Samy Mohamed, Hamdy Rehab M
Cardiology Department, Al-Azhar University, Mokhaim Al-Daemstreet, Mokhaim Al-Daem street, Nasr City, Cairo5, Egypt.
Cardiology Department, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt.
Eur Heart J Case Rep. 2022 Feb 2;6(2):ytac056. doi: 10.1093/ehjcr/ytac056. eCollection 2022 Feb.
Competent lateral and posterolateral valves showed proximal tortuosity that might hinder left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT).
A 57-year-old woman was diagnosed as non-ischaemic cardiomyopathy, no other comorbidities, complaining of dyspnoea [New York Heart Association (NYHA) class III], and on optimal medical therapy. Electrocardiogram showed left bundle branch block with QRS duration 150 ms. The patient was candidate for CRT. However, during LV lead implantation, a competent posterolateral vein valve and proximal tortuosity hindered LV lead implantation that was overcome by balloon-assisted tracking technique. At 9 months of follow-up, the patient had NYHA class II, ejection fraction improved to 38%, and all implanted leads were still in place.
Balloon-assisted tracking technique can be used to cross coronary sinus and smaller veins with competent valves and coronary veins tortuosity.
功能正常的外侧和后外侧静脉瓣显示出近端迂曲，这可能会妨碍心脏再同步治疗（CRT）中左心室（LV）导线的植入。
一名57岁女性被诊断为非缺血性心肌病，无其他合并症，主诉呼吸困难[纽约心脏协会（NYHA）III级]，并接受了最佳药物治疗。心电图显示左束支传导阻滞，QRS时限为150毫秒。该患者适合接受CRT治疗。然而，在植入LV导线过程中，一个功能正常的后外侧静脉瓣和近端迂曲阻碍了LV导线的植入，通过球囊辅助追踪技术得以克服。随访9个月时，患者NYHA分级为II级，射血分数提高到38%，所有植入的导线仍在位。
球囊辅助追踪技术可用于穿过冠状窦以及有功能正常瓣膜和冠状静脉迂曲的较小静脉。
