Bioptome

Abstract: Background— An unequivocal diagnosis of myocarditis and cardiac virus persistence is based on histological, immunohistological, and molecular biological analyses of endomyocardial biopsies (EMBs). Biopsy-based diagnosis of myocarditis has become increasingly important because recent studies have demonstrated the beneficial effects of biopsy-based causal treatment strategies (immunosuppressive or antiviral). Because the risks of major complications caused by EMB procedures have not yet been well defined, we evaluated the incidence of major and minor complications of right ventricular EMB procedures in this retrospective and prospective single-center study. Methods and Results— With the use of a modified Cordis bioptome, 1919 patients underwent 2505 EMB procedures retrospectively over a 9-year period (January 1995 to December 2003), and 496 patients underwent 543 EMB procedures prospectively between January 2004 and December 2005. A total of 2415 patients had 3048 EMB procedures via the right femoral vein a...

Abstract: Despite the increasing use of alternative techniques, endomyocardial biopsy remains the primary method for diagnosing cardiac allograft rejection Improved patient longevity and an increasing number of transplantation centers are resulting in an increase in the number of biopsies performed Although endomyocardial biopsy is usually considered a safe procedure, no large studies of the risks of endomyocardial biopsy specifically in the transplant population have been undertaken To determine the risk of endomyocardial biopsy in these patients, we reviewed 2454 endomyocardial biopsies performed from January 1983 to December 1990 in 133 cardiac allograft patients at our institution At the time of each endomyocardial biopsy, a worksheet was completed detailing the patient's interval history, the site of vascular introduction, the number of attempts, the number of specimens, and any complications encountered A total of 74 (30%) complications occurred Fifty-six (23%) complications were associated with catheter insertion, including carotid puncture (18%), vasovagal reaction (01%), and prolonged bleeding (04%) Complications during biopsy included arrhythmias (025%) and conduction abnormalities (02%) In addition, we observed five episodes (three patients) of allergic reaction to a reusable bioptome and one case of pacemaker dislodgement All complications were without significant long-term sequelae In contrast to the cardiomyopathy population, no ventricular perforations or deaths occurred Thus although endomyocardial biopsy has some risk, it continues to be a safe and effective way of monitoring rejection

Abstract: To obtain endomyocardial biopsies, a catheter sheath is introduced into the right internal jugular vein with the patient under a local anesthetic, and a catheter bioptome is advanced under fluoroscopic control to the apex of the right ventricle. Adequate specimens are obtained for light and electron microscopy and for immunofluorescent studies. In 20 biopsy specimens obtained from ten patients following cardiac transplantation, the histologic information has been valuable in diagnosing acute rejection episodes. Serial percutaneous transvenous endomyocardial biopsy is now a part of our routine management of patients receiving heart transplants.