Routine use of fluoroscopic and real‐time transthoracic echocardiographic guidance to ensure safety of right ventricular endomyocardial biopsy in a low‐volume center

Abstract

To determine whether the routine use of real‐time transthoracic echocardiographic (TTE) guidance in addition to fluoroscopy would ensure the safety of right ventricular endomyocardial biopsy (RV EMB) in a low‐volume center. RV EMB is a valuable tool and plays an important role in the diagnosis and management of patients with myocardial diseases. However, it has yet to gain widespread acceptance due to its perceived low diagnostic yield and concerns regarding its invasive nature and potential complications. Although the safety of EMB when performed by experienced operators in high‐volume centers is well established, the complication rate in low‐volume centers is less well defined but appears to be higher. This is a retrospective single‐center cross‐sectional study. Consecutive adult patients who underwent RV EMB procedures at Tygerberg Hospital (Cape Town, South Africa) between August 2017 and December 2020 were included. RV EMB was successfully performed in 85 patients. No major complications were reported. Five (5.88%) patients experienced minor complications: three transient right bundle branch blocks and two hemodynamically stable ventricular tachycardia. A definitive biopsy diagnosis was made in 37 (43.54%) patients. The average procedural time was 27.06 min, which equated to 4.09 min per specimen taken. The routine use of real‐time TTE guidance in addition to fluoroscopy ensured the safety of RV EMB in a low‐volume center without unnecessarily prolonging procedural time.

Comparing the findings and diagnostic sensitivity of cardiovascular magnetic resonance in biopsy confirmed acute myocarditis with infarct-like vs. heart failure presentation

“…Right ventricular (RV) septal biopsies were performed on all patients as described in detail previously [ 3 ]. At least six specimens were taken from different sections of the septum to improve sensitivity.…”

“…Although endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of AM [ 1 , 2 ] and despite safety data, even in low volume centres [ 3 ], it is infrequently sought in patients with clinically suspected AM due to its invasive nature and the perceived low diagnostic yield resulting from sampling error. As a result, cardiovascular magnetic resonance (CMR) is now considered the reference imaging modality for providing a non-invasive diagnosis of AM [ 4 – 7 ].…”