Feasibility, safety and diagnostic impact of endomyocardial biopsies for the diagnosis of myocardial disease in children and adolescents.

AIMS: Endomyocardial biopsies (EMBs) are performed infrequently in children owing to significant past complication rates and controversial discussions about the therapeutic value of results. The objective of this study is to investigate the safety and feasibility of EMBs for suspected myocardial disease in relation to their clinical value.

METHODS AND RESULTS: Retrospective multicentre review of the Working Group for Interventional Cardiology of the German Society for Paediatric Cardiology. During 3 consecutive years 206 EMBs (84 female / mean age 8.95±6.62 years) were performed and analysed at 15 heart centres. In the majority of cases biopsies were taken from the right ventricle (RV/ 89.8%; p<0.001). The overall complication rate was 9.7%, whereas major complications occurred in only 0.97% of cases. Risk factors associated with a higher complication rate were biopsy during the first year of life (20.5%) and from the left ventricle (31.1%); (p<0.05). There was no procedure-related mortality. Treatment was changed in 18.0% of cases based on biopsy results.

CONCLUSIONS: Today, endomyocardial biopsies in older children with suspected myocardial disease can be performed safely with a low risk of major complications and mortality, whereas the risk of complications if the biopsy is carried out in the first year of life or taken from the left ventricle remains high.