Feasibility and Safety of Left Ventricular Myocardial Biopsies in Children and Adolescents

All articles of this category (opens in new window) Background: The diagnostic value of endomyocardial biopsy depends on the affected myocardial region that is sampled. Myocarditis and cardiomyopathies primarily manifest in the left ventricle (LV). Due to a potentially higher complication rate associated with left ventricular access, most centers prefer right ventricular (RV) biopsies in pediatric patients. Moreover, some studies in adults suggest superior diagnostic performance of LV biopsies. This study aimed to evaluate the feasibility and safety of LV biopsies in children and adolescents. Methods: All consecutive endomyocardial biopsies performed at our institution between 2011 and 2025 were retrospectively analyzed. Patient characteristics, indication, ventricular access, number of samples, radiation dose, and complications were reviewed. Results: A total of 73 biopsies were performed in 63 patients (mean age: 11.8 ± 6.1 years). Indications included myocarditis or suspected myocarditis ( n = 46, 63%), cardiomyopathy ( n = 18, 25%), exclusion of acute or chronic rejection after heart transplantation ( n = 7, 9%), and others ( n = 2, 3%). LV access was used in 40 procedures (55%) and RV access in 33 (45%). On average, 5.8 ± 1.3 samples were obtained. There were no significant differences between the LV and RV groups with respect to age, number of samples, dose-area product, or fluoroscopy time. Five complications occurred: in the LV group, one pericardial tamponade requiring drainage, one thrombotic renal artery occlusion with partial renal infarction, one self-limiting supraventricular tachycardia, and one self-limiting ventricular tachycardia; in the RV group, one pneumopericardium. Thus, complication rates were 10% for LV biopsies (4/40; two major, two minor) and 3% for RV biopsies (1/33; minor). No procedure-related deaths or long-term sequelae were observed in both groups. Over the study period, the proportion of LV biopsies increased, indicating a clear temporal trend toward LV access. Conclusion: LV biopsies in children and adolescents can be performed safely with an acceptable rate of complications. Although complications were more frequent compared with RV access, overall risk remained low, and the potential diagnostic advantage of LV sampling may justify this approach in selected patients. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany