Endomyocardial Biopsy
Thomas K. Jones, MD
Professor, Pediatrics and Medicine
University of Washington School of Medicine
Director, Cardiac Catheterization Laboratories
Seattle Children’s Hospital
2009 Pediatric andCongenital/Structural
Fellows Course
Disclosures
•None related to this presentation
2009 Pediatric andCongenital/Structural
Fellows Course
Indications
•Evaluation of Cardiomyopathy
–Myocarditis
–Anthracycline cardiotoxicity
–Unexplained myocardial hypertrophy
•Storage diseases
•Mitochondrial disorders
•Cardiac Tumors
–Unexplained arrhythmias
•Monitoring Allograft Rejection
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How To
•Femoral vs. jugularvenous approach
•Importance of longsheath
•Bioptome size
•Number of samples
•Location for sampling
•Imaging
How to
•Meticulous care inpositioning sheath,first opening thenadvancing jaws,gentle counterforcewith sheath whenwithdrawing bioptome
•Do not close thenreopen jaws insidebody
Tampa Bay Guiding Catheter
•Useful for femoralapproach
•8 F short sheath
•6 F guide
•Introduced into RVwith balloonwedge catheter
Canedo M. Tampa bay catheter: A new guiding catheter for endomyocardial biopsy viafemoral approach. Cath Cardiovasc Diag 1992;25:71-75
Not a Tampa Bay Catheter
Adverse events
Safety of endomyocardial biopsy
in children
Cowley CG, et al. Cardiol Young 2003;13:4040407
Complications of endomyocardial biopsy
in children
Pophal SG, et al. J Am Coll Cardiol 1999;34:2105-10
Adverse events
•Cowley paper
–1986-2002
–1051 procedures in 135patients
–IJ approach 68%
–48 < 1yr
–92% rejection surv.
–1% SAE (no perfs)
–No deaths
–Increased risk inyounger patients
•Bophal paper
–1987-1996
–1000 procedures in194 patients
–IJ approach (57%)
–64 < 1yr
–85% rejection surv.
–1.9% SAE (9 perfs)
–One death (from perf)
–Increased risk inyounger patients,myocarditis and FVapproach
Thanks
A special ‘Thumbs-Up” to Ziyad