Use of guiding catheters to target pericardial and endomyocardial biopsy sites

Mehan, Vivek K.; Dalvi, Bharat; Lokhandwala, Yash; Kale, Purshottam A.

doi:10.1016/0002-8703(91)90549-w

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…Feasibility of aimed pericardial biopsy under endoscopic control included feasibility of pericardial access (96.2% in group 2 and 100% in group 3), 16.5F sheath introduction (96.0% in group 2 and 100% in group 3), adequate pericardial visualization (90.9% in group 2 and 93.3% in group 3), and sampling efficiency (84.9% in group 2 and 84.2% in group 3) ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Complications were associated with induction to anesthesia before pericardiocentesis in patients with large pericardial effusion. In contrast to surgical procedures, Endrys et al 17 and Mehan et al 16 reported no major complications. Minor complications included premature ventricular beats in 40% and a small subcutaneous hematoma in 4%.…”

Section: Complicationsmentioning

confidence: 95%

“…Larger sample volume (8F bioptome) and more aggressive sampling (6 to 8 samples from each patient) may have improved the diagnostic value. Mehan et al 16 investigated 25 patients using angioplasty guiding catheters for pericardial biopsy guidance. Histologic diagnosis of tuberculous pericarditis was established in 44%, purulent pericarditis was established in 8%, and nonspecific inflammatory changes were found in 48% of patients.…”

Section: Pericardial Biopsy With Fluoroscopy Controlmentioning

confidence: 99%

“…Minor complications included premature ventricular beats in 40% and a small subcutaneous hematoma in 4%. 16 …”

Section: Complicationsmentioning

confidence: 99%

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Diagnostic Value of Pericardial Biopsy

et al. 2003

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Background— The clinical significance of pericardial biopsy is controversial. The aim of this study was to assess the feasibility and diagnostic value of 3 approaches to pericardial biopsy: fluoroscopic control and standard sampling, pericardioscopy guidance with standard sampling, and pericardioscopy guidance with extensive sampling. Methods and Results— Forty-nine subsequent patients with a large pericardial effusion underwent parietal pericardial biopsy. In group 1 (12 patients, 66.7% males, age 46.7±12.2 years), pericardial biopsy was guided by fluoroscopy (3 to 6 samples per patient). Group 2 included 22 patients (50% males, age 50.8±10.4 years) undergoing 4 to 6 pericardial biopsies per patient guided by pericardioscopy (16F flexible endoscope). In group 3, extensive pericardial sampling was performed, guided by pericardioscopy (15 patients, 53.3% males, age 53.7±12.8 years, 18 to 20 samples per patient). Sampling efficiency was better with pericardioscopy (group 2, 84.9%; group 3, 84.2%) compared with fluoroscopic guidance (group 1, 43.7%; P <0.01). Diagnostic value was defined as a new diagnosis uncovered, etiology revealed, clinical diagnosis confirmed, and the biopsy false-negative. Pericardial biopsy in group 3 had higher diagnostic value than in group 1 in revealing new diagnosis (40% versus 8.3%, P <0.05) and etiology (53.3% versus 8.3%, P <0.05). In group 2, pericardial biopsy had a higher yield in establishing etiology than in group 1 (40.9% versus 8.3%; P <0.05). Pericardial biopsy was false-negative in 58.3% in group 1 in contrast to 6.7% in group 3 ( P <0.01). There were no major complications. Conclusions— Pericardioscopic guidance enhanced pericardial sampling efficiency. The diagnostic value of pericardial biopsy was significantly improved by extensive sampling made possible by pericardioscopy.

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Section: Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 95%

Section: Pericardial Biopsy With Fluoroscopy Controlmentioning

confidence: 99%

“…Minor complications included premature ventricular beats in 40% and a small subcutaneous hematoma in 4%. 16 …”

Section: Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Value of Pericardial Biopsy

et al. 2003

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“…The use of flexible fiberoptic pericardioscope and thoracoscope will help to target the lesions over both the parietal and visceral pericardium, but they are cumbersome procedures requiring special instruments, and may be limited in their ability to sample all areas of the pericardium [4]. The PPB techniques we introduced, and its various modifications by others, are simple, nonsurgical procedures providing pericardial fluid as well as tissue from multiple areas of the parietal pericardium [3,6,10,12]. Therefore these procedures have a potential not only to improve the yield of specific diagnoses but also to exclude them confidently.…”

Section: The Need For and The Value Of Percutaneous Pericardial Biopsymentioning

confidence: 99%

Percutaneous Pericardial Biopsy: Technique, Efficacy, Safety, and Value in the Management of Pericardial Effusion in Children and Adolescents

et al. 1997

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This study describes our technique of nonsurgical percutaneous pericardial biopsy (PPB), its efficacy and safety, and its diagnostic and therapeutic usefulness in the management of pericardial effusion (PE) in children and adolescents. In an 8-year period, 19 selected patients, aged 2 to 20 years, had PPB for evaluation and treatment of PE. Using this procedure we procured multiple biopsy specimens from various areas of the thickened parietal pericardium, and also procured pericardial fluid for investigation. The biopsy material helped establish a specific etiologic diagnosis in 63% and helped exclude tuberculosis and malignancy in the rest (37%). The histopathologic diagnoses were tuberculous pericarditis (37%), uremic pericarditis (16%), radiation pericarditis (5%), connective tissue disease (5%), and idiopathic pericarditis (37%). In tuberculous pericarditis, the biopsy specimen provided an immediate histopathologic diagnosis, and a higher culture positivity (71%) than pericardial fluid (29%). In addition, the procedure was therapeutically effective in relieving tamponade and in treating effusion. Our experience indicates that the PPB procedure has both diagnostic and therapeutic value, and it can be performed easily, safely, and without complications even in small children.

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