Endomyocardial Biopsy

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Presentation transcript:

Endomyocardial Biopsy 2009 Pediatric and Congenital/Structural Fellows Course Endomyocardial Biopsy Thomas K. Jones, MD Professor, Pediatrics and Medicine University of Washington School of Medicine Director, Cardiac Catheterization Laboratories Seattle Children’s Hospital

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

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

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

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

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

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 Bophal paper Cowley paper 1987-1996 1986-2002 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 Cowley paper 1986-2002 1051 procedures in 135 patients IJ approach 68% 48 < 1yr 92% rejection surv. 1% SAE (no perfs) No deaths Increased risk in younger patients

Thanks A special ‘Thumbs-Up” to Ziyad