Endomyocardial biopsy. Do it whenever you need it!

Endomyocardial biopsy (EMB) was initially performed via thoracotomy and it was only in 1961 that the percutaneous technique was introduced by Sakakibara and Konno. 1 Over the last few decades, we have seen major developments in EMB and non-invasive cardiac imaging diagnostic modalities.These methods complement each other particularly well in the study of non-ischemic myocardiopathy.Biopsy is still the gold standard in the diagnosis of various myocardial diseases, in assessing rejection in patients who have undergone a heart transplantand in clarifying the etiology of some intracardiac masses.In spite of the well-established diagnostic value and therapeutic guidelines for applying the technique and indications, 2,3 EMB has been underused thus far, in part due to fear of complications.Despite this, the number of native heart biopsies has seen significant growth, demonstrated by improved procedure outcomes, immunohistochemical diagnostic techniques and molecular virology.4,5 Several studies seem to indicate better diagnostic yield in some diseases (myocarditis, some infiltrative myocardiopathies) when obtained by left ventricular or biventricular biopsy.6,7 Menezes et al. 8 describe the first cases of EBM in Portugal using a radial access approach.The observational trial with selected patients demonstrated the technique's safety and