Right ventricular endomyocardial biopsy from the femoral vein

Several methods are used for percutaneous right ventricular endomyocardial biopsy, including the subclavian venous approach, internal jugular venous approach and femoral venous approach. The femoral venous approach is the most suitable for routine cardiac catheterization, but the risk of right bundle branch block may be increased because the specimens often must be taken from a high position in the right ventricle. We modified the femoral venous approach using King's biotome, and obtained adequate tissue specimens in 14 cases without any complications. We reformed the tip of the biotome into an inverted S shape by scrubbing with the thumb, and we reformed the tip of the long sheath (Cordis) into a J shape by warming with steam, for easy introduction of the biotome and safe biopsy. We describe here the methodological details of our technique.