Real-time sonography in central venous access for endomyocardial biopsy in cardiac transplantation patients.

Abstract

Endomyocardial biopsy remains the gold standard to assess cardiac rejection in cardiac transplantation patients. The aim of this study is to evaluate the supportive role and benefits of real-time sonography in central venous access for cardiac biopsy. Between January and September 2006, a retrospective review was carried out for the performance of central venous access using real-time sonography on 74 transplantion patients undergoing 305 cardiac biopsies by a single operator. The study included 56 male and 18 female patients, some of whom had severe dyspnea, obesity, dehydration, peripheral and pulmonary edema. All patients underwent successful central venous access using real-time ultrasonic guidance. With increasing experience as a sonographer, central venous access became less invasive and traumatic and more precise and successful. The supportive role of real-time sonography was associated with less major complications and greater patient comfort, even among conscious patients with severe dyspnea and obesity in non-Trendelenburg position using routine local anesthesia. Use of real-time sonography during percutaneous sheath insertion of the right internal jugular vein and the right subclavian vein provides an improved means to safe and quick access for cardiac biopsies with high success rates and low complication rates.