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Myocardial biopsy

Heart biopsy; Biopsy - heart

 

Myocardial biopsy is the removal of a small piece of heart muscle for examination.

How the Test is Performed

 

Myocardial biopsy is done through a catheter that is threaded into your heart (cardiac catheterization). The procedure will take place in a hospital radiology department, special procedures room, or cardiac diagnostics laboratory.

To have the procedure:

  • You may be given medicine to help you relax (sedative) before the procedure. However, you will remain awake and able to follow instructions during the test.
  • You will lie flat on a stretcher or table while the test is being done.
  • The skin is scrubbed and a local numbing medicine (anesthetic) is given.
  • A surgical cut will be made your arm, neck, or groin.
  • The health care provider inserts a thin tube (catheter) through a vein or artery, depending on whether tissue will be taken from the right or left side of the heart.
  • If the biopsy is done without another procedure, the catheter is most often placed through a vein in the neck and then carefully threaded into the heart. The doctor uses moving x-ray images (fluoroscopy) to guide the catheter to the correct area.
  • Once the catheter is in position, a special device with small jaws on the tip is used to remove small pieces of tissue from the heart muscle.
  • The procedure may last 1 or more hours.

 

How to Prepare for the Test

 

You will be told not to eat or drink anything for 6 to 8 hours before the test. The procedure takes place in the hospital. Most often, you will be admitted the morning of the procedure, but in some cases, you may need to be admitted the night before.

A provider will explain the procedure and its risks. You must sign a consent form.

 

How the Test will Feel

 

You may feel some pressure at the biopsy site. You may have some discomfort due to lying still for a long period of time.

 

Why the Test is Performed

 

This procedure is routinely done after heart transplantation to watch for signs of rejection.

Your provider may also order this procedure if you have signs of:

  • Alcoholic cardiomyopathy
  • Cardiac amyloidosis
  • Cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Idiopathic cardiomyopathy
  • Ischemic cardiomyopathy
  • Myocarditis
  • Peripartum cardiomyopathy
  • Restrictive cardiomyopathy

 

Normal Results

 

A normal result means no abnormal heart muscle tissue was discovered. However, it does not necessarily mean your heart is normal because sometimes the biopsy can miss abnormal tissue.

 

What Abnormal Results Mean

 

An abnormal result means abnormal tissue was found. This test may reveal the cause of cardiomyopathy. Abnormal tissue may also be due to:

  • Amyloidosis
  • Myocarditis
  • Transplant rejection

 

Risks

 

Risks are moderate and include:

  • Blood clots
  • Bleeding from the biopsy site
  • Cardiac arrhythmias
  • Infection
  • Injury to the recurrent laryngeal nerve
  • Injury to the vein or artery
  • Pneumothorax
  • Rupture of the heart (very rare)
  • Tricuspid regurgitation

 

 

References

Cooper LT, Knowlton KU. Myocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 67.

O'Connor CM, Rogers JG. Heart failure: Pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.

 
  • Heart transplant - overview

    Heart transplant - overview

    Animation

  •  

    Heart transplant - overview - Animation

    Basic information about heart transplantation.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Biopsy catheter

    Biopsy catheter - illustration

    When a small piece of heart muscle tissue is needed for examination, a heart biopsy can be performed. A catheter is carefully threaded into an artery or vein to gain access into the heart. A bioptome (catheter with jaws in its tip) is then introduced. Once the bioptome is in place, three to five small pieces of tissue from the heart muscle are removed. The test is performed routinely after heart transplantation to detect potential rejection. It may also be performed when cardiomyopathy, myocarditis, cardiac amyloidosis, or other disorders are suspected.

    Biopsy catheter

    illustration

  • Heart transplant - overview

    Animation

  •  

    Heart transplant - overview - Animation

    Basic information about heart transplantation.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Biopsy catheter

    Biopsy catheter - illustration

    When a small piece of heart muscle tissue is needed for examination, a heart biopsy can be performed. A catheter is carefully threaded into an artery or vein to gain access into the heart. A bioptome (catheter with jaws in its tip) is then introduced. Once the bioptome is in place, three to five small pieces of tissue from the heart muscle are removed. The test is performed routinely after heart transplantation to detect potential rejection. It may also be performed when cardiomyopathy, myocarditis, cardiac amyloidosis, or other disorders are suspected.

    Biopsy catheter

    illustration

A Closer Look

 

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        Tests for Myocardial biopsy

         

         

        Review Date: 5/5/2016

        Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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