Lo Chung-Yu, Chang Hsiao-Huang, Hsu Chiao-Po, Lai Shiau-Ting, Shih Chun-Che
Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2007 May;70(5):185-92. doi: 10.1016/S1726-4901(09)70356-9.
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.
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 iatrogenic 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).
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.
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 iatrogenic tricuspid apparatus damage induced by EMB.
多项研究报道了心脏移植后经心内膜心肌活检（EMB）导致三尖瓣（TV）损伤并引发三尖瓣反流（TR）的情况。本研究旨在确定原位心脏移植后与EMB相关的三尖瓣装置医源性损伤的发生率，并评估其对患者的影响。
1987年7月至2005年3月期间，50例患者接受了原位心脏移植。11例患者因术后早期死亡或随访不充分被排除在研究之外。对其余39例患者的病历进行回顾性分析，以了解其基本特征以及每次尝试进行的EMB情况。采用二维和多普勒超声心动图评估三尖瓣装置的医源性损伤以及TR的系列变化。使用SPSS（12.0版）对获得的数据进行统计学意义分析。
1987年至2005年期间，对39例患者共进行了373次活检。随访时间为42.9±26.7个月。心脏移植后立即出现TR的发生率为84.6%，仅有25.6%的患者存在中度或重度TR。随访结束时，TR的发生率分别增至92.3%和61.5%的患者存在中度或重度TR。8例患者（20.5%）在进行6.6±3.2次活检后出现小腱索断裂（SCR），10例患者（25.6%）在进行5.7±5.1次活检后出现三尖瓣脱垂（FTV）。在SCR患者中，62.5%的患者TR病情进展，70%的FTV患者TR有显著变化。
本研究中医源性三尖瓣装置损伤的发生率较高。无论损伤严重程度如何，它都显著促成了TR的进展。应采取措施预防EMB引起的医源性三尖瓣装置损伤。
