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Myocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Samples should be obtained from >1 region of the right ventricular septum. The number of samples obtained should range from 5 to 10, depending on the studies to be performed, and each sample should be 1–2 mm3 in size. The sample must be handled carefully to minimize artefacts and transferred from the bioptome to fixative (10% neutral buffered formalin) by use of a sterile needle and not with forceps. The fixative should be at room temperature to prevent contraction band artefacts.
Haemodynamic evaluation of the heart transplant patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Kavitha Muthiah, Christopher S. Hayward, Andrew Jabbour, Peter Macdonald
The procedure is generally performed without pre-medication. With the right internal jugular vein approach, venous puncture is performed under ultrasound guidance with infiltration of local anaesthesia. This is followed by the insertion of a 9 Fr sheath using the Seldinger technique. The bioptome is advanced under fluoroscopic guidance into the right atrium. Using counterclockwise rotation, the bioptome is passed across the tricuspid valve towards the interventricular septum (Figure 29.1b). Contact of the bioptome with the myocardium generates ventricular ectopics. Resistance is felt when contact is made. The bioptome is then partially withdrawn, and with the jaws opened, readvanced to contact the myocardium. The jaws of the biopsy forceps are then closed and the bioptome withdrawn with the piece of myocardial tissue. The tissue is removed and placed in formalin for histopathological analysis. Five pieces of myocardium of 1–2 mm diameter are necessary for adequate sampling. Transplant recipients undergo endomyocardial biopsy numerous times, which leads to scarring of the interventricular septum with time. This increases the difficulty in obtaining adequate future tissue samples for histologic analysis.
Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
Another catheter-based device is the bioptome for performing an endocardial biopsy. These devices consist of small stainless-steel cutting jaws on the end of a catheter controlled with an actuator at the handle; these devices are inserted through the jugular or femoral veins to remove samples of tissue from the inner wall of the right heart, primarily for surveillance of heart transplant rejection. These devices are regulated as Class II, requiring performance of sampling ability and safety for intravascular use. The devices are associated with a low serious complication rate (<1%), but risks of injury to the sample site include hematoma, disruption of the conduction system, and perforations. Site selection and sampling should be performed under fluoroscopic guidance.
Utilization of cardiac imaging in sarcoidosis
Published in Expert Review of Cardiovascular Therapy, 2022
Mohamed Y. Elwazir, John P. Bois, Panithaya Chareonthaitawee
The diagnosis of CS is complicated by a lack of a reliable gold standard. Contemporary imaging modalities – while sensitive – lack specificity, and the pathological gold standard, endomyocardial biopsy, has a low yield (around 20–30%) [10] owing to the patchy myocardial nature of the disease, with considerable variation in the location of involvement from patient to patient, as well as a predilection for the subepicardium, which is not accessible to an endomyocardial bioptome [11]. This yield can be improved to an extent with electrophysiologic voltage mapping or imaging guidance [12], but requires specialized expertise and the increase in sensitivity comes at the expense of a significant drop in specificity [13]. In addition, while noncaseating granulomas on cardiac histopathology is a relatively uncommon finding in other cardiomyopathies, it is not exclusive to sarcoidosis [14]. Furthermore, endomyocardial biopsy is, after all, an invasive procedure with potential for serious, although uncommon, complications. This has led to the development of a number of societal guidelines to enable establishment of the diagnosis on a probable basis by fulfilling a set of pathological, clinical, and imaging criteria. The two guidelines most often in use are those of the Japanese Circulation Society (JCS) [15] and the Heart Rhythm Society (HRS) [16] (Table 1).
Trends in post–heart transplant biopsies for graft rejection versus nonrejection
Published in Baylor University Medical Center Proceedings, 2021
Aayla K. Jamil, Aasim Afzal, Tariq Nisar, Aaron Y. Kluger, Joost Felius, Detlef Wencker, Shelley A. Hall, Parag Kale
Endomyocardial biopsies (EMBs) are performed routinely for the diagnosis of cardiomyopathies and have been the standard of care for surveillance of post–heart transplant cardiac allograft rejection. This invasive procedure uses flexible bioptomes through femoral access in the groin or internal jugular access through the neck to get small 2 to 5 mm tissue samples from the heart ventricles. The procedure is guided by two-dimensional echocardiography or fluoroscopy, both of which have limitations. Fluoroscopic imaging systems can make the directional control of the bioptome tip tricky, while echocardiography can miss the tip of a deflectable bioptome, and the chordae tendineae, fibrous heart valve cords, can be damaged due to missed detection. Scarring from frequent biopsies can also result in difficult biopsy with insufficient tissue for testing.1 Newer noninvasive blood tests are commercially available to test graft rejection by serial gene expression to gauge cellular function, using microarrays to test gene transcription from mRNA, which also provides information about the immune status of the allograft.2 Such testing is easier on the patients and requires fewer hospital resources than invasive EMBs done in a catheterization unit. In this study, we looked at national trends for EMB procedures in posttransplant patients to determine the burden of EMBs done in noncomplicated heart graft recipients.
Extreme Right Atrial Disc Expansion of Septal Occluder Post Iatrogenic Atrial Septal Defect Closure
Published in Structural Heart, 2020
Sahil Khera, Richard Ro, Barry Love, Parasuram Krishnamoorthy, Gila Perk, Gilbert H. L. Tang, Samin Sharma, Annapoorna Kini, Stamatios Lerakis
With further evaluation via fluoroscopy, extreme expansion of the right atrial disc with the displacement of the locking pin was seen (Figure 3a). This displacement of the locking pin in the setting of elevated left-to-right pressures was concerning and we proceeded with extraction as device stability was at risk. The patient was taken to the catheterization laboratory; an 18 F sheath was placed in the left femoral vein and the device was extracted intact from the patient using a 25 mm gooseneck snare and a bioptome (Figure 3b). In Figure 3c, the device is seen right before extraction through the femoral sheath. An alternative nitinol mesh-based occluder was implanted with an unremarkable appearance on follow-up imaging. The experience with the GORE CARDIOFORM in the literature has been generally favorable. The ASSURED trial recently demonstrated effectiveness and safety in a multicenter, prospective registry of 125 patients using this device.1 Freixa et al. found no clinical or echocardiographic complications at a 3-month follow-up.2