Utility of screening echocardiogram after endomyocardial biopsy for identification of cardiac perforation or tricuspid valve injury

Abstract

Per protocol, our institution obtains echocardiograms immediately after each EMB to rule out procedural complication. We sought to determine the incidence of echocardiogram-detected cardiac perforation and TV injury and to evaluate the utility of routine screening echocardiogram after each EMB in the current era. At a single center, 99% (1917/1942) EMB performed in 162 patients were immediately followed by an echocardiogram per protocol. There were five newly diagnosed pericardial effusions, and only one required pericardiocentesis. In the three echocardiograms demonstrating new flail TV, only one patient underwent surgical repair 2 months later. This study demonstrates the very low incidence of significant hemopericardium and TV injury after EMB in pediatric heart transplant recipients and argues against the utility of post-EMB echocardiograms to screen solely for procedural complications.

Predictors and clinical significance of pericardial effusions after pediatric heart transplantation

“…This difference is most likely due to the fact that the PHIS study did not look at interventions occurring during the initial transplant hospitalization. The incidence of cardiac perforation after endomyocardial biopsy requiring pericardial drain was previously reported to be quite rare in one pediatric study 11 . Although still uncommon, there were 3 patients that were found to have larger pericardial effusions on routine post‐biopsy surveillance that ultimately underwent pericardial drainage in this cohort.…”

“…The incidence of cardiac perforation after endomyocardial biopsy requiring pericardial drain was previously reported to be quite rare in one pediatric study. 11 Although still uncommon, there were 3 patients that were found to have larger pericardial effusions on routine post-biopsy surveillance that ultimately underwent pericardial drainage in this cohort. The effusion size increase in these patients was in comparison with their prior echocardiogram, and the temporal relationship to the biopsy is uncertain given the lack of constant echocardiographic surveillance.…”

“…An immune‐mediated or inflammatory process and donor/recipient size discrepancies have been proposed as possible etiologies for the development of pericardial effusion early on after HT 1,4,7,10 . One previous study reported low risk of hemopericardium after endomyocardial biopsy, though that remains a potential complication 11 …”

“…1,4,7,10 One previous study reported low risk of hemopericardium after endomyocardial biopsy, though that remains a potential complication. 11 Thus, we aimed to (1) examine the incidence of pericardial effusions in children within 6 months after HT, (2) evaluate for factors associated with the development of pericardial effusions post-HT, and (3) describe the clinical course and survival in patients with pericardial effusions after pediatric HT.…”

Diagnostic value of myocardial strain using two‐dimensional speckle‐tracking echocardiography in acute cardiac allograft rejection: A systematic review and meta‐analysis

“…Currently, endomyocardial biopsy (EMB) is still the gold‐standard method to diagnose ACAR 1 . However, EMB is expensive, laborious, invasive, and may associated with complications that cannot be ignored, such as carotid artery puncture injuries, arrhythmias, prolonged bleeding time, coronary artery fistula, tricuspid regurgitation, myocardial perforation, and pericardial tamponade 5‐9 . Furthermore, EMB may not be able to detect ACAR in up to 20% of patients due to sampling error 10 .…”