Huang Jie, Yang Yue-jin, Yin Dong, Feng Lei, Liao Zhong-kai, Wang Yong, Xu Bo, Liu Yan, Hu Sheng-shou
Heart Transplantation Center, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Jan;38(1):43-6.
Primary indications for endomyocardial biopsy (EMB) include heart transplant rejection surveillance and identifying cardiomyopathy or myocarditis. EMB procedures have not yet gained widespread acceptance because of concerns about possible complications associated with EMB procedures. In this single-center retrospective study, we analyzed the incidence of major and minor EMB procedure-related complications of 439 EMBs during the past 4.5 years.
From May 2004 to November 2008, 15 patients with cardiomyopathy and 1 patient with suspected cardiac tumor underwent 16 EMB procedures and 131 heart transplant recipients underwent 423 EMB procedures with the use of a modified Cordis bioptome. All EMB procedures were made via the right internal jugular vein approach and RV septum EMBs were performed under fluoroscopic guidance without additional echocardiographic monitoring. Operators were allowed to perform EMB procedure alone if a minimum of 50 EMB procedures had been previously supervised by a senior operator and all EMBs were performed by 4 operators. All patients underwent a 12-lead electrocardiogram (ECG), 12-hour continuous ambulatory ECG monitoring, chest X-ray and transthoracic echocardiography before and after EMB procedures to obtain a detailed evaluation of the incidence of conduction abnormalities, arrhythmias, pericardial effusions and worsening valve insufficiency.
There was no major complications like cardiac tamponade, hemothorax and pneumothorax. Minor complications such as conduction abnormalities including temporary RBBB (lasting < 24 h after EMB procedures) were found in 2 cases (0.47%) and sustained RBBB (> 24 h) was evidenced in 1 case (0.23%). There were no A-V block, complex ventricular arrhythmias or episodes of atrial fibrillation during and post procedure. In addition, 4 cases (0.91%)of EMB induced mild-moderate tricuspid regurgitation during the procedure were diagnosed by echocardiography.
The EMB procedure via the right internal jugular vein approach under fluoroscopic guidance is safe and associated with a very low complication rate when performed by experienced operators.
心内膜心肌活检（EMB）的主要适应证包括心脏移植排斥反应监测以及识别心肌病或心肌炎。由于担心EMB操作可能带来的并发症，该操作尚未得到广泛应用。在这项单中心回顾性研究中，我们分析了过去4.5年中439例EMB操作相关的主要和次要并发症的发生率。
2004年5月至2008年11月，15例心肌病患者和1例疑似心脏肿瘤患者接受了16次EMB操作，131例心脏移植受者使用改良的Cordis活检钳进行了423次EMB操作。所有EMB操作均通过右颈内静脉途径进行，右心室间隔EMB在荧光透视引导下进行，无需额外的超声心动图监测。如果至少50次EMB操作此前已由一名高级操作人员监督，且所有EMB操作均由4名操作人员完成，则允许操作人员单独进行EMB操作。所有患者在EMB操作前后均接受12导联心电图（ECG）、12小时动态心电图监测、胸部X线检查和经胸超声心动图检查，以详细评估传导异常、心律失常、心包积液和瓣膜功能不全恶化的发生率。
未发生心脏压塞、血胸和气胸等主要并发症。发现2例（0.47%）出现轻微并发症，如传导异常，包括临时右束支传导阻滞（EMB操作后持续<24小时），1例（0.23%）出现持续性右束支传导阻滞（>24小时）。操作期间及操作后均未发生房室传导阻滞、复杂性室性心律失常或房颤发作。此外，超声心动图诊断4例（0.91%）EMB操作期间诱发轻度至中度三尖瓣反流。
在荧光透视引导下经右颈内静脉途径进行EMB操作是安全的，由经验丰富的操作人员进行时并发症发生率非常低。
