title: Tricuspid valve chordal tissue in endomyocardial biopsy specimens of patients with significant tricuspid regurgitation.
abstract: OBJECTIVE
  Tricuspid regurgitation is the most common valvular abnormality after orthotopic heart transplantation, with multiple etiologic factors implicated. The purpose of this study was to determine if the endomyocardial biopsy specimens of patients who developed significant tricuspid valve regurgitation (TVR) after cardiac transplantation had evidence of chordal tissue.
  
  
  METHODS
  The echocardiograms of 98 patients who had cardiac transplantation between 1986 and 2002 were reviewed for evidence of significant TVR greater than mild. The biopsy specimens of all patients with significant TVR were then reviewed for histologic evidence of tricuspid chordal tissue and frequency and severity of rejection episodes. Clinical information collected included the presence of any systolic murmurs, significant dyspnea, and invasive hemodynamic measurements.
  
  
  RESULTS
  The incidence of significant TVR was 19% (n = 19 patients). Histologic evidence of chordal tissue was present in 9 patients (47%) with significant TVR. Patients whose biopsy specimens evidenced chordal tissue tended to have a greater degree of TVR, but this was not statistically significant (odds ratio, 2.07; 95% confidence interval, 0.537-8.01, p = 0.32). There was no statistically significant difference in the number of biopsy specimens (p = 0.798), the number of rejection episodes (p = 0.73), or overall left or right ventricular systolic function between the patients with and without biopsy specimen evidence of chordal tissue disruption. Most of the patients with evidence of significant TVR after chordal tissue biopsy were clinically asymptomatic, with no significant change in their hemodynamics.
  
  
  CONCLUSIONS
  Histologic evidence of chordal tissue in endomyocardial biopsy specimens was present in 47% of patients with significant TVR and did not relate to the number of biopsy procedures performed or the frequency of rejection episodes. This study provides histologic evidence that chordal tissue damage can occur after cardiac biopsy, resulting in significant TVR; however, it is clinically well tolerated by affected patients.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mielniczuk
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.forename: Ross A
authors.initials: RA
authors.lastname: Davies
authors.forename: John P
authors.initials: JP
authors.lastname: Veinot
mesh_terms: D000328:Adult; D001706:Biopsy / Q000009:adverse effects; D015150:Echocardiography, Doppler; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D015995:Prevalence; D014261:Tricuspid Valve / Q000473:pathology*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*