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

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.

Food and fluid are restricted for 6 - 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.

The procedure takes place in a radiology department, special procedures room, or cardiac diagnostics laboratory within a hospital. You will be given sedation to relax prior to the procedure, but you will remain 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 will be 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.

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 heart muscle tissue
• No abnormal tissues

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

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).