Endomyocardial biopsy: variations in venous access for endomyocardial biopsy in cardiac transplantation

With the increasing number of cardiac transplantation procedures performed worldwide, a strategy for endomyocardial biopsy techniques has evolved at our institution. Specific approaches for venous access for biopsy purposes are described. These include approaches via the right internal jugular vein, right external jugular vein, left subclavian vein, and the femoral veins. Particular emphasis is placed on the technical nuances of each approach. In approximately 2,000 endomyocardial biopsies performed on 155 transplant patients from 1984-1989, only two major complications occurred, only one of which required operative intervention. This was a perforated right ventricle, and the patient recovered after repair without further sequelae. No pneumothoraces or infection occurred during this time period. With proper understanding of regional anatomy, fluoroscopic appearance, and experience, endomyocardial biopsies can be performed with an extremely low incidence of major or minor complications.