BIOPSY-INDUCED FLAIL TRICUSPID LEAFLET AND TRICUSPID REGURGITATION FOLLOWING ORTHOTOPIC CARDIAC TRANSPLANTATION

Damage to the tricuspid valve apparatus has been described after endom yocardial biopsy and may be associated with hemodynamically significan t tricuspid regurgitation (TR). This study was performed to determine the prevalence of TR and flail tricuspid leaflet in cardiac transplant recipients and to evaluate the use of a 45 cm sheath placed directly in the right ventricle during endomyocardial biopsy to reduce the inci dence of these complications. Echocardiograms and right heart catheter ization dan of 72 orthotopic cardiac transplant recipients were assess ed for the presence of flail tricuspid leaflet, TR, and right-sided ca rdiac dysfunction 29 +/- 20 months (mean +/- SD) after transplantation . Moderate or severe TR was present in 23 patients (32%). Ten patients (14%) had flail tricuspid leaflet, with 7 of these having severe TR. Right atrial pressure (10 +/- 5 vs 6 +/- 5 mm Hg, p < 0.05) was higher , cardiac index (2.0 +/- 0.2 vs 2.5 +/- 0.7 L/min/m(2), p < 0.05) was lower, and right-sided cardiac dimensions were greater in patients wit h gall leaflets than in those without flail leaflets. Both the prevale nce of flail tricuspid leaflet (41% to 6%, p < 0.0001) and mean grade of TR (2 to 1, p < 0.0001) were reduced after the use of a 45 cm sheat h. We conclude that TR secondary to biopsy-induced damage to the valve apparatus occurs in cardiac transplant recipients and is associated w ith signs of early right-sided heart failure. Use of a 45 cm sheath du ring endomyocardial biopsy reduces the prevalence of flail tricuspid l eaflet and the severity of TR.