Endomyocardial biopsy causing coronary artery-right ventricular fistula after cardiac transplantation

Area of Science:

• Cardiology
• Transplant Surgery

Background:

• Endomyocardial biopsy is a crucial procedure for monitoring cardiac transplant recipients.
• Assessing potential complications is vital for patient management.

Observation:

• Three cases of coronary artery-right ventricular fistulae were diagnosed in 160 cardiac transplant patients over 13 years.
• Fistulae involved branches of the right coronary artery and left anterior descending artery.
• Histological analysis revealed small caliber arteries not observed in control samples.

Findings:

• Coronary artery-right ventricular fistulae are a potential, albeit rare, complication of endomyocardial biopsy.
• The observed fistulae were hemodynamically insignificant and did not necessitate intervention.
• Small caliber arteries in biopsy specimens may indicate a predisposition or be a consequence of the procedure.

Implications:

• The risk of developing coronary artery-ventricular fistulae should be considered alongside other known complications of endomyocardial biopsy.
• Routine surveillance may detect these fistulae, but their clinical significance is generally low.
• Further research into the pathogenesis and long-term implications of these fistulae is warranted.