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Myocardial Biopsy

Myocardial biopsy is the removal of a small piece of heart muscle for examination.

The heart muscle is known as the myocardium. If your doctor suspects a problem with your heart muscle, you may need a biopsy. This involves removing a small piece of tissue for examination. A doctor often performs a myocardial biopsy during cardiac catheterization or other heart tests. However, you can also have this test on its own. The procedure usually occurs in a hospital. 

This biopsy uses a small catheter called a bioptome to remove a small piece of heart tissue. This is a special type of catheter that has jaws on its end. After the biopsy, your doctor will send the sample to a laboratory for analysis.

Who is eligible for a myocardial biopsy?

This procedure is needed for patients who may have:

  • Myocarditis.
  • Heart failure.
  • Cardiac tumors.
  • Heart transplant.
  • Cardiomyopathy.
  • Cardiac sarcoidosis.

Tests that may be used to detect the need for a myocardial biopsy include:

  • Lung (pulmonary) function tests.

  • Eye exam to check for vision problems that may be caused by sarcoidosis.

  • Blood and urine tests to measure white and red blood cell counts, as well as levels of certain enzymes that indicate damage to your heart muscle. Blood tests can also detect antibodies against viruses and other organisms that might indicate a myocarditis-related infection.

  • Chest X-ray to show the size and shape of your heart, as well as whether you have fluid in or around the heart that might indicate heart failure.

  • Positron emission tomography (PET) scan or magnetic resonance imaging (MRI) if sarcoidosis seems to be affecting your heart or central nervous system.

  • Electrocardiogram (EKG) to detect heart's electrical patterns and abnormal rhythms.

  • Cardiac MRI to show your heart's size, shape and structure and any inflammation.

  • Echocardiogram to show moving images of the beating heart, enlargement of your heart, poor pumping function, valve problems, clots or fluid around the heart.

What conditions can be diagnosed by a myocardial biopsy?

The results of a myocardial biopsy will let your doctor know if there’s any abnormality. A number of conditions can cause an abnormal biopsy, including:

  • Rejection of a heart transplant.

  • Heart damage from alcohol abuse.

  • Myocarditis, inflammation of the heart muscle.

  • Cardiac amyloidosis, a disease where amyloid protein builds up in the heart.

  • Cardiomyopathy, a heart muscle disease that makes it harder for your heart to pump blood to the rest of your body.

How do I prepare for a myocardial biopsy?

Your doctor will give you instructions on whether you can eat and drink before the biopsy. Typically, you shouldn’t consume food or liquid for six to eight hours before the test.

If you take any medications or supplements, ask your doctor whether you should stop them before the procedure. If you have diabetes, your doctor may need to adjust your medications for the day of the biopsy. Let your doctor know about any allergies you may have.

You’ll probably enter the hospital the morning of your biopsy. In rare cases, you may need to go to the hospital the night before.

Bring someone with you to the procedure or have a car service send a car for you after it’s over. You will not be able to drive yourself home.

What should I expect during my myocardial biopsy?

Myocardial biopsy is done through a catheter that is threaded into your heart (cardiac catheterization). The procedure will take place in a hospital radiology department, special procedures room, or cardiac diagnostics laboratory.

Steps in the procedure:

  • You may be given medicine to help you relax (sedative) before the procedure. However, you will remain awake and able to follow instructions during the test.

  • You will lie flat on a table.

  • The skin is scrubbed, and a local numbing medicine (anesthetic) is given.

  • A surgical cut will be made on your arm, neck, or groin.

  • The doctor inserts a thin tube (catheter) through a vein or artery, depending on whether tissue will be taken from the heart's right or left side.

  • If the biopsy is done without another procedure, the catheter is most often placed through a vein in the neck and then carefully threaded into the heart. The doctor will use moving X-ray images (fluoroscopy) or echocardiography (ultrasound) to guide the catheter to the correct area.

  • Once the catheter is in position, a special device with small jaws on the tip is used to remove small tissue pieces from the heart muscle.

  • The procedure takes one or more hours.

Why choose Presbyterian for myocardial biopsy?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options, including lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.