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Myocardial biopsy

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

  • Alternative Names
    • Heart biopsy; Biopsy - heart

  • How the Test is Performed
    • 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.

      To have 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 stretcher or table while the test is being done.
      • The skin is scrubbed and a local numbing medicine (anesthetic) is given.
      • A surgical cut will be made your arm, neck, or groin.
      • The health care provider inserts a thin tube (catheter) through a vein or artery, depending on whether tissue will be taken from the right or left side of the heart.
      • 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 uses moving x-ray images (fluoroscopy) 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 pieces of tissue from the heart muscle.
      • The procedure may last 1 or more hours.
      Biopsy catheter
  • How to Prepare for the Test
    • You will be told not to eat or drink anything for 6 to 8 hours before the test. The procedure takes place in the hospital. Most often, you will be admitted the morning of the procedure, but in some cases, you may need to be admitted the night before.

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

  • How the Test will Feel
    • You may feel some pressure at the biopsy site. You may have some discomfort due to lying still for a long period of time.

  • Why the Test is Performed
  • Normal Results
    • A normal result means no abnormal heart muscle tissue was discovered. However, it does not necessarily mean your heart is normal because sometimes the biopsy can miss abnormal tissue.

  • What Abnormal Results Mean
    • An abnormal result means abnormal tissue was found. This test may reveal the cause of cardiomyopathy. Abnormal tissue may also be due to:

  • Risks
    • Risks are moderate and include:

      • Blood clots
      • Bleeding from the biopsy site
      • Cardiac arrhythmias
      • Infection
      • Injury to the recurrent laryngeal nerve
      • Injury to the vein or artery
      • Pneumothorax
      • Rupture of the heart (very rare)
      • Tricuspid regurgitation
  • References
    • Cooper LT, Knowlton KU. Myocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 67.

      O'Connor CM, Rogers JG. Heart failure: Pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.