Comparison of Echocardiography‐guided and Fluoroscopy‐guided Endomyocardial Biopsy Techniques

Abstract

The accuracy of bioptome placement for endomyocardial biopsy was evaluated using standard fluoroscopic guidance and compared simultaneously with two-dimensional echocardiography in six healthy subadult grizzly bears (Ursus arctos horribilis). Despite perceived adequate positioning of the bioptome toward the septum when judged using fluoroscopy, only one out of the six placements were actually positioned in the right ventricular apex toward the septum when evaluated using two-dimensional echocardiography. The bioptome was readily relocated to the right ventricular apex/septal location by echocardiography. The forceps were easily visualized at all times and the open cups were readily directed into the desired location for biopsy. Based on a subjective score for tissue quantity from 1 to 4 (poor to excellent), biopsies collected by echocardiographic-guided technique had a mean score of 3.4, while biopsies collected by fluoroscopic-guided technique had a mean score of 1.8. In summary, this study suggests that endomyocardial biopsy locations can be accurately positioned using two-dimensional echocardiography with the advantages of less radiation, lower procedural costs, and direct visualization of the sampling site. Clear definition of endocardial surface as afforded by echocardiography may enhance tissue sample quality and lower potential complications from this procedure.

Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience

“…This biopsy forceps was originally designed for endomyocardial biopsies (13) and consisted of three parts: A three-pull ring handle, cutting jaws, and a coiled shaft. Our group described the use of biopsy forceps to perform biopsies in the upper urinary tract with trans-ureteral approach (14).…”

Transjugular biopsy case report of inferior vena cava hepatocellular carcinoma with intracardiac extension

“…This method of transvenous sampling is not limited to the vascular system. Intracardiac neoplasms have been biopsied in this way with a variety of imaging-guidance including transoesophageal echocardiography, fluoroscopy and intracardiac echocardiography [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] . Renal biopsies have also been performed safely on a large series of patients using the internal jugular vein, as have hepatic biopsies [33] , [34] .…”

Right atrial and right ventricular ultrasound‐guided biopsy technique in standing horses

“…In contrast, other studies in human medicine revealed greater accuracy of bioptome positioning and greater tissue sample sizes with an echocardiography‐guided technique . A comparative study in grizzly bears demonstrated that forceps positioning by fluoroscopy often does not correspond to the location by echocardiography . In mature horses, chest fluoroscopy is practically infeasible due to the large thorax width, and thus echocardiography is the imaging method of choice.…”

“…The only complication found in our study was the presence of atrial and ventricular arrhythmias, which resolved spontaneously in 9/10 horses. During endomyocardial sampling in grizzly bears, ventricular premature depolarisations appearing to originate from the right ventricle were also found and paroxysmal ventricular tachycardia at rates of 200–250 beats/min was present despite continuous lidocaine infusion . A study in human patients reported atrial or ventricular arrhythmia in only 1.1% of biopsy procedures .…”