Cardiac Resynchronization Therapy: Double Cannulation Approach to Coronary Venous Lead Placement via a Prominent Thebesian Valve
Article first published online: 20 MAR 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 3, pages e70–e73, March 2013
How to Cite
CAO, M., CHANG, P., GARON, B. and SHINBANE, J. S. (2013), Cardiac Resynchronization Therapy: Double Cannulation Approach to Coronary Venous Lead Placement via a Prominent Thebesian Valve. Pacing and Clinical Electrophysiology, 36: e70–e73. doi: 10.1111/j.1540-8159.2012.03362.x
- Issue published online: 5 MAR 2013
- Article first published online: 20 MAR 2012
- Manuscript Accepted: 3 DEC 2011
- Manuscript Revised: 7 AUG 2011
- Manuscript Received: 16 JUN 2011
- electrophysiology – clinical;
- congestive heart failure
We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.