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Specialists in the Field of Myocardial Biopsie
Information About the Field of Myocardial Biopsie
What Is Myocardial Biopsy?
A myocardial biopsy is the sampling of heart muscle tissue used to diagnose heart muscle diseases.
When Is a Myocardial Biopsy Arranged?
A myocardial biopsy may be ordered when a heart muscle disease is suspected or has already been proven.
The tissue removed can ultimately be examined in the laboratory and provide essential insights into the state of the disease, which play a central role in further therapy and significantly influence the decisions of the treating physician.
Which Heart Diseases Can Be Detected?
The heart muscle tissue can be examined for inflammatory and structural changes, thus opening up a wide range of diagnostic possibilities for the physician.
The most commonly detected is inflammation of the heart muscle ( myocarditis ). Special laboratory tests can be used to analyze the type of pathogen and the severity of the disease. Here it is essential to find out whether the inflammation is infectious or non-infectious and whether the inflammatory reaction is still active, has regressed, has already been overcome, or has even turned into a chronic disease.
In addition, myocardial biopsies can detect structural changes in the heart muscle ( cardiomyopathy ). A more detailed examination can clarify the cardiomyopathy's nature and its cause. Similarly, rejection reactions after heart transplantation can be observed and excluded.
In addition, storage diseases, in which proteins are usually deposited in the heart muscle, can be detected by biopsy and treated further.
Procedure and Duration
A myocardial biopsy is usually performed with the aid of a cardiac catheter. After local anesthesia, a vessel is first punctured, and the catheter is moved up to the heart. The surgeon then removes tiny samples from the heart muscle using small forceps while monitoring the entire procedure with an X-ray.
Depending on the localization of the disease, a distinction can be made between left-sided and right-sided catheterization. For example, to investigate inflammation of the myocardium of the left ventricle, the left-sided biopsy is chosen, in which an artery is punctured either at the wrist or in the groin, and the catheter is passed directly into the left side of the heart. In other cases, right-sided biopsy via venous access may likewise be preferred.
Risks and Follow-Up
Myocardial biopsy is performed in cardiac catheterization laboratories by experienced physicians and has a low complication rate. The low-risk procedure is constantly monitored by X-ray to ensure that the catheter is correctly placed at all times and complications are avoided.
Immediately after the procedure, patients receive a pressure dressing placed over the puncture site for 1-2 hours to prevent post-procedure bleeding. An echocardiogram is performed a few hours after the procedure to ensure the patient is free of complications.
Complications can occur despite all caution, as with other medical procedures. These include cardiac arrhythmias, which usually manifest as harmless palpitations and disappear after a short time. In rare cases, these disturbances can last longer and require immediate treatment.
Very rarely the heart wall can be injured by the catheter, resulting in bleeding into the pericardium. Depending on the severity, this medical emergency may require immediate treatment.
- Lapp, H., & Krakau, I. (2014). Das Herzkatheterbuch diagnostische und interventionelle Kathetertechniken ;. Stuttgart: Thieme.
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