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Complications of endomyocardial biopsy in children
S G Pophal1, G Sigfusson, K L Booth
1Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania, USA. spophal@rush.edu
Insights
Endomyocardial biopsy (EMB) in children has a low risk, but complications like perforation are higher in those with suspected myocarditis or on inotropic support. Pediatric heart transplant recipients experience very low morbidity from EMB.
Area of Science:
- Pediatric Cardiology
- Cardiac Procedures
- Diagnostic Medicine
Background:
- Endomyocardial biopsy (EMB) is a standard diagnostic tool in adults with established safety.
- Data on the safety and complications of EMB in pediatric populations is limited.
- Understanding pediatric EMB risks is crucial for patient care and procedural refinement.
Purpose of the Study:
- To determine the incidence of complications associated with endomyocardial biopsy in children.
- To identify risk factors contributing to adverse events during pediatric EMB.
- To assess the safety profile of EMB in different pediatric patient groups.
Main Methods:
- Retrospective analysis of 1,000 consecutive endomyocardial biopsy procedures performed between July 1987 and March 1996.
- Review of morbidity and mortality data, including specific complications and patient characteristics.
- Multivariate analysis to identify predictors of procedural complications.
Main Results:
- One death occurred due to cardiac perforation in an infant with dilated cardiomyopathy.
- Nine right ventricular perforations were observed, primarily in children with dilated cardiomyopathy and linked to the femoral venous approach.
- Higher perforation risk was associated with evaluating children for myocarditis and those on inotropic support.
Conclusions:
- Endomyocardial biopsy carries the highest risk in critically ill children with suspected myocarditis requiring inotropic support.
- EMB can be performed with very low morbidity in pediatric heart transplant recipients for rejection surveillance.
- Risk stratification and careful procedural approach are essential for safe pediatric EMB.
Objectives:
To evaluate the incidence of, and risk factors for, complications of endomyocardial biopsy in children.
Background:
Endomyocardial biopsy (EMB) is a low risk procedure in adults, but there is a paucity of data with regard to performing this procedure in children.
Methods:
Retrospective review of the morbidity and mortality of 1,000 consecutive EMB procedures.
Results:
One thousand EMB procedures (right ventricle 986, left ventricle 14) were performed on 194 patients from July 1987 through March 1996. Indications for EMB included heart transplant rejection surveillance (846) and the evaluation of cardiomyopathy or arrhythmia for possible myocarditis (154). Thirty-seven (4%) procedures were performed on patients receiving intravenous inotropic support. There was one biopsy related death, secondary to cardiac perforation, in a two-week-old infant with dilated cardiomyopathy. There were nine perforations of the right ventricle, eight occurring in patients with dilated cardiomyopathy and one in a transplant recipient. The transplant patient did not require immediate intervention; two patients required pericardiocentesis alone, and six underwent pericardiocentesis and surgical intervention. All nine perforations were from the femoral venous approach (p < 0.01). Multivariate analysis demonstrated that the greatest risk of perforation occurred in children being evaluated for possible myocarditis (p = 0.01) and in those requiring inotropic support (p < 0.01). Other complications included arrhythmia (5) and single cases of coronary-cardiac fistula, flail tricuspid leaflet, pneumothorax, hemothorax, endocardial stripping and seizure.
Conclusions:
Risk of endomyocardial biopsy is highest in sick children with suspected myocarditis on inotropic support. However, EMB can be performed safely with very low morbidity in pediatric heart transplant recipients.