Endomyocardial biopsy with a disposable bioptome: A modified technique

Abstract

Right ventricular endomyocardial biopsy can be obtained successfully with a manually shaped flexible disposable bioptome introduced in the right jugular vein. Introduction of a curve at the tip provides better control of the bioptome so that a short introducer sheath can be used and the right ventricular sampling site can be varied.

Novel long-neck sheath for endomyocardial biopsy

“…However, even in experienced hands, complications occur in 3-6% of procedures [3][4][5][6][7][8][9][10][11][12][13][14]. Although most complications are minor (e.g., inadvertent arterial puncture and transient arrhythmias), biopsy may result in more serious and potentially catastrophic complications including cardiac perforation leading to cardiac tamponade [1][2][3][4][5]9,14] and tricuspid valve damage, occasionally necessitating surgery for severe regurgitation [6][7][8]. Given that the typical cardiac transplantation patient undergoes multiple biopsies over time for rejection surveillance, the impact of these potential complications is cumulative [3,5].…”

“…Transvenous endomyocardial biopsy is an established technique for myocardial tissue sampling [1][2][3][4][5]. However, even in experienced hands, complications occur in 3-6% of procedures [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…In such patients, the internal jugular venous approach is preferable because it facilitates more rapid hemostasis and ambulation compared than does the femoral approach. Using the internal jugular approach, a short guiding sheath is advanced into the right atrium [1][2][3][4][5], or a longer sheath is positioned in the right ventricle [5,7]. Two types of biopsy forceps are available: a stiff reusable instrument [1,[3][4][5] and a flexible disposable bioptome [2,5,7,[10][11][12][13][14][15].…”

Endomyocardial biopsy: Advantages of adding a posterior bend to the bioptome

“…Current conventional techniques for a right internal jugular approach with a flexible bioptome modifies the distal 7-10 cm into a 60-90" curve in the sagittal plane [ 5 ] . After entering the right ventricle, the bioptome is rotated 180" counterclockwise in order to approach the septum [6].…”