Luedorff Guido, Grove Rainer, Kranig Wolfgang, Thale J
Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, Bad Rothenfelde, Germany.
Clin Res Cardiol. 2009 Mar;98(3):159-64. doi: 10.1007/s00392-008-0734-x. Epub 2008 Dec 18.
Cardiac resynchronization therapy (CRT) has growing impact in the treatment of severe heart failure Stenosis of coronary veins, complex structure of coronary sinus and occlusions of subclavian veins can limit lead passage in the target vein.
Retrospective analysis of 705 implantation procedures of CRT devices from 1999 to July 2007 in a single centre to show the impact of venous angioplasty manoeuvres for successful placement of left ventricular lead. In 31 patients (3.5%) venous angioplasty was performed for LV-lead placement: 24 coronary veins (balloons 2.5-4.0 mm), 4 subclavian veins, 3 valves in the coronary sinus and one Marshall vein were dilated. Ring like strictures of coronary veins made high inflation pressures (16 +/- 4 atm) necessary. Success rate of LV lead placement were 99%. Complications were rare.
Angioplasty of coronary or subclavian veins and valve structures of coronary sinus are a useful and safe tool for successful lead placement. The use of balloons of 3.0mm in size usually allows implantation of at least a unipolar lead.
心脏再同步治疗（CRT）在严重心力衰竭的治疗中作用日益显著。冠状静脉狭窄、冠状窦结构复杂以及锁骨下静脉闭塞会限制导线进入目标静脉。
对1999年至2007年7月在单一中心进行的705例CRT设备植入手术进行回顾性分析，以显示静脉血管成形术对成功放置左心室导线的影响。31例患者（3.5%）为放置左心室导线进行了静脉血管成形术：扩张了24条冠状静脉（使用2.5 - 4.0毫米球囊）、4条锁骨下静脉、冠状窦中的3个瓣膜以及1条Marshall静脉。冠状静脉的环状狭窄需要较高的膨胀压力（16±4个大气压）。左心室导线放置成功率为99%。并发症罕见。
冠状静脉或锁骨下静脉以及冠状窦瓣膜结构的血管成形术是成功放置导线的一种有用且安全的手段。使用3.0毫米大小的球囊通常至少能植入一根单极导线。
