The efficacy of real-time 3-dimensional echocardiography for right ventricular biopsy

Background. In recipients of cardiac transplant, repetitive right ventricular (RV) biopsies can result in decreased sample quality as a consequence of fibrosis from oversampling specific locations. Real-time 3-dimensional echocardiography (RT3D) is a new imaging modality that may precisely guide bioptome placement and, therefore, is a potential alternative to fluoroscopy (FI). We sought to determine if a RT3D-guided biopsy procedure would result in a comparable or decreased incidence of fibrosis versus Fl. Methods: Fifteen patients underwent 32 RV biopsy procedures with an equal number by each technique. RT3D was performed from the apical 4-chamber position. Fl was performed with biplane images. With both RT3D and Fl, attempts were made to vary bioptome position with each sample. A pathologist determined the percent fibrosis, with a biopsy sample containing 50% or more fibrosis considered uninterpretable for rejection. Results. RT3D provided excellent visualization of the distal end of the bioptome within the right atrium and RV. A mean of 4.3 +/- 1.0 RV biopsy samples were collected per procedure with 64 samples obtained by Fl and 72 obtained by RT3D. In all, 13 samples (20.3%) by Fl versus 10 samples (13.9%) by RT3D (P =.45) contained fibrosis and 7 samples (10.9%) by Fl versus 4 samples (5.6%) were uninterpretable (P =.41). Two Fl- versus zero RT3D-guided procedures contained 75% or more uninterpretable samples (P =.47) and were, therefore, nondiagnostic. There were no complications. Conclusions: RT3D is a new modality to facilitate accurate localization of the bioptome in patients undergoing transplant providing comparable quality RV samples to that of biplane Fl.