BIOPSY-INDUCED TRICUSPID REGURGITATION AFTER CARDIAC TRANSPLANTATION

Transvenous endomyocardial biopsy is now well-established as the gold standard for evaluation of possible rejection episodes after cardiac t ransplantation. From 1985 to August 1992, 190 patients have undergone 193 cardiac transplantations at Barnes Hospital. One hundred eighty-th ree patients survived their initial hospitalization and serve as the s tudy group. Their records were reviewed for the purposes of identifyin g those with tricuspid regurgitation as a complication of right ventri cular endomyocardial biopsy. These patients have undergone a total of 2,960 biopsies for an average of 16.2 biopsies per patient. Over a mea n follow-up period of 4.22 years, all patients have been evaluated wit h standard two-dimensional echocardiograms. Mild to moderate tricuspid regurgitation was very common, but was thought to be biopsy-induced o nly if severe and accompanied by flail components of the tricuspid val ve. Twelve patients were identified with this entity at our institutio n. Of these, 5 had no symptoms and were receiving no diuretics, 3 had mild symptoms consisting of lower extremity edema and continued to rec eive diuretics, 2 had moderate symptoms, and 2 had right heart failure and anasarca refractory to medical therapy. Both of the severely affe cted patients subsequently required tricuspid valve replacement. We co nclude that the tricuspid valve apparatus is at significant risk of in jury during endomyocardial biopsy, that most patients will be minimall y symptomatic due to tricuspid regurgitation when this injury occurs, and that when the injury is accompanied by severe symptoms, the likeli hood of improvement with medical therapy is small.