Complications of endomyocardial biopsy in children

Abstract

Risk of endomyocardial biopsy is highest in sick children with suspected myocarditis on inotropic support. However, EMB can be performed safely with very low morbidity in pediatric heart transplant recipients.

Comparison of the Clinical Presentation, Treatment, and Outcome of Fulminant and Acute Myocarditis in Children

“…In a review of 1,000 endomyocardial biopsy procedures, the incidence of this complication was 0.9%. 29 The ACC/AHA guidelines for the treatment of heart failure include endomyocardial biopsy as a Class IIb recommendation. In any type of MC, endomyocardial biopsy is quite informative for making an accurate diagnosis, in assessing the use of anti-inflammatory agents, and in predicting prognosis.…”

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011

“…Although endomyocardial biopsy in acute myocarditis is relatively safe with experienced providers, accurate interpretation remains a challenge, and there is a risk of arrhythmia, right ventricular perforation, and tamponade. 16 On univariable analysis, MRI was associated with lower mortality/transplantation and endomyocardial biopsy with higher mortality/transplantation; however, there was a lack of independent association. Several factors, including the severity of a patient's condition, might impact the decision to perform these tests and hence this finding.…”

Myocarditis in Childhood: An Update on Etiology, Diagnosis and Management

“…Of these only two have received class I recommendation for EMB (Table). In a retrospective review analyzing the morbidity and mortality of EMB in children, highest risk was found in children with suspected myocarditis on inotropic support (Pophal et al, 1999). Authors also found that risk of biopsy in small children (< 10 kg) or sick infants was extreme.…”

“…Several issues have to be considered before making a decision about biopsy. As stated earlier, some complications such as pneumothorax, dysrhythmia, perforation and death, may occur during the procedure, and it can be hazardous for particularly pediatric patients (Pophal et al, 1999). Limited sensitivity of EMB that is related with sampling error should also be evaluated (Hauck et al, 1989).…”