Myocardial infarction after endomyocardial biopsy in a heart transplant patient
Gérard Drobinski1, Richard Dorent, Jean-Jacques Ghossoub
1Department of Cardiology, Pitié-Salpétrière University Hospital, Paris, France. gerard.drobinski@psl.ap-hop-paris.fr
Insights
Endomyocardial biopsy complications can include rare coronary artery fistulas and myocardial infarction. This case highlights a left anterior descending artery fistula to the right ventricle following a biopsy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Endomyocardial biopsy is a crucial diagnostic tool in heart transplant recipients.
- Complications, though infrequent, can arise from invasive cardiac procedures.
Observation:
- A heart transplant patient presented with severe left ventricular dysfunction post-stroke.
- Ultrasound revealed significant cardiac abnormalities.
- Coronary angiography identified a fistula between the left anterior descending artery and the right ventricle.
Findings:
- Left ventricular angiogram demonstrated apical dyskinesia.
- Electrocardiogram and angiographic findings suggested myocardial infarction.
- The myocardial infarction was attributed to a hematoma secondary to the endomyocardial biopsy.
Implications:
- Post-endomyocardial biopsy hematoma is a potential cause of myocardial infarction.
- Coronary artery fistula is a rare but serious complication of endomyocardial biopsy.
- This case expands the spectrum of known endomyocardial biopsy complications.
Abstract:
In a heart transplant patient who had undergone several endomyocardial biopsies, ultrasound examination revealed severe left ventricular dysfunction after a stroke. Coronary angiography showed a distal left anterior descending artery fistula to the right ventricle. Left ventricular angiogram showed apical dyskinesia. The electrocardiogram and angiographic changes were thought to be due to a myocardial infarction secondary to a postendomyocardial biopsy hematoma, which should be added to the list of possible complications involved in endomyocardial biopsy.
