A myocardial (heart) biopsy is an invasive examination of the heart and is performed as a last resort when other tests have failed to make a definitive diagnosis. Cardiac biopsy is associated with various types of complications, the most serious of which are right ventricular perforation and cardiac tamponade, which may result in the patient's death. What are the indications and contraindications for a heart biopsy? What is the examination about? What other complications can it give?
Myocardial biopsy , in terminology endomyocardial biopsy, is the removal of heart tissue for microscopic examination to diagnose heart disease.
Myocardial biopsy - indications and contraindications
A heart muscle biopsy is performed to diagnose the following heart conditions:
- myocarditis
- cardiomyopathy
- heart failure of unknown cause
- heart tumors
Myocardial biopsy can also be performed in the case of myocardial damage after treatment with cytostatics, and to assess its function after heart transplantation. It can help to answer the question why the heart rhythm is disturbed despite the treatment.
A heart biopsy is not performed in people with blood clotting disorders and treated with anticoagulants. Myocardial biopsy is also not recommended for:
- hypokalemia
- decompensated hypertension
- fever-related infections
- circulatory failure
- severe anemia
- endocarditis
- during pregnancy.
Read also: Biopsy: types of biopsy and the course of the examination
Myocardial biopsy - how to prepare?
You don't need to prepare yourself for a heart biopsy. Only about 6 hours before the test, you should give up eating.
Myocardial biopsy - course
1. An echocardiogram of the heart is performed
2. The patient is given local anesthesia.
3. The jugular vein is punctured (sometimes the femoral vein or the femoral artery) and the vascular sheath is inserted - it is a tube through which a biopsy is then inserted - a type of catheter with a tip incharacters of sharpened spoons
During the biopsy, the heart rhythm (electrocardiographically), blood pressure and blood oxygen saturation are constantly monitored with a pulse oximeter
Thanks to this tip, you can extract a piece of the heart muscle (1-3 mm2) by biting into the tissue, not through incisions. Sections are taken in small amounts (1-3 mm 2) and usually from the septum, outflow tract and apex of the heart, less often from the free wall of the ventricle. After collecting the heart muscle fragment, the biotome is removed, then the vascular sheath and the puncture site is compressed.
4. The echocardiographic examination of the heart (UKG) is performed again.
5. The collected sections are fixed and stained, and then sent to the laboratory for histological examination (evaluation under the microscope).
Myocardial biopsy - complications
Wearing a sheath carries the risk of an arterial puncture during local anesthesia, a vasovagal reaction (vasodilation and a slower heart rate, which leads to a drop in blood pressure), and prolonged bleeding after the sheath is removed.
In turn, the biopsy itself carries the risk of cardiac arrhythmias (e.g. atrial fibrillation), deep vein thrombosis, pneumothorax, and even cardiac perforation with a tamponade, which is a life-threatening condition. The risk of death after myocardial biopsy is 0.05-0.5%.