Correlation between gallium-67 imaging and endomyocardial biopsy in children with severe dilated cardiomyopathy
Paulo Roberto CamargoR MazzieriR SnitcowskyMaria de Lourdes HiguchiJosé Cláudio MeneghettiJosé SoaresAlfredo Inácio FiorelliMunir EbaidF Pileggi
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Dilated Cardiomyopathy
Endomyocardial Biopsy
Since the introduction of the bioptome in 1962, examination of fresh endomyocardial tissue has been undertaken progressively in many centres despite the misgivings of some investigators. In my own experience, I have examined biopsies from 3225 patients, of whom 1978 were suspected to have dilated cardiomyopathy. Of these patients, 549 showed evidence of myocarditis. Categorization into active (acute), resolving (healing) and resolved (healed) stages is important because of therapeutic implications. It is concluded that endomyocardial biopsies are of immense value in dilated cardiomyopathy where the relationship with myocarditis has become established. Even though in many cases only non-specific features are found, biopsy excludes those conditions that can result in a hypertrophied, dilated heart. Biopsy also forms the baseline for further investigations, such as virological, immunological, morphometric analyses and distinction from alcohol effects, all of which have thrown light on the pathogenetic mechanism of dilated cardiomyopathy.
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The authors summarize experience gained with a study of biopsy specimens obtained on endomyocardial biopsies from 88 patients with a clinical diagnosis of dilated cardiomyopathy. The diagnostic value of the study was equal to 70%. Dilated cardiomyopathy largely masked myocarditis and alcoholic cardiomyopathy which were diagnosed morphologically in 30 and 13% of the patients, respectively. No morphological alterations which would allow one to change the clinical diagnosis of dilated cardiomyopathy were discovered in 26% of cases. It has been shown that endomyocardial biopsy is an important tool of diagnosis. In order to introduce it on a broader scale, it is necessary that quantitative uniform criteria for the diagnosis of endomyocardial diseases, primarily myocarditis, be elaborated.
Dilated Cardiomyopathy
Endomyocardial Biopsy
Restrictive cardiomyopathy
Alcoholic cardiomyopathy
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Abstract Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy in children. Heart transplantation is considered standard therapy in dilated cardiomyopathy with end-stage heart failure. We present a case of a 15-year-old patient diagnosed with DCM in the neonatal period, who underwent heart transplantation for end-stage heart failure. Despite the use of induction therapy, the endomyocardial biopsy performed at two weeks post-transplant revealed mixed moderate cellular (2R) and humoral (pAMR2) allograft rejection. Aggressive rejection treatment was initiated with good outcome. Besides endomyocardial biopsy, advanced echocardiography can also be a valuable noninvasive tool for rejection assessment.
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Endomyocardial Biopsy
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Dilated Cardiomyopathy
Endomyocardial Biopsy
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Dilated Cardiomyopathy
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Dilated cardiomyopathy (DCM) associated with inflammation is diagnosed by endomyocardial biopsy; patients with this have a poorer prognosis than patients without inflammation. To date, standard diagnostic criteria have not been established.
Dilated Cardiomyopathy
Endomyocardial Biopsy
Infiltration (HVAC)
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