title: Three-dimensional rotational venography of the coronary sinus tree facilitates left ventricular lead implantation for CRT.
abstract: BACKGROUND
  Precise knowledge of the coronary sinus (CS) tree anatomy facilitates catheter-based intubation of the CS, target vein and lead selection and reduces the need for fluoroscopy, contrast medium and overall procedure time in cardiac resynchronization therapy (CRT). Three-dimensional rotational angiography (3DRA) provides a new means of multiangle imaging of the CS tree that can be applied preoperatively.
  
  
  OBJECTIVE
  Our study aims to investigate the feasibility of preoperative rotational CS venography and its implications for CRT device implantation procedures. For this purpose, CS visualization was done either conventionally with retrograde CS venography and standard fluoroscopic views (SFV, n = 30), or with antegrade CS imaging via contrast medium injection into the left coronary artery using 3DRA in the venous phase of contrast flow (3DRA, n = 30).
  
  
  RESULTS
  3DRA successfully identified the posterior and left marginal veins in 92% of patients and allowed target vein visualization in 86%. Additional retrograde venography was necessary in four patients (14%). Fluoroscopy time and contrast medium administration for stable CS intubation were lower in the group with 3DRA than in those with SFV (all p < 0.05). The time for CS lead placement after guiding catheter intubation was 8.9 ± 5.5 min in the 3DRA group versus 14.7 ± 7.4 min in SFV patients (p < 0.05). Consequently, total fluoroscopy time (-12.1 min), volume of contrast medium (-29.5 ml) and overall procedure time (-32.8 min) were significantly lower in 3DRA than in SFV patients (p < 0.05).
  
  
  CONCLUSIONS
  3DRA offers reliable multiangle visualization of the CS anatomy and facilitates successful CRT lead implantation.
authors.affiliation: Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, jkaufmann@dhzb.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Kaufmann
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kriatselis
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Stephan
authors.initials: S
authors.lastname: Goetze
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D004567:Electrodes, Implanted; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D012399:Rotation