A 25-year experience of endomyocardial biopsy safety in infants
Derek Zhorne1, Christopher J Petit, Frank F Ing
1Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Endomyocardial biopsy (EMB) is safe in infants, but those under 6 months and weighing less than 8 kg face higher complication risks. Careful consideration is needed for this high-risk pediatric group.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Pediatric Cardiac Procedures
Background:
- Endomyocardial biopsy (EMB) is crucial for diagnosing myocarditis, identifying tumors, and monitoring heart transplant rejection in children.
- Limited data exists on EMB outcomes and risks specifically in infants under one year old.
Purpose of the Study:
- To analyze the outcomes and identify risk factors associated with endomyocardial biopsy (EMB) in infants.
- To assess the safety and complications of EMB in children less than one year of age.
Main Methods:
- Retrospective review of a cardiology database from 1984-2008.
- Analysis of 99 EMB procedures in patients under one year of age.
- Review of cardiac catheterization reports for demographics, indications, procedural details, and complications.
Main Results:
- 12.1% of EMB procedures (12/99) resulted in complications, including arrhythmias, perforations, pneumothorax, and one death.
- Infants under 6 months (40 procedures) had a higher complication rate (11) compared to those 6 months or older (4/59).
- Perforation was significantly associated with weight <8 kg (P=0.05) and age <6 months (P=0.01).
Conclusions:
- Endomyocardial biopsies can be performed safely in infants.
- Infants under 6 months and weighing less than 8 kg represent a high-risk group for EMB complications.
- Special consideration and careful monitoring are warranted for high-risk infants undergoing EMB.
Objectives:
To analyze the outcomes and risk factors associated with endomyocardial biopsy (EMB) in children less than one year of age.
Background:
EMB has proven to be an integral diagnostic tool to evaluate suspected myocarditis, identify tumor histology, and provide tissue-graft surveillance after cardiac transplantation. The morbidity and mortality of EMB has been well established in the adult literature and reviewed in the general pediatric population, but there remains limited data for children in the first year of life.
Methods:
We retrospectively reviewed the cardiology database at our institution to identify patients less than one year of age who underwent EMB between 1984 and 2008. Cardiac catheterization reports were reviewed for patient demographics, biopsy indication, procedural details, and complications.
Results:
A total of 99 EMBs were performed, 49 for evaluation of suspected myocarditis, 43 for transplant rejection surveillance, 3 to identify tumor histology, and 4 for suspected endocardial fibroelastosis. Forty procedures were performed in children age < 6 months with 11 complications and 59 procedures performed in children age ≥ 6 months with four complications. In total, there were 12 EMB procedures (12.1%) with associated complications: 9 arrhythmias, 4 perforations requiring pericardiocentesis, 1 pneumothorax, and 1 death. Univariate analysis revealed a significant association between perforation and both weight <8 kg (P = 0.05) and age <6 months (P = 0.01).
Conclusion:
Endomyocardial biopsies can be performed safely in infants, although children under 6 months of age and less than 8 kg represent a high risk group and deserve special consideration due to the incidence of complications in this cohort.
