title: Failure of endocardial biopsy from the internal jugular vein due to endocardial scar: a new indication for the femoral venous approach.
abstract: Following cardiac transplantation, patients undergo serial endomyocardial biopsies to evaluate rejection, usually by the internal jugular approach. A case report and data are presented that demonstrate that this approach becomes less efficient and occasionally impossible in the third year after transplant (53% success rate per biopsy attempt) as compared to the first year after transplant (80%) probably due to the development of endocardial scar in the area sampled by the bioptome. Alternatively, one can change to the femoral venous approach which continues to have a high success rate in the third year after transplant (83%) because a different area of the interventricular septum is sampled when this approach is used.
authors.affiliation: Cardiac Catheterization Laboratory, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: W H
authors.initials: WH
authors.lastname: Matthai
authors.forename: H C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: W G
authors.initials: WG
authors.lastname: Kussmaul
mesh_terms: D001706:Biopsy / Q000379:methods; D002921:Cicatrix; D004699:Endocardium / Q000473:pathology*; D005268:Femoral Vein; D006084:Graft Rejection / Q000175:diagnosis; D016027:Heart Transplantation; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure