Surveillance for rejection by echocardiographically guided endomyocardial biopsy in the infant heart transplant recipient.

Echocardiographically guided endomyocardial biopsy via percutaneous right internal jugular vein puncture has been performed 98 times in six patients 5-16 years of age at our institutions. The use of this approach was extended for rejection surveillance in seven infants transplanted at 2 weeks to 15 months of age (median, 2 months; mode, 2 weeks). A total of 35 consecutive biopsies were performed under heavy sedation in these infants (lowest weight, 3.0 kg) with the use of a 5F semirigid bioptome through a 5.0-cm 5F sheath. There was no case of entrance failure. A median of four biopsies was performed on each child (range, one to 14). Four to seven tissue pieces per biopsy were obtained using an apical four-chamber view for bioptome guidance. Ten instances of clinically suspected rejection were not confirmed by biopsy, and two cases of unsuspected rejection were found. The only complication was one instance of new mild tricuspid regurgitation in this group compared with one instance of increased tricuspid regurgitation after biopsy in the older child group. These preliminary results suggest that echocardiographically guided endomyocardial biopsy from the right internal jugular approach is a reliable and safe means for rejection surveillance in the infant and young child.