Journal of the Chinese Medical Association
Volume 70, Issue 5 , Pages 185-192, May 2007

Endomyocardial Biopsy-related Tricuspid Regurgitation After Orthotopic Heart Transplantation: Single-center Experience

  • Chung-Yu Lo

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Hsiao-Huang Chang

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chiao-Po Hsu

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Shiau-Ting Lai

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chun-Che Shih

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chun-Che Shih, Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 10 April 2006; accepted 12 October 2006.

Article Outline

Background

Damage of tricuspid valve (TV) with resultant tricuspid regurgitation (TR) induced by endomyocardial biopsy (EMB) following heart transplantation has been reported in several studies. This study tried to determine the prevalence of EMB-related iatrogenic damage over tricuspid apparatus following orthotopic heart transplantation and to evaluate its impact on the patients.

Methods

Fifty patients received orthotopic heart transplantation between July 1987 and March 2005. Eleven patients were excluded from the study due to early postoperative mortality or inadequate follow-up. The medical records of the remaining 39 patients were reviewed retrospectively for basic characteristics as well as each attempted EMB. The iatro-genic damage of tricuspid apparatus and serial change of TR were accessed with 2-D and Doppler echocardiography. The obtained data were analyzed for their statistical significance with SPSS (version 12.0).

Results

A total of 373 biopsies were performed on the 39 patients between 1987 and 2005. The follow-up duration was 42.9 ± 26.7 months. The prevalence of TR immediately following heart transplantation was 84.6%, with only 25.6% of patients having moderate or severe TR. At the end of the follow-up, the prevalence of TR increased to 92.3% and 61.5% of patients having moderate or severe TR, respectively. Eight patients (20.5%) had small chordae rupture (SCR) noted after 6.6 ± 3.2 biopsies, and 10 patients (25.6%) had flail tricuspid valve (FTV) after 5.7 ± 5.1 biopsies. Of patients with SCR, 62.5% had progression of TR, and 70% of patients with FTV showed significant TR change.

Conclusion

The prevalence of iatrogenic tricuspid apparatus damage was high in this study. It contributed to the progression of TR significantly regardless of the damage severity. Measurements should be taken for prevention of iatro-genic tricuspid apparatus damage induced by EMB.

Key Words:  endomyocardial biopsy , heart transplantation , tricuspid regurgitation

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chan MC , Giannetti N , Kornbluth M , Valantine HA , Hunt SA . Severe tricuspid regurgitation after heart transplantation . J Heart Lung Transplant . 2001;20:709–717
  2. Williams MJY, Lee MY, DiSalvo TG, Dec GW, Picard MH, Palacios IF, et al  Biopsy-induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation . Am J Cardiol . 1996;77:1339–1344
  3. Yankah AC, Musci M, Weng Y, Loebe M, Zurbruegg HR, Siniawski H, et al  Tricuspid valve dysfunction and surgery after orthotopic cardiac transplantation . Eur J Cardio-thorac Surg . 2000;17:343–348
  4. Hausen B , Albes JM , Rohde R , Demertzis S , Mügge A , Schäfers HJ . Tricuspid regurgitation attributable to endomyo-cardial biopsies and rejection in heart transplantation . Ann Thorac Surg . 1995;59:1134–1140
  5. Lu L , Chang J , Lai ST , Shih CC . Clinical outcome of heart transplantation at Taipei Veterans General Hospital . J Chin Med Assoc . 2003;66:400–405
  6. Billingham ME . Dilemma of variety of histopathologic grading systems for acute cardiac allograft rejection by endomyocardial biopsy . J Heart Transplant . 1990;9:272–276
  7. Billingham ME , Elizabeth M , McCallister HA , Zerbe A . A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group . J Heart Transplant . 1990;9:587–593
  8. Rees AP , Milani RV , Lavie CJ , Smart FW , Ventura HO . Valvular regurgitation and right-sided cardiac pressures in heart transplant recipients by complete Doppler and color flow evaluation . Chest . 1993;104:82–87
  9. Michelsen S , Hurlen M , Otterstad JE . Prevalence of tricuspid and pulmonary regurgitation diagnosed by Doppler in apparently healthy women. Possible influence on their physical performance? . Eur Heart J . 1988;9:61–67
  10. Tei C, Kisanuki A, Minagoe S, Shibata K, Yutsudou T, Otsuji Y, et al  Incidence of tricuspid regurgitation in normal subjects according to a new Doppler echographic criterion . J Cardiol . 1987;17:551–558
  11. Morgan JA , Edwards NM . Orthotopic cardiac transplantation: comparison of outcome using biatrial, bicaval, and total techniques . J Card Surg . 2005;20:102–106
  12. Braverman AC , Coplen SE , Mudge GH , Lee RT . Ruptured chordae tendineae of the tricuspid valve as a complication of endomyocardial biopsy in heart transplant patients . Am J Cardiol . 1990;66:111–113
  13. Tucker PA , Jin BS , Gaos CM , Radovancevic B , Frazier OH , Wilansky S . Flail tricuspid leaflet after multiple biopsies following orthotopic heart transplantation: echocardiographic and hemodynamic correlation . J Heart Lung Transplant . 1994;13:466–472
  14. Nath J , Foster E , Heidenreich PA . Impact of tricuspid regur-gitation on long-term survival . J Am Coll Cardiol . 2004;43:405–409
  15. Nguyen V , Cantarovich M , Cecere R , Giannetti N . Tricuspid regurgitation after cardiac transplantation: how many biopsies are too many? . J Heart Lung Transplant . 2005;24(Suppl):227–231
  16. Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C, Dearani J, et al  Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets . J Thorac Cardiovasc Surg . 2004;128:296–302
  17. Stahl RD , Karwande SV , Olsen SL , Taylor DO , Hawkins JA , Renlund DG . Tricuspid valve dysfunction in the transplanted heart . Ann Thorac Surg . 1995;59:477–480

PII: S1726-4901(09)70356-9

doi:10.1016/S1726-4901(09)70356-9

Journal of the Chinese Medical Association
Volume 70, Issue 5 , Pages 185-192, May 2007

Article Tools