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[Endomyocardial biopsy in childhood]
M G Gagliardi1, M Bevilacqua, F Parisi
1Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Roma.
Insights
Pediatric endomyocardial biopsy is a safe procedure for diagnosing acute myocarditis and heart transplant rejection. While limited in other pediatric heart conditions, it offers crucial diagnostic value in specific cases.
Area of Science:
- Pediatric Cardiology
- Cardiac Pathology
- Interventional Cardiology
Context:
- Endomyocardial biopsy experience in pediatric patients is limited.
- This study reviews 144 procedures in 84 children (33 days to 14 years) between 1986 and 1990.
- The bioptome was introduced directly without a long sheath.
Purpose:
- To evaluate the safety and utility of right ventricle endomyocardial biopsy in pediatric patients.
- To assess its diagnostic yield for various pediatric cardiac conditions.
Summary:
- The study included patients with dilated, hypertrophic, and restrictive cardiomyopathy, heart tumors, and ventricular arrhythmias.
- Acute myocarditis was diagnosed in 27% of eligible dilated cardiomyopathy cases.
- Moderate to severe rejection was diagnosed in 47 out of 65 heart transplant recipients.
- The procedure was safe, with transient atrioventricular block and one right ventricular perforation as complications.
Impact:
- Right ventricle endomyocardial biopsy is a safe diagnostic tool in pediatric cardiology.
- Its primary utility lies in diagnosing acute myocarditis and heart allograft rejection.
- Findings aid in guiding therapeutic decisions for pediatric cardiac transplant recipients and myocarditis patients.
Abstract:
The experience with endomyocardial biopsy in pediatric age is still limited. From February 1986 to August 1990, 144 right ventricle endomyocardial biopsies were performed in 84 patients (age range 33 days--14 years, median age 31 months, weight range 3--57 kgs). Clinical diagnosis was: dilated cardiomyopathy in 50 patients; graft reject in 19; hypertrophic cardiomyopathy in 4; restrictive cardiomyopathy in 5; heart tumor in 3; ventricular arrhythmia in 3. The bioptome was introduced directly, without the use of a long sheath. There were no major complications; 2 patients experienced complete transient atrioventricular block and in 1 case right ventricular perforation occurred. In 11/45 patients (27%) with the clinical diagnosis of dilated cardiomyopathy and available myocardial specimens, acute myocarditis was diagnosed. In 47/65 procedures in the transplanted patients, a moderate to severe rejection was diagnosed. In the remaining patients, endomyocardial biopsy did not help the clinical diagnosis. We conclude that the right ventricular endomyocardial biopsy is a safe procedure in pediatric age; its utility is mostly limited to the diagnosis of acute myocarditis and graft reject after cardiac transplantation.