Myocardial biopsy

Alternative names
Heart biopsy; Biopsy - heart

Myocardial biopsy is a diagnostic procedure in which a small piece of heart muscle tissue is removed for examination.

How the test is performed

Myocardial biopsy is performed similarly to (or as part of) cardiac catheterization. The skin is scrubbed and a local anesthetic is injected into the skin. A catheter (thin tube) is inserted through a vein or artery, depending on whether cardiac tissue is needed from the right or left ventricle, respectively.

When myocardial biopsy is performed by itself, the jugular vein in the neck is most commonly used. The catheter is then carefully threaded into the heart, using a type of X-ray images called fluoroscopy to guide the insertion. A catheter with jaws in its tip, called a bioptome, is then introduced. Once the bioptome is in place, three to five small pieces of tissue are removed from the heart muscle.

How to prepare for the test

Food and fluid are restricted for 6 to 8 hours before the test. The procedure takes place in the hospital. Generally, you will be admitted as either an outpatient or an inpatient the morning of the procedure. In some cases you may need to be admitted the night before.

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

A mild sedative is usually given 1/2 hour before the procedure. You will wear hospital clothing.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

The procedure takes place in a radiology department, special procedures room, or cardiac diagnostics laboratory within a hospital. You are given sedation to relax prior to the procedure, but you are awake and able to follow instructions during the test. You will remain on a stretcher or flat on a radiology table for the duration of the test.

An incision will be made into a vein in your arm, neck, or groin for threading the catheter into your heart. You are given a local anesthesia for the insertion of the catheter, and the only sensation should be one of pressure at the site.

You may feel some discomfort due to lying still for a prolonged period of time. The procedure may last from one to several hours.

Why the test is performed
This 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.

Normal Values

  • Normal heart muscle tissue  
  • No abnormal tissues

What abnormal results mean

This test may reveal:

  • Causes of cardiomyopathy  
  • Myocarditis  
  • Amyloidosis  
  • Transplant rejection

Additional conditions under which the test may be performed:

  • Alcoholic cardiomyopathy  
  • Hypertrophic cardiomyopathy  
  • Idiopathic cardiomyopathy  
  • Ischemic cardiomyopathy  
  • Peripartum cardiomyopathy  
  • Restrictive cardiomyopathy

What the risks are
Risks are moderate and include cardiac arrhythmias, trauma to the vein or artery, infection, blood clots (thrombosis) in the vein, bleeding from the biopsy site, pneumothorax, injury to the recurrent laryngeal nerve, and rupture of the heart (very rare).

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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