RUPTURED CHORDAE TENDINEAE OF THE TRICUSPID-VALVE AS A COMPLICATION OF ENDOMYOCARDIAL BIOPSY IN HEART-TRANSPLANT PATIENTS

Percutaneous transvenous endomyocardial biopsy is the preferred method to detect graft rejection in the transplanted heart. This procedure has undergone improvements and modifications making endomyocardial biopsy safe from the right internal jugular or femoral venous approach.1,2 Large series have documented the low morbidity and mortality associated with endomyocardial biopsy. Major complications include cardiac perforation and tamponade occurring in <0.4%.1,2 Other cardiac complications are arrhythmias, bundle branch block and endocarditis. Recently, coronary arterial-right ventricular fistula secondary to repeated endomyocardial biopsies has been described.3 With improved survival in cardiac transplant patients, complications of repeated endomyocardial biopsies may become more apparent. This report describes 5 patients with orthotopic cardiac transplants who have echocardiographic evidence of tricuspid valve chordal rupture as a complication of endomyocardial biopsy. © 1990.