Complications of endomyocardial biopsy in children

OBJECTIVES To evaluate the incidence of and risk factors for, complications of endomyocardial biopsy in children. BACKGROUND Endomyocardial biopsy (EMB) is a low risk procedure in adults, b ut there is a paucity of data with regard to performing this procedure in c hildren. METHODS Retrospective review of the morbidity and mortality of 1,000 consec utive EMB procedures. RESULTS One thousand EMB procedures (right ventricle 986, left ventricle 14 ) were performed on 194 patients from July 1987 through March 1996. Indicat ions for EMB included heart transplant rejection surveillance (846) and the evaluation of cardiomyopathy or arrhythmia for possible myocarditis (154). Thirty-seven (4%) procedures were performed on patients receiving intraven ous inotropic support. There was one biopsy related death, secondary to car diac perforation, in a two-week-old infant with dilated cardiomyopathy. The re were nine perforations of the right ventricle, eight occurring in patien ts with dilated cardiomyopathy and one in a transplant recipient. The trans plant patient did not require immediate intervention; two patients required pericardiocentesis alone, and six underwent pericardiocentesis and surgica l intervention. All nine perforations were from the femoral venous approach (p < 0.01). Multivariate analysis demonstrated that the greatest risk of p erforation occurred in children being evaluated for possible myocarditis (p = 0.01) and in those requiring inotropic support (p < 0.01). Other complic ations included arrhythmia (5) and single cases of coronary-cardiac fistula , flail tricuspid leaflet, pneumothorax, hemothorax, endocardial stripping and seizure. CONCLUSIONS Risk of endomyocardial biopsy is highest in sick children with suspected myocarditis on inotropic support. However, EMB can be performed s afely with very low morbidity in pediatric heart transplant recipients. (C) 1999 by the American College of Cardiology.