Tricuspid valve insufficiency as a complication of endomyocardial biopsy

The purpose of this study was to investigate the occurrence of major tricuspid insufficiency caused by endomyocardial biopsy in heart transplant recipients. Endomyocardial biopsy was used for the detection of rejection and Doppler echocardiography was performed at regular intervals. Six of 96 heart transplant patients (6.3%) had sudden appearance of large tricuspid regurgitation, all of which were directly related to a preceding biopsy. Chordal tissue was identified histologically in biopsy samples of all six patients. All patients developed symptoms of right ventricular failure which was confirmed by right heart catheterization. Three patients subsequently underwent valvuloplasty for ruptured chordae tendineae of either of the three leaflets. Two of these three patients were free from symptoms during follow-up, but the third patient developed moderate tricuspid regurgitation and clinical symptoms. It is concluded that endomyocardial biopsy, although it is the most useful tool for detection of rejection, should be used with caution with regard to anatomical structures and the risk of damage to the tricuspid valve must not be neglected. It is also concluded that valvuloplasty of the tricuspid valve can be successfully performed in a transplanted heart.