Abstract
Tricuspid regurgitation, a fairly common finding after cardiac transplantation, is generally mild or moderate, and is not clinically significant The etiology of tricuspid regurgitation is not entirely understood, and experience with valve replacement after cardiac transplantation is limited. We describe a case of progressively severe tricuspid regurgitation ultimately requiring tricuspid valve replacement At operation, the ruptured chordae of the posterior part of anterior and septal leaflet with resulting partially flail leaflets were found. Examination of the papillary muscle showed origins of several of the ruptured chordae. Damage to the tricuspid subvalvular apparatus at endomyocardial biopsy appeared to be a possible cause. A 31-mm Carpentier-Edwards porcine valve was implanted. This was because replacement with a mechanical prosthesis would prevent future right-side heart catheterization and endomyocardial biopsy and in valve repair, the patient remains exposed to the risk of the recurrence of chordal rupture. We discuss proposed causes and choices in surgical technique.
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Cladellas M, Abadal ML, Pons G, Ballester M, Carreras F, Obrador D, et al. Early transient multivalvular regurgitation detected by pulsed doppler in cardiac transplantation. Am J Cardiol 1986; 58: 1122–4.
Lewen MK, Bryg RJ, Miller LW, Williams GA, Labovitz AJ. Tricuspid regurgitation by Doppler echocardiography after orthotopic cardiac transplantation. Am J Cardiol 1987; 59: 1371–4.
Angermann CE, Spes CH, Tammen A, Stempfle HU, Schutz A, Kemkes BM, et al. Anatomic characteristics and valvular function of the transplanted heart: transthoracic versus transesophageal echocardiographic findings. J Heart Transplant 1990; 9: 331–8.
Haverich A, Albes JM, Fahrenkamp G, Schafers HJ, Wahlers T, Heublein B. Intraoperative echocardiography to detect and prevent tricuspid valve regurgitation after heart transplantation. Eur J Cardiothorac Surg 1991; 5: 41–5.
Braverman AC, Coplen SE, Mudge GH, Lee RT. Ruptured chordae tendineae of the tricuspid valve as a complication of endomyocardial biopsy in heart transplant patients. Am J Cardiol 1990; 66: 111–3.
Crumbley AJ III, Van Bakel AB. Tricuspid valve repair for biopsy-induced regurgitation after cardiac transplantation. Ann Thorac Surg 1994; 58: 1156–60.
Wijburg ER, Balk AHMM, van Herwerden LA. Double valve repair in a transplanted heart. J Thorac Cardiovasc Surg 1998; 115: 250–51.
Hoffmeier A, Schmid C, Deng MC, Weyand M, Kerber S, Schmit CH, et al. Multiple cardiac procedures after heart transplantation: a case report. Thorac Cardiovasc Surgeon 1996; 44: 216–8.
Wahlers T, Albest J, Pething K, Oppelt P, Fieguth HG, Jurmann M, et al. Valve reconstruction or replacement for long-term biopsy induced tricuspid regurgitation following heart transplantation. Transplant Int 1996; 9 (Suppl 1): s247–48
Hausen B, Albes JM, Rohde R, Demertzis S, Mugge A, Schafers HJ. Tricuspid valve regurgitation attributable to endomyocardial biopsies and rejection in heart transplantation. Ann Thorac Surg 1995; 59: 1134–40.
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Ichikawa, S., Takeuchi, Y., Suda, Y. et al. Tricuspid valve replacement after cardiac transplantation. Jpn J Thorac Caridovasc Surg 48, 659–662 (2000). https://doi.org/10.1007/BF03218224
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DOI: https://doi.org/10.1007/BF03218224