Gagliardi M G, Bevilacqua M, Parisi F, Giannico S, Marcelletti C
Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Roma.
G Ital Cardiol. 1992 Aug;22(8):963-8.
The experience with endomyocardial biopsy in pediatric age is still limited. From February 1986 to August 1990, 144 right ventricle endomyocardial biopsies were performed in 84 patients (age range 33 days--14 years, median age 31 months, weight range 3--57 kgs). Clinical diagnosis was: dilated cardiomyopathy in 50 patients; graft reject in 19; hypertrophic cardiomyopathy in 4; restrictive cardiomyopathy in 5; heart tumor in 3; ventricular arrhythmia in 3. The bioptome was introduced directly, without the use of a long sheath. There were no major complications; 2 patients experienced complete transient atrioventricular block and in 1 case right ventricular perforation occurred. In 11/45 patients (27%) with the clinical diagnosis of dilated cardiomyopathy and available myocardial specimens, acute myocarditis was diagnosed. In 47/65 procedures in the transplanted patients, a moderate to severe rejection was diagnosed. In the remaining patients, endomyocardial biopsy did not help the clinical diagnosis. We conclude that the right ventricular endomyocardial biopsy is a safe procedure in pediatric age; its utility is mostly limited to the diagnosis of acute myocarditis and graft reject after cardiac transplantation.
小儿心内膜心肌活检的经验仍然有限。从1986年2月至1990年8月，对84例患者（年龄范围33天至14岁，中位年龄31个月，体重范围3至57千克）进行了144次右心室心内膜心肌活检。临床诊断为：扩张型心肌病50例；移植排斥19例；肥厚型心肌病4例；限制型心肌病5例；心脏肿瘤3例；室性心律失常3例。活检钳直接插入，未使用长鞘。无重大并发症；2例患者出现完全性短暂房室传导阻滞，1例发生右心室穿孔。在临床诊断为扩张型心肌病且有心肌标本的45例患者中，11例（27%）诊断为急性心肌炎。在移植患者的65次活检中，47次诊断为中度至重度排斥。在其余患者中，心内膜心肌活检无助于临床诊断。我们得出结论，右心室心内膜心肌活检在小儿年龄段是一种安全的操作；其用途主要限于诊断急性心肌炎和心脏移植后的移植排斥。
