Mechanical Effects of Cardiovascular Drugs and Devices
Michel R. Labrosse in 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.
Endomyocardial biopsy: indications and procedures
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Sakakibara and Konno introduced a flexible bioptome with sharpened cups allowing biopsy by a pinching technique rather than advancement of a cutting needle.[6] The original Konno bioptome is now infrequently used because of its lack of durability and a stiff, large caliber shaft often requiring venous cutdown for access. In the early 1970s, Caves made a series of modifications to the Konno biopsy forceps to allow percutaneous biopsy through the right internal jugular vein with only local anesthesia and rapid serial tissue sampling through a preformed sheath.[7,8] Pioneered at Stanford University, the Stanford-Caves-Schulz bioptome became central to monitoring cardiac transplant patients for rejection and served as the standard device for endo-myocardial biopsy from 1975 to 1995. The biopsy forceps were more flexible and had features allowing the operator to adjust the force applied to the forceps using a surgery- like clamp. The Stanford-Caves-Schulz device was also reusable. This led to the requirement for frequent retooling and resharpening, along with concerns about protecting patients from infection and pyrogen reaction. Richardson in 1974, and Kawai in 1977, added special features to the bioptome for right or left ventricular sampling by increasing sheath flexibility, electrocardiographic monitoring, and intracardiac maneuverability.[9,10]
Myocarditis
Mary N. Sheppard in 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.
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.
Transcatheters for closure of patent foramen ovales
Published in Expert Review of Medical Devices, 2018
Gianluca Rigatelli, Marco Zuin
The device is made of braided nitinol threads and it is quite similar to the Amplatzer [19]. It consists of two disks with a small intermediate waist. Inside each of the disks, there is a PET patch to support the immediate closure. This helps stop the blood going through the mesh-work of the device. The ceramic titanium oxide surface gives the ‘golden’ aspect of the nitinol wires. The device will be pushed through the delivery catheter across the defect, then both disks will fix the device at the septum wall, and the device will then be released when placed in the correct position to close the defect. The delivery system is an angled bioptome-type delivery system which allows a full circular movement of the device.
Subtyping of cardiac amyloidosis by mass spectrometry-based proteomics of endomyocardial biopsies
Published in Amyloid, 2023
Fredrik Noborn, Christer Thomsen, Egor Vorontsov, Emanuele Bobbio, Carina Sihlbom, Jonas Nilsson, Christian L. Polte, Entela Bollano, Kristina Vukusic, Joakim Sandstedt, Göran Dellgren, Kristjan Karason, Anders Oldfors, Göran Larson
Transvenous EMB was performed in the supine position by cardiologists subspecialized in heart failure and transplantation using the standard Seldinger technique. Biopsies were obtained from the right ventricular septum by using a disposable bioptome with fluoroscopic and echocardiographic guidance [21]. Three to five specimens were obtained from each patient. One specimen was placed on a cork plate in O.C.T. mounting medium and directly frozen in isopentane chilled by dry ice and then stored at −80 °C. The other specimens were fixed in formalin and embedded in paraffin. No complications related to EMB were reported. Corresponding control tissues were obtained from the same location of explanted organ donor hearts.
Related Knowledge Centers
- Echocardiography
- Fluoroscopy
- Surgical Instrument
- Cardiac Muscle
- Endomyocardial Biopsy
- Heart Transplantation
- Transplant Rejection