A new technique for endomyocardial biopsy in infants and small children

Endomyocardial biopsy (EMB) is usually performed from the femoral veins in infants and small children. This requires the use of a long vascular sheath to direct a bioptome to the ventricular septum. We describe a technique of EMB in this population that obviates the need for the use of a long vascul ar sheath. A 5 Fr 0.038" internal diameter, no-sideholes Cobra catheter (Co ok, Bloomington, IN) introduced via a 5 Fr short sheath was used to direct a 3 Fr, 60-cm-length Cook bioptome to the ventricular septum. From January 1998 to August 1999, this technique was used 22 times in seven patients for EMB (median, age 13 months; range, 1-72 months). Indications for EMB in th is group were posttransplantation surveillance (21 times) and evaluation fo r cardiomyopathy/myocarditis (1). Median number of EMB specimens obtained p er procedure was 6 (range, 5-9). There was one pneumopericardium seen post- EMB with this technique without hemodynamic embarrassment. EMB in infants a nd small children can be performed successfully, safely, and repeatedly fro m the femoral veins without the need for a long sheath. Cathet Cardiovasc. Intervent 50:441-444, 2000. (C) 2000 Wiley-Liss, Inc.