ABSTRACT
Disorders of the heart muscle remain among the most poorly understood disease processes in all of cardiovascular medicine. Endomyocardial biopsy techniques have now been available for over 50 years to evaluate underlying primary myocardial pathology. This chapter reviews the history of endomyocardial biopsy. It defines the anatomic considerations and basic biopsy technique. The chapter then discusses the indications, complications, and future directions of this important procedure. Modern bioptomes in use since the mid-1990s are disposable, single-use devices eliminating concerns about disease transmission, pyrogen reactions, or cutting edge resharpening. Bioptomes are made in standard lengths of 50 cm for use in the neck and chest central venous system, or over 100 cm, for use in the femoral vein or artery. The greatest risk to patients undergoing endomyocardial biopsy is ventricular perforation. Ventricular ectopy is an expected consequence of cannulation and mechanical stimulation of the cardiac chambers by the sheath or bioptome.
