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Echo-guided endomyocardial biopsy in heart transplant recipients

  • Original Article
  • Published:
Transplant International

Abstract

After heart transplantation the effect of immunosuppression is monitored by histopathology of endomyocardial biopsy (EMB). EMB is usually carried out under X-ray guidance. Between January 1998 and March 2003, 1,262 biopsies were collected under echo-guidance in 156 patients. The biopsy access was gained through the internal jugular vein, by the standard catheterization technique. The average time of the procedure was 17 min. Four or five specimens were obtained from each patient, with a success rate of 96%. Complications involved two episodes of partial pneumothorax in one patient, atrial flutter in another and ventricular fibrillation in three patients. Conversion from echo to X-ray guidance was indicated in 11 patients. No case of significant tricuspid regurgitation related to the EMB procedure was recorded. The echo-guided endomyocardial biopsy appears to be a prospective alternative to the conventional approach under X-ray guidance. Its duration is comparable, it eliminates X-ray exposure, enables continuous echocardiographic monitoring and can be performed at the bedside.

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References

  1. Caves P, Stinson E, Billingham M, et al. Percutaneous transvenous endomyocardial biopsy in human heart recipients. Ann Thorac Surg 1973; 16:325.

    CAS  PubMed  Google Scholar 

  2. French J, Popp R, Pitlick P. Cardiac localization of transvascular bioptome using two-dimensional echocardiography. Am J Cardiol 1983; 51:219.

    CAS  PubMed  Google Scholar 

  3. Mortensen S, Engeblad H. Endomyocardial biopsy guided by cross-sectional echocardiography. Br Heart J 1983; 50:246.

    CAS  PubMed  Google Scholar 

  4. Billingham ME, Cary NR, Hammond ME, et al. A working formulation for the standardization of nomenclature in diagnosis of heart and lung rejection: Heart Rejection Study Group. J Heart Transplant 1990; 9:587.

    CAS  PubMed  Google Scholar 

  5. Kirklin JK, Bourge RC, Naftel DC, McGiffin DC. Is there a need for surveillance endomyocardial biopsies in heart transplantation. Transplant Proc 2002; 34:1857.

    Article  CAS  PubMed  Google Scholar 

  6. Barry WH. Mechanisms of immune mediated myocyte injury. Circulation 1994; 89:2421.

    CAS  PubMed  Google Scholar 

  7. May RM, Cooper DK, Dutoit ED, et al. Cytoimmunologic monitoring after heart and heart lung transplantation. J Heart Transplant 1990; 9:133.

    CAS  PubMed  Google Scholar 

  8. Fieguth MG, Haverich A, Schafers MG, et al. Cytoimmunologic monitoring in early and late acute cardiac rejection. J Heart Transplant 1988; 7:95.

    CAS  PubMed  Google Scholar 

  9. Carrier M. Noninvasive assessment of cardiac transplant rejection. A critical look at the approach to acute rejection. Can J Surg 1991; 34:569.

    CAS  PubMed  Google Scholar 

  10. Hsu DT, Spotnitz HM. Echocardiographic diagnosis of cardiac allograft rejection. Prog Cardiovasc Dis 1990; 33:149.

    Article  CAS  PubMed  Google Scholar 

  11. Dodd DA, Brady LD, Carden KA, et al. Pattern of echocardiographic abnormalities with acute cardiac allograft rejection in adults: correlation with endomyocardial biopsy. J Heart Lung Transplant 1993; 12:1009.

    CAS  PubMed  Google Scholar 

  12. Cilliberto GR, Mascarello M, Gronda E, et al. Acute rejection after heart transplantation: noninvasive echocardiographic evaluation. J Am Coll Cardiol 1994; 23:1156.

    PubMed  Google Scholar 

  13. Müller J, Eubel A, Dandel M, et al. Non-invasive rejection monitoring after heart transplantation. A retrospective analysis of data from 734 cardiac recipients. Am J Transplant, Suppl 1, 2001; 1, 582.

    Google Scholar 

  14. Dandel M, Hummel M, Muller J, Wellnhofer E, et al. Reliability of tissue Doppler wall motion monitoring after heart transplantation for replacement of invasive routine screenings by optimally timed cardiac biopsies and catheterizations. Circulation 2001; 12:1184.

    Google Scholar 

  15. Hetzer R, Potapov EV, Muller J, Loebe M, Hummel M, Weng Y, et al. Daily noninvasive rejection monitoring improves long-term survival in pediatric heart transplantation. Ann Thorac Surg 1998; 66:1343.

    Article  CAS  PubMed  Google Scholar 

  16. Iberer F, Grasser B, Schreier G, Schaffellner S, Prenner G, et al. Introducing a new clinical method for noninvasive rejection monitoring after heart transplantation to clinical practice: analysis of paced intramyocardial electrograms. Transpl Proc 1998; 30:895.

    Article  CAS  Google Scholar 

  17. Ragni T, Martinelli L, Goggi C, et al. Echo-controlled endomyocardial biopsy. J Heart Transplant 1990; 9:538.

    CAS  PubMed  Google Scholar 

  18. Gramiak R, Shah PM, Kramer DH. Ultrasound cardiography: contrast studies in anatomy and function. Radiology 1969; 92:939.

    CAS  PubMed  Google Scholar 

  19. Mason J. Techniques for right and left ventricular endomyocardial biopsy. Am J Cardiol 1978; 41:887.

    Article  CAS  PubMed  Google Scholar 

  20. Masura J, Gavora P, Formanek A, et al. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder. Catheter Cardiovasc Diagn 1997; 42:388.

    Article  CAS  Google Scholar 

  21. Penn I, Cancers following cyclosporine therapy. Transplantation 1987; 43:32.

    CAS  PubMed  Google Scholar 

  22. Grande A, Minzioni G, Martinelli L, Rinaldi M, et al. Echo-controlled endomyocardial biopsy in orthotopic heart transplantation with bicaval anastomosis. G Ital Cardiol 1997; 27:877.

    CAS  PubMed  Google Scholar 

  23. Aziz TM, Burgess MI, Rahman AN, et al. Risk factors for tricuspid valve regurgitation after orthotopic heart transplantation. Ann Thorac Surg 1999; 68:1247.

    Article  CAS  PubMed  Google Scholar 

  24. Yankah AC, Musci M, Weng Y, et al. Tricuspid valve dysfunction and surgery after orthotopic cardiac transplantation. Eur J Cardiothorac Surg 2000; 17:343.

    Article  CAS  PubMed  Google Scholar 

  25. Ichikawa S, Takeuchi Y, Suda Y, et al. Tricuspid valve replacement after cardiac transplantation. Jpn J Thorac Cardiovasc Surg 2000; 48:659.

    CAS  PubMed  Google Scholar 

  26. Nguyen V, Cecere R, Cantarovich M, et al. Tricuspid regurgitation after cardiac transplantation: how many biopsies are too many? J Heart Lung Transplant 2003; 22:S171.

    Article  Google Scholar 

  27. Hunt SA. Pregnancy in heart transplant recipients: a good idea? J Heart Lung Transplant 1991; 10:499.

    CAS  PubMed  Google Scholar 

  28. Armenti VT, Radomski JS, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry(NTPR): outcomes of pregnancy after transplantation. Clin Transplant 2000; 123.

  29. Cowan SW, Coscia LA, McGrory CH, et al. Outcomes of pregnancies in female heart transplant recipients. J Am Transplant, Suppl 1, 2001; 1:1177.

    Google Scholar 

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Authors and Affiliations

  1. Centre of Cardiovascular and Transplant Surgery, Pekarska 52, 656 91, Brno, Czech Republic

    Helena Bedanova, Josef Necas, Erik Petrikovits, Petr Pokorny, Sylva Kovalova, Petr Malik, Jiri Ondrasek & Jan Cerny

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  1. Helena Bedanova
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  2. Josef Necas
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  3. Erik Petrikovits
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  4. Petr Pokorny
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  5. Sylva Kovalova
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  6. Petr Malik
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  7. Jiri Ondrasek
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  8. Jan Cerny
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Correspondence to Helena Bedanova.

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Bedanova, H., Necas, J., Petrikovits, E. et al. Echo-guided endomyocardial biopsy in heart transplant recipients. Transpl Int 17, 622–625 (2004). https://doi.org/10.1007/s00147-004-0760-1

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  • DOI: https://doi.org/10.1007/s00147-004-0760-1

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