Histomorphological diagnostic features to consider histological diagnosis
| Clinical indications for endomyocardial biopsy | Complications of endomyocardial biopsies | Tissue/Histopathology | Consider in diagnosis | |||
| Endocardium | Certain | Probable | Possible | |||
| Allograft heart rejection surveillance Myocarditis Amyloidosis Haemochromatosis Sarcoidosis Fabry’s disease Loeffler’s endomyocarditis Mastocytosis Neoplasia Cardiomyopathies (hypertrophic, dilated or restrictive) Drug toxicity Arrhythmia Unexplained chest pain Unexplained congestive heart failure Differentiation between restriction and pericardial constriction |
Major complications
Haemopericardium Tamponade Mediastinitis Pneumothorax Air embolism Pneumopericardium Thromboembolism Myocardial infarction Infection Valve damage Pericardial fibrosis Minor complications Chest pain ECG abnormalities Nerve palsy Rupture of chordae tendineae Valve damage Haematoma Hypotension Deep vein thrombosis Vascular fistulae | Fibrosis | Organised thrombus Healed biopsy site Myocardial infarct Healed acute rejection site Graft procurement injury Adjacent prosthetic device Abnormal blood flow haemodynamics Hypereosinophilic syndrome Mastocytosis Endocardial fibroelastosis Healed myocarditis Cardiomyopathy Drug toxicity | Myocarditis Acute Endocarditis Sarcoidosis Amyloidosis Storage diseases Duchenne Neoplasia | Mitochondrial disease Arrhythmogenic right ventricular dysplasia Fabry’s disease Glycogenosis Immunological disease | Mitochondrial disease Cardiomyopathies (hypertrophic, dilated or restrictive) |
| Ulceration/necrosis | Adjacent prosthetic device Healing biopsy site Hypereosinophilic syndrome | |||||
| Myocardium | ||||||
| Hypertrophy | Hypertrophic/dilated cardiomyopathy Pressure/volume overloaded ventricle Storage disorders Primary myopathies (Duchenne’s/Becker’s) Muscular dystrophies (myotonic) | |||||
| Fibre disarray | Hypertrophic cardiomyopathy Healed biopsy site Ventricular apex Junction of free wall and interventricular septum | |||||
| Interstitium | ||||||
| Fibrosis | Healed biopsy site Myocardial infarct Healed acute rejection site Adjacent prosthetic device Hypereosinophilic syndrome Mastocytosis Healed myocarditis Cardiomyopathy Drug toxicity | |||||
| Lymphocytes | Allograft rejection (focal or diffuse) Quilty lesion (A or B) Normal allograft (sparse and diffuse) Myocarditis/dilated cardiomyopathy Post-transplant lymphoproliferative disease Lymphoma Leukaemia | |||||
| Neutrophils | Bacterial/fungal endocarditis (±necrosis) Fulminant acute allograft rejection Fulminant myocarditis Hypereosinophilic syndrome (+eosinophils) Sepsis | |||||
| Eosinophils | Hypereosinophilic syndrome (Loeffler’s) Hypersensitivity (eg, drug) Fulminant allograft rejection Parasitic infection (Chagas) | |||||
| Granulomas | Sarcoidosis Amyloidosis Aschoff nodules Foreign body reaction Giant cell myocarditis | |||||
| Intramural vessel changes | Allograft vasculopathy Hypertrophic cardiomyopathy Systemic arterial hypertension Collagen vascular disorders Mitral valve prolapse Amyloidosis |