Jamal Kheyi a,⇑, Abdelilah BenelmekkI a, Hicham Bouzelmat a, Ali Chaib a a
a
Cardiology Department, Mohammed V Military Teaching Hospital, Rabat
Morocco
A
61-year-old man with long-standing nonis-
chemic dilated cardiomyopathy and New York Heart Association III heart failure symptoms despite guideline-directed medical therapy was referred for consideration of cardiac resynchronization therapy. His electrocardiograph showed sinus rhythm with left bundle branch block
(QRS = 172 milliseconds), and his left ventricular ejection fraction was 25%. An attempt at a standard transvenous cardiac resynchronization therapy implant was complicated by the inability of locating and cannulating the coronary sinus. A veinogram from a left sided superior vena cava was performed (Fig. 1) and demonstrated a
Figure 1. Veinography from the left superior vena cava (white arrow), target vein for left lead (black arrow), and coronary sinus ostium (red arrow).
Disclosure: Authors have nothing to disclose with regard to commercial support. Received 18 June 2016; accepted 11 July 2016. Available online 1 August 2016
⇑ Corresponding author at: Cardiology Department, Mohammed V Military Teaching Hospital, Post Office Box 7855 Agence Dar El Hadith, Rabat 10100, Morocco. E-mail address: [email protected] (J. Kheyi).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email: [email protected] URL: www.sha.org.sa
1016–7315 Ó 2016 King Saud University. Production and hosting by Elsevier B.V. All rights reserved. Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa http://dx.doi.org/10.1016/j.jsha.2016.07.001
Production and hosting by Elsevier
IMAGES IN REVIEW
Cardiac resynchronization therapy and challenging coronary sinus angiography
284
KHEYI ET AL CARDIAC RESYNCHRONIZATION THERAPY
J Saudi Heart Assoc 2016;28:283–284
IMAGES IN REVIEW Figure 2. Steps of minimally invasive left ventricular lead placement by minithoracotomy.
thebesian valve that occludes the coronary sinus ostium. The patient was referred for minimally invasive left ventricular lead placement by minithoracotomy (Fig. 2). The chest X-ray (Fig. 3) showed both transvenous leads (right atrium and right ventricle leads) and the left epicardial lead.
Figure 3. The chest X-ray showed both transvenous leads (right atrium and right ventricle leads) and the left epicardial lead (arrow).
a
Cardiology Department, Mohammed V Military Teaching Hospital, Rabat
Morocco
A
61-year-old man with long-standing nonis-
chemic dilated cardiomyopathy and New York Heart Association III heart failure symptoms despite guideline-directed medical therapy was referred for consideration of cardiac resynchronization therapy. His electrocardiograph showed sinus rhythm with left bundle branch block
(QRS = 172 milliseconds), and his left ventricular ejection fraction was 25%. An attempt at a standard transvenous cardiac resynchronization therapy implant was complicated by the inability of locating and cannulating the coronary sinus. A veinogram from a left sided superior vena cava was performed (Fig. 1) and demonstrated a
Figure 1. Veinography from the left superior vena cava (white arrow), target vein for left lead (black arrow), and coronary sinus ostium (red arrow).
Disclosure: Authors have nothing to disclose with regard to commercial support. Received 18 June 2016; accepted 11 July 2016. Available online 1 August 2016
⇑ Corresponding author at: Cardiology Department, Mohammed V Military Teaching Hospital, Post Office Box 7855 Agence Dar El Hadith, Rabat 10100, Morocco. E-mail address: [email protected] (J. Kheyi).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email: [email protected] URL: www.sha.org.sa
1016–7315 Ó 2016 King Saud University. Production and hosting by Elsevier B.V. All rights reserved. Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa http://dx.doi.org/10.1016/j.jsha.2016.07.001
Production and hosting by Elsevier
IMAGES IN REVIEW
Cardiac resynchronization therapy and challenging coronary sinus angiography
284
KHEYI ET AL CARDIAC RESYNCHRONIZATION THERAPY
J Saudi Heart Assoc 2016;28:283–284
IMAGES IN REVIEW Figure 2. Steps of minimally invasive left ventricular lead placement by minithoracotomy.
thebesian valve that occludes the coronary sinus ostium. The patient was referred for minimally invasive left ventricular lead placement by minithoracotomy (Fig. 2). The chest X-ray (Fig. 3) showed both transvenous leads (right atrium and right ventricle leads) and the left epicardial lead.
Figure 3. The chest X-ray showed both transvenous leads (right atrium and right ventricle leads) and the left epicardial lead (arrow).
