Endomyocardial Biopsy as Risk Factor in the Development of Tricuspid Insufficiency After Heart Transplantation
Endomyocardial Biopsy as Risk Factor in the Development of Tricuspid Insufficiency After Heart Transplantation
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DOI：
10.1016/j.transproceed.2009.02.011
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发表时间：
2009-04-01
影响因子：
0.9
通讯作者：
Stolf, N. A. G.
中科院分区：
文献类型：
--
作者：
Fiorelli, A. I.;Coelho, G. H. B.;Stolf, N. A. G.
Objective.用于监测排斥反应的肌内膜活检（EMB）可能导致原位心脏移植（OHT）后三尖瓣返流（TR）。本研究的目的是检查三尖瓣组织在OHT后常规EMB获得的心肌标本中的发生率。从2000年1月至2008年7月，125例接受OHT的患者存活超过1个月。他们的随访时间从1个月到8.5年不等（平均5.1 ± 3.7年）。EMB是金标准检查，镓心肌造影作为常规监测排斥反应的筛查。本研究共收集了428个EMB，每个EMB包含4 ~ 7个片段，共计1715个片段。每例患者的EMB数量从3到8不等（平均4.6 +/- 3.5）。组织学分析显示4例患者（3.2%）有三尖瓣组织，其中仅I例显示TR加重。EMB仍然是诊断奥尔特后排斥反应的标准方法。它可以以低风险进行。使用镓心肌造影或其他替代方法减少EMB的数量，以及在活检过程中采取特殊护理，可以显着减少对三尖瓣的创伤。
Objective. Endomyocardial biopsy (EMB), which is used to monitor for rejection, may cause tricuspid regurgitation (TR) after orthotopic heart transplantation (OHT). The purpose of this investigation was to examine the occurrence of tricuspid valve tissue in myocardial specimens obtained by routine EMB performed after OHT.Patients and Methods. From January 2000 to July 2008, 125 of the patients who underwent OHT survived more than I month. Their follow-up varied from I month to 8.5 years (mean, 5.1 +/- 3.7 years). EMB was the gold standard examination and myocardial scintigraphy with gallium served as a screen to routinely monitor rejection.Results. Each of 428 EMB including 4 to 7 fragments, totaling 1715 fragments, were reviewed for this study. The number of EMB per patient varied from 3 to 8 (mean, 4.6 +/- 3.5). Histopathological analysis of these fragments showed tricuspid tissue in 4 patients (3.2%), among whom only I showed aggravation of TR.Conclusions. EMB remains the standard method to diagnose rejection after OLT. It can be performed with low risk. Reducing the number of EMB using gallium myocardial scintigraphy or other alternative methods as well as adoption of special care during the biopsy can significantly minimize trauma to the tricuspid valve.