Comparison of Three-Dimensional Echocardiography to Two-Dimensional Echocardiography and Fluoroscopy for Monitoring of Endomyocardial Biopsy

Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, California, USA.
The American Journal of Cardiology (Impact Factor: 3.28). 03/2007; 99(6):864-6. DOI: 10.1016/j.amjcard.2006.10.050
Source: PubMed


Real-time 3-dimensional echocardiography (RT3DE) offers the rapid acquisition of quantitative and qualitative anatomic data without the use of geometric assumptions. This study was designed to test the feasibility and potential superiority of RT3DE versus 2-dimensional echocardiography (2DE) and standard fluoroscopy for monitoring endomyocardial biopsies (EMBs). Thirty-eight consecutive EMBs performed under fluoroscopic guidance in 26 patients were monitored using 2DE and RT3DE alternately. Two reviewers scored each biopsy pass for visualization of the tip of the bioptome and location of the actual biopsy. Overall image quality was noted as good or poor, and the effect of image quality on tip localization was analyzed. A total of 243 biopsy attempts were made during 38 EMBs. The location of the biopsy was determined in 74% of the biopsies monitored with RT3DE, whereas 2DE demonstrated the location with certainty in only 43% of the biopsies (p <0.0001). On a procedure-by-procedure comparison, RT3DE was found to show the bioptome tip better in 23 of 38 biopsies, compared with 1 of 38 for 2DE (p = 0.001). In 14 of 38 EMBs, neither method was clearly better. In conclusion, RT3DE improves the ability to see the location of the bioptome during EMB compared with 2DE and fluoroscopy.

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    • "Although, 2-D echocardiography has limitations in that the current resolution is not sufficient for direct visualization of chordae tendineae, 2-D echocardiographic guidance might reduce the occurrence of valve injury by visualizing both the tip of bioptome and cardiac tissue around the tip of bioptome. Recent advances in echocardiography, including real-time 3-D echocardiography, may allow for better visualization of heart structure and biopsy instruments (26, 27). "
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    ABSTRACT: Endomyocardial biopsy (EMB) is one of the reliable methods for the diagnosis of various cardiac diseases. However, EMB can cause various complications. The purpose of this study is to evaluate the complication of transfemoral EMB with both fluoroscopic and two-dimensional (2-D) echocardiographic guidance. A total of 228 patients (148 men; 46.0±14.6 yr-old) who underwent EMB at Kyungpook National University Hospital from January 2002 to June 2012 were included. EMB was performed via the right femoral approach with the guidance of both echocardiography and fluoroscopy. Overall, EMB-related complications occurred in 21 patients (9.2%) including one case (0.4%) with cardiac tamponade requiring emergent pericardiocentesis, four cases (1.8%) with small pericardial effusion without pericardiocentesis, two cases (0.9%) with hemodynamically unstable ventricular tachycardia (VT), one case (0.4%) with nonsustained VT, one case (0.4%) with tricuspid regurgitation, twelve cases (5.3%) with right bundle branch block. There was no occurrence of either EMB-related death or cardiac surgery. Left ventricular ejection fraction was significantly lower (32.0±18.7% vs 42.0±19.1%, P=0.023) and left ventricular end-diastolic dimension was larger (60.0±10.0 mm vs 54.2±10.2 mm, P=0.013) in patients with EMB related complications than in those without. It is concluded that transfemoral EMB with fluoroscopic and 2-D echocardiographic guidance is a safe procedure with low complication rate.
    Journal of Korean medical science 09/2013; 28(9):1323-8. DOI:10.3346/jkms.2013.28.9.1323 · 1.27 Impact Factor
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    • "Echocardiography gives also the possibility to avoid damaging of tricuspid valve, papillary muscles or chords and to promptly identify the eventual presence of other complications like pericardial effusion. Real time 3-D echocardiography seems very promising in improving the ability to see the location of the bioptome during EMBs compared with 2-D echocardiography and fluoroscopy [68,69]. "
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    ABSTRACT: Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.
    Cardiovascular Ultrasound 02/2008; 6:2. DOI:10.1186/1476-7120-6-2 · 1.34 Impact Factor
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    ABSTRACT: Before the development of echocardiography, cardiac disease in the horse was diagnosed if a loud heart murmur (grade III-IV/VI or louder) and clinical signs of congestive heart failure (coughing, edema, venous distention, jugular pulsations) were detected on physical examination. Arrhythmias that persisted during and after exercise also indicated cardiac disease, which could be characterized electrocardiographically. Electrocardiography, thoracic radiography, angiography, cardiac catheterization, and oximetry could add only small pieces of information about the heart. M-mode echocardiography provided the first "window" with which to evaluate the heart and its intracardiac structures, albeit an ice-pick one-dimensional view. With M-mode echocardiography, the diameter of the aorta at the valves, the left ventricle, right ventricle, and left atrial appendage, as well as the thickness of the interventricular septum and left ventricular free wall, could be measured. Motion and thickness of the tricuspid, mitral, and aortic valves could be assessed, but only in a one-dimensional plane. Two-dimensional echocardiography provided an added dimension, resulting in visualization of all the intracardiac structures, aorta, and pulmonary artery. Two-dimensional echocardiography became the diagnostic technique of choice for the evaluation and characterization of congenital cardiac disease in critically ill neonates, as well as in adult horses. Two-dimensional echocardiography also improved the ability to diagnose valvular regurgitations, characterize valvular lesions (bacterial endocarditis, ruptured chorda tendineae), myocardial function (segmental wall motion abnormalities), atrial size, mass lesions (endocarditis, neoplasia, and thrombi), and pericardial effusion. Information about blood flow was obtained using contrast echocardiography but was limited to certain cardiac abnormalities (congenital cardiac defects and tricuspid regurgitation). This information about blood flow was limited to the detection of positive or negative contrast jets. Comprehensive information about blood flow was lacking until the application of Doppler echocardiography to equine cardiology. Pulsed-wave and color flow Doppler echocardiography resulted in precise localization of the abnormal blood flow and semiquantitation of the shunt flow or regurgitant jet. Color flow Doppler echocardiography sped up the localization and semiquantitation of the jet in many instances and provided some information about blood flow velocity in the enhanced and variance modes. The peak velocity of jets can be determined using continuous-wave Doppler echocardiography. This value then can be used to estimate pressure difference between cardiac chambers or to calculate cardiac output noninvasively if angles parallel to flow can be obtained. Thus, information about cardiac size, function, and blood flow can be combined to diagnose cardiac disease in horses and to formulate a prognosis for life and performance.
    Veterinary Clinics of North America Equine Practice 09/1991; 7(2):435-50. · 0.44 Impact Factor
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