title: Cardiac resynchronization therapy: double cannulation approach to coronary venous lead placement via a prominent thebesian valve.
abstract: We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.
authors.affiliation: Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1510 San Pablo Suite 322, Los Angeles, CA 90033, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cao
authors.forename: Philip
authors.initials: P
authors.lastname: Chang
authors.forename: Bonnie
authors.initials: B
authors.lastname: Garon
authors.forename: Jerold S
authors.initials: JS
authors.lastname: Shinbane
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002404:Catheterization / Q000379:methods; D054326:Coronary Sinus / Q000002:abnormalities; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged