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Cardiology
Endomyocardial Biopsy Indications and Procedures
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 75 slides
Overview
- Scope of this presentation
History and current role
- Endomyocardial biopsy in current practice
- Evolution of the biopsy technique
- Classification and long sheath access
Indications
- Guideline indications for endomyocardial biopsy
- Post-transplant indication and the routine biopsy caveat
- Definition and diagnosis of myocarditis
- Noninvasive assessment in stable suspected myocarditis
- Cardiac magnetic resonance guiding the decision to biopsy
- Biopsy in haemodynamically unstable myocarditis
- Giant cell myocarditis
- Biopsy in autoimmune disease
- Infiltrative cardiomyopathies
- Cardiac amyloidosis
- Rejection surveillance after heart transplantation
- Traditional post-transplant biopsy schedule
- Noninvasive rejection surveillance assays
- Changing role of surveillance biopsy
Preparation and equipment
- Personnel and operator competency
- Preprocedure laboratory assessment
- Bleeding risk thresholds
- Anticoagulant management before biopsy
- Proceeding despite increased bleeding risk
- Procedural location and monitoring
- Echocardiography-guided biopsy
- Bioptome shaft types
- Floppy shaft endomyocardial bioptome
- Bioptome length and sheath size
Right ventricular biopsy
- Venous access for right ventricular biopsy
- Right internal jugular approach
- Resistance at the superior vena cava anastomosis
- Long sheath solution for a resistant anastomosis
- Left internal jugular approach
- Femoral venous approach
- Right heart catheterisation at the time of biopsy
- Haemodynamic assessment in non-transplant patients
- Right atrial tracing in severe tricuspid regurgitation
- Fluoroscopic views and anatomical landmarks
- Crossing the tricuspid valve
- Bioptome directed to the interventricular septum
- Obtaining the septal sample
- Confirming contact with the endocardial surface
- Avoiding a false-negative biopsy
- Patient symptoms during biopsy
Specimens and left ventricular biopsy
- Specimen number and fixation
- Appearance of specimens in formalin
- Recognising non-myocardial samples
- Transferring specimens to fixative
- Indications for left ventricular biopsy
- Left ventricular biopsy technique
- Antithrombotic management for left ventricular biopsy
- Post-procedure monitoring
- Resuming anticoagulation after biopsy
Complications and limitations
- Overall complication rates
- Vascular access complications
- Biopsy-related complications
- Tricuspid valve injury after biopsy
- Flail tricuspid leaflet on echocardiography
- Why bleeding from the biopsy site is rare
- Summary and future direction
- References
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- References
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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