Endomyocardial biopsy access routes include which vessels?

• A. Right internal jugular vein or right femoral vein
• B. Left internal jugular vein
• C. Right radial artery
• D. Brachial artery

Answer: (A)

Endomyocardial biopsy is performed by entering the venous system to reach the right heart, since most tissue samples come from the right ventricular endocardium and the interventricular septum. The preferred access routes are through a central vein that provides a straight, stable path to the right atrium and ventricle. The right internal jugular vein and the right femoral vein offer the easiest, most reliable trajectories for advancing the biopsy catheter to the target area with lower risk of complications. Using arterial access, such as the radial or brachial arteries, would require entering the left heart and carries greater risk; left-sided venous access (like the left internal jugular) is less common due to similar challenges with catheter maneuverability and increased complexity. Therefore, the vessels that are routinely used for endomyocardial biopsy access are the right internal jugular vein or the right femoral vein.