Transseptal fine needle aspiration of a large left atrial tumour

Diagnosis of a rare cardiac human herpesvirus-8 positive B-cell lymphoma manifestation: a case report of a transoesophageal echocardiography-guided trans-septal catheter biopsy

Introduction

Human herpesvirus-8-associated B-cell lymphoma is a common disease entity in immunocompromised individuals, particularly in patients with chronic HIV-infection or AIDS. However, cardiac manifestations are extremely rare. Tissue for histopathology of left cardiac tumours is most commonly obtained by open surgery.

Case presentation

In this report, we present a case of a solitary left atrial manifestation of an HHV8+ B-cell lymphoma in a 59-year-old patient presenting with B symptoms and a cardiac mass on echocardiography. Due to the high operative risk of the patient, a transcatheter/trans-septal biopsy was performed to establish the diagnosis.

Discussion

In the era of routine trans-septal catheter interventions, this approach may represent a straight-forward, minimally invasive alternative for patients at high risk for surgery.

Particle formation and risk of embolization during transseptal catheterization: comparison of standard transseptal needles and a new radiofrequency transseptal needle

Objective

Anecdotally, the Brockenbrough transseptal needle generates plastic particles through a process of skiving (shaving off particles), when advanced through the dilator and sheath. This study was performed to assess particle creation by the Brockenbrough needle during transseptal catheterization. We explore strategies that may reduce this phenomenon, including use of the Brockenbrough stylet and a radiofrequency transseptal needle.

Method

In vitro simulations of transseptal catheterization were performed using Brockenbrough transseptal needles and a new radiofrequency transseptal needle. Particles that were created during advancement of transseptal needles through the sheath and dilator were collected and analyzed. Particles in the visible range of 50 μm to 4 mm were identified using a light microscope, whereas particles in the sub-visible, yet clinically relevant range of 10 to 50 μm, were counted using a light obscuration method.

Results

All simulated procedures using the Brockenbrough transseptal needles, with or without a stylet, generated visible particles. Simulated procedures with the radiofrequency transseptal needle generated no visible particles. A greater number of sub-visible particles were generated with the standard Brockenbrough transseptal needle (BKR-1) without stylet compared with the standard Brockenbrough needle (BRK-1) with stylet, the Brockenbrough extra sharp (BRK-1XS) needle with or without stylet, and the radiofrequency needle (NRG C1).

Conclusion

Clinically relevant particles, both visible and sub-visible, with the potential for causing embolic complications, are generated by the BRK-1 needle without stylet. Use of a stylet in the BRK-1 needle, or the BRK-1XS needle with or without stylet, appears to reduce the size and amount of particles created. The NRG C1 needle appears to eliminate visible particles and is comparable to the BRK-1 with stylet and the BRK-1XS with or without stylet in generation of sub-visible particles. Important steps can be taken to minimize the creation of particles during the advancement of the BRK-1 through the transseptal sheath and dilator.