Endomyocardial biopsy as risk factor in the development of tricuspid insufficiency after heart transplantation.
OBJECTIVE
Endomyocardial biopsy (EMB), which is used to monitor for rejection, may cause tricuspid regurgitation (TR) after orthotopic heart transplantation (OHT). The purpose of this investigation was to examine the occurrence of tricuspid valve tissue in myocardial specimens obtained by routine EMB performed after OHT.


METHODS
From January 2000 to July 2008, 125 of the patients who underwent OHT survived more than 1 month. Their follow-up varied from 1 month to 8.5 years (mean, 5.1 +/- 3.7 years). EMB was the gold standard examination and myocardial scintigraphy with gallium served as a screen to routinely monitor rejection.


RESULTS
Each of 428 EMB including 4 to 7 fragments, totaling 1715 fragments, were reviewed for this study. The number of EMB per patient varied from 3 to 8 (mean, 4.6 +/- 3.5). Histopathological analysis of these fragments showed tricuspid tissue in 4 patients (3.2%), among whom only 1 showed aggravation of TR.


CONCLUSIONS
EMB remains the standard method to diagnose rejection after OLT. It can be performed with low risk. Reducing the number of EMB using gallium myocardial scintigraphy or other alternative methods as well as adoption of special care during the biopsy can significantly minimize trauma to the tricuspid valve.
Fiorelli
A I
AI
Heart Institute, São Paulo University School of Medicine, São Paulo, Brazil. fiorelliai@uol.com.br
Coelho
G H B
GH
Oliveira
J L
JL
Aiello
V D
VD
Benvenuti
L A
LA
Santos
A
A
Chi
A
A
Tallans
A
A
Igushi
M L
ML
Bacal
F
F
Bocchi
E A
EA
Stolf
N A G
NA
D001021:Aortic Valve / Q000473:pathology; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008943:Mitral Valve / Q000473:pathology; D011664:Pulmonary Valve / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D014261:Tricuspid Valve / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000473:pathology*