Endomyocardial biopsy

Heart Fever, lethargy, weakness, SOB, DOE, hypotension, tachycardia, atrial flutter, ventricular arrhythmias Leukocytosis, endomyocardial biopsy positive for mononuclear infiltrates... 

Nimata, M., Kishimito, C., Shioji, K., Ishizaki, K., Kitaguchi, S., Hashimoto, T., Nagata, N., and Kawai, C. 2003. Upregulation of redox-regulating protein, thioredoxin, in endomyocardial biopsy samples of patients with myocarditis and cardiomyopathies. Mol. Cell. Biochem. 248 193-196. 

Pleissner, K. P., Emig, S., )ungblut, P., Hildebrandt, A., Fleck, E. (1994a). Dilated cardiomyopathy computer-assisted analysis of endomyocardial biopsy protein patterns by two-dimensional gel electrophoresis. Eur. J. Clin. Chem. Clin. Biochem. 32, 615-624. 

Becker, A.E. Heijmans, C.D. Essed CE. Chronic nonischemic heart disease and endomyocardial biopsies. Worth the Extra. Eur. Heart. J. 1991,12, 218-223. 

In 11 patients with anthracycline cardiotoxicity studied by heart catheterization and endomyocardial biopsy, myocytic damage correlated linearly with cumulative dose (11). There was a non-linear relation between electron microscopic changes and the extent of hemodynamic impairment. There was pronounced fibrous thickening of... 

Epirubicin is considered to cause substantially less cardiotoxicity than doxorubicin on a molar basis (4,21). This has been attributed to its more rapid clearance rather than a different action (22). In a randomized, double-blind comparison of epirubicin and doxorubicin, there was a significant reduction in left ventricle ejection fraction with doxorubicin but not with epirubicin (23). However, data from large clinical series and from morphological examination of endomyocardial biopsies in smaller series of patients suggest that the incidence and severity of cumulative cardiac toxicity associated with epirubicin 900 mg/m is similar to that associated with doxorubicin 450-550 mg/raf (24). In 29 patients treated with epirubicin in cumulative doses ranging... 

Torti FM, Bristow MM, Lum BL, Carter SK, Howes AE, Aston DA, Brown BW Jr, Harmigan JF Jr, Meyers FJ, Mitchell EP, et al. Cardiotoxicity of epirubicin and doxorubicin assessment by endomyocardial biopsy. Cancer Res 1986 46(7) 3722-7. 

Rowan RA, Masek MA, Billingham ME. Ultrastructural morphometric analysis of endomyocardial biopsies. Idiopathic dilated cardiomyopathy, anthracycline cardiotoxicity, and normal myocardium. Am J Cardiovasc Pathol 1988 2(2) 137 4. 

Light and electron microscopic abnormalities were found on endomyocardial biopsy in two patients with cardiac failure. The first had taken hydroxychloroquine 200 mg/day for 10 years, then 400 mg/day for a further 6 years the second had taken hydroxychloroquine 400 mg/day for 2 years (SEDA-13, 239). A similar case was reported after the use of 250 mg/day for 25 years (SEDA-18, 286). 

Findings on autopsy and endomyocardial biopsy have shown diffuse, interstitial edema, intracytoplasmic vacuolization of myocytes, and no inflammatory infiltrate (34). Acute myocardial infarction has been demonstrated pathologically in some, but not all, patients with clinical infarction (10). 

Trace elemeuts were measured iu myocardial and muscle-tissue samples from 13 patieuts diaguosed with idiopathic dilated cardioutyopathy (IDCM). The subjects had no history of Hg exposure. Findings were compared with Hg concentrations measured in n ocardi and muscle biopsies from age-matched patients with valvular (12 patients) or ischemic heart disease (13 patients), papillary and skeletal-muscle biopsies from 10 patients with mitral stenosis, and left-ventricle endomyocardial biopsies from 4 normal subjects. Hg concentrations in myocardial samples collected from patients with IDCM were... 

Detection of cardiotoxicity is via endomyocardial biopsy as well as serial radionu elide angiocardiography (165). Endomyocardial biopsy remains the technique that prO vides the best linear correlation with cardiac toxicity and power of predicting onset of early cardiac failure. Serial radionuclide angiocardiography also has been used in adults, although the technique is not as accurate in children due to the anatomical considera tions that make the image less clear (205). 

Vogelsberg H et al. (2008) Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol 51 1022-1030... 

Each of these noninvasive tests have a different sensitivity and specificity. Unfortunately, an algorithm for the diagnosis of cardiac sarcoidosis has not been determined because of the diagnostic limitations of the gold standard, which is endomyocardial biopsy. Moreover, when noninvasive tests are compared with each other within the same clinical trials, there is a poor concordance of the tests such that a negative result on any one test does not ensure the possibility of another test being positive (120,133,135). 

Uemura A, Morimoto S, Hiramitsu S, et al. Histologic diagnostic rate of cardiac sarcoidosis evaluation of endomyocardial biopsies. Am Heart J 1999 138 299-302. 

Barnard CN (1968) Human cardiac transplantation an evaluation of the first two operations performed at the Groote Schuur Hospital, Cape Town. Am J Cardiol 22 791-803 Batista RJV, Santos JLV, Takeshita N et al (1996) Partial left ventriculectomy to improve left ventricular function in end-stage heart disease. J Cardiac Surg 11 96-97 Billingham ME (1985) Endomyocardial biopsy detection of acute rejection in cardiac allograft recipients. Heart Vessels Suppl 1 86-90... 

More specifically in heart transplant recipients, bleeding, leaks, and frank rupture can occur at the anastomosis sites the most critical of which is the aortic anastomosis, particularly if there is a marked difference in diameter between the donor and recipient aorta (Knisely et al. 1999 Reitz et al. 1982) (Fig. 2.2.3). In addition, acute or chronic breakdown at the aortic anastomosis can lead to aortic dehiscence, dissection, and pseudoaneurysm formation (Henry et al. 1989 Knollmann et al. 2000a Knosalla et al. 1996). Pseudoaneurysms can also form at two additional sites in the cardiac transplant patient at the cannulation sites used for cardiopulmonary bypass and at the endomyocardial biopsy sites in the right ventricle, taken to look for rejection (Knisely et al. 1999). Although most of these complications occur in the immediate post-operative period, some can occur months to years later (Knisely et al. 1999). Aortic dissection, when it occurs in the heart transplant patient (l%-2%), usually involves the recipient s native aorta, although rare cases of dissection involving the donor s aorta have been reported (ScHELLEMANS et al. 2004). Dissection can occur in the immediate peri-operative period usually due to mismatches in donor-recipient vessel size or years later when they may he due to infection or accelerated atherosclerosis (Schellemans et al. 2004). 

Rejection can now be detected early by endomyocardial biopsy, which is employed according to a reg-... 

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