Dataset Information

A case report of balloon-assisted tracking to overcome coronary sinus competent valve: a novel technique in left ventricular lead implantation.

ABSTRACT:

Background

Competent lateral and posterolateral valves showed proximal tortuosity that might hinder left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT).

Case summary

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.

Discussion

Balloon-assisted tracking technique can be used to cross coronary sinus and smaller veins with competent valves and coronary veins tortuosity.

SUBMITTER: Samy M

PROVIDER: S-EPMC8841238 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

A case report of balloon-assisted tracking to overcome coronary sinus competent valve: a novel technique in left ventricular lead implantation.

Samy Mohamed M Hamdy Rehab M RM

European heart journal. Case reports 20220202 2

<h4>Background</h4>Competent lateral and posterolateral valves showed proximal tortuosity that might hinder left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT).<h4>Case summary</h4>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 ca ...[more]

PMID: 35169680

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Project description:A 49-year-old man was admitted with symptomatic, sustained monomorphic ventricular tachycardia. He had a previous history of AMP-kinase disease associated with hypertrophic cardiomyopathy and complete heart block, and a pre-existing dual chamber pacemaker. He also had a mechanical tricuspid valve replacement and mitral valve replacement, for severe tricuspid regurgitation from right ventricle (RV) lead-induced injury to the tricuspid valve and a fibroblastoma on the mitral valve. His pre-existing RV lead was maintained between the prosthetic valve annulus and the native annulus. Inability to place an implantable cardioverter-defibrillator (ICD) in the RV due to the presence of a mechanical tricuspid valve replacement represented a rare but challenging clinical scenario. Surgical epicardial lead placement or the use of a subcutaneous ICD (S-ICD) were possible alternatives. Traditional ICD lead placement was favored because of the broad QRS from RV pacing meaning that use of the S-ICD was not possible due to failure of the electrocardiogram to lie within the bounds of the screening template, and the perceived high risk of repeat thoracotomy. We describe the technique for ICD lead placement in a mid-lateral cardiac venous branch of the coronary sinus with the ability to deliver anti-tachycardia pacing and cardiac resynchronization. To our knowledge this is the first report of an ICD in the mid-lateral cardiac vein, with cardiac resynchronization. <Learning objective: This case describes the technique for implantable cardioverter-defibrillator placement in the coronary sinus with biventricular pacing in a patient with a mechanical tricuspid and pre-existing right ventricular endocardial lead. This technique represents a viable alternative to repeat thoracotomy and surgical lead placement, where the risks of complication, prolonged hospital stay and lead failure are high. It also offers the ability to deliver anti-tachycardia pacing and cardiac resynchronization.>.

Dataset Information

A case report of balloon-assisted tracking to overcome coronary sinus competent valve: a novel technique in left ventricular lead implantation.

Background

Case summary

Discussion

Publications

A case report of balloon-assisted tracking to overcome coronary sinus competent valve: a novel technique in left ventricular lead implantation.

Similar Datasets

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