Study shows heart biopsy possible via arm catheterization
SAN DIEGO–Heart biopsies, which are typically performed via catheterization through the groin or neck, are possible and may cause less discomfort for patients when performed through a vein in the wrist, according to a study by Penn State Cardiovascular Center specialists.
"Although not everyone is a candidate for catheterization through the wrist, called transradial catheterization, this study shows that this technique is promising as an option for patients who need heart biopsies," said Ian C. Gilchrist, M.D., professor of medicine, Penn State College of Medicine at Penn State Milton S. Hershey Medical Center. "Up to now, even physicians trained in the transradial catheterization approach had avoided offering the arm catheterization option for patients who needed a heart biopsy because we weren't sure about the technique's effectiveness for biopsies."
Carey D. Moyer, M.D., cardiology fellow, Penn State College of Medicine, Penn State Hershey Medical Center, presented the study today (April 29, 2004) at the scientific poster session of the Society of Cardiac Angiography and Intervention Annual Meeting in San Diego.
Heart biopsies, in which a small sample of heart muscle is removed for testing, are prescribed yearly for heart transplant patients so physicians can check for signs of rejection of the transplanted heart. Heart biopsies also are used to diagnose the cause of a patient's heart failure, or to check the hearts of some patients who are being treated with chemotherapy. Originally, surgeons would do heart biopsies through a large incision in the chest. In the late 1970s, physicians started taking heart biopsies through catheters that were snaked through a vein in the groin or the neck to the heart.
"Some patients who've suffered with heart problems for many years can have severe scarring in the veins and arteries in the groin and neck, making it difficult to retrieve the sample of heart tissue," Gilchrist said. "Knowing that we can obtain the biopsy sample through wrist catheterization affords patients an alternative to another groin or neck catheterization."
Transradial catheterization uses a vein or artery in the wrist to take pictures of the heart arteries, to access the pulmonary artery in the lungs or the right side of the heart, or to measure blood pressures in certain blood vessels. Previous studies have shown that patients who have catheterization through the arm recover more quickly. When patients have catheterization through the groin, they must wait at least two hours before standing up to make sure the deep incision does not bleed. Because the blood vessels in the arms are smaller and the incision to access the surface blood vessels is shallow, patients who have arm catheterization can stand up and move around immediately after catheterization. This allows patients to be discharged more quickly. Studies also have shown a very low rate of major complications with arm catheterization.
The study included eight patients undergoing post-heart transplant testing. The biopsy was taken using the same equipment that would have been used if the catheterization had been done through the groin or neck.
"Although this study is based on early experience, all eight of the patients tolerated the procedure very well and had no procedural complications such as venous or arterial bleeding or bruising," Gilchrist said. "All patients expressed satisfaction with their procedure and one patient had the procedure repeated a year later from the same site without incident."
Gilchrist notes that the biopsies were performed by an operator with extensive experience in using the transradial catheterization technique and in heart biopsies.
Co-authors on the study are: C.D. Moyer, M.D., M. Kozak, M.D., S.M. Ettinger, M.D., C.E. Chambers, M.D., P.H. McNulty, M.D., Penn State Cardiovascular Center, Penn State Milton S. Hershey Medical Center.
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