title: The efficacy of real-time 3-dimensional echocardiography for right ventricular biopsy.
abstract: BACKGROUND
  In recipients of cardiac transplant, repetitive right ventricular (RV) biopsies can result in decreased sample quality as a consequence of fibrosis from oversampling specific locations. Real-time 3-dimensional echocardiography (RT3D) is a new imaging modality that may precisely guide bioptome placement and, therefore, is a potential alternative to fluoroscopy (Fl). We sought to determine if a RT3D-guided biopsy procedure would result in a comparable or decreased incidence of fibrosis versus Fl.
  
  
  METHODS
  Fifteen patients underwent 32 RV biopsy procedures with an equal number by each technique. RT3D was performed from the apical 4-chamber position. Fl was performed with biplane images. With both RT3D and Fl, attempts were made to vary bioptome position with each sample. A pathologist determined the percent fibrosis, with a biopsy sample containing 50% or more fibrosis considered uninterpretable for rejection.
  
  
  RESULTS
  RT3D provided excellent visualization of the distal end of the bioptome within the right atrium and RV. A mean of 4.3 +/- 1.0 RV biopsy samples were collected per procedure with 64 samples obtained by Fl and 72 obtained by RT3D. In all, 13 samples (20.3%) by Fl versus 10 samples (13.9%) by RT3D (P = .45) contained fibrosis and 7 samples (10.9%) by Fl versus 4 samples (5.6%) were uninterpretable (P = .41). Two Fl- versus zero RT3D-guided procedures contained 75% or more uninterpretable samples (P = .47) and were, therefore, nondiagnostic. There were no complications.
  
  
  CONCLUSIONS
  RT3D is a new modality to facilitate accurate localization of the bioptome in patients undergoing transplant providing comparable quality RV samples to that of biplane Fl.
authors.affiliation: Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Aggarwal
authors.forename: Cinthia
authors.initials: C
authors.lastname: Drachenberg
authors.forename: Layna
authors.initials: L
authors.lastname: Douglass
authors.forename: Christopher
authors.initials: C
authors.lastname: deFilippi
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging* / Q000473:pathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity