Endomyocardial biopsy

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Endomyocardial biopsy
rejection following heart transplantation

Endomyocardial biopsy (EMB) is an

heart diseases.[1]

A bioptome is used to gain access to the heart via a sheath inserted into the right internal jugular or less commonly the femoral vein.[1] Monitoring during the procedure consists of performing ECGs and blood pressures.[1] Guidance and confirmation of correct positioning of the bioptome is made by echocardiography or fluoroscopy.[1]

The risk of complications is less than 1% when performed by an experienced physician in a specialist centre.

AV block, tricuspid regurgitation and pneumothorax.[2]

EMB, sampling

myocardium was first pioneered in Japan by S. Sakakibra and S. Konno in 1962.[1][3]

Indications

The main reason for performing an EMB is to assess

ventricular arrhythmias,[4] or unexplained ventricular dysfunction.[5][6]

Transplant monitoring

Visualising the

cell-mediated or antibody-mediated rejection and is recommended episodically during the first year after heart transplantation. Occasionally, monitoring continues beyond one year.[1]

The use of EMB in heart transplant rejection surveillance remains the gold standard test, although the pre-test predictors of rejection cardiac magnetic resonance imaging (CMR) and gene expression profiling, are increasingly used.[1]

Myocardial diseases

EMB has a role in the diagnosis of viral myocarditis and inflammatory myocarditis.[1]

Procedure

EMB of the right ventricle via the internal jugular vein is standard after heart transplant. [4] A bioptome is used to gain access to the heart via a sheath inserted into the right internal jugular or less commonly the femoral vein.[1] Monitoring during the procedure consists of performing ECGs and blood pressures. Guidance and confirmation of correct positioning of the bioptome is made by echocardiography or fluoroscopy[1] before the biopsy specimen is taken and in the case of transplants, usually three[4] or four or more samples are taken.[1]

Endomyocardial fibrosis can occur if biopsies are performed repeatedly. This risk is reduced if the operator is experienced. Unlike for rejection detection, for diagnosing heart disease, different biopsy sites within the heart are targeted.[4]

It is possible but less common to biopsy the left ventricle via the

femoral arteries.[1]

Limitations

The accuracy of diagnosis by EMB depends on whether the correct site is biopsied. There is a risk that a diagnosis can be missed if the biopsy misses the diseased part of heart muscle, particularly with myocardial inflammation or fibrosis.[5][7]

An experienced pathologist trained in biopsy analysis and interpretation also reflects EMB’s reliability. Variability between pathologists has been observed. [4]

Complications

A frequent concern regarding EMB has been its safety.[1] However, it has a low risk of less than 1% when performed by an experienced physician in a specialist centre.[1][3]

Possible complications, which almost all occur at time of procedure,

right intraventricular septum, conduction block, arrhythmias, pneumothorax, tricuspid regurgitation, atrioventricular fistula,[8] and pulmonary embolism. Death has been reported, but is rare.[1]

History

Early heart biopsies, sampling

arrythmias.[3]

EMB, sampling

percutaneously.[6]

References

  1. ^ a b c d e f g h i j k l m n o p q Asher, Alex (July 2017). "A review of endomyocardial biopsy and current practice in England: out of date or underutilised?". The British Journal of Cardiology. Retrieved 26 September 2018.
  2. ISBN 978-3-319-72442-3
    .
  3. ^
    PMID 7044509
    .
  4. ^
    ISBN 978-0-7637-6468-5
    .
  5. ^
    PMID 22033254
    .
  6. ^
    ISBN 978-0-7817-5567-2
    .
  7. PMID 18702960
    .
  8. PMID 7917350
    .
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