*2.5.1 Diagnostic assessment*

Initial diagnostic workup by echocardiography confirmed large ASD (46 mm), severely dilated right atrium—65 × 81 mm, and right ventricle (RV) – 52 mm, PH of 60 mmHg and severe tricuspid regurgitation (vena contracta—9 mm, regurgitant volume—83 ml). A contrast-enhanced cardiac computed tomography (CCT) revealed a large ostium secundum (53 × 43 mm, 17 cm<sup>2</sup> ) (**Figure 8**), severely dilated RV (end-diastolic volume of 550 ml, end-systolic volume of 355 ml), and reduced ejection fraction (EF) of 35%, right ventricle fractional area contraction (RV FAC)—25%, tricuspid annulus plane systolic excursion (TAPSE)—10 mm. The patient was scheduled for concomitant surgery. Having discussed all available options for tricuspid surgery, patient's informed concern was obtained with regard to either annuloplasty or homograft replacement. The patient refused either mechanical or stented biological prosthesis because of personal and religious beliefs.
