Early experience with real-time three-dimensional echocardiographic guidance of right ventricular biopsy in children

Right ventricular endomyocardial biopsy is the gold standard for detecting active myocardial inflammation in cardiomyopathy as well as rejection after cardiac transplantation. This procedure has historically required the exclusive use of fluoroscopic guidance to guide catheter, sheath, and bioptome manipulation. The current study evaluates the feasibility and utility of real-time transthoracic three-dimensional echocardiography (3DE) to guide right ventricular endomyocardial biopsies in children.

From July 2003 to April 2004, we utilized real-time 3DE in 28 consecutive cardiac catheterizations in children aged 18 months to 16 years who were undergoing endomyocardial biopsy. A commercially available 3DE scanner (Philips Sonos 7500) equipped with a 2-4 MHz 3D matrix array transthoracic probe was utilized in all cases.

A total of 123 endomyocardial biopsy samples were obtained in nine patients (BSA 0.85 m(2)+/- 0.33 m(2)). Of these 123 samples, 99 (80%) were obtained with the use of real-time transthoracic 3DE. There were no complications, including no new tricuspid valve leaflet flail or pericardial effusion. 3DE proved to be a reliable noninvasive modality to properly direct the bioptome to the desired site of biopsy within the right ventricle. As familiarity with this technique increased, the need for fluoroscopic guidance of bioptome manipulation in the right ventricle was minimized.

The use of real-time transthoracic 3DE in endomyocardial right ventricular biopsies in children is both feasible and safe. Further study to determine the impact of real-time 3DE guidance on fluoroscopy and case times for endomyocardial biopsies is warranted.