Usefulness of hyperemic venous return angiography for studying coronary venous anatomy prior to cardiac resynchronization device implantation.
OBJECTIVE
Implantation of electrodes via the coronary sinus (CS) can be very challenging because access to the target vessel is restricted by anatomical obstacles. Consequently, prior knowledge of coronary venous anatomy is crucial. The objective of this study was to evaluate the usefulness of hyperemic venous return angiography relative to that of occlusive retrograde venography prior to cardiac resynchronization device implantation.


METHODS
Coronary venous anatomy was studied in 200 patients both by videoing venous coronary return, which was optimized by inducing hyperemia, and by occlusive venography. The visibility of different portions of the coronary venous system was scored.


RESULTS
Overall, sufficient anatomic information was obtained in 99.5% of patients. Visibility scores for the CS and the lateral vein of the left ventricle were slightly higher in the group studied using occlusive venography, though there was no significant difference between the two techniques. In contrast, the middle cardiac vein and the anterior interventricular vein could be visualized in greater detail using venous return angiography. There were no complications in the group studied using venous return angiography whereas dissection of the great cardiac vein occurred in three patients studied using occlusive venous angiography, though this did not prevent electrode implantation.


CONCLUSIONS
With venous return angiography, it was possible to visualize accurately the venous anatomy of the lateral wall of the left ventricle and, consequently, to anticipate the level of difficulty posed by electrode implantation.
Arbelo
Elena
E
Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain. elenaarbelo@secardiologia.es
García-Quintana
Antonio
A
Caballero
Eduardo
E
Hernández
Enrique
E
Caballero-Hidalgo
Araceli
A
Amador
Celestina
C
de Lezo
Javier Suárez
JS
Medina
Alfonso
A
D000368:Aged; D001810:Blood Volume; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000033:anatomy & histology*; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D008297:Male; D010690:Phlebography; D011300:Preoperative Care / Q000379:methods*