title: Successful endomyocardial biopsy guided by transthoracic two-dimensional echocardiography.
abstract: BACKGROUND
  Two-dimensional (2-D) echocardiography is an excellent alternative method to perform endomyocardial biopsies (EB) in special situations, mainly when the patient is in a critical state and cannot go to the catheterization laboratory or when there are contraindications to the use of fluoroscopy as in the pregnancy.
  
  
  OBJECTIVE
  This single-center experience analyzed the last 25 years use of an EB technique guided by echocardiography realized at the bedside on critical patients.
  
  
  METHODS
  From 1985 to 2010, we performed 76 EB guided by 2-D echocardiography on 59 patients, among whom 38 (64.4%) were critically ill with examinations at the bedside; among 10 (16.9%) subjects, the procedure was carried out simultaneously with fluoroscopy for safety's sake during the learning period. In addition, 8 (13.6%) were unavailable for fluoroscopy, and 3 (5.1%) required a hybrid method due to an intracardiac tumor.
  
  
  RESULTS
  The main adverse effects included local pain (n = 4, 5.6%); difficult out successful puncture due to previous biopsies (n = 4, 5.6%); local hematoma without major consequences (n = 3, 4.2%); failed but ultimately successful puncture on the first try due to previous biopsies or (n = 3, 4.2%); obesity and immediate postoperative period with impossibility to pass the bioptome into the right ventricle; however 2 days later the procedure was repeated successfully by echocardiography (n = 1, 1.4%). All myocardial specimens displayed suitable size. There were no undesirable extraction effects on the tricuspid valve tissue. In this series, there was no case of death, hemopericardium, or other major complication as a direct consequence of the biopsy.
  
  
  CONCLUSIONS
  2-D echocardiography is a special feature to guide EB is mainly in critically ill patients because it can be performed at the bedside without additional risk or disadvantages of fluoroscopy. The hybrid method associating 2-D echocardiography and fluoroscopy allows the procedure in different situations such as intracardiac tumor cases.
authors.affiliation: Heart Institute of Sao Paulo University Medical School, Sao Paulo, Brazil. fiorelliai@uol.com.br
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: G B
authors.initials: GB
authors.lastname: Coelho
authors.forename: R H B
authors.initials: RH
authors.lastname: Santos
authors.forename: J L
authors.initials: JL
authors.lastname: Oliveira
authors.forename: V
authors.initials: V
authors.lastname: Aielo
authors.forename: L
authors.initials: L
authors.lastname: Benvenuti
authors.forename: A S
authors.initials: AS
authors.lastname: Oliveira
authors.forename: M A F
authors.initials: MA
authors.lastname: Da Silva
authors.forename: P R
authors.initials: PR
authors.lastname: Chizzola
authors.forename: R
authors.initials: R
authors.lastname: Costa
authors.forename: W
authors.initials: W
authors.lastname: Mathias
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: E A
authors.initials: EA
authors.lastname: Bocchi
authors.forename: N A G
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D001706:Biopsy / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D009206:Myocardium / Q000473:pathology*