A 77-year-old man underwent echocardiography-guided right ventricular endomyocardial biopsy for suspected cardiac amyloidosis. After the procedure, severe tricuspid regurgitation with a flail posterior leaflet was detected. A myocardial biopsy specimen contained a segment of tricuspid valve chorda tendinea. Endomyocardial biopsy is considered the standard for detecting transplant rejection and evaluating infiltrative cardiomyopathies and myocarditis. Echocardiography complements, and in some institutions has replaced, fluoroscopy as a method of bioptome guidance because of its superior resolution of the tricuspid valve anatomy, endocardial surface, and thin right ventricular free wall and apex. Nevertheless, because of the limitations of 2-dimensional imaging, complications do occur.