MORPHOLOGICAL EVALUATION OF ENDOMYOCARDIAL BIOPSY

Endomyocardial biopsy (EMB) has evolved as a simple and safe procedure with minimal morbidity and mortality. It is performed via the transva scular approach and can be done either as an individual procedure or, more commonly, at the time of routine cardiac catheterization. Sequent ial biopsies can be performed without ill-effects. Conventionally, the right ventricle is biopsied through the transvenous approach. It has been shown that biopsies from the right side are adequately representa tive if the disease is biventricular. The left ventricle can be biopsi ed in disease states affecting that chamber, viz. left ventricular tum our or predominant involvement of the left ventricle in endomyocardial fibrosis. For proper evaluation, biopsy pieces need to be handled and processed carefully. A large amount of valuable information can be re trieved from routinely processed tissue-a process which can be done in all laboratories. Important indications for EMB include diagnosis and monitoring of cardiac allograft rejection, adriamycin toxicity and di agnosis and follow up of myocarditis. Pathologists need to be aware of inherent artefacts of the biopsy procedure and should interpret these with caution. Thus, EMB provides useful information for diagnosis, fo llow up, monitoring of therapy and studying the evolution of several c ardiac disorders.