Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
J Cardiovasc Med (Hagerstown). 2024 Sep 1;25(9):700-703. doi: 10.2459/JCM.0000000000001655. Epub 2024 Aug 2.
Endomyocardial biopsies for rejection monitoring after heart transplantation are generally performed through the right internal jugular vein. We aimed to assess the feasibility and safety of using the left internal jugular vein approach as a valid alternative to a femoral vein for endomyocardial biopsies whenever thrombosis of the right internal jugular vein precludes insertion of a bioptome. We have reviewed our experience with heart transplantation in the last 2 decades to identify patients in whom surveillance endomyocardial biopsy was performed through the left internal jugular vein. We herein describe the step-by-step procedure and report the preliminary results. From May 1, 2000 to January 31, 2024, 561 orthotopic heart transplants have been performed in our unit. In 49 patients (8.7%), the right internal jugular vein access was found to be unsuitable or occluded at eco-Doppler evaluation; in 15 of them (30%) a total of 206 endomyocardial biopsies have been performed, using the left internal jugular vein, without complications. Our experience demonstrates that the left internal jugular vein is a valid alternative approach for endomyocardial biopsies when the right internal jugular vein is not available. This technique is feasible, safe and reproducible and allows adequate rejection monitoring after heart transplantation.
经心内膜心肌活检术通常通过右颈内静脉进行，用于心脏移植后的排斥反应监测。本研究旨在评估在右颈内静脉血栓形成导致无法插入活检针时，使用左颈内静脉作为股静脉的有效替代方法进行经心内膜心肌活检的可行性和安全性。我们回顾了过去 20 年的心脏移植经验，以确定通过左颈内静脉进行监测性经心内膜心肌活检的患者。在此，我们详细描述了该技术的操作步骤并报告了初步结果。2000 年 5 月 1 日至 2024 年 1 月 31 日，我们单位共进行了 561 例原位心脏移植。在 49 例（8.7%）患者中，经超声心动图评估发现右颈内静脉通路不合适或阻塞；其中 15 例（30%）共进行了 206 次经心内膜心肌活检，均通过左颈内静脉完成，未发生并发症。我们的经验表明，当右颈内静脉无法使用时，左颈内静脉是进行经心内膜心肌活检的有效替代方法。该技术可行、安全且可重复，可在心脏移植后进行充分的排斥反应监测。
