Three cases of fatal cardiac tamponade following ventricular endocardial biopsy

Three patients had perforation of the ventricular free wall and fatal cardiac tamponade following endocardial biopsy to evaluate congestive heart failure. The number of endocardial biopsies at this institution at the time of the third death was 2372, resulting in an overall mortality rate of 0.13%. Of the 2372 biopsies, 2136 (90%) were performed to evaluate cardiac graft rejection and 236 (10%) were performed for other reasons. All the patients who died belonged to the latter group. None of the cardiac transplant patients have had fatal ventricular perforation--a significant difference. At our institution, the frequency of mortality following endocardial biopsy in the noncardiac transplant patients is 1.3%. Patients who have ventricular endocardial biopsy of native hearts rather than transplanted hearts may be at increased risk for fatal perforation.