背景——对心肌炎和心肌病毒持续感染的明确诊断以心内膜心肌活检组织（EMBs）的组织学、免疫组化及分子生物学检验为依据。基于活检来诊断心肌炎已变得日益重要，因为最近的研究表明，基于活检的病因疗法策略（免疫抑制或抗病毒治疗）可产生有益效应。心内膜心肌活检操作所导致主要并发症的风险还没有被很好的确定，因此我们在这个回顾性及前瞻性的单中心研究中评价了由右室心内膜心肌活检操作导致的主要及次要并发症的发生率。

方法和结果——1995年1月到2005年12月这9年，1919位患者接受了2505次应用改良心脏活组织钳的心内膜心肌活检操作（作为回顾性研究），496名患者于2004年1月至2005年12月接受了543次心内膜心肌活检操作（作为前瞻性研究）。共2415名患者实行了在心血管造影透视控制下经右股静脉入路的3048次心内膜心肌活检操作，目的是评价无法解释的在除外继发性原因后出现的左室功能障碍（回顾组左室射血分数，49.8±18.8%;前瞻组，48.8±19.7%）。在每个心内膜心肌活检操作中，回顾组平均获得8.2±0.8块心内膜心肌活检组织，前瞻组平均获得8.2±0.8块样本，总计26025块样本。无患者死亡或需要紧急心脏手术。其它主要并发症，如需要心包穿刺抽液的心包填塞或需要永久性人工起搏的完全房室传导阻滞非常罕见：在回顾性研究中占0.12%，在前瞻性研究中占0%。心内膜心肌活检操作的次要并发症例如心包积液、传导异常或心律失常的发生率在回顾性研究中为0.20%，在前瞻性研究中为5.5%。

结论——由有经验的操作者完成的在透视下经股动脉入路心内膜心肌活检操作，其并发症发生率非常低。

来源：丁香园

Complication Rate of Right Ventricular Endomyocardial Biopsy via the Femoral Approach
A Retrospective and Prospective Study Analyzing 3048 Diagnostic Procedures Over an 11-Year Period

Background— An unequivocal diagnosis of myocarditis and cardiac virus persistence is based on histological, immunohistological, and molecular biological analyses of endomyocardial biopsies (EMBs). Biopsy-based diagnosis of myocarditis has become increasingly important because recent studies have demonstrated the beneficial effects of biopsy-based causal treatment strategies (immunosuppressive or antiviral). Because the risks of major complications caused by EMB procedures have not yet been well defined, we evaluated the incidence of major and minor complications of right ventricular EMB procedures in this retrospective and prospective single-center study.

Methods and Results— With the use of a modified Cordis bioptome, 1919 patients underwent 2505 EMB procedures retrospectively over a 9-year period (January 1995 to December 2003), and 496 patients underwent 543 EMB procedures prospectively between January 2004 and December 2005. A total of 2415 patients had 3048 EMB procedures via the right femoral vein approach under biplane fluoroscopic control to evaluate unexplained left ventricular dysfunction (retrospective left ventricular ejection fraction, 49.8±18.8%; prospective, 48.8±19.7%) after exclusion of secondary causes. During each EMB procedure, an average of 8.2±0.8 EMBs were obtained retrospectively and 10.1±0.6 specimens prospectively for a total of 26 025 specimens. No patient died or required emergency cardiac surgery. Other major complications like cardiac tamponade requiring pericardiocentesis or complete atrioventricular block requiring permanent pacing were very rare: 0.12% in the retrospective study and 0% in the prospective study. Minor complications such as pericardial effusion, conduction abnormalities, or arrhythmias occurred in 0.20% of the EMB procedures in the retrospective study and 5.5% in the prospective study.

Conclusions— The EMB procedure via the femoral vein approach under fluoroscopic guidance has a very low complication rate when performed by experienced operators。

source:Circulation.com