53 consecutive and unselected patients undergoing endomyocardial biopsy (EMB) had concomitant two-dimensional echocardiographic (2DE) and fluoroscopic control during 62 biopsy procedures (49 of the right, 13 of the left ventricle) in order to assess the capacity of 2DE to identify biopsy site, to allow a selective biopsy in different areas of the ventricles and to foresee a positive sampling. The echocardiographic documentation of a close contact of the bioptome tip with the ventricular wall was compared with the presence of endomyocardial tissue in the forceps of the bioptome. Contact of the bioptome tip with the endocardium was visualized in 86% of the right ventricular biopsies and in 85% of the left ventricular biopsies. Under 2DE monitoring it was possible to change the site of biopsy and selected areas were easily sampled. In a subgroup of 29 biopsies prospectively studied to assess the ability of 2DE to foresee positive sampling, the 2DE forecast was confirmed in 93% of the right and in 100% of the left ventricular samples. The apical view was more commonly used because it provides a good visualization of the bioptome tip and of intracardiac structures without interfering with concomitant fluoroscopic control. Our results suggest that 2DE monitoring during EMB may: 1) provide definite forceps position during the procedure in a large number of patients; 2) guide the bioptome to obtain samples from different and/or selected sites of the ventricles; 3) foresee a positive samples.