Biopsy-induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation
Biopsy-induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation
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DOI：
10.1016/s0002-9149(96)00202-0
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发表时间：
1996-06-15
影响因子：
2.8
通讯作者：
Semigran, MJ
中科院分区：
文献类型：
--
作者：
Williams, MJA;Lee, MY;Semigran, MJ
心肌内膜活检后三尖瓣器官受损，可能与血流动力学上显著的三尖瓣反流（TR）有关。本研究旨在确定心脏移植受者TR和连枷状三尖瓣小叶的患病率，并评估在心内膜活检期间直接在右心室放置45厘米鞘以减少这些并发症的发生率。对72例原位心脏移植受者在移植后29 +/- 20个月（平均+/- SD）的超声心动图和右心导管检查中是否存在连枷状三尖瓣小叶、TR和右侧心功能障碍。23例（32%）患者出现中度或重度TR。10例（14%）患者有连枷状三尖瓣小叶，其中7例有严重TR。右心房压（10 +/- 5 vs 6 +/- 5 mm Hg, p < 0.05）较高，心脏指数（2.0 +/- 0.2 vs 2.5 +/- 0.7 L/min/m(2), p < 0.05）较低，胆囊小叶患者右侧心脏尺寸大于无连枷状小叶患者。使用45 cm鞘后，连枷状三尖瓣小叶的患病率（41%至6%，p < 0.0001）和TR的平均等级（2至1，p < 0.0001）均有所降低。我们得出结论，心脏移植受者继发于活组织检查引起的瓣膜损伤的TR与早期右侧心力衰竭的迹象有关。在心肌膜活检中使用45厘米鞘可减少连枷状三尖瓣小叶的患病率和TR的严重程度。
Damage to the tricuspid valve apparatus has been described after endomyocardial biopsy and may be associated with hemodynamically significant tricuspid regurgitation (TR). This study was performed to determine the prevalence of TR and flail tricuspid leaflet in cardiac transplant recipients and to evaluate the use of a 45 cm sheath placed directly in the right ventricle during endomyocardial biopsy to reduce the incidence of these complications. Echocardiograms and right heart catheterization dan of 72 orthotopic cardiac transplant recipients were assessed for the presence of flail tricuspid leaflet, TR, and right-sided cardiac dysfunction 29 +/- 20 months (mean +/- SD) after transplantation. Moderate or severe TR was present in 23 patients (32%). Ten patients (14%) had flail tricuspid leaflet, with 7 of these having severe TR. Right atrial pressure (10 +/- 5 vs 6 +/- 5 mm Hg, p < 0.05) was higher, cardiac index (2.0 +/- 0.2 vs 2.5 +/- 0.7 L/min/m(2), p < 0.05) was lower, and right-sided cardiac dimensions were greater in patients with gall leaflets than in those without flail leaflets. Both the prevalence of flail tricuspid leaflet (41% to 6%, p < 0.0001) and mean grade of TR (2 to 1, p < 0.0001) were reduced after the use of a 45 cm sheath. We conclude that TR secondary to biopsy-induced damage to the valve apparatus occurs in cardiac transplant recipients and is associated with signs of early right-sided heart failure. Use of a 45 cm sheath during endomyocardial biopsy reduces the prevalence of flail tricuspid leaflet and the severity of TR.