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Published on: August 16, 2016
Fluoroscopic angles should be individualised when performing myocardial biopsies in children
Koichi Takamizawa1, Katsutoshi Nakano1,2, Hideki Doi1
1Department of Pediatrics, Graduate School of Medicine, https://ror.org/022cvpj02University of Tokyo, Tokyo, Japan.
Insights
Paediatric myocardial biopsy requires precise instrument alignment due to variable ventricular septal angles. Individualized fluoroscopic guidance, informed by CT scans, can improve biopsy forceps positioning and reduce serious complications.
Area of Science:
- Cardiology
- Pediatric Interventional Procedures
- Medical Imaging
Background:
- Percutaneous myocardial biopsy carries a risk of ventricular perforation.
- Accurate fluoroscopic orientation of biopsy forceps is crucial for safety.
- Paediatric patients exhibit complex ventricular septal variations complicating biopsy procedures.
Purpose of the Study:
- To investigate ventricular septal orientation variability in paediatric patients.
- To assess the efficacy of individualized fluoroscopic guidance for myocardial biopsy in children.
Main Methods:
- Retrospective analysis of paediatric myocardial biopsies (2019-2023).
- Cardiac CT used to measure ventricular septal angles relative to the sagittal plane.
- Fluoroscopic guidance with individualized angles for biopsy forceps alignment.
Main Results:
- Analyzed 16 paediatric patients (85 biopsies total, first per patient).
- Mean septal angle: 54.3° (range 30.0-75.0°).
- Mean combined angle for forceps alignment: 75.6° (range 45.0-115.7°).
- No ventricular perforations occurred.
Conclusions:
- Significant variability exists in paediatric ventricular septal orientation.
- Pre-procedural CT measurements enable individualized fluoroscopic angles.
- This approach enhances biopsy forceps accuracy and may mitigate severe procedural risks.
Background:
Ventricular perforation is a serious complication of percutaneous myocardial biopsy. Accurate orientation of the biopsy forceps toward the ventricular septum under fluoroscopy is essential to minimise this risk. However, in paediatric patients, variations in ventricular septal orientation complicate proper forceps alignment. No previous studies have addressed this variability in children.
Methods:
We retrospectively analysed paediatric patients who underwent myocardial biopsy between January 2019 and June 2023. The angle of the ventricular septum relative to the sagittal plane was measured using cardiac CT. Biopsies were performed under fluoroscopic guidance, with individualised angles adjusted to align with the septum. Fluoroscopic images were used to calculate the angle between the biopsy forceps and the septum and the combined angle relative to the sagittal plane.
Results:
Sixteen patients underwent a total of 85 biopsies; only the first biopsy per patient was included in the analysis. The mean angle of the septum was 54.3° (range: 30.0-75.0°), the mean angle between forceps and septum was 21.3° (range: 3.5-53.4°), and the combined angle relative to the sagittal plane was 75.6° (range: 45.0-115.7°). No cases of ventricular perforation were observed.
Conclusion:
Ventricular septal orientation varies significantly in paediatric patients. Individualised adjustment of fluoroscopic angles based on pre-procedural CT measurements allows accurate positioning of biopsy forceps and may reduce the risk of severe complications.
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