Definition  

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 in a procedure similar to (or during) cardiac catheterization. The skin is scrubbed and a local anesthetic is given. A thin tube (catheter) is inserted through a vein or artery, depending on whether cardiac tissue is needed from the right or left ventricle.

When myocardial biopsy is performed by itself, the catheter is most often inserted in the jugular vein in the neck and then carefully threaded into the heart. A type of moving x-ray images called fluoroscopy is used 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  

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

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

How the test will feel  

The procedure will take place in a hospital radiology department, special procedures room, or cardiac diagnostics laboratory. You will be given a sedative prior to the procedure to help you relax, but you will remain awake and able to follow instructions during the test. You will lie flat on a stretcher or 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 will be given a local anesthesia for the insertion of the catheter, and the only sensation you should feel will be 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 watch for signs of rejection. It may also be performed when a disorder such as cardiomyopathy, myocarditis, or cardiac amyloidosis is suspected.

Normal Values 

• Normal heart muscle tissue
• No abnormal tissue

What abnormal results mean   

This test may reveal:

• The cause of cardiomyopathy
• Myocarditis
• Amyloidosis
• Transplant rejection

Additional conditions for which the test may be performed include:

• 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).