An initiative to minimize amount of contrast media utilizing a novel rotational coronary sinus occlusive venography technique with ordinary cath-lab X-ray machine during CRT implantation.
BACKGROUND
Rotational angiography is one of the latest angiographic modalities to map the coronary venous tree anatomy. It provides a significant reduction in both contrast agent usage and radiation dose (up to 30%), without compromising the clinical utility of images. Hence, the present study was conducted to describe a new technique to minimize the amount of contrast media used during cardiac resynchronization therapy (CRT) implantation.


METHODS
The SL3 sheath was inserted into the right atrium via the femoral vein followed by withdrawal of the dilator. The tip of the sheath was manipulated to the vicinity of the coronary sinus (CS) ostium (OS). The CS was entered using a deflated balloon catheter. The sheath was then advanced gently beyond the CS OS. Occlusive venography was performed using 5-8 ml of contrast media in a rotational view starting from 45 degrees LAO to 0 degrees AP while holding the inflated balloon for a few seconds.


RESULTS
Data from 30 consecutive patients who underwent CRT implantation were analyzed. The feasibility of rotational angiography, while occluding the CS with a specialized long, preshaped sheath and using an ordinary cath-lab imaging machine, was supported by the correctly delineated CS anatomy of all patients without any complications and death related to the placement of the CS catheters or sheaths. The mean contrast dose used for the entire procedure in all patients undergoing CRT was 14.76 +/- 6.8 ml.


CONCLUSIONS
Use of rotational CS occlusive venography utilizing an ordinary cath-lab X-ray machine minimizes the use of contrast media during CRT implantation without compromising the visualized anatomy.
Al Fagih
Ahmed
A
Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. aafagih@yahoo.com
Al Ghamdi
Saleh
S
El Tayeb
Areeg
A
Dagriri
Khaled
K
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D058406:Cardiac Resynchronization Therapy; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010690:Phlebography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011829:Radiation Dosage
D003287:Contrast Media