On July 23, 2025, the cardiovascular team led by Professor Lu Qun from the Department of Cardiovascular Medicine at the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU) successfully performed the first case of trans-left ventricular endomyocardial biopsy in Shaanxi Province, marking a significant advancement in the hospital’s capability for the precise diagnosis of complex and challenging myocardial diseases to a level comparable with leading institutions nationwide.
The patient, a 46-year-old male, had suffered for many years from recurrent chest tightness and symptoms of heart failure. Despite undergoing conventional multimodal imaging diagnostics at multiple hospitals, the etiology of his cardiomyopathy remained unclear. The expert team of the Department of Cardiovascular Medicine concluded that a myocardial biopsy was necessary to obtain pathological tissue for a definitive diagnosis. Traditionally, myocardial biopsy is performed via the right heart route. However, as the patient’s lesion was primarily located in the left ventricle, a trans-left ventricular subendocardial myocardial biopsy became the only viable option. This technique, performed under DSA guidance, involves minimally invasive catheter access to the left ventricle, enabling precise sampling of a small amount of myocardial tissue for pathological, immunological, and even genetic testing. This approach provides irreplaceable direct evidence for identifying the etiology and formulating an individualized treatment plan.
Due to the thicker myocardial wall of the left ventricle, higher intracavitary pressure, a more complex procedural pathway, and its proximity to critical coronary artery branches and the cardiac conduction system, the trans-left ventricular biopsy technique poses significantly greater technical challenges and demands more stringent risk control. After obtaining informed consent from the patient and family, the surgical team engaged in repeated discussions, designed a tailored operative plan, and established contingency measures to minimize surgical risks and ensure patient safety. Under real-time guidance from multimodal imaging technologies, including echocardiography and X-ray fluoroscopy, the catheter pathway was navigated with precision and safety.
With their extensive experience and exceptional technical skills, Professors Lu Qun and Yu Hang maintained steady control of the catheter and biopsy forceps, achieving precise sampling within the beating heart. The team of the Department of Cardiovascular Medicine, the cardiac ultrasound unit, and interventional catheterization laboratory worked in close coordination, providing continuous and meticulous intraoperative monitoring to ensure the patient’s safety.
Postoperatively, the patient remained in stable condition and showed good recovery. The myocardial tissue samples have been submitted to the Department of Pathology for in-depth analysis, which will provide decisive evidence for the patient’s subsequent precision treatment.
Endomyocardial biopsy is a highly demanding procedure that requires exceptional operator expertise, advanced imaging support, and strong pathological diagnostic capabilities. Previously, this technique had been routinely performed only in a few top-tier cardiovascular centers in China. The successful implementation of this technique at the FAH fills a critical gap in this field within Shaanxi Province and marks a significant milestone in the development of the cardiovascular interventional diagnostics in our province.
The success of this first trans-left ventricular endomyocardial biopsy will strongly promote the overall improvement of cardiovascular disease diagnosis and treatment in Shaanxi Province and the broader Northwest China region.
