Canpolat Uğur, Şahiner Levent, Aytemir Kudret, Oto Ali
Department Of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2012 Apr;40(3):251-4. doi: 10.5543/tkda.2012.82435.
Variations in coronary sinus (CS) anatomy can make subclavian vein approach dif?cult or even impossible for LV lead delivery. A combination of interventional and electrophysiological methods is therefore the state of art technique for implantation of LV leads. A 52 year-old male patient with ischemic dilated cardiomyopathy (LVEF: 15%, QRS: 160 msec) who was symptomatic under optimal medical therapy was hospitalized for implantation of cardiac resynchronization therapy. Although right ventricular and atrial electrodes were implanted successfully, we had difficulty during placement of the left ventricular electrode. There was an anatomical variation in CS with a piped shape, which prevented cannulation from the superior approach. We describe a practical method for guidance of transfemoral route for pipe-shaped CS cannulation and epicardial placement of LV lead with superior approach.
冠状窦（CS）解剖结构的变异会使经锁骨下静脉途径在植入左心室电极时变得困难甚至无法进行。因此，介入和电生理方法相结合是目前植入左心室电极的先进技术。一名52岁男性缺血性扩张型心肌病患者（左心室射血分数：15%，QRS波时限：160毫秒），在最佳药物治疗下仍有症状，因植入心脏再同步治疗而住院。尽管成功植入了右心室和心房电极，但在放置左心室电极时遇到了困难。CS存在管道状的解剖变异，这使得无法从上方途径进行插管。我们描述了一种实用的方法，用于引导经股静脉途径对管道状CS进行插管，并通过上方途径将左心室电极放置于心外膜。
