“…The high prevalence of AF, RV dysfunction and TR in patients undergoing TMVR is often the consequence of long existing MR. Once TR is present it maintains itself in a vicious circle, where TR begets further RV dilatation and dysfunction, causing more TR etcetera. 17 Patients undergoing TMVR are often in an advanced stage of MR, which is reflected by the high prevalence of AF, RV dysfunction and TR (Figure 5 ). 7 It appeared that referral for TMVR was often delayed as physicians tend to wait until patients are progressively symptomatic, despite optimal medical therapy.…”