Safety of endomyocardial biopsy in children
Collin G Cowley1, John S Lozier, Garth S Orsmond
1Division of Pediatric Cardiology, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. collin.cowley@ihc.com
Insights
Pediatric endomyocardial biopsy is crucial for diagnosing heart conditions and monitoring transplants. This study found a very low complication rate of 1.1% in children, indicating its safety in experienced centers.
Area of Science:
- Pediatric Cardiology
- Cardiac Pathology
- Transplantation Medicine
Background:
- Endomyocardial biopsy (EMB) is essential for diagnosing pediatric cardiomyopathy, myocarditis, and graft rejection.
- Assessing the safety and complications of EMB in pediatric patients is critical.
Purpose of the Study:
- To evaluate the morbidity and complications associated with endomyocardial biopsy in a pediatric population.
- To determine the incidence of adverse events and specific complications, such as tricuspid regurgitation, following EMB.
Main Methods:
- Retrospective review of 1051 endomyocardial biopsies performed on 135 pediatric patients (9 days to 18 years) between November 1986 and April 2002.
- Analysis of procedural complications requiring intervention or additional observation.
- Review of echocardiograms to assess tricuspid regurgitation severity post-biopsy.
Main Results:
- A total of 1051 EMBs were performed with an overall morbidity incidence of 1.1% (10 acute complications).
- No deaths or cardiac perforations occurred.
- Severe tricuspid regurgitation developed in two patients post-cardiac transplantation with multiple biopsies; one required valve replacement.
Conclusions:
- Endomyocardial biopsy in children can be performed with very low morbidity when conducted by experienced teams.
- The procedure is a safe diagnostic tool for pediatric cardiac conditions and post-transplant monitoring.
- Tricuspid regurgitation is a potential complication, particularly in transplant patients with repeated biopsies.
Abstract:
Endomyocardial biopsy in children remains important in the evaluation of cardiomyopathy, myocarditis, and rejection following cardiac transplantation. We sought to evaluate the morbidity associated with endomyocardial biopsy on the basis of a large experience from a single institution. We reviewed records of all endomyocardial biopsies performed at our institution. Complications were defined as adverse events resulting from the biopsy requiring intervention or additional observation. We also reviewed the most recent echocardiogram from all the patients for the presence and severity of tricuspid valvar regurgitation. Between November 1986 and April 2002, we performed 1051 endomyocardial biopsies in 135 patients ranging in age from 9 days to 18 years. The internal jugular vein was the site of vascular access in 68% of the procedures. There were 10 acute procedural complications requiring intervention or additional observation. Severe tricuspid regurgitation developed in two patients who had undergone multiple biopsies after cardiac transplantation, one of whom underwent subsequent replacement of the tricuspid valve. There were no deaths or cardiac perforations. The total incidence of morbidity was 1.1%. No demographic or procedural factors were identified to be predictive of complications. In experienced hands, therefore, endomyocardial biopsy can be safely performed in children with very low morbidity.
