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Endomyocardial biopsy

Leslie T Cooper, Jr, MD
Section Editors
William J McKenna, MD
Sharon A Hunt, MD
Heidi M Connolly, MD, FASE
Deputy Editor
Susan B Yeon, MD, JD, FACC


Interest in the use of endomyocardial biopsy (EMB) as a diagnostic tool for patients who present with abnormal systolic or diastolic function has grown as the technique has been refined and perfected. The first transvenous EMB forcep, the Konno-Sakakibara bioptome, was developed in Japan in 1962 [1]. A modified bioptome, the Caves-Schultz-Stanford bioptome, was developed in 1972, and versions of this device are still widely used [2]. Flexible bioptome devices with smaller jaws have been developed and are associated with very low complication rates [3]. Declines in the procedural risk of EMB and increasing evidence of its value in diagnosis and guiding therapy are extending the role for EMB at medical referral centers with necessary technical expertise.

Monitoring for allograft rejection after cardiac transplantation is the strongest indication for EMB (see "Acute cardiac allograft rejection: Diagnosis"). The role for this procedure in other disorders, such as myocarditis and idiopathic dilated cardiomyopathy, has been more controversial.

The general role of EMB in cardiovascular disease will be reviewed here. The importance of EMB in individual diseases will be discussed in detail in the appropriate topic reviews.


Access and imaging — Endomyocardial biopsy (EMB) was initially performed via the internal jugular vein and the right internal jugular vein remains the most common access site in the United States. However, the advent of long, flexible bioptome devices permits a femoral venous approach with equal efficacy.

EMB is usually performed with fluoroscopic guidance. Transthoracic echocardiography is increasingly used in conjunction with fluoroscopy in an effort to reduce the risk of cardiac perforation. Echocardiography also allows visualization of biopsy location, which is important to confirm that the same site is not repeatedly biopsied and for conditions such as intracardiac mass.

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Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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