Video 4-9-7 (AB): (A) Endomyocardial biopsy performed with echo guidance. The bioptome can be seen entering the RV being withdrawn toward the RA. With echo guidance, immediate complications such as chordal disruption resting in TR and the development of a pericardial effusion can be identified. In this patient the pericardial effusion was present prior to the procedure. (B) Endomyocardial biopsy performed with echo guidance. The bioptome can be seen in the RV with the sampling forceps directed toward the septum. With echo guidance, immediate complications such as chordal disruption resting in TR and the development of a pericardial effusion can be identified. In this patient the pericardial effusion was present prior to the procedure.