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Endomyocardial Biopsy Thomas K. Jones, MD Professor, Pediatrics and Medicine University of Washington School of Medicine Director, Cardiac Catheterization.

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Presentation on theme: "Endomyocardial Biopsy Thomas K. Jones, MD Professor, Pediatrics and Medicine University of Washington School of Medicine Director, Cardiac Catheterization."— Presentation transcript:

1 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 and Congenital/Structural Fellows Course

2 Disclosures None related to this presentation 2009 Pediatric and Congenital/Structural Fellows Course

3 Indications Evaluation of Cardiomyopathy –Myocarditis –Anthracycline cardiotoxicity –Unexplained myocardial hypertrophy Storage diseases Mitochondrial disorders Cardiac Tumors –Unexplained arrhythmias Monitoring Allograft Rejection

4 How To Femoral vs. jugular venous approach Importance of long sheath Bioptome size Number of samples Location for sampling Imaging

5 How to Meticulous care in positioning sheath, first opening then advancing jaws, gentle counterforce with sheath when withdrawing bioptome Do not close then reopen jaws inside body

6 Tampa Bay Guiding Catheter Useful for femoral approach 8 F short sheath 6 F guide Introduced into RV with balloon wedge catheter Canedo M. Tampa bay catheter: A new guiding catheter for endomyocardial biopsy via femoral approach. Cath Cardiovasc Diag 1992;25:71-75 Not a Tampa Bay Catheter

7 Adverse events Safety of endomyocardial biopsy in children Cowley CG, et al. Cardiol Young 2003;13: Complications of endomyocardial biopsy in children Pophal SG, et al. J Am Coll Cardiol 1999;34:

8 Adverse events Cowley paper – –1051 procedures in 135 patients –IJ approach 68% –48 < 1yr –92% rejection surv. –1% SAE (no perfs) –No deaths –Increased risk in younger patients Bophal paper – –1000 procedures in 194 patients –IJ approach (57%) –64 < 1yr –85% rejection surv. –1.9% SAE (9 perfs) –One death (from perf) –Increased risk in younger patients, myocarditis and FV approach

9 Thanks A special ‘Thumbs-Up” to Ziyad


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