[A critical review of the role of endomyocardial biopsy in heart transplantation].

Endomyocardial biopsy is still considered the most reliable means for the detection of acute cardiac rejection after heart transplantation. However, this technique has several limitations that might not have been sufficiently underscored. In this review, some of the limitations of endomyocardial biopsy are discussed. In order to overcome these problems, the possibility of using this technique in a more selective and oriented manner is suggested. A combined approach is proposed, using serial echocardiographic studies to monitor rejection episodes and to selectively indicate the need for endomyocardial biopsy. In this way, the total number of biopsies might be reduced along with a more individualized therapy for the rejection episodes. The experience with this new approach in the Heart Transplantation Program of the Hospital Universitario Marqués de Valdecilla, Santander, Spain, is presented.