Grande A M, Minzioni G, Martinelli L, Campana C, Rinaldi M, D'Armini A M, Ragni T, Pederzolli C, Ardemagni E, Pederzolli N, De Pieri G, Castiglione N, Viganò M
Divisione Cardiochirurgia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia.
G Ital Cardiol. 1997 Sep;27(9):877-80.
Starting in January 1995, we performed heart transplantation, randomly using standard and bicaval techniques. In the latter technique, the anatomy of the right atrium is maintained, since the venae cavae are anastomosed. In 38 patients who received heart transplantation with bicaval anastomosis, 339 endomyocardial biopsies (EMB) were performed. EMB was done under echocardiographic control in 309 cases, whereas the remaining 30 were done under fluoroscopy. When EMB was echo-guided there was one major complication, namely right hemothorax in a 29-year-old man, who had had heart transplantation one week before, and this required surgical exploration. Other complications, correlated to venipuncture were: left hemothorax in a 65-year-old woman determined by arterial puncture, treated by means of chest tube drainage; pneumothorax (1 case). Echocardiographic guidance during EMB allows a better choice of biopsy site, reduces the risk of damaging cardiac structures and allows immediate monitoring of heart performance. Moreover the risk of X-ray exposure to both patient and operators is reduced. In any case, because the superior vena cava suture line is not visualized by two-dimensional echocardiography, if the bioptome cannot be introduced easily through superior vena cava, fluoroscopic control should be immediately applied, particularly in the early post-operative period when cicatrization is not complete.
从1995年1月开始，我们进行心脏移植手术，随机采用标准技术和双腔静脉技术。在双腔静脉技术中，由于腔静脉进行了吻合，所以右心房的解剖结构得以保留。在38例行双腔静脉吻合心脏移植的患者中，共进行了339次心内膜心肌活检（EMB）。309例EMB在超声心动图引导下进行，其余30例在荧光透视引导下进行。当EMB在超声引导下进行时，出现了1例主要并发症，即1名29岁男性在心脏移植术后1周发生了右侧血胸，这需要进行手术探查。与静脉穿刺相关的其他并发症有：1例65岁女性因动脉穿刺导致左侧血胸，通过胸腔闭式引流治疗；1例气胸。EMB过程中的超声心动图引导能更好地选择活检部位，降低损伤心脏结构的风险，并能即时监测心脏功能。此外，还降低了患者和操作人员接受X线照射的风险。无论如何，由于二维超声心动图无法显示上腔静脉缝合线，如果活检钳不能轻易通过上腔静脉插入，应立即采用荧光透视引导，尤其是在术后早期瘢痕形成尚未完成时。
