The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
INTERVENTIONS FOR VALVULAR DISEASE AND HEART FAILURE
Feasibility, safety and diagnostic impact of endomyocardial biopsies for the diagnosis of myocardial disease in children and adolescents
EuroIntervention 2018;14:1089-1095 published online August 2018. DOI: 10.4244/EIJ-D-18-00128
Goetz C. Mueller1*, MD; Ina Michel-Behnke2, PhD; Walter Knirsch3, PhD; Nikolaus A. Haas4, PhD; Hashim Abdul-Khaliq5, PhD; Roland Gitter6, MD; Sven Dittrich7, PhD; Ingo Dähnert8, PhD; Frank Uhlemann9, PhD; Stephan Schubert10, PhD; Gleb Tarusinov11, MD; Christoph Happel12, MD; Harald Bertram12, PhD; Ludger Sieverding13, PhD; Andreas Eicken14, PhD; Rainer Kozlik-Feldmann1, PhD; Jochen Weil1, PhD
1. Department of Paediatric Cardiology, University Heart Centre Hamburg, Hamburg, Germany; 2. Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria; 3. Department of Paediatric Cardiology, University Children’s Hospital Zurich, Zurich, Switzerland; 4. Department of Paediatric Cardiology, Ludwig-Maximilians University of Munich, Munich, Germany; 5. Department of Congenital Heart Disease and Paediatric Cardiology, Homburg/Saar, Germany; 6. Division of Paediatric Cardiology, Children’s Hospital of Linz, Linz, Austria; 7. Department of Paediatric Cardiology, University of Erlangen, Erlangen, Germany; 8. Department of Paediatric Cardiology, Heart Centre Leipzig, Leipzig, Germany; 9. Centre for Congenital Heart Defects, Klinikum Stuttgart, Stuttgart, Germany; 10. Department of Congenital Heart Disease – Pediatric Cardiology, Heart Center Berlin, Berlin, Germany; 11. Department of Paediatric Cardiology, Heart Centre Duisburg, Duisburg, Germany; 12. Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany; 13. Department of Paediatric Cardiology, University of Tübingen, Tübingen, Germany; 14. Department of Paediatric Cardiology, Heart Centre Munich, Munich, Germany
Aims: Endomyocardial biopsies (EMBs) are performed infrequently in children owing to significant past complication rates and controversial discussions about the therapeutic value of results. The objective of this study was to investigate the safety and feasibility of EMBs for suspected myocardial disease in relation to their clinical value.
Methods and results: We performed a retrospective multicentre review of the Working Group for Interventional Cardiology of the German Society for Paediatric Cardiology. During three consecutive years, 206 EMBs (84 female/mean age 8.95±6.62 years) were performed and analysed at 15 heart centres. In the majority of cases, biopsies were taken from the right ventricle (RV/89.8%; p<0.001). The overall complication rate was 9.7%, whereas major complications occurred in only 0.97% of cases. Risk factors associated with a higher complication rate were biopsy during the first year of life (20.5%) and from the left ventricle (31.1%) (p<0.05). There was no procedure-related mortality. Treatment was changed in 18.0% of cases based on biopsy results.
Conclusions: Today, endomyocardial biopsies in older children with suspected myocardial disease can be performed safely with a low risk of major complications and mortality, whereas the risk of complications if the biopsy is carried out in the first year of life or taken from the left ventricle remains high.