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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.
In adults and older children routine heart biopsies are performed approximately every week for the first four weeks after the operation and then with less frequency, depending on your course. After six months, most patients can have routine biopsies every three months. The need for surveillance biopsies on a routine basis is indefinite.
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 treat yourself to pizza or other salty foods)
- Don't lift heavy objects for 24 hours following the biopsy
How it works
The procedure is done in the operating room or cardiac cath lab and takes about 30 minutes. A doctor will give you a local anesthetic to numb an area around your neck.
A long tube (catheter) called a bioptome is passed through a small incision on the right side of the neck then down into your heart. (See Figure 7). Sometimes the biopsy catheter will be placed though a vein in your groin if the neck veins aren’t accessible. (See Figure 6).
A type of X-ray called fluoroscopy, helps the doctors guide the bioptome 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.
They will look for white blood cells to determine if you are experiencing rejection. The biopsy results are usually available within 24 to 48 hours. The Transplant Coordinator will notify you of the results as soon as possible.
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.