Yoshizato T, Edwards W D, Alboliras E T, Hagler D J, Driscoll D J
Division of Pathology, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1990 Feb;15(2):436-42. doi: 10.1016/s0735-1097(10)80074-9.
The benefits and risks of endomyocardial biopsy in infants, children and adolescents were determined by reviewing the indications for and complications and results of 66 procedures in 53 patients aged 2 months to 20 years. One patient had a pneumothorax, and three had a right ventricular perforation. Ventricular tachycardia developed in four patients; it was treated with lidocaine in three and was self-limited in one. The procedure was unsuccessful in two patients. Among 25 patients with a prebiopsy diagnosis of idiopathic dilated cardiomyopathy, microscopic features were consistent with cardiomyopathy in 24 (96%) and were normal in 1. Of nine patients with clinically suspected myocarditis, only two (22%) had microscopic evidence of inflammation, and seven had chronic nonspecific features suggestive of dilated cardiomyopathy. Of eight patients with unexplained arrhythmias, six (75%) had microscopic findings compatible with dilated cardiomyopathy and two had myocarditis. Biopsy tissue samples from seven patients with nondilated forms of cardiomyopathy (four hypertrophic, three restrictive) were consistent with the clinical diagnosis in six and were inadequate in one. Cardiac biopsies were also performed in four patients with other disorders. Among the 51 patients with adequate biopsy specimens, microscopic features were considered diagnostic in 5, confirmatory in 44 and not helpful in 2 with normal tissue. The results indicate that endomyocardial biopsy is safe in infants, children and adolescents. It is useful for the evaluation of cardiomyopathy and specific secondary forms of myocardial disease. There seems to be little correlation, however, between clinical and tissue diagnoses of myocarditis.
通过回顾53例年龄在2个月至20岁患者的66次心内膜心肌活检的适应证、并发症及结果，确定了婴儿、儿童和青少年心内膜心肌活检的益处和风险。1例患者发生气胸，3例出现右心室穿孔。4例患者发生室性心动过速；3例用利多卡因治疗，1例为自限性。2例患者活检未成功。在活检前诊断为特发性扩张型心肌病的25例患者中，24例（96%）的显微镜特征与心肌病相符，1例正常。9例临床疑似心肌炎的患者中，只有2例（22%）有炎症的显微镜证据，7例有提示扩张型心肌病的慢性非特异性特征。8例不明原因心律失常患者中，6例（75%）的显微镜检查结果与扩张型心肌病相符，2例为心肌炎。7例非扩张型心肌病（4例肥厚型，3例限制型）患者的活检组织样本，6例与临床诊断相符，1例样本不足。另外4例患有其他疾病的患者也进行了心脏活检。在51例活检标本充足的患者中，显微镜特征被认为具有诊断意义的有5例，具有确诊意义的有44例，2例正常组织患者的活检结果无帮助。结果表明，心内膜心肌活检在婴儿、儿童和青少年中是安全的。它有助于评估心肌病和特定的继发性心肌疾病。然而，心肌炎的临床诊断与组织学诊断之间似乎几乎没有相关性。
