Cooper D K, Fraser R C, Rose A G, Ayzenberg O, Oldfield G S, Hassoulas J, Novitzky D, Uys C J, Barnard C N
Thorax. 1982 Oct;37(10):727-31. doi: 10.1136/thx.37.10.727.
A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report.
本文报道了对157例异位心脏移植患者供体心内膜连续活检的回顾。描述了该手术后经皮经静脉心内膜活检技术；当供体上腔静脉与右心房的吻合口较小（这可能是手术技术问题或后续收缩所致）时，将导管和活检钳插入该吻合口可能会有困难。并发症发生率为4%，但有1例患者可能因活检导致感染死亡，当时活检钳必须经腹股沟插入。活检标本中观察到的组织病理学变化已根据评分系统进行分级，以便为临床医生提供排斥反应严重程度的指导。组织病理学评估在96%的病例中具有临床价值，但有两次不准确，一次是因为对事后看来不充分的样本给出了诊断意见。在持续发生轻度急性或慢性排斥反应的患者中，难以检测或评估心肌纤维化的真实程度；这导致两名患者免疫抑制治疗不足。需要注意的是，慢性排斥反应的血管变化导致的缺血性纤维化可能不累及心内膜，心内膜因心腔内血液而保持存活，这可能导致误导性的组织病理学报告。
