SAFETY OF TRANSVENOUS RIGHT-VENTRICULAR ENDOMYOCARDIAL BIOPSY GUIDED BY 2-DIMENSIONAL ECHOCARDIOGRAPHY

A total of 231 endomyocardial biopsy procedures performed in 74 consec utive patients were evaluated to compare the incidence and nature of c omplications in procedures guided by fluoroscopy versus those guided b y echocardiography. Sixty biopsy procedures were guided by fluoroscopy and 171 by two-dimensional echocardiography. The right interventricul ar septum was the target site for biopsy sampling in all patients. Cli nical signs of myocardial perforation occurred during one (1.7%) proce dure guided by fluoroscopy versus two (1.2%) procedures guided by echo cardiography. Two cases of interventricular septal perforation were vi sualized during the echo-guided procedures. The biopsy specimens were judged to be inadequate for diagnosis in 2.2% of the biopsy procedures , all of which were guided by fluoroscopy. The number of samples obtai ned during a procedure guided by fluoroscopy was lower (mean 2.3 +/- 1 .6) (mean +/- 1 SD) than that taken during a procedure guided by echoc ardiography (mean 4.0 +/- 1.2). Epicardial or pericardial tissue was p resent in 5.8% of the samples obtained under fluoroscopic guidance, ve rsus 0.7% of the samples obtained using echocardiography (p = 0.0003). It is concluded that although echocardiography seems to provide more accurate and safer guidance for the positioning of the bioptome toward the septum, the presence of epicardium or pericardium in 0.7% of the samples indicates that inadvertent sampling from the right ventricular free wall cannot be avoided.