Endomyocardial Biopsy Guided by Echocardiography

In the recent year, transcatheter endomyocardial biopsy is a procedure relatively simple that has been increasingly utilized in cardiomyopathy diagnosis. It is estimated that over 50,000 biopsies are performed annually in the United States in general to control rejection episodes after heart transplantation. Endomyocardial biopsy plays important role in the diagnosis and treatment of adult and pediatric cardiovascular disease due to many specific myocardial disorders the etiology is seldom discovery by noninvasive testing. The indication this procedure may be especially challenging for many nonspecialists because the method is invasive and always must weigh the risks and benefits. The percutaneous transvenous endomyocardial biopsy has become the procedure safe and more convenient for rejection control after heart transplantation, histopathological diagnosis of cardiomyopathies or tumors1,2,3. The endomyocardial biopsy technique is safe in experienced hands however the method may lead to several complications, the most serious them is the right ventricle perforation with cardiac tamponade4,5. Heart biopsy already experimented investigation with different methods such as: open thoracotomy6; partial extrapleural thoracotomy with resection of a rib to facilitate the exposition7; percutaneous introduction of Vim-Silverman and Menghini needle8,9,10; introduction of a modified Ross transseptal needle through the superior vena cava or carotid artery11; and the use of cutting blades introduced through a catheter for endomyocardial biopsy12. Unfortunately, the heart biopsy history was marked by severe complications, which included pericardial tamponade, cardiac perforation, pneumothorax and hemothorax, and eventually death. Since 1980, the technique has become routinely used. Weinberg et al., in 1958, reported their experience with five patients who were undergone pericardial and myocardial biopsy13. The procedure was performed percutaneously under local anesthesia and the thorax was opened by resection of the fourth cartilage on the left. This invasive method did not gain ample acceptance due to high risk. The cardiac biopsy with needle through a limited thoracotomy was associated with pulmonary injuries, cardiac tamponade, coronary vessels laceration, arrhythmia, and sometimes with death. Despite these risks, direct needle biopsy was carried out in some centers.