Download Slides - Clinical Trial Results

2009 Pediatric and
Congenital/Structural
Fellows Course
Endomyocardial Biopsy
Thomas K. Jones, MD
Professor, Pediatrics and Medicine
University of Washington School of Medicine
Director, Cardiac Catheterization Laboratories
Seattle Children’s Hospital
2009 Pediatric and
Congenital/Structural
Fellows Course
Disclosures
• None related to this presentation
Indications
• Evaluation of Cardiomyopathy
– Myocarditis
– Anthracycline cardiotoxicity
– Unexplained myocardial hypertrophy
• Storage diseases
• Mitochondrial disorders
• Cardiac Tumors
– Unexplained arrhythmias
• Monitoring Allograft Rejection
How To
• Femoral vs. jugular
venous approach
• Importance of long
sheath
• Bioptome size
• Number of samples
• Location for sampling
• Imaging
How to
• Meticulous care in
positioning sheath,
first opening then
advancing jaws,
gentle counterforce
with sheath when
withdrawing bioptome
• Do not close then
reopen jaws inside
body
Tampa Bay Guiding Catheter
• Useful for femoral
approach
• 8 F short sheath
• 6 F guide
• Introduced into RV
with balloon
wedge catheter
Not a Tampa Bay Catheter
Canedo M. Tampa bay catheter: A new guiding catheter for endomyocardial biopsy via
femoral approach. Cath Cardiovasc Diag 1992;25:71-75
Adverse events
Safety of endomyocardial biopsy
in children
Cowley CG, et al. Cardiol Young 2003;13:4040407
Complications of endomyocardial biopsy
in children
Pophal SG, et al. J Am Coll Cardiol 1999;34:2105-10
Adverse events
• Cowley paper
– 1986-2002
– 1051 procedures in 135
patients
– IJ approach 68%
– 48 < 1yr
– 92% rejection surv.
– 1% SAE (no perfs)
– No deaths
– Increased risk in
younger patients
• Bophal paper
– 1987-1996
– 1000 procedures in
194 patients
– IJ approach (57%)
– 64 < 1yr
– 85% rejection surv.
– 1.9% SAE (9 perfs)
– One death (from perf)
– Increased risk in
younger patients,
myocarditis and FV
approach
Thanks
A special ‘Thumbs-Up” to Ziyad