Balzer D, Moorhead S, Saffitz J E, Sekarski D R, Canter C E
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
J Am Soc Echocardiogr. 1993 Sep-Oct;6(5):510-5. doi: 10.1016/s0894-7317(14)80470-7.
Endomyocardial biopsy has had limited utilization for the diagnosis of myocardial disease in the pediatric population. Through the use of echocardiography for guidance, we attempted 155 consecutive biopsies in 33 patients. A successful biopsy was performed 151 times, including 48 (31%) in infants less than 6 months of age. Biopsies were performed with a right internal jugular approach using 3F, 5F, and 7F bioptomes. A combination of apical four-chamber and parasternal short-axis views could visualize the passage of the bioptome into the ventricle and the action of the jaws. There was no case of ventricular perforation. After biopsy one transplant recipient was left with an increase in the amount of preexisting tricuspid regurgitation by color flow mapping echocardiography. These results demonstrate that echocardiographically guided endomyocardial biopsies may be safely performed over a wide range of patient sizes. The increased portability, lack of radiation exposure, and the simultaneous visualization of the bioptome and chamber wall combined with these results indicate that echocardiographically guided endomyocardial biopsies should be considered the technique of choice for the pediatric population.
心内膜心肌活检在儿科人群中心肌疾病诊断方面的应用有限。通过使用超声心动图进行引导，我们对33例患者连续进行了155次活检。成功进行活检151次，其中包括对48例（31%）6个月以下婴儿的活检。活检采用右颈内静脉入路，使用3F、5F和7F活检钳。通过心尖四腔心和胸骨旁短轴视图相结合，可以观察到活检钳进入心室的过程以及钳夹动作。没有发生心室穿孔的病例。活检后，通过彩色多普勒超声心动图检查发现一名移植受者原有的三尖瓣反流程度有所增加。这些结果表明，在广泛的患者体型范围内，超声心动图引导下心内膜心肌活检可以安全地进行。超声心动图引导下心内膜心肌活检具有更高的便携性、无辐射暴露，并且能够同时观察活检钳和室壁，结合这些结果表明，超声心动图引导下心内膜心肌活检应被视为儿科人群的首选技术。
