Williams M J, Lee M Y, DiSalvo T G, Dec G W, Picard M H, Palacios I F, Semigran M J
Department of Medicine, Massachusetts General Hospital, USA.
Am J Cardiol. 1996 Jun 15;77(15):1339-44. doi: 10.1016/s0002-9149(96)00202-0.
Damage to the tricuspid valve apparatus has been described after endomyocardial biopsy and may be associated with hemodynamically significant 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 incidence of these complications. Echocardiograms and right heart catheterization data of 72 orthotopic cardiac transplant recipients were assessed for the presence of flail tricuspid leaflet, TR, and right-sided cardiac 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/m2, p < 0.05) was lower, and right-sided cardiac dimensions were greater in patients with flail leaflets than in those without flail leaflets. Both the prevalence 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 sheath. We conclude that TR secondary to biopsy-induced damage to the valve apparatus occurs in cardiac transplant recipients and is associated with signs of early right-sided heart failure. Use of a 45 cm sheath during endomyocardial biopsy reduces the prevalence of flail tricuspid leaflet and the severity of TR.
心内膜心肌活检后已发现三尖瓣装置受损，且可能与具有血流动力学意义的三尖瓣反流（TR）相关。本研究旨在确定心脏移植受者中TR和三尖瓣叶连枷样病变的发生率，并评估心内膜心肌活检时直接置于右心室的45 cm鞘管对降低这些并发症发生率的作用。对72例原位心脏移植受者移植后29±20个月（均值±标准差）的超声心动图和右心导管检查数据进行评估，以确定是否存在三尖瓣叶连枷样病变、TR及右侧心功能不全。23例患者（32%）存在中度或重度TR。10例患者（14%）有三尖瓣叶连枷样病变，其中7例有重度TR。有三尖瓣叶连枷样病变的患者右心房压力更高（10±5 vs 6±5 mmHg，p<0.05），心脏指数更低（2.0±0.2 vs 2.5±0.7 L/min/m²，p<0.05），且右侧心脏尺寸更大。使用45 cm鞘管后，三尖瓣叶连枷样病变的发生率（41%降至6%，p<0.0001）和TR的平均分级（2级降至1级，p<0.0001）均降低。我们得出结论，心脏移植受者中存在活检引起的瓣膜装置损伤继发的TR，并与早期右侧心力衰竭的体征相关。心内膜心肌活检时使用45 cm鞘管可降低三尖瓣叶连枷样病变的发生率及TR的严重程度。
