title: Three-dimensional coronary sinus reconstruction-guided left ventricular lead implantation based on intraprocedural rotational angiography: a novel imaging modality in cardiac resynchronization device implantation.
abstract: OBJECTIVE
  Rotational angiography (RA) of the coronary sinus (CS) provides more anatomical insights compared with static angiographies. We evaluated intraprocedural three-dimensional (3D) CS reconstruction (RC) based on RA, using syngo(®) DynaCT Cardiac to guide CS lead implantation.
  
  
  RESULTS
  In 24 patients with indication for cardiac resynchronization therapy, intraprocedural RA and 3D RC of the CS was performed. Lead placement was guided by 3D image integration into real-time fluoroscopy. Rotational angiography and 3D RCs were evaluated regarding visibility of the CS and tributaries, CS-to-target vein angles, and vessel diameters. The target vein for CS lead implantation, identified by RA, was successfully displayed by 3D RC in 20 (91%) of 22 patients with adequate RA. All lead implantations were guided successfully by 3D image integration into real-time fluoroscopy. Cranial or caudal angulations were used in 95% of the procedures without further angiographies. Rotational angiography displayed a mean of 2.9 ± 1.0 second-order side branches compared with 1.8 ± 1.1 in 3D RCs (P< 0.05). The CS-to-target vein angle estimated from static projections (right anterior oblique 20°, left anterior oblique 40°, and even optimal RA view) differed substantially from 3D RCs. Main vessel diameters did not differ significantly between both techniques.
  
  
  CONCLUSIONS
  Intraprocedural 3D RC of the CS and 3D image integration-guided lead placement is feasible. Coronary sinus-to-target vein angles seemed to be misestimated even by RA views compared with 3D RC. Thus RA and 3D CS RC should be applied routinely for CS lead implantation.
authors.affiliation: Klinikum Coburg GmbH, Coburg, Germany. gutleben@gmx.de
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Guido
authors.initials: G
authors.lastname: Ritscher
authors.forename: Harald
authors.initials: H
authors.lastname: Rittger
authors.forename: Christopher
authors.initials: C
authors.lastname: Rohkohl
authors.forename: Günter
authors.initials: G
authors.lastname: Lauritsch
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Anil Martin
authors.initials: AM
authors.lastname: Sinha
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D014680:Veins