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      Biopsia endomiocárdica: Revisión y experiencia de 176 procedimientos Translated title: Endomiocardial biopsy: Revision and experience of 176 procedures

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          Abstract

          La biopsia endomiocárdica, es de ayuda diagnóstica para diversas cardiopatías. Se realizaron 176 procedimientos en 65 pacientes, 43 masculinos y 22 femeninos, edad 29.8 ±11.5 años (4 días a 66 años). En el grupo A (n = 26) pacientes postrasplante cardíaco, se realizaron 137 procedimientos, 39 en trasplante heterotópico y 98 ortotópico. En el grupo B integrado por 39 pacientes con cardiopatías diversas, se realizaron 39 procedimientos. El acceso fue por vía yugular en 3 pacientes (1.7%), la vía femoral se utilizó en 173 (98.3%) pacientes; 168 (95%) por vía venosa; vía arterial en 5 (2.5%). Se presentaron complicaciones mayores en 3 pacientes (1.7%). La biopsia endomiocárdica tiene una morbilidad y mortalidad muy baja. La ayuda diagnóstica histológica para la decisión terapéutica en el grupo A fue del 100%. En pacientes postrasplante cardíaco hay una mortalidad de 0% y complicaciones graves en el 1.7% tales como enfermedad vascular cerebral (EVC) y fístula coronaria derecha al ventrículo derecho. La vía de acceso más frecuentemente utilizada en nuestra serie fue la vía venosa femoral.

          Translated abstract

          Endomyocardial biopsy (EB) is often used in the clinical evaluation of several cardiac disease. Hundred-seventy-six consecutive procedures were performed in 65 patients, 43 men and 22 women mean age was 29.86 ± 11.53 (range 4 days to 66 years). Group A, 26 post-cardiac transplantation patients in whom 137 EB were performed (39 heterotopic and 98 orthotopic), average sample 5.2 biopsy for each patient. Group B (n = 39) was studied for several cardiac diseases during cardiac diagnostic catheterism. The jugular venous approach was performed in 3 patients (1.7%), femoral in 173 patients. Major complications were found in 3 (1.7%) cases consisting in cerebrovascular accident (stroke) and coronary fistula into the right ventricle. Endomyocardial biopsy provides a low incidence of adverse reactions, mortality was 0%.

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          Most cited references70

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          Myocarditis: The Dallas criteria

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            Interobserver variability in the pathologic interpretation of endomyocardial biopsy results.

            Controversy exists over the role of endomyocardial biopsy in evaluating patients with dilated cardiomyopathy, particularly in detecting myocarditis and in assessing prognosis. Interobserver variability, if high, could explain conflicting reports. To assess this possibility, we submitted biopsy specimens from 16 patients with dilated cardiomyopathy to seven cardiac pathologists. The same slides were independently reviewed by each and assessed for fibrosis, hypertrophy, nuclear changes on a 0 to 3+ scale, mean lymphocyte count per high-power field, and myocarditis. The prevalance of significant fibrosis ranged from 25% to 69%, hypertrophy from 19% to 88%, nuclear changes from 31% to 94%, and abnormal lymphocyte count from 0 to 38%. One or more pathologists diagnosed definite or possible myocarditis in 11 of the 16 patients. Of these 11 patients, three pathologists agreed about three and two pathologists agreed about five. Myocarditis was diagnosed by a single pathologist in three cases. We conclude that interobserver variability is high in interpreting biopsy specimens from patients with dilated cardiomyopathy and that quantitative and standardized methods are needed to increase diagnostic consistency.
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              Doxorubicin cardiomyopathy: evaluation by phonocardiography, endomyocardial biopsy, and cardiac catheterization.

              Right ventricular endomyocardial biopsy, right heart catheterization, and systolic time intervals were done in 33 adult patients receiving doxorubicin (AdriamycinTM). Doxorubicin administration was associated with a dose-related increase in the degree of myocyte damage, and 27 of 29 patients biopsied at doses greater than or equal to 240 mg/m2 had doxorubicin-associated degenerative changes identified on biopsy. The pre-ejection period to left ventriculr ejection time ratio (PEP/LVET) showed a threshold phenomenon and did not begin to increase until a total dose of 400 mg/m2 had been reached. Seven patients with catheterization-proven heart failure had a significantly greater amount of myocyte damage on biopsy than dose-matched control subjects (P less than 0.01). Preveious mediastinal radiation appeared to potentiate the doxorubicin-associated degenerative process. Mediastinal radiation and age greater than or equal to 70 years appeared to be risk factors for doxorubicin-associated heart failure. Dose limitation by combined clinical, noninvasive, invasive, and morphologic criteria offered an advantage over empirical dose limitation or dose limitation by PEP/LVET alone.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Journal
                acm
                Archivos de cardiología de México
                Arch. Cardiol. Méx.
                Elsevier (México )
                1405-9940
                September 2007
                : 77
                : 3
                : 200-208
                Affiliations
                [1 ] Centro Médico La Raza Mexico
                Article
                S1405-99402007000300004
                68c247d3-8fd2-4150-967f-dfa9e8eb3422

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                Cardiac & Cardiovascular Systems

                Cardiovascular Medicine
                Endomyocardial biopsy,Heart transplatation,Heterotopic and orthotopic heart transplatation,Biopsia endomiocárdica,Trasplante heterotópico,Trasplante ortotópico

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