspid valve parameters [annulus diameter (TAD), tenting area, tenting height, distal tricuspid septal leaflet angle (TSLA)], right ventricular (RV) function, pulmonary arterial pressures and severity of TR were recorded. Post-closure TR was defined as PISA radius >= 6 mmat 3 months. Results: The TR severity was reduced after ASD closurewith post-closure TR in 31 patients (48%) at follow-up. TR patients had larger ventricles, more TR, greater TAD, and larger tenting area/height and TSLA but similar RV long-axis function and pulmonary pressures at baseline. Pre-closure TAD [odds ratio (OR): 6.076, p = 0.032] and TSLA (OR: 1.218, p = 0.001) were the independent predictors for TR. A TAD >3.5 cm and a TSLA >30 degrees had sensitivity, specificity, and area under the curve of 97%, 76%, and 0.82 and 100%, 78%, and 0.84, respectively. Assessment of TSLA showed an incremental value over TAD for predicting TR after closure (chi(2) = 21.3 vs. 9.9, p < 0.001). Conclusion: Nearly half of adults had TR following device closure of ASD. It was related to the excessive preoperative structural remodeling in tricuspid valve rather than changes in RV. (C) 2015 Elsevier Ireland Ltd. All rights reserved.