Problems ofmyocardial biopsy

ITseemseasytotalk abouttheproblems ofanew technique, especially inthecaseofatechnique for obtaining humanmyocardial tissue invivo. Surprisingly, themainproblems donotlieinthetechnique itself, butrather inthedecision whether such abiopsy isindicated inacertain caseornot. Endomyocardial biopsy oftheRV bytheKonno method hasbeenperformed inninety patients. The small bioptome wasintroduced percutaneously by wayoftheright venafemoralis. Thelarge bioptome wasnotusedbecause ofits rigidity. Generally, itwaseasier tointroduce thebioptome into adilated RV thaninto anormal sized oreven small RV.Twotofour biopsy specimens wereusually taken. No complications occurred. Intwocases a biopsy by thoracotomy wasperformed by the surgeons. Thefirst problem onehastodiscuss before performing amyocardial biopsy isthequestion asto whichkindofmyocardial disease issuspected. Ifit isaquestion ofapatchy distribution ofthediseased myocardium, itisnotadvisable touseablind method. Neither theendomyocardial methodnorthetransthoracic needle biopsy islikely toprovide representative specimens. A somewhat better chance foramorphological diagnosis isgiven incases ofsuspected myocarditis, butitisstill necessary tohit afocus ofinflammation. Cases ofrestrictive cardiomyopathy offer thebest chance ofobtaining a morphologically supported diagnosis bymeansofanendomyocardial biopsy. Itispurechance ifonediagnoses aheart tumour bytheendomyocardial technique. Inonecasea diagnostic specimen wassuccessfully obtained. In twoother cases, thetumourwaslocalized byangiography butitwasnotpossible toobtain aspecimen fromitbecause itwaslocated toodeepinside the wallandcouldnotbereached. Infuture cases of suspected tumour, localization will beattempted and thesurgeons asked toperform athoracotomy. Another problem isthatofthenumberofspeci