Transesophageal echocardiography-guided transvenous endomyocardial biopsy used to diagnose primary cardiac angiosarcoma

Primary cardiac tumors are rare clinical entities with the histologic diagnosis usually made from surgically obtained tissue or at postmortem examination. Transvenous endomyocardial biopsy has been used less frequently, under fluoroscopic or transthoracic echocardiographic guidance. In this case report, we utilized the transesophageal echocardiography to guide the endomyocardial biopsy from a right atrial tumor in a 35-year-old man. © 1996 Wiley-Liss, Inc.     

Cardiac amyloidosis: Diagnosis by transvenous endomyocardial biopsy

Endomyocardial tissue, obtained from two patients presenting with restrictive cardiomyopathies, demonstrated amyloid infiltration. The percutaneous transvenous cardiac biopsy technic, using a modified Konno-Sakakibara cardiac bioptome, was safe and quick. Physical examination and catheterization data may not provide a definite differential diagnosis between restrictive and constrictive myocardial disease. Confirmation by biopsy of the cardiac amyloidosis assisted in providing optimum diagnostic and therapeutic care for these patients.     

Diagnosis of myocarditis with endomyocardial biopsy

Endomyocardial biopsy (EMB) was performed in 24 cases suspected of having myocarditis and 42 cases with cardiac symptoms and signs of unknown etiology. There was an obvious correlation between the clinical manifestations and the pathological findings in cases suspected of having myocarditis (r = 0.5296, P less than 0.005). The ratio of correspondence was 78.8%. It is shown that EMB is more sensitive than 201TI myocardial imaging in diagnosing myocarditis and serial EMB can follow its clinical process closely. Moreover, EMB can discriminate myocarditis from myocardiopathy.     

Cardiac amyloidosis causing ventricular tachycardia. Diagnosis made by endomyocardial biopsy

In patients with malignant ventricular arrhythmias, endomyocardial biopsy may be helpful when all other findings from the workup are negative. A case of nonsustained polymorphic ventricular tachycardia is presented. The findings from an echocardiogram, coronary angiogram, and cardiac catheterization were negative. An electrophysiologic study showed inducible nonsustained ventricular tachycardia. A right ventricular endomyocardial biopsy was diagnostic of cardiac amyloid. The findings from a workup for systemic amyloidosis were negative. Primary cardiac amyloidosis should be considered in patients with malignant arrhythmias and no documented heart disease, and endomyocardial biopsy is helpful in making this diagnosis.     

A new method for isolation of cardiac myocytes by percutaneous endomyocardial biopsy

The objective of this study was to demonstrate the feasibility of isolating viable canine cardiac myocytes from percutaneous right ventricular endomyocardial biopsy specimens. Although histologic data can be obtained from percutaneous endomyocardial biopsies, this approach has not been used as a source of viable cells for evaluating pathological conditions. Study of isolated viable myocytes may provide insight into the electrical, biochemical, and physiologic functions of the heart. Using a standard 8F sheath, a 5F bioptome was introduced via the right femoral vein and advanced to the right ventricle, where 85 biopsies were obtained from 8 mongrel dogs. An average of six biopsy specimens were pooled for processing to provide adequate tissue substrate. This resulted in 14 groups of specimens which were then processed to isolate individual myocytes. Viable myocytes were striated, rod-shaped, and excluded trypan blue dye. Nonviable myocytes were rounded, had no cross-striations, and did stain with trypan blue. Partially-injured myocytes contracted spontaneously and had a region of loss of cross-striations. The average number of viable cells recovered per group of pooled specimens was 1.8 × 10⁴ (1.8 × 10³ cells/mg of tissue). The greatest yield of viable myocytes recovered was 8.0 × 10⁴, which represented a viability of 90% by trypan blue dye exclusion and morphological criteria. Percutaneous right ventricular endomyocardial biopsy is a novel method for obtaining viable cardiac myocytes. Its feasibility and utility in humans warrant further investigation. © 1996 Wiley-Liss, Inc.     

Ventricular fibrillation complicating endomyocardial biopsy of a cardiac allograft

Transvenous endomyocardial biopsy remains the most useful diagnostic aid in assessing rejection in the transplanted heart. Although invasive, the complications associated with endomyocardial biopsy are few, and the procedure is generally regarded as safe. We report a case of apparent ventricular fibrillation complicating transvenous endomyocardial biopsy. Histologic section revealed evidence of moderate acute rejection. This case represents the first report of a life threatening ventricular dysrhythmia following routine endomyocardial biopsy in a cardiac transplant recipient.     

Critical assessment of diagnostic value of endomyocardial biopsy. Assessment of cardiac biopsy

Right or left ventricular endomyocardial biopsy with the Konno or the Olympus bioptome was attempted in 73 patients aged 5 months to 61 years, with 82 per cent success. Light and electron microscopy showed non-specific features in over half the biopsies with new or diagnostically useful information in only 10 per cent of cases, usually as a result of electron microscopy. The method is safe but is of strictly limited diagnostic value and is likely to be of most help as a research tool in the biochemical study of cardiomyopathies.     

Primary cardiac lymphoma: diagnosis by transjugular biopsy

Primary cardiac lymphoma, defined as a non-Hodgkin's lymphoma involving only the heart and pericardium, is an extremely rare malignancy. It should be suspected in patients with a heart mass and heart failure, unexplained refractory pericardial effusion or rhythm disturbances. Transvenous intracardiac tumor biopsy under fluoroscopic or transesophageal echocardiographic guidance, is a minimally invasive technique which makes definite diagnosis possible. We describe a patient in whom primary cardiac lymphoma was diagnosed by this technique. He also underwent percutaneous balloon pericardiotomy because of severe refractory pericardial effusion. Seven months after diagnosis and treatment with standard chemotherapy, the patient remained free of disease.     

Critical assessment of diagnostic value of endomyocardial biopsy. Assessment of cardiac biopsy.

Right or left ventricular endomyocardial biopsy with the Konno or the Olympus bioptome was attempted in 73 patients aged 5 months to 61 years, with 82 per cent success. Light and electron microscopy showed non-specific features in over half the biopsies with new or diagnostically useful information in only 10 per cent of cases, usually as a result of electron microscopy. The method is safe but is of strictly limited diagnostic value and is likely to be of most help as a research tool in the biochemical study of cardiomyopathies.     

Doxorubicin cardiomyopathy: evaluation by phonocardiography, endomyocardial biopsy, and cardiac catheterization

Right ventricular endomyocardial biopsy, right heart catheterization, and systolic time intervals were done in 33 adult patients receiving doxorubicin (AdriamycinTM). Doxorubicin administration was associated with a dose-related increase in the degree of myocyte damage, and 27 of 29 patients biopsied at doses greater than or equal to 240 mg/m2 had doxorubicin-associated degenerative changes identified on biopsy. The pre-ejection period to left ventriculr ejection time ratio (PEP/LVET) showed a threshold phenomenon and did not begin to increase until a total dose of 400 mg/m2 had been reached. Seven patients with catheterization-proven heart failure had a significantly greater amount of myocyte damage on biopsy than dose-matched control subjects (P less than 0.01). Preveious mediastinal radiation appeared to potentiate the doxorubicin-associated degenerative process. Mediastinal radiation and age greater than or equal to 70 years appeared to be risk factors for doxorubicin-associated heart failure. Dose limitation by combined clinical, noninvasive, invasive, and morphologic criteria offered an advantage over empirical dose limitation or dose limitation by PEP/LVET alone.