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Toronto General Hospital using new alternative to open heart surgery for biopsies

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Doctors at the University Health Network have started to use a minimally invasive technique, previously used on lung patients, to carry out biopsies on patients with a mass needing diagnosis in their hearts.

Susan Bell was one of those patients.

After a medical technician detected something unusual in her heart during a routine checkup last fall, Bell underwent more testing only to find out she had a large mass right in the middle of her heart.

"Nobody had ever dealt with this type of tumour," she says. "It's right in the centre part of my heart, in the wall…The complexity, the location and the size made it a really rare (thing)."

Bell's doctor told her she would need open heart surgery to biopsy the mass and determine if it was cancerous.

But he also happened to be attending a medical conference around the same time. So, he presented Bell's case and asked for alternatives to biopsy the tumour.

A colleague of his from Toronto General Hospital (TGH), Dr. Patrik Rogalla, was also there and offered to do a minimally invasive procedure to get a sample of the tissue from the heart, which he had previously done to obtain lung tissue samples.

But the heart, says Dr. Rogalla, is quite different from the lungs.

"It is relatively easy for most people to hold their breath for a few seconds, during which we can do the sampling procedure and can take the tissue from a target," says Rogalla. "But we can't ask the heart to stop beating!"

This past April, Bell's physician, cardiac surgeon Dr. Robert Cusimano, and Dr. Rogalla, performed a minimally invasive biopsy on Bell while she was wide awake.

She was given a local anesthetic and a sedative but kept conscious so she could follow instructions, like holding her breath at certain points to minimize the movements of the chest, if not the heart itself, as much as possible.

No real incision was made, only a one-millimetre wide needle, inserted to take out a couple of tissue samples from the mass in Bell's heart. The procedure involves manually synchronizing a computerized tomography (CT) scan and fluoroscopy with the electrocardiogram (ECG) to collect the sample safely.

"They took the samples out and I had the results within three days," says Bell. "And I had absolutely no recovery (period), just an hour recovery at the hospital and other than that, I was on a plane and playing golf the next day."

Dr. Rogalla points out that some cases will still require open heart surgery for biopsies. But for cases like Bell's, the ability to avoid the surgery with its risks of infection, general anesthetics and lengthy recovery make this new procedure a clear benefit.

Plus, he points out, open heart surgery is very costly. The traditional procedure would cost just under $7,000 and require several days in the hospital, including a day and a half in the intensive care unit.

Bell went home the same day.

The biopsy showed her mass was simply a fatty tissue in her heart, and no further treatment was required. However, they will continue to do scans to monitor the mass for any changes.

Dr. Rogalla says in the near future, Toronto General Hospital could perform this 20 to 30-minute procedure on about 30 patients yearly.

And while TGH is the only hospital in Canada he knows of currently doing this technique for heart biopsies, he sees no reason others could not use it. 

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