ABSTRACT
From October 1984 to June 1991, 1,549 endomyocardial biopsies (EMB) were performed on 122 patients submitted to a Cardiac Transplant procedure (CT) at the Hospital Puerta de Hierro in Madrid. All biopsies were performed with the long sheath technique and the King bioptome. A total of 8,707 specimens were obtained, of which 7,311 (83.97%) were considered adequate for pathological examination. We did not find significant differences between the internal jugular (83.21%) and the femoral vein (84.82%) approaches. About 20% of the samples were not adequate for pathological evaluation after the fifth procedure performed on the same patient. There has been no deaths in our group. One patient (0.06%) had right ventricular perforation with tamponade that required surgical treatment. Two patients (2.98%) presented coronary fistulae related to EMB. The percent of other minor complications was less than 0.5%. EMB is mandatory for the control of rejection in the first year after cardiac transplantation, and has shown to be a reliable and safe method in experienced hands.
Subject(s)
Endocardium/pathology , Graft Rejection/pathology , Heart Transplantation , Postoperative Care/methods , Adolescent , Adult , Aged , Biopsy/adverse effects , Biopsy/methods , Child , Clinical Protocols , Female , Heart Ventricles/pathology , Humans , Male , Middle AgedABSTRACT
Three cases of membranous obstruction of the inferior vena cava (IVC) are presented. Two of them underwent transcardiac membranotomy with good results. The third patient was treated symptomatically and died from gastrointestinal hemorrhage and hepatic coma two years after the diagnosis of Budd-Chiari syndrome. At autopsy, membranes were found in the inferior vena cava and hepatic veins. Differentiation of Budd-Chiari syndrome secondary to the presence of such a membrane is essential since these patients are potentially curable by surgical treatment. Cavography visualizes the obstruction and is the procedure of choice for diagnosis of this condition. Surgical treatment with transcardiac membranotomy is effective. Some hepatic abnormalities regress after surgery. Prophylactic postoperative treatment with diuretics seems advisable in these patients to prevent congestive cardiac failure.
