Innovative Transcatheter Valve Biopsy: A Modern Diagnostic and Therapeutic Approach for Prosthetic Valve Endocarditis and Pulmonary Valve Stenosis

Background: Diagnosing prosthetic valve endocarditis is challenging, often requiring a combination of imaging, microbiological, and histopathological data. PET-CT, while insightful, is limited in cases of hemodynamic compromise and may be confounded by noninfective immunological effects. Cardiac catheterization offers a distinct advantage by enabling both diagnostic tissue sampling and immediate intervention when necessary. We present a novel transcatheter valve biopsy technique developed to address these diagnostic challenges, particularly in patients with clinical, laboratory, and echocardiographic signs of endocarditis (modified Duke’s criteria) and/or significant pulmonary valve thickening or stenosis.

Methods: The technique was applied to 12 subsequent patients presenting with endocarditis indicators and/or massive pulmonary valve thickening or stenosis. Following balloon valvuloplasty, three to four biopsies were obtained directly from the valve site using a long sheath advanced into the right ventricular outflow tract (RVOT) and a 5F or 6F bioptome.

Results: In all cases, the biopsies were feasible and provided sufficient tissue samples for histopathological examination. Notably, there was no exacerbation of pulmonary valve regurgitation postprocedure, underscoring the safety of this approach.

Conclusion: This transcatheter valve biopsy technique is both safe and effective, consistently yielding adequate specimens for pathological evaluation without compromising valve function. It enhances diagnostic accuracy in complex cases like prosthetic valve endocarditis and provides the added benefit of enabling immediate therapeutic intervention in hemodynamically unstable patients. This method represents a valuable addition to the clinical arsenal for managing challenging valve pathologies.

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Artikel online veröffentlicht:
11. Februar 2025