- Leslie T Cooper, Jr, MD
Leslie T Cooper, Jr, MD
- Professor of Medicine
- Mayo Clinic College of Medicine and Science
- Section Editors
- William J McKenna, MD
William J McKenna, MD
- Section Editor — Myopericardial Disease
- Professor of Cardiology
- University College, London
- Sharon A Hunt, MD
Sharon A Hunt, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Heart Transplantation
- Professor of Medicine
- Stanford University School of Medicine
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
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 . A modified bioptome, the Caves-Schultz-Stanford bioptome, was developed in 1972, and versions of this device are still widely used . Flexible bioptome devices with smaller jaws have been developed and are associated with very low complication rates . 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Access and imaging
- Right or left ventricle
- Sampling and analysis
- EMB recommended
- - Fulminant HF
- - Early AV block, arrhythmias, or refractory HF
- EMB suggested in selected cases
- - Late AV block, arrhythmias, or refractory HF
- - DCM with eosinophilia
- - Anthracycline cardiotoxicity
- - Restrictive cardiomyopathy
- - Selected cardiac tumors
- - Unexplained cardiomyopathy in children
- - HCM with HF
- - ARVC
- EMB of unproven value
- - General evaluation of heart failure
- - Recent onset DCM
- - Chronic DCM
- - Unexplained arrhythmias
- - Unexplained atrial fibrillation
- SUMMARY AND RECOMMENDATIONS