Vaseghi Marmar, Cesario David A, Ji Sen, Shannon Kevin M, Wiener Isaac, Boyle Noel G, Fonarow Gregg C, Valderrábano Miguel, Shivkumar Kalyanam
UCLA Cardiac Arrhythmia Center, Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA.
Pacing Clin Electrophysiol. 2005 Mar;28(3):185-90. doi: 10.1111/j.1540-8159.2005.09548.x.
The purpose of this study was to define the role coronary arteriography (venous phase) for improving the success of left ventricular (LV) lead implantation and to define the value of identifying the pericardiophrenic vein for optimal LV lead placement in biventricular (bi-v) device implantation.
Seventy-seven patients underwent bi-v device implantation between July 2002 and October 2003. If the coronary sinus (CS) could not be accessed, then left coronary arteriography was performed during the same procedure. CS access was guided by venous phase images of the coronary arteriogram. The pericardiophrenic vein was identified by selective cannulation or direct visualization. Patients with Cr > 1.5 had gadolinium used as the contrast agent.
Seventy-five successful implants were performed (97%). In seven patients (9%) repeated attempts at retrograde cannulation of the CS failed (attempt time 130 +/- 20 minute, mean +/- SD). In these patients, coronary arteriography helped define the location of the CS, which was subsequently successfully cannulated. In six patients the pericardiophrenic vein was identified either during occlusion venography of the CS (postthoracotomy, veno-venous collaterals, n = 2) or during selective cannulation of the pericardiophrenic vein (using a DAIG Csl catheter, n = 4). The vein was directly visualized in three patients who underwent surgical LV lead implantation. LV leads in all these cases were implanted in areas not overlying the preidentified pericardiophrenic vein. During follow-up, none of these patients had evidence of phrenic nerve stimulation.
Intraoperative left coronary arteriography increases the success of CS cannulation. Identification of the pericardiophrenic vein is a useful method to avoid phrenic nerve stimulation.
本研究旨在明确冠状动脉造影（静脉期）在提高左心室（LV）导线植入成功率方面的作用，并确定在双心室（bi-v）装置植入中识别心包膈静脉以实现最佳LV导线放置的价值。
2002年7月至2003年10月期间，77例患者接受了双心室装置植入。如果无法进入冠状窦（CS），则在同一手术过程中进行左冠状动脉造影。通过冠状动脉造影的静脉期图像引导进入CS。通过选择性插管或直接观察来识别心包膈静脉。肌酐清除率>1.5的患者使用钆作为造影剂。
成功植入75例（97%）。7例患者（9%）逆行插管CS的反复尝试失败（尝试时间130±20分钟，平均±标准差）。在这些患者中，冠状动脉造影有助于确定CS的位置，随后成功插管。6例患者在CS闭塞静脉造影期间（开胸术后，静脉-静脉侧支循环，n = 2）或心包膈静脉选择性插管期间（使用DAIG Csl导管，n = 4）识别出心包膈静脉。在3例接受手术LV导线植入的患者中直接观察到了该静脉。所有这些病例中的LV导线均植入未覆盖预先识别的心包膈静脉的区域。在随访期间，这些患者均无膈神经刺激的证据。
术中左冠状动脉造影可提高CS插管的成功率。识别心包膈静脉是避免膈神经刺激的一种有用方法。
