Anastasiou-Nana M I, O'Connell J B, Nanas J N, Sorensen S G, Anderson J L
Division of Cardiology, University of Utah School of Medicine, Salt Lake City.
Cathet Cardiovasc Diagn. 1989 Sep;18(1):7-11. doi: 10.1002/ccd.1810180103.
Right ventricular endomyocardial biopsy remains the gold standard for the diagnosis of acute rejection of the cardiac allograft. Among 704 consecutive procedures performed in 39 transplant recipients (2,842 myocardial samples), endomyocardial biopsy by either the right internal jugular (n = 661) or the femoral venous (n = 43) approach was compared with 243 consecutive procedures performed in nontransplant patients (n = 149 and n = 94, internal jugular and femoral approach, respectively). The internal jugular vein could not be located in only 0.61% (4/661) of heart transplant versus 5% (7/149) of nontransplant procedures (P less than 0.001). Vascular access plus sufficient myocardial sampling was obtained in all but 0.61% (4/661) internal jugular procedures performed in heart transplant patients and in all but 7% (11/149) of those performed in nontransplant patients (P less than 0.0001). (Vascular access was achieved in all femoral venous procedures performed in both transplant and nontransplant patients; sampling was successful after vascular access in all heart transplant recipients and all but two [2.1%] nontransplant procedures.) Cardiac complications occurred in nontransplant patients after one internal jugular procedure (cardiac perforation with tamponade) and after one femoral venous procedure (pericardial effusion). No cardiac complications occurred in transplant recipients, but 2 other complications were observed: One local abscess and one superior vena caval perforation with hemothorax associated with hypotension, both after an internal jugular approach. The overall efficiency (no safety problem; vascular access and adequate sample) was higher among transplant than nontransplant procedures (99% vs 93%, respectively, P less than 0.0001). These observations continue to support routine application of endomyocardial biopsy for monitoring rejection in cardiac transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)
右心室心内膜活检仍是诊断心脏移植急性排斥反应的金标准。在39例移植受者中连续进行了704例手术（2842份心肌样本），将经右颈内静脉（n = 661）或股静脉（n = 43）途径的心内膜活检与在非移植患者中连续进行的243例手术进行比较（分别为n = 149例和n = 94例，颈内静脉和股静脉途径）。心脏移植中仅0.61%（4/661）的患者无法找到颈内静脉，而非移植手术中这一比例为5%（7/149）（P<0.001）。在心脏移植患者中，除0.61%（4/661）的颈内静脉手术外，其余所有手术均获得了血管通路并采集到了足够的心肌样本；在非移植患者中，这一比例为除7%（11/149）的手术外（P<0.0001）。（移植患者和非移植患者的所有股静脉手术均成功建立了血管通路；所有心脏移植受者以及除两例[2.1%]非移植手术外的所有手术在建立血管通路后采样均成功。）非移植患者在1例颈内静脉手术后发生心脏并发症（心脏穿孔伴心包填塞），在1例股静脉手术后发生心脏并发症（心包积液）。移植受者未发生心脏并发症，但观察到另外2例并发症：1例局部脓肿和1例颈内静脉途径后发生的上腔静脉穿孔伴血胸并伴有低血压。移植手术的总体效率（无安全问题；有血管通路且样本充足）高于非移植手术（分别为99%和93%，P<0.0001）。这些观察结果继续支持在心移植患者中常规应用心内膜活检来监测排斥反应。（摘要截取自250字）
