Clinical heart transplantationTricuspid Valve Chordal Tissue in Endomyocardial Biopsy Specimens of Patients With Significant Tricuspid Regurgitation
Section snippets
Methods and patients
Between 1986 and 2003, 213 orthotopic heart transplantations with biatrial anastomosis were performed at the University of Ottawa Heart Institute. Ninety-eight (46%) of these patients had echocardiographic assessments available at either 1 and/or 2 years after transplantation and were included in the study. Twenty-two patients (22%) were women and 76 (77%) were men. The average patient age at transplantation was 48.5 ± 6.3 years.
Prevalence of Significant TVR
The study comprised 98 patients. Thirty patients (31%) had only echocardiographic assessments at 1 year post-transplant, 2 (2%) had echocardiograms only at 2 years post-transplant, and 66 (67%) had echocardiograms available at both 1 and 2 years post-transplant. Significant TVR between 1 and 2 years after cardiac transplant in this study occurred in 19 patients (19%), 2 (10%) of which had severe regurgitation (Table 2).
Prevalence and Significance of Chordal Tissue
Nineteen of 98 patients in this study had significant TVR by echocardiogram.
Prevalence of TVR After Cardiac Transplantation
TVR has a reported prevalence of 65% to 85% in echocardiographic studies of patients after cardiac transplantation.1 It is the most common valvular abnormality after orthotopic heart transplantation, with a prevalence and severity greater than in healthy subjects. Color Doppler studies show that the prevalence of any degree of TVR in the general population can be as high as 15% to 70%. Almost all of this regurgitation is trivial and of no physiologic significance. In our study, the prevalence
References (10)
- et al.
Risk factors for tricuspid valve regurgitation after orthotopic heart transplantation
Ann Thorac Surg
(1999) - et al.
Clinical significance of tricuspid valve dysfunction after orthotopic heart transplantation
J Heart Lung Transplant
(2002) - et al.
Valvular regurgitation and right-sided cardiac pressures in heart transplant recipients by complete Doppler and color flow evaluation
Chest
(1993) - et al.
Severe tricuspid regurgitation after heart transplantation
J Heart Lung Transplant
(2001) - et al.
Biopsy induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation
Am J Cardiol
(1996)
Cited by (32)
Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance
2017, Journal of the American Society of EchocardiographyEpidemiology, Etiology, and Natural History of Tricuspid Regurgitation
2015, ASE’s Comprehensive EchocardiographyTissue Doppler imaging for rejection surveillance in pediatric heart transplant recipients
2013, Journal of Heart and Lung TransplantationNative Cardiac Valve Pathology
2012, Surgical Pathology ClinicsCitation Excerpt :Closed chest trauma can lead to papillary muscle rupture and flail of the tricuspid leaflet.52–55 Another cause is right ventricular myocardial biopsy which inadvertently damages the papillary muscle or chord resulting in flail of the tricuspid leaflet.56,57 Other causes of tricuspid regurgitation are infective endocarditis and Ebstein’s anomaly.58–60
Complications of endomyocardial biopsy in heart transplant patients: A retrospective study of 2117 consecutive procedures
2011, Transplantation ProceedingsCitation Excerpt :We have encountered valve tissue in nearly 11% of our patients. Mielniczuk and colleagues reported a similar rate of valvular fragment collection (9.2%) among 205 EMB.20 Fiorelli et al reported a much lower rate (3.2%),21 probably due to the use of transthoracic echocardiography guidance during the EMB procedures.
The international society of heart and lung transplantation guidelines for the care of heart transplant recipients
2010, Journal of Heart and Lung Transplantation