Endomyocardial biopsy (EMB) is widely used for surveillance of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. Typically, EMB is performed through the jugular or femoral veins and is associated with a serious acute complication rate of less than 1% using current flexible bioptomes. Although it is accepted that EMB should be used to monitor for rejection after transplant, use of EMB for the diagnosis of various myocardial diseases is controversial. Diagnosis of myocardial disease in the nontransplant recipient is often successful via noninvasive investigations including laboratory evaluation; echocardiography, nuclear studies, and magnetic resonance imaging can yield specific diagnoses in the absence of invasive EMB. Therefore, use of the technique is patient specific and depends on the potential prognostic and treatment information gained by establishing a pathologic diagnosis beyond noninvasive testing.

https://www.mayoclinicproceedings.org/article/S0025-6196(11)65199-9/pdf

Current status of endomyocardial biopsy.

Impaired coronary vasodilator reserve in the immediate postcoronary angioplasty period: analysis of coronary artery flow velocity indexes and regional cardiac venous efflux.

Endomyocardial fibrosis and restrictive cardiomyopathy: pathologic and clinical features.

The detailed features of right sided endomyocardial fibrosis are described in 15 out of 10,000 consecutive patients who all had infection with Schistosoma mansoni and came from rural Egypt. Laboratory investigations, 12 lead electrocardiography, chest radiography, and Doppler echocardiography were performed in all patients. Cardiac catheterisation and angiography were performed in eight. Endomyocardial biopsy specimens were obtained from the right ventricles of two patients and pericardial biopsy specimens from two. Pericardiocentesis was performed in all patients. All patients were infected with S mansoni and had schistosomal hepatic fibrosis and ascites. Eleven had splenomegaly. All patients had raised cervical venous pressure with prominent Y descent and atrial fibrillation. Eosinophilia was notably absent. Echocardiography showed apical fibrosis in the right ventricle, obliteration of the ventricle, and moderate to massive exudative pericardial effusion in all patients. Calcification and fibrosis extended into the right ventricular outflow tracts in two patients. Huge right atrial thrombi occurred in five patients. Tricuspid regurgitation (grades I-II) was detected in 11 patients by Doppler ultrasonography. Haemodynamic and angiographic data confirmed the pure right sided restrictive pathophysiology. Pericardial biopsy specimens showed perivascular inflammatory infiltrates in two patients and a schistosomal granuloma in one. Endocardial biopsy specimens showed dense fibrosis with many fibroblasts. Endomyocardial fibrosis in Egypt is unique in several aspects. It always affected only the right side of the heart. Calcification and fibrosis extended to the right ventricular outflow tract. Pericardial inflammatory reaction was present. The relation to schistosomiasis and the link to periportal hepatic fibrosis in these patients is intriguing.

https://heart.bmj.com/content/heartjnl/73/3/284.full.pdf

Endomyocardial fibrosis in Egypt: an illustrated review.

We report a male patient with Leber's hereditary optic neuropathy (LHON) and hypertrophic cardiomyopathy. Besides a G11778A mutation in the ND4 gene of the mitochondrial DNA (mtDNA), one of the most common mutations in LHON patients, sequencing of total mtDNA revealed a G12192A mutation in the tRNA (His) gene that was recently noted to be a risk factor for cardiomyopathy. Because no case of LHON presenting with cardiomyopathy has been reported, the present finding suggests that the G12192A mutation caused cardiomyopathy as an additional symptom. In the present case, the double pathogenic mtDNA mutations may be associated either synergistically or concomitantly with two different clinical manifestations.

/pdf/a-double-mutation-g11778a-and-g12192a-in-mitochondrial-dna-4xqt9nxjwa.pdf

A double mutation (G11778A and G12192A) in mitochondrial DNA associated with Leber's hereditary optic neuropathy and cardiomyopathy

Endomyocardial fibrosis: report of eight cases.

A retrospective study of 22 Saudi patients with a diagnosis of dilated cardiomyopathy confirmed by cardiac catheterization was undertaken to study the pattern of this disease in Saudi Arab...

Dilated Congestive Cardiomyopathy in Saudi Patients

Comparison of early results of balloon mitral valvotomy to closed mitral commissurotomy in complex mitral stenosis

The clinical, echocardiographic, and hemodynamic data on 15 patients 52 to 68 years old with hypertrophic cardiomyopathy are reported. In 60% of the cases, the referring clinical diagnosis...

Hypertrophic Cardiomyopathy in Patients over 50 Years Old

Between 1980 and 1982, 75 patients (aged over 40 years) with valvular heart disease underwent cardiac catheterization and coronary arteriography at King Faisal Specialist Hospital and Rese...

The Incidence of Coronary Artery Disease in Patients with Valvular Heart Disease in Saudi Arabia

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