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01.12.2018 | Case report | Ausgabe 1/2018 Open Access

BMC Cardiovascular Disorders 1/2018

Endomyocardial biopsy guided by intracardiac echocardiography as a key step in intracardiac mass diagnosis

BMC Cardiovascular Disorders > Ausgabe 1/2018
Marco Zanobini, Antonio Dello Russo, Matteo Saccocci, Sergio Conti, Elisa De Camilli, Giulia Vettor, Valentina Catto, Maurizio Roberto, Cesare Fiorentini, Giuseppe Viale, Claudio Tondo, Michela Casella
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12872-018-0749-9) contains supplementary material, which is available to authorized users.



Based on a plenty of different applications, intracardiac echocardiography (ICE) is now a well-established technology in complex electrophysiological procedures. Recently, ICE has become the most widely used ultrasound-based imaging tool to guide diagnostic endomyocardial biopsy (EMB). EMB of cardiac mass guided by ICE is an interesting application of ICE. Allowing a correct positioning of the bioptome, ICE reduce the procedure-related risks and the need of a diagnostic open-chest procedure reserving the more invasive approach to selected cases.

Case presentation

Hereby we report a case series of right ventricular masses in which the EMB was safely and effectively performed under ICE guidance giving essential information for planning the therapeutic strategy.


The diagnosis of both metastatic and primary cardiac tumors relies on the histopathological analyses. The endomyocardial biopsy is a valuable tool for preoperative diagnosis and surgical planning of intracardiac masses suspected for tumors. In our experience, the use of ICE for right ventricle EMB of an intracardiac mass is an attractive modality thanks to the precise localization of the cardiac structures and the ability to guide bioptic withdrawal in the target area.
Additional file 1: Movie 1.
The whole action of EMB is showed. Fluoroscopy image in RAO view: ICE probe is placed across the tricuspid valve and positioned in the right ventricular inflow tract to image the ventricles in the long axis view. Through a long-deflectable sheath (Agilis, St. Jude Medical, MN, USA) the bioptome is inserted and directed to the mass visualized by ICE. After checking carefully the placement of the bioptome, a sample is taken. (MOV 4285 kb)
Additional file 2: Movie 2.
ICE imaging of EMB taken in the right ventricular apex. (MOV 4960 kb)
Additional file 3: Movie 3.
ICE imaging of massive multi-lobed intracardiac mass in the right ventricular outflow tract. (MOV 4341 kb)
Additional file 4: Movie 4.
EMB guided by ICE. ICE visualizes a good contact between the bioptome and the mass. (MOV 4225 kb)
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