The Heart Biopsy

| August 3, 2011 | 1 Comments

Last Friday, I had a heart biopsy.  At this point of recovery, I would normally be on an every six-month biopsy schedule.  The complexity of my transplant calls for a heart biopsy every three months.  Once again, the results were very positive.

I mentioned before that I preferred the way Dr. Hoffman of Tampa General did the biopsies because I have great confidence in her.  Dr. Hoffman does many biopsies and catheterizations every week and I have found that her skills breed confidence.  She has a steady hand and very capable assistants at all times.

At Columbia Presbyterian, Dr. Mancini was my cardiologist.  She did not handle catheterizations or biopsies.  The biopsy – catheterization area at Columbia Pres is a busy place.  By the end of the day, these physicians, patients, staff and resident physicians are exhausted.  One day when we were in for a catheterization they had sixty procedures scheduled.

Friday was the first time I had a biopsy at Albany Medical Center.  As expected, Dr. Philbin was in good form.  I do not know how many biopsies I have had since the transplant but upon release from the hospital after the transplant I had my first biopsy in order to be released.  For the next six weeks, I had one each week.  As they were all negative for rejection, I then went to every other week, then once every month and now once every three months.

During the period that I was receiving a biopsy every week, the entry point in my neck, where they say I have a great vein, became calloused. This meant we would have to use the groin as the point of entry.  Patients who receive groin biopsies or catheterizations will have to spend about 90 minutes or more before they will be discharged. If the right side of the neck is used as the entry point, the patient can be released as soon as they receive their discharge papers.

Small Differences

At TGH and Albany Med, the cardiologist does the procedure.  I thought there were minor differences between the two centers.  When a patient checks in at TGH, they go to a private waiting room where a nurse gathers all recent information, including any adjustments in medications.  The nurse also takes all the vitals.

When this information is gathered, the patient slips into the gown and rests on a bed until the physician’s assistant comes in to review everything so that the physician has all info.

The patient’s preparation for both types of these procedures really begins about five days before the scheduled event.  For patients who are on Coumadin, they are instructed to halt their Coumadin intake and replace the Coumadin with Lovenox injections.  Lovenox neutralizes the blood flow, which Coumadin users know causes easy bruising and telling purple blotches.  A week before the biopsy, my INR was 3.1, way too high for the procedure.  At that level controlling the bleeding at the point of entry could cause a problem.  By the day of the procedure the Lovenox has helped reduce the INR but stabilizes the blood flow.  My reading was 1.1on Thursday before the test.

After the procedure, the patient continues to self inject the Lovenox but also begins to take the Coumadin again.  After five days, my level is still only 1.5 and the cardiologist wants it between 2.0 and 3.0.  I just received word to continue both blood thinners and get another reading on Friday.

What I like about Tampa General is the privacy afforded by the individual rooms and the fact that the screens are in the patient’s line of view. At Albany Med, there were six screens but they were at the end of the operating table and to the right.  Because the patient’s head is turned to the left, there was no way to see the screens.  It really is no big deal.

One difference between the way Albany Med and TGH go through the procedure is the fact that at TGH, a lidocaine patch is applied to the entry area. This numbs the exterior area so the patient is as comfortable as possible and barely feels any pressure at the point of entry.  Albany Med did not use this patch but the entry is almost commonplace for me.  Again, Dr. Hoffman has great hands. Both she and Dr. Philbin always keep the patient informed so when there might be a tinge of discomfort, the warning goes out.

The biggest difference, and a step that certainly was beneficial to me this time was the use of an x-ray after the procedure to make sure the lungs have not been accidentally punctured.  That is the single biggest risk of this procedure.

Unfortunately the x-ray revealed a “substantial unidentifiable mass” in the left lung, where I have had so much difficulty with aspergillius mold.  I received the call from Dr. Philbin’s office that they needed other x-ray angles to identify the mass.

It is not uncommon for transplant patients to contract cancer, especially skin cancer.  A recent visit to the dermatologist resulted in the freezing of several pre-cancer spots and a biopsy for one spot on my face.  The results of the biopsy are still unknown.  I was unnerved by the possibility of a cancerous growth in the lung.

It took me two days of self-pity to come to grips with the fact that I might have lung cancer.  But, by this morning I was fired up to get at whatever it was.  I had a cat scan of the spine to see if the aspergillius had resurfaced.

I received a call from infectious disease minutes ago.  The mass in the lung is scar tissue from previous infections.  Just as Suzanne came home, Dr Kiehl called to notify me about the results from the lung and from the spine.  I was so greatly surprised!  Wow!  What a break.  I think the die is changing.

The purpose of a heart biopsy, also called myocardial biopsy or cardiac biopsy, is to evaluate or establish the status of rejection.  The heart biopsy is also used to provide information about inflammation of the heart (myocarditis). 

Whereas the catheterization is usually used to measure the heart’s output or ability to serve as a vital pump for blood flow through the body, the biopsy actually snips minute pieces of the heart for lab analysis. 

The cardiologist numbs the exterior on the entry point with a local anesthetic.  A short hollow tube, which is a plastic sheath is inserted into a small incision.  A bioptome is inserted through the sheath and into a vessel in the neck. 

The bioptome is then threaded through the vein to the right ventricle.  The physician is guided by the use of x-rays (fluoroscopy) on a screen as the bioptome is threaded to a happy landing zone.

The bioptome has grasping clips at the end.  Once the right ventricle is reached, the physician uses the snips to claim about three or four pieces of the heart.  Each snip is about the size of the head of a pin.

Once the samples are claimed, the bioptome is carefully withdrawn as is the sheath.  An assistant will then apply pressure to the wound for five to seven minutes.  Once the blood has stopped, the larger bandage in applied. The bandage should remain in place for 24 hours.  It should not be wet.  The patient should not lift anything until the blood has completely halted.  If bleeding does not stop or starts up again, call the cardiologist immediately.

The biopsy and the catheterization are invasive but are relatively low risk procedures.  Compared to other procedures, this one is a piece of cake.  The hospital or treatment center will insist that the patient have an adult driver take the patient home.  From my perspective, these procedures are now so ordinary that there is little need to be intimidated. Relax and good luck!

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1 Comment on "The Heart Biopsy"

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  1. Dave Griffin says:

    Hiland!
    Glad to hear you are apparently doing well. We were wondering about you.
    Dave and Carolyn Griffin
    Saugerties

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