title: Risk of endomyocardial biopsy in immunosuppressed patients after cardiac transplantation.
abstract: OBJECTIVE
  Central venous puncture is required for endomyocardial biopsy to identify rejection after cardiac transplantation. We evaluated our use of the Seldinger technique to determine the safety of this invasive method.
  
  
  METHODS
  In 42 immunosuppressed patients central venous puncture was performed after cardiac transplantation using the Seldinger technique for right heart biopsy. Together with physical examinations, chest X-ray and cardiac ultrasonography were performed during the inhospital follow-up. Outpatient follow-up continues and all reported adverse effects were evaluated by the attending cardiologist.
  
  
  RESULTS
  There were a total of 620 central venous punctures, most via the right internal jugular vein (77.9%). The planned puncture could not be performed in 3.2% of the cases and an alternative site was used. The femoral approach was associated with the longest radiation time. No severe adverse effects were observed and no complications (infection, large haematoma, pneumothorax, severe rhythm disorders) were recorded.
  
  
  CONCLUSIONS
  Even in immunosuppressed patients frequently requiring central venous puncture, right heart endomyocardial biopsy can be safely performed to evaluate rejection.
authors.affiliation: Abteilung für Kardiologie Johann Wolfgang Goethe-Universität, Frankfurt/Main, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Cieslinski
authors.forename: H G
authors.initials: HG
authors.lastname: Olbrich
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: R
authors.initials: R
authors.lastname: Schräder
authors.forename: G
authors.initials: G
authors.lastname: Kober
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007108:Immune Tolerance; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents