Real-time 3-dimensional echocardiography imaging for right ventricular endomyocardial biopsy: A comparison with fluoroscopy

Real-time 3-dimensional (RT3D) echocardiography has the potential to precis ely identify the position of an object in 3-dimensional space. Therefore, w e hypothesized that RT3D echocardiography could rapidly facilitate accurate placement of a bioptome within the right ventricle and may offer advantage s over a fluoroscopically guided approach. During 63 routine right ventricu lar biopsy procedures (total of 315 biopsy attempts) in 33 cardiac allograf t recipients, the bioptome was initially guided against the intraventricula r septum with the use of biplane fluoroscopy. Bioptome position was then ev aluated by RT3D echocardiography by using the Volumetrics Model 1 with the transducer placed at the apex. Multiple long-axis and short-axis planes wer e simultaneously visualized and customized to identify the tip of the biopt ome. Bioptome placement was prospectively classified as septal, free wall/s eptal junction, or free wall Of the 36 patients studied, 33 (91%) had adequ ate RT3D images. Of 315 bioptome placements visualized by RT3D echocardiogr aphy after fluoroscopic placement, bioptome position against the septum was confirmed in 113 (36%), against the septal/free wall (anterior or posterio r) junction in 140 (44%), against the free wall in 60 (19%), and in the cor onary sinus in 2 (1%). RT3D echocardiography is readily feasible for use in the majority of transplant patients undergoing right ventricular endomyoca rdial biopsy. Visualization of the bioptome in multiple simultaneous planes allows accurate localization of the biopsy site. The potential for improve d localization of the bioptome tip in the right ventricle may have importan t clinical implications for augmenting the efficacy of this procedure.