Myocardial protection via the coronary sinus. (17/174)

BACKGROUND: Recent reports on facilitated reperfusion therapy re-address interests in coronary sinus interventions (CSI). Patients in whom short time results have been reported earlier were re-evaluated, with the aim of gathering the long-term results of pressure-controlled intermittent coronary sinus occlusion (PICSO) generated in patients with acute myocardial infarction (MI) and revascularization. METHODS AND RESULTS: Thirty-four patients with ST elevated MI, in whom complete revascularization was achieved, underwent primary thrombolysis with or without PICSO. Follow-up data from these patients were collected for at least 48 months. Immediate perioperative differences were observed for time to peak creatine kinase (CK), as well as cumulative CK. In addition, the time until reperfusion was considerably less than for the control group (p=0.014). Long-term data showed significant differences in reinfarction (p=0.015), as well as in major adverse cardiovascular events, between the 2 groups (p<0.0001). CONCLUSION: These data, because of the wide interval between collection and current analysis, could have inherited historical bias. Nonetheless, they are also uniquely indicating the potential of CSI to induce not only immediate, but also clinically significant long-term, effects as an adjunct to reperfusion therapy. Therefore, CSI should be, once again, on the study agenda and be placed under contemporary and best-available scientific scrutiny.  (+info)

Duplicated coronary sinus with a connecting branch. (18/174)

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Temporary pacing wire in the coronary sinus: a novel treatment of acute heart failure? (19/174)

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Transvenous biventricular pacing for cardiac resynchronization therapy in patients with persistent left superior vena cava and right superior vena cava atresia. (20/174)

Biventricular pacing for cardiac resynchronization therapy is an effective adjunctive therapy for the treatment of symptomatic moderate and severe congestive heart failure. However, experience with transvenous cardiac resynchronization therapy in patients who have both persistent left superior vena cava and right superior vena cava atresia is extremely limited. We successfully performed cardiac resynchronization therapy in 2 patients who had persistent left superior vena cava, right superior vena cava atresia, and congestive heart failure. Our 2 cases demonstrate the possibility of a total transvenous approach for left ventricular pacing despite the presence of serious cardiac venous anomalies. This approach enables clinicians to avoid the riskier epicardial lead placement, which requires a thoracotomy under general anesthesia.  (+info)

Antegrade visualisation of the coronary sinus for left ventricular pacing. (21/174)

INTRODUCTION: Failure to achieve left ventricular pacing remains one of the obstacles to cardiac resynchronisation therapy. METHODS: A new technique for the placement of left ventricular pacing leads in the tributaries of the coronary sinus is described. Antegrade visualisation of the coronary sinus is accomplished by selective coronary angiography and a hydrophilic 0.032" wire is advanced along the coronary sinus. This facilitates advancement of a coronary sinus sheath over a multipurpose diagnostic catheter. A hydrophilic angioplasty wire is then utilised for negotiation of the inferior left ventricular vein and successful placement of the left ventricular pacing lead. RESULTS: In 5 patients in whom cannulation attempts were unsuccessful despite prolonged fluoroscopy time (39.85 +/- 9.6 min), the new technique resulted in successful placement of the left ventricular pacing lead within an average fluoroscopy time of 6.5 +/- 2.1 min. CONCLUSION: Antegrade visualisation of the coronary sinus via selective coronary angiography and the use of a hydrophilic angiography wire may facilitate successful implantation of a left ventricular pacing lead in difficult cases.  (+info)

Three-dimensional reconstruction of the coronary sinus with rotational angiography. (22/174)

BACKGROUND: High-speed rotational coronary venous (CV) angiography (RCVA) permits dynamic, multi-angle visualization of the CV anatomy. METHODS AND RESULTS: RCVA uses a rapid isocentric rotation over a 108 degrees arc, right anterior oblique (RAO) 54 degrees to left anterior oblique (LAO) 54 degrees, in 4 s. Three-dimensional models of the venous tree were reconstructed, and the rotational images were analyzed using a full range of gantry angles, providing the operator with considerably more information about the CV anatomy than standard coronary sinus angiography images (SCVA). CONCLUSIONS: The SCVA view, which optimally displayed the appropriate coronary sinus branch for left ventricular lead implantation, was often different from the conventional RAO and LAO views.  (+info)

Magnetically guided left ventricular lead implantation based on a virtual three-dimensional reconstructed image of the coronary sinus. (23/174)

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Reversing cardiac resynchronization therapy non-responder status in a patient with a surgically placed epicardial left ventricular lead by switching to an active fixation coronary sinus lead. (24/174)

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