forceps are used generally for myocardial biopsy, but we used the same forceps for the biopsy of the aortic wall.
is considered the gold standard for the diagnosis of myocarditis.6 However, the biopsy has low sensitivity due to focal nature of the disease and being an invasive procedure it carries potential risk of complications.
Lum et al., "Cardiotoxicity of epirubicin and doxorubicin: assessment by endomyocardial biopsy
," Cancer Research, vol.
Concepts through a study employing endomyocardial biopsy
is the gold standard test for myocarditis; however, the clinical presentation in conjunction with the raised troponin level and a cardiac MRI demonstrating myocardial muscle oedema in keeping with myocarditis was considered sufficient to make a diagnosis without a myocardial biopsy, since such a procedure would be invasive and not without significant side effects.
is indicated when giant cell myocarditis or necrotizing eosinophilic myocarditis is suspected.
An endomyocardial biopsy
(EMB) is a diagnostic procedure during which a small piece of the patient's heart muscle is removed and taken for laboratory testing.
Definite acute myocarditis is defined based on endomyocardial biopsy
results according to the Dallas criteria .
After extensive evaluation including endomyocardial biopsy
, the patient was diagnosed of idiopathic HES.
The clinical features of her CI, consisting of abrupt onset, pericardiac effusion, and exacerbation of skeletal myositis, were more indicative of myocarditis, although this assessment had limitation since we have not excluded viral myocarditis or carried out endomyocardial biopsy
. However still there was implication that immune suppressive intervention, including glucocorticoid pulse therapy, in addition to palliative therapy against heart failure with diuretics, a [beta]-blocker, and an ACE inhibitor, markedly improved her CI as well as the skeletal myositis.
Regarding the cause of cardiac inflammation, acute myocarditis was considered because the serum antibody titer of cytomegalovirus was significantly elevated in a few weeks though endomyocardial biopsy
was not done because the patient did not agree with it.
A comparative effectiveness study, the Invasive Monitoring Attenuation through Gene Expression Study, compared clinical outcomes of patients managed with AlloMap to outcomes of patients managed with endomyocardial biopsy