Cardiac Monitoring / Cardiac Biopsy
Cardiac biopsy is presently the only reliable means of diagnosing heart rejection. It is performed at regular intervals after surgery, at occasional times when rejection is suspected, and to assess the adequacy of anti-rejection therapy.
If, while admitted to the hospital, a heart biopsy is done, you should follow all instructions from your attending physician.
If you are coming in for an outpatient biopsy, we suggest you:
-
do not take diuretics the evening before or morning of the biopsy
-
have a "salty meal" the night before (here's the time to "go Chinese" or treat yourself to pizza)
-
don't lift heavy objects for 24 hours following the biopsy
The procedure is done in the operating room or cardiac cath lab. It is most often done by inserting the biopsy instrument (called a bioptome) through a small incision in the skin on the right side of the neck. (See Figure 7).
Under fluoroscopy, the bioptome will be guided through the jugular vein and into the right ventricular chamber of the heart. The jaws of the instrument are opened and closed, and a small piece of tissue is snipped off and removed. Four or five separate pieces are needed for adequate sampling. The procedure ordinarily takes about 30 minutes and is done with a local anesthetic at the site where the bioptome is inserted.
In some patients the jugular vein is not accessible, and the bioptome must be inserted from the femoral vein in the groin area, instead of the neck. (See Figure 6).
Following the biopsy, you will be asked to keep your head upright to avoid increased pressure in the jugular vein which could result in bleeding at the site of biopsy. After the biopsy, your neck area will be observed for bleeding and gentle pressure applied. You should notify the nurses or physician if you experience either bleeding or swelling. This rarely occurs and is usually controlled readily with additional light pressure.
Shortness of breath or unusual chest pain immediately after a biopsy may be signs of a complication and should be reported promptly. If the femoral approach is used, you will be asked to lie on your back with your leg straight for an hour after the procedure.
Biopsy specimens are examined under the microscope for signs of rejection and take one day to process. You will receive the results of the biopsy the next day and be advised about the need for any changes in your medication regimen based on the results. An echocardiogram is done with each heart biopsy to assess ventricular function and is used in conjunction with the heart biopsy to determine a treatment regimen.