Transepicardial Biopsy For An Intracardiac Tumor In An Infant- Surgical Technique
Syed M. Bukhari, Manan Desai, Lok Sinha, Mia Maamari, Yue-Hin Loke, Bhupender Yadav, Ranjith Vellody, Richard Jonas, Pranava Sinha, Karthik Ramakrishnan.
Childrens Natinal Medical Center, Washington DC, Washington, DC, USA.
Objective: We demonstrate a surgical technique to obtain core biopsy sample from an intracardiac tumor in an infant.
Patient details: A term newborn was incidentally detected to have a large intracardiac mass arising from the interventricular septum. Although the mass appeared to compromise the left ventricular cavity, there was no evidence of left ventricular inflow or outflow obstruction. Cardiac magnetic resonance imaging revealed a large heterogeneous mass within the interventricular septum. The type of tumor could not be ascertained from the imaging characteristics of the mass.
Surgical technique: The heart was accessed through a midline sternotomy. Using epicardial echocardiogram, the mass was localized in the region of the interventricular septum, around the location of the distal left anterior descending artery. The epicardial surface seemed to be involved by the tumor. Under epicardial ultrasound guidance, a 17Ga BioPince co-axial introducer needle was placed into the mass through a purse-string placed on the epicardial surface above the tumor. The introducer needle was directed away from the cystic region of the tumor. An 18Ga 10cm BioPince biopsy stylet was passed through the introducer needle and multiple cores of tissue from various parts of the tumor were obtained for histopathological analysis, using the same epicardial puncture site by redirecting the introducer needle with each pass. Histological examination was consistent with a cardiac fibroma.
Conclusion: Multidisciplinary management with imaging cardiologist, interventional radiologist and cardiac surgeon using hybrid transpericardial -epicardial approach is a safe and effective way of obtaining cardiac tumor tissue for histopathological examination.