A 128-slice CT scanner helpful in localising coronary sinus ostium during CRT-D implantation - case report.
BACKGROUND
Cardiac resynchronization therapy (CRT) has become a successful treatment option for symptomatic heart failure in patients with poor left ventricular (LV) systolic function and broad QRS complex in the surface electrocardiogram (ECG).


METHODS
In this report we present a case of a 70-year-old woman with advanced heart failure due to ischaemic heart disease who underwent an upgrade from VVIR stimulator (pacemaker, PM) to cardiac resynchronization therapy defibrillator (CRT-D). The first attempt was unsuccessful due to problems with inefficient cannulation of the orifice of the coronary sinus (CS). After performing a 3D reconstruction with a 128-slice CT scanner, it was possible to carry out the up-grade to CRT-D resulting in enormous clinical improvement.


CONCLUSIONS
The case represents an example of the usefulness of 3D reconstruction with the 128-slice CT scanner used after failed CRT-D implantation due to difficulties with efficient cannulation of the coronary sinus orifice in a rare anatomical variant.
Department of Clinical Radiology and Imaging Diagnostics, 4 Military Hospital in Wrocław, Wrocław, Poland.
Przemysław
P
Jaźwiec
Cardiology Clinic, Centre for Heart Diseases, 4 Military Hospital in Wrocław, Wrocław, Poland.
Dariusz
D
Jagielski
Department of Clinical Radiology and Imaging Diagnostics, 4 Military Hospital in Wrocław, Wrocław, Poland.
Paweł
P
Gać
128-slice CT scanner; cardiac resynchronization therapy; cardioverter-defibrilator (CRT-D); coronary sinus