Myocardial Biopsy

About the Procedure

Myocardial Biopsy (also known as Endomyocardial Biopsy) is a procedure to remove a small piece of heart muscle after heart transplants to detect rejection, or diagnosis of suspected disorders such as cardiomyopathy, and myocarditis. Since the heart affects and is affected by other organs and processes, the biopsy can be a tool in identifying the interrelationship between an illness and the heart. The procedure is sometimes done during a cardiac catheterization when a catheter has already been inserted.

The biopsy is an hour long procedure performed by a cardiac surgeon in a hospital or cardiac lab while the patient is lightly sedated but awake. Anti-clotting medications may be used intravenously to reduce the risk of an embolism. When performed on its own, an incision is made in either the jugular vein (for right ventricle access) or the femoral artery (for left ventricle access) and a bioptome, a small catheter designed to pinch off a piece of heart muscle, is threaded along until it reaches the heart. Three or more pieces of tissue the size of a pinhead are obtained for biopsy, the bioptome is removed and the incision closed up. Firm pressure is applied to the incision site to discourage bleeding.

What to Know Before the Procedure

The risks in a myocardial biopsy are considered moderate and manageable. They include: blood clots, bleeding at the site from which the tissue was taken, cardiac arrhythmias, injury to arteries, veins, nerves, or valves. As the procedure involves direct contact with the heart, serious complications could occur. There are many diagnostic and treatment options available prior to performing a biopsy, therefore the patient needs to communicate openly with the physician before deciding to have this procedure.

The physician may prescribe an anticoagulant medication such as Heparin or Aspirin, to be taken for several days before the scheduled biopsy. It is intended to lessen the likelihood of a clot during and after the procedure. Preadmission x-rays and blood work will be done prior to the day of the procedure and instructions on food and water intake will be provided by the doctor. Patients are advised to plan in advance for a ride at discharge as post-operative pain medications may cause drowsiness and they are encouraged to avoid unnecessary moving around.

What to Know After the Procedure

Patients are monitored for complications in a recovery room for a few hours after the heart biopsy. They are instructed to remain flat and rest for six to eight hours. While the procedure is performed on an out-patient basis, at-risk patients often need closer monitoring and may be required to have the biopsy in a hospital where they will stay for up to 24 hours. Most patients will be discharged on the same day. Instructions on wound care are given prior to discharge along with symptoms to report to the physician. Normal activities can be resumed once any prescribed narcotic medicine is discontinued. Strenuous activities are to be avoided for two to three days and the doctor should be consulted about returning to a strenuous job.

If you Need to Travel Outside of your Local Hospital

For patients looking to travel for this procedure, the most critical concern should be to find a skilled physician with considerable experience to perform it. Most patients are discharged on the same day with no long recovery period, making this procedure viable for local, short-distance and long-distance travel. When having this procedure performed abroad, be sure to discuss with your doctor any follow-up care or screenings that may be necessary, as well as how to go about having those done after leaving their country of residence. The primary concerns in deciding on where to have the procedure performed should be the doctor’s reputation and level of skill; overall cost for the procedure, travel, and hospital stay; and time that can be allocated for travel, recovery, and any necessary follow-up care.