(1128) - Utility of the Routine Screening Echocardiogram After Endomyocardial Biopsy for Identification of Hemopericardium or Tricuspid Valve Injury

Abstract

There is risk of hemopericardium and tricuspid valve injury after endomyocardial biopsy (EMB). Prior studies have shown that procedural complications during EMB are uncommon. The practice of obtaining a routine screening echocardiogram after EMB is varied. The purpose of this study was to determine the utility of the routine screening echocardiogram in identifying complications after EMB. All echocardiograms performed on the same day after an EMB, from January 2010 through August 2015, were reviewed at a single institution where echocardiograms are routinely performed after each EMB. Studies describing significant pericardial effusion (defined as at least “small-moderate”) and/or tricuspid regurgitation (defined as at least “moderate”) were identified. During the study period, 2,200 EMB were performed in 204 heart transplant patients (median age 11.9 yrs, range 0.3-24). Seventy-four percent (1,630/2,200) of the EMB were followed by a routine echocardiogram on the same day. Thirty-four at least “small-moderate” pericardial effusions were noted in 15 patients. Of these, there was one new “moderate” pericardial effusion that required pericardiocentesis and was found to have hemopericardium. Of note, hemodynamic compromise had already been detected in this 5 yo patient, who received a fluid bolus in recovery prior to his echocardiogram. The other 33 effusions had been seen in previous echocardiograms. These effusions were all expectantly managed and none required intervention. Two echocardiograms identified new flail tricuspid valve with at least “moderate” regurgitation in 2 different patients (age 3 and 13yrs). To date, only the younger patient has undergone surgical tricuspid valvuloplasty. Echocardiography following endomyocardial biopsy rarely detects clinically significant complications. These findings argue against the utility of routine post-biopsy echocardiographic screening for identification of hemopericardium or tricuspid valve injury.