Transradial bilateral cardiac catheterization and endomyocardial bioposy: a feasibility study

A case series and technique of transradial cardiac catheterization with cardiac biospy are described. Transradial cardiac catheterization is perceived to be limited to arterial procedures. Using the veins of the forearm, we have converted many previous femoral arterial/venous cardiac procedures to a transradial/forearm approach. Retrospective review of patients undergoing transradial procedures with concurrent cardiac biopsies was undertaken. A convenience sample of transfemoral procedures with biopsies performed by the same operator was identified for comparison. Coronary angiography/left heart catheterization was performed using standard transradial/femoral approaches. A 7 Fr introducer sheath was placed via a large median forearm or femoral vein. Right heart catheterization was done using a 120 cm balloon-tipped catheter and endomyocardial biopsy was performed with a 7 Fr biotome. Both groups were then compared for baseline characteristics and procedural events. Transradial (n = 8) and transfemoral (n = 12) procedures were all done for postcardiac transplantation management. There was no crossover between groups. Durations of the radial procedures (median, 73 min; range, 40-95) were similar to transfemoral procedures (median, 68 min; range, 45-105). No procedural complications were reported. Endomyocardial biopsy plays an important role in the diagnosis of transplant rejection and identification of pathological processes that cause myocardial dysfunction. Transradial cardiac catheterization has some clear advantages over a transfemoral approach. Bilateral cardiac catheterization with concurrent cardiac biopsy is technically feasible using a transradial/forearm approach. This approach offers an alternative approach for selected patients in need of cardiac biopsy.