Gupta Anoop K, Gupta Jyotika, Jain Siddhant, Shah Pooja
Department of Cardiology, Epic Hospital, Room Number 6, OPD Block, Rajpath Rangoli Road, Ahmedabad, Gujarat 380052, India.
Life Sciences, Ahmedabad University, Ahmedabad, Gujarat 380009, India.
Eur Heart J Case Rep. 2025 Jun 5;9(6):ytaf241. doi: 10.1093/ehjcr/ytaf241. eCollection 2025 Jun.
Coronary sinus venous branch stenosis is an uncommon entity. Balloon dilatation of venous tributary may not always be safe. We report a case of venous perforation following balloon dilatation, which was managed by glue occlusion and completion of cardiac resynchronization therapy (CRT) implantation.
A 50-year-old man was diagnosed with non-ischaemic cardiomyopathy with New York Heart Association (NYHA) Class III dyspnoea despite optimal medical therapy. The electrocardiogram showed a left bundle branch block with a QRS duration of 168 ms, and 2D echocardiography revealed dilated cardiomyopathy with a left ventricular ejection fraction of 20%. The patient was taken for CRT implantation; however, there was severe stenosis in the posterolateral vein noted during left ventricular (LV) lead implantation, hindering LV lead advancement. Following balloon dilatation, there was perforation of the vein with hypotension. The perforation was sealed with glue injection (-butyl-2-cyanoacrylate), and LV lead placement was performed. At the 4-year follow-up, the patient is in NYHA Class I and the ejection fraction improved to 60%, with an excellent LV threshold and good synchronization.
Glue (-butyl-2-cyanoacrylate) occlusion can manage coronary sinus perforation with suitable long-term LV lead parameters.
冠状静脉窦分支狭窄是一种罕见的病症。静脉分支的球囊扩张并不总是安全的。我们报告一例球囊扩张后发生静脉穿孔的病例，该病例通过胶水封堵并完成心脏再同步化治疗（CRT）植入得以处理。
一名50岁男性被诊断为非缺血性心肌病，尽管接受了最佳药物治疗，但仍有纽约心脏协会（NYHA）III级呼吸困难。心电图显示左束支传导阻滞，QRS波时限为168毫秒，二维超声心动图显示扩张型心肌病，左心室射血分数为20%。该患者接受CRT植入；然而，在植入左心室（LV）导线期间，发现后外侧静脉严重狭窄，阻碍了LV导线推进。球囊扩张后，静脉穿孔并出现低血压。通过注射胶水（α-氰基丙烯酸正丁酯）封堵穿孔，并进行了LV导线植入。在4年的随访中，患者处于NYHA I级，射血分数提高到60%，LV阈值良好，同步性佳。
胶水（α-氰基丙烯酸正丁酯）封堵可通过合适的长期LV导线参数处理冠状静脉窦穿孔。
