In cardiac catheterization for myocardial biopsy, a sample of heart muscle tissue is taken. For this purpose, a cardiac catheterization for myocardial biopsy scan is performed. This cardiac catheterization can be done when certain symptoms indicate issues with the heart muscle or its valves.
Cardiac catheterization procedure indications
Cardiac catheterization for myocardial biopsy is performed to determine if heart disease is the cause of certain symptoms.
Diseases that can be diagnosed or evaluated by cardiac catheterization, depending on their severity, include narrowing of the coronary arteries (coronary artery disease), heart valve changes, congenital heart defects, and heart infections (myocarditis).
Moreover, cardiac catheterization for myocardial biopsy can be performed after a heart transplant in order to identify potential tissue rejection.
What are the indications for cardiac catheterization for myocardial biopsy?
Three fundamentally different conditions constitute the indication for myocardial biopsy.
- If myocarditis is suspected, a sample of myocardial tissue is requested. This way, the presence of a chronic or acute viral disease of the heart can be established.
- Myocardial Biopsy After a heart transplant, a myocardial biopsy can be used to determine whether or not the body has rejected the new organ. A myocardial biopsy is therefore vital for heart transplant patients in many cases.
- If so-called heart storage disease is suspected, a myocardial biopsy is used.
A number of diseases are summarized under the term storage disease. These diseases are characterized by the fact that various substances are deposited in the cells or organs of the body. As in the case of amyloidosis. In this disease, insoluble protein fibers are deposited in cells. These fibrous cells and tissue components are responsible for preventing the heart from functioning as intended.
In addition to the case of protein body storage (amyloidosis), cardiac catheterization for myocardial biopsy is also ordered if the following deposits are suspected: Iron, copper.
Some other diseases can also be precursors to cardiomyopathy. For example, if a patient has cardiomyopathy, the doctor may order cardiac catheterization for myocardial biopsy. The so-called cardiomyopathies are a group of heart muscle diseases that cause electrical and/or mechanical dysfunction of the heart muscle. Also, in the case of cardiac muscle atrophy, so-called muscular dystrophy that reduces the efficiency of the heart muscle, the above-mentioned cardiac catheterization can be used. This also confirms whether there is congenital thickening of the heart muscle.
Diagnostics
In case of heart disease or suspicion thereof, the patient is first questioned (anamnesis), and a detailed physical examination is performed. In particular, the heart is examined with a stethoscope. An electrocardiogram (EKG) is performed, and blood pressure is measured, possibly over a 24-hour period. Imaging procedures (such as chest wall ultrasound and X-rays) are used. With certain test results, further diagnostic measures are carried out.
Description of the procedure
Depending on the symptoms and test results, a right heart catheterization test or a left heart catheterization test will be performed. Local anesthesia is usually used for both procedures.
Using a right heart catheter (venous catheter) in Cardiac catheterization for myocardial biopsy, a hole is made in the groin or in the elbow crease. The catheter is pushed through the vein in question into the right ventricle of the heart or into other vessels (such as the pulmonary artery). Sometimes, a balloon can also be incorporated into the catheter, which is inflated so that the tip of the catheter is transported to the right heart by blood flow (flood catheterization).
In Cardiac catheterization for myocardial biopsy, a left heart catheter (arterial catheter) is inserted through an artery in the groin or leg against the blood flow to the left ventricle.
Various examinations can be performed with the catheter in place. In cardiovascular, pressure or pressure differences can be determined at the site in question. Blood can be drawn for a blood test, especially to determine the oxygen levels in the heart chambers. Contrast media can also be injected for an X-ray examination (angiography) to examine and evaluate the function of the heart’s arteries and valves, where the coronary arteries are scanned (coronary angiography) and the right half of the heart and the pulmonary artery or the left half of the heart and the aorta (main artery) can be visualized.
Furthermore, in cardiac catheterization for myocardial biopsy, with the catheter in place, a stress test can be performed in which pressure values are determined and the function of the heart muscle to pump blood is examined, for example, when pedaling a bicycle in the supine position.
For Cardiac catheterization for myocardial biopsy (taking a small sample of heart muscle tissue), tissue samples are taken using a special right heart catheter, and rarely also using a left heart catheter, due to the fact that the blood pressure on the right side of the heart is much lower than the blood pressure on the left side. As a result, a biopsy can be performed in the area of the right side of the heart with much less risk than in the left side.
The catheter in cardiac catheterization for myocardial biopsy has biopsy forceps to remove tissue. X-rays provide the necessary visibility during the procedure. Using the biopsy forceps, between four to seven tissue samples are taken. These samples are small, usually no larger than the head of a pin. Sampling occurs at different points. The patient may be given a contrast agent in order to ensure better visibility.
During the sampling of the heart muscle in cardiac catheterization for myocardial biopsy, the patient should not feel any pain. The entire myocardial biopsy usually takes half an hour to an hour.
After each cardiac catheterization for myocardial biopsy check, the puncture site is closed, and a pressure dressing is applied. If a short incision was made (for example, at the bend of the elbow) to insert the catheter, the site may be closed with a suture.
In cardiac catheterization, the samples are placed in small glass or plastic tubes filled with formalin; this liquid makes the removed tissue durable. In this way, the samples can be sent to the responsible laboratory. The obtained myocardial tissue samples are subjected to histopathological examination (pathological dissection).
What happens after cardiac catheterization for myocardial biopsy?
After successful tissue sampling via cardiac catheterization for myocardial biopsy, the doctor removes the catheter and the entire sheath. The puncture site after cardiac catheterization for myocardial biopsy is provided with a piece of bandage that the doctor or nurse presses firmly for about five minutes. The patient must then wear a pressure bandage in the area of the venous access after cardiac catheterization for myocardial biopsy for two to three hours. This is how long the patient stays in bed.
Before the patient can leave the hospital after cardiac catheterization for myocardial biopsy, an ultrasound scan of the heart is performed about an hour later. This serves to rule out possible damage to the vital organ or to be able to recognize it in time. Finally, there is a risk of injury to the heart during tissue removal via cardiac catheterization for myocardial biopsy; you may need to stay in the hospital for observation and follow-up in the ICU.
After cardiac catheterization for myocardial biopsy, excessive physical exertion should be avoided for a week; bed rest is not often required.
In case of symptoms after cardiac catheterization for myocardial biopsy that may indicate complications, you should contact your doctor as soon as possible.
Complications
There are relatively few complications in myocardial biopsy by cardiac catheterization. In some cases during cardiac catheterization, the tissue surrounding the procedure can be harmed, for example when the vein wall is penetrated. Sometimes during cardiac catheterization, the heart can be punctured or the heart valve can be damaged as well.
An irregular heartbeat can sometimes occur during cardiac catheterization, which often goes away on its own. Bleeding and bruising (hematoma) are possible during cardiac catheterization. In exceptional cases of cardiac catheterization, this can lead to life-threatening conditions, for example when bleeding occurs around the heart (pericardial effusion). Nerve injuries during cardiac catheterization can lead to numbness or paralysis, among other things. Rarely during cardiac catheterization, the lungs are accidentally punctured, causing air to build up in the chest (pneumothorax), which hinders breathing.
The catheter itself during cardiac catheterization can also be damaged, for example, the tip of the catheter can break off and travel with the bloodstream, causing issues. Catheters during cardiac catheterization can cause blood clots (thrombi) to form, which sometimes occur and can lead to circulatory disorders, such as a pulmonary embolism (pulmonary infarction). The use of iodine-containing contrast media in cardiac catheterization can lead to increased thyroid activity. Finally, inflammation and allergic reactions during cardiac catheterization cannot be ruled out either.
Prognosis after cardiac catheterization for myocardial biopsy
Cardiac catheterization for myocardial biopsy often provides an accurate diagnosis of the disease in question and its severity.
A treatment plan is then determined depending on the results of the examination.
However, we may get an insufficient or incorrect result using cardiac catheterization for myocardial biopsy.
However, as a general rule, it makes more sense to perform cardiac catheterization for myocardial biopsy than to risk a serious heart disease that goes undetected.
Preparing for cardiac catheterization for myocardial biopsy
The patient should be on an empty stomach before cardiac catheterization for myocardial biopsy. This means that you should not drink or eat anything from midnight until the end of cardiac catheterization for myocardial biopsy. The doctor in charge may ask the patient to take some medications before cardiac catheterization for myocardial biopsy. It is essential to follow these instructions. It is also important to clarify on a case-by-case basis to what extent the patient should stop taking anticoagulant medications before cardiac catheterization for myocardial biopsy.
The doctor in charge must be informed before cardiac catheterization for myocardial biopsy of the following:
- If the patient tends to bleed
- If the patient has suffered in the past from an illness that increased the tendency to bleed
- If you are taking anticoagulant medications before cardiac catheterization for myocardial biopsy, Metformin, a medication used to treat diabetes, often must be stopped before cardiac catheterization because it can cause issues with the contrast agent. Other medications may also need to be omitted.
A few hours before cardiac catheterization for myocardial biopsy, the patient should stop smoking and drinking alcoholic beverages.
Jewelry, contact lenses, and removable dentures should be removed before cardiac catheterization for myocardial biopsy. You should also not use cosmetics before cardiac catheterization for myocardial biopsy.
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