Role of Left Ventricular Biopsy in the Management of Heart Disease

The Changing Role for Endomyocardial Biopsy in the Diagnosis of Giant-Cell Myocarditis

“…Biventricular EMB yielded more frequent diagnostic results (79.3%) compared to left or right ventricle-selective EMBs (67.3%, P < 0.001) [ 17 ]. In clinical scenarios in which the left ventricle if solely or primarily affected, LV biopsy may add substantially to the sensitivity of EMB for the diagnosis of myocarditis and probably GCM [ 18 , 19 ].…”

“…The diagnostic accuracy can be optimized when the EMB is performed by experienced cardiac interventionalists, sampling error reduced by performing EMB early in the course of the disease, and taking multiple samples, at least 3, each 1–2 mm in size from either the right or the left ventricle [ 15 ], and performing immunohistochemistry and viral genome amplification for assessment of suspected myocarditis [ 18 ].…”

Myocardial biopsy: techniques and indications

“…Patients who present with unexplained heart failure of <2 weeks’ duration, causing haemodynamic compromise, should be investigated with EMB (class of recommendation 1, level of evidence B) 41. This can offer useful diagnostic and prognostic information.…”

Preemptive Cardioprotective Strategies in Patients Receiving Chemotherapy

“…Despite being invasive and requiring transvenous approach, EMB carries less than a 6 % risk of complications [72], which include bleeding, transient arrhythmia, valvular injury, pulmonary embolism, and cardiac chamber perforation [73,74]. Because there is variable myocardial regional involvement, 4-6 biopsies are usually taken from the right and occasionally left ventricle to maximize diagnostic yield [75]. Electron microscopy shows characteristic depletion of myofibrillar bundles, distortion and disruption of the Z-lines, mitochondrial disruption, and myocyte vacuolization [76].…”