Expectations and limitations of endomyocardial biopsy

Endomyocardial biopsy represents an attempt at applying tissue examination to the diagnosis of primary myocardial disease. The right ventricular septum is biopsied from either the internal jugular or femoral venous approach. Left ventricular endomyocardial biopsy has not gained widespread acceptance in North America. A complication rate of 1-4% has been reported. Clinical indications for endomyocardial biopsy include acute cardiac allograft rejection, adriamycin cardiotoxicity and the differentiation of restrictive myopathy from constrictive pericardial disease. The biopsy of patients with idiopathic dilated congestive myopathy to find a treatable form of myocarditis remains controversial and principally a research tool. Only 5-25% of patients with dilated cardiomyopathy are found to have myocarditis and immunosuppressive therapy in these patients has yet to be proven beneficial.