CS Cannulation using Anchor Balloon technique to prevent implant failure скачать в хорошем качестве

CS Cannulation using Anchor Balloon technique to prevent implant failure

When interventional tools and techniques are applied to a previously failed implant over 99% can go on to have successful LV lead placement. Don’t send the patient for an epicardial lead, learn interventional tools and techniques and learn to enjoy CRT. A patient with LV lead implant failure related to CS cannulation. Without the options provided by interventional tools and techniques the patient was headed to the OR for an epicardial lead. The 9 Fr. "braided core" of the Worley sheath would not engage the CS adequately. In this situation, I find that hand forming a specific 6 Fr. multipurpose guide to the shape of the "braided core" is helpful for locating the CS. The initial shape of the multipurpose guide is critical to successful hand shaping. It is important to use a guide not a diagnostic catheter because there is only room for one wire in a diagnostic catheter. This is the same catheter I use to cannulate the CS from the right. The 6 Fr. Guide (not diagnostic catheter) that can be hand shaped to resemble the braided core of the Worley CSG 1. 6 Fr. Boston Scientific Mach 1 MP2 Ref # 34356-39 2. 6 Fr. Medtronic MB1 Z2 Guiding Ref # Z26MB1 3. 6 Fr. Medtronic Launcher MB2 Ref # LA6MB2. 4. 6 Fr. Cordis Vista Bright Tip MPB 1 Reference # 670-275-00. Once the CS was engaged the only wire that would advance was an angioplasty wire. In order to create an anchor, a 3 mm x 15 mm coronary balloon was advanced over the wire into the coronary sinus and out into the anterior interventricular vein. The balloon was inflated to nominal pressure. An initial attempt to advance the modified MP2 guide without traction on the balloon was unsuccessful. Without traction on the balloon the os of the CS acted as a fulcrum point preventing CS cannulation. Traction on the balloon changed the angle of approach allowing the guide to be advanced into the coronary sinus. At this point I thought I did not need the anchor balloon anymore so a Cook Amplatz wire advanced into the coronary sinus, the balloon deflated and removed. Despite excellent support the 6 FR. MP guide and Amplatz wire the sheath would not advance. The balloon was returned to the anterior interventricular vein & Inflated to nominal pressure. Traction on the balloon allowed the sheath to be advanced over the Amplatz wire stabilized MP2 guiding catheter. The coronary sinus venogram revealed that the AIV was unaffected by the balloon anchor. The venogram balloon can also be used to implement the anchor technique when CS access is stable enough to allow the venogram balloon the be advanced. In the case above the only balloon that would advance was a coronary balloon. For what it’s worth I also find the coronary anchor balloon more stable than the venogram balloon.