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An approach to endomyocardial biopsy interpretation

¹ Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario M5G 2CA, Canada
² Department of Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa K1Y 4E9 Canada

Correspondence to:
Dr J Butany
Department of Pathology E4-301, Toronto General Hospital, Toronto, Ontario M5G 2CA, Canada; jagdish.butany{at}uhn.on.ca
ABSTRACT
The endomyocardial biopsy (EMB) remains the gold standard mode of investigation for diagnosing many primary and secondary cardiac conditions. Through a percutaneous and transvenous route, tissue fragments are generally procured from the right ventricular septum, with very few complications. Widespread use of EMB followed the development of heart transplantation as a means to follow allograft rejection. It has since been useful in helping to diagnose conditions affecting the heart, including cardiomyopathies, myocarditis, infiltrative lesions, arrhythmias, and drug toxicities. The procedure has also been used as a research tool to investigate the natural history of disease and the cardiotoxicity of new medications. This review presents an approach to the evaluation of the EMB, which is particularly directed towards those who may be asked to interpret such biopsies, but are not dedicated cardiovascular pathologists. Through a systematic evaluation of the endocardium, myocardium, interstitium, and intramural vessels, in the context of a complete clinical history, enough information can be deduced to diagnose or exclude specific conditions of clinical value.

Abbreviations: DCM, dilated cardiomyopathy; EMB, endomyocardial biopsy; TEM, transmission electron microscopy

Keywords: endomyocardial; biopsy; heart

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