The role of endomyocardial biopsy in the diagnosis and treatment of heart disease.

Endomyocardial biopsies (EMBs) have recently become a routine examination method at a number cardiological departments. In general, EMB is indicated whenever it appears necessary to establish or supplement a clinical diagnosis pertaining to a myocardial lesion. Good results can be expected in diffuse processes showing endomyocardial predilection, such as acute rejection and cardiotoxicity or in well-circumscribed lesions such as asymmetric hypertrophy, Löffler's endocarditis or endomyocardial fibrosis. The bioptic confirmation is an auxiliary and positive contribution. The present publication has been based on personal experience with a collection of 550 EMBs. Indications for obtaining EMBs included acute rejection in the cardiac allograft, anthracycline-induced cardiotoxicity, myocarditis, cardiomyopathies, specific heart diseases, idiopathic chest pain and arrhythmias, as well as the differential diagnosis of restrictive versus constrictive heart diseases. The treatise deals with the usefulness and significance of EMB, critical remarks on the problems of EMBs, methodology and evaluation of EMBs and their pitfalls. The above-mentioned indications have been presented as separate chapters comprising the basic problems, discussion of pertinent data from the world literature and correlations between our EMBs with the results published. As a matter of fact, some chapters have been documented by small numbers of personal EMBs (cardiotoxicity, specific heart diseases), but they have been included for the sake of completeness. In the future EMBs appear to remain a useful diagnostic as well as research tool in problems of cardiovascular diseases. An exact interpretation of EMBs requires an experienced pathologist capable of arriving at adequate conclusions from the changes disclosed in EMBs.