Serviço de Cardiologia - Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.
Departamento de Medicina Interna da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2024 Oct 28;121(10):e20240223. doi: 10.36660/abc.20240223. eCollection 2024.
Endomyocardial biopsy (EB) is the preferred procedure for post-heart transplant rejection diagnosis. The rigid bioptome technique has been used due to its greater simplicity and has been criticized for the potential risk of tricuspid regurgitation (TR). We aimed to review all the EBs performed by this technique in a tertiary center and estimate the rate of complications and/or aggravation of TR. Cross-sectional, retrospective, anterograde study. Data were collected from 729 EBs performed in 55 post-heart transplant patients with a rigid Scholten Novatome™ bioptome between September 2012 to March 2022. All EBs were performed via the right jugular vein under local anesthesia and through micro-puncture and ultrasound guidance. A total of 729 procedures had an echocardiography performed before and after the procedures. The estimate of TR was categorized as absent, minimal, mild, moderate, and severe. McNemar's chi-square test was used to analyze the degree of pre- and post-EB TR. There was a worsening enough to become moderate or severe post-biopsy TR in two (0.27%) procedures, and there was a slight change in TR from minimal to mild TR in 25 (3.42%) procedures. In 729 percutaneous EBs performed with a rigid bioptome, there was no myocardial perforation, cardiac tamponade or pneumothorax. One death occurred within 24 hours after the procedure for an unknown reason. EB using a rigid bioptome is safe and has not been associated with worsening TR in a follow-up of 729 EBs performed after cardiac transplantation. The overall complication rate, including moderate to severe TR, was 0.81%. The mortality rate was 0.14%.
心内膜心肌活检（EB）是心脏移植后排斥反应诊断的首选方法。由于刚性活检枪技术更为简单，因此一直被采用，但也因其可能导致三尖瓣反流（TR）而受到批评。我们旨在回顾在一家三级中心使用该技术进行的所有 EB，并估计并发症和/或 TR 加重的发生率。横断面、回顾性、顺行研究。数据收集自 2012 年 9 月至 2022 年 3 月期间，55 例心脏移植后患者使用刚性 Scholten Novatome™活检枪进行的 729 次 EB。所有 EB 均在局部麻醉下经右颈内静脉、通过微穿刺和超声引导进行。共有 729 例在操作前后进行了超声心动图检查。TR 的估计分为无、轻度、轻度、中度和重度。采用 McNemar 卡方检验分析 EB 前后 TR 的严重程度。有 2 例（0.27%）活检后 TR 程度加重到中度或重度，25 例（3.42%）TR 从轻度变为轻度 TR。在 729 例使用刚性活检枪进行的经皮 EB 中，没有发生心肌穿孔、心脏压塞或气胸。1 例患者在术后 24 小时内死亡，原因不明。在心脏移植后进行的 729 次 EB 随访中，使用刚性活检枪进行 EB 是安全的，与 TR 恶化无关。包括中度至重度 TR 在内的总并发症发生率为 0.81%。死亡率为 0.14%。
