English Audio Request

As shown in previous slide, antegrade coronary venography during diagnostic CAG should be obtained especially in patient with heart failure and CLBBB . During CAG, the presence of lateral vein can be easily identified. But, CV lumens are not fully filled by the contrast, and orifice of CS and/or lateral branch tends to be unclear due to wash-out of the contrast. As shown in previous slide, antegrade coronary venography during diagnostic CAG should be obtained especially in patient with heart failure and complete left bundle branch block. During CAG, the presence of lateral vein can be easily identified. But, CV lumens are not fully filled by the contrast, and orifice of CS and/or lateral branch tends to be unclear due to wash-out of the contrast. The next possible method to observe CV anatomy, is Multi-slice CT. This slide shows comparison of CV anatomy obtained by MDCT and retrograde CV venography. As you can see, very closely similar imaging of CV on both methods were observed. This slide shows CT images from two different papers. These figures identified anatomical relationship between phrenic nerve and CV. To avoid phrenic nerve stimulation is very important during CRT implantation procedure. Identification of the site with high possibility of nerve stimulation may contribute to select appropriate site of CV and to shorten the procedure time. The benefits of MDCT are considered as follows, It detects 3D images of CVs, provides CVs and phrenic nerve anatomy, and is Non-invasive method.
On the contrary, there can be some problems of MDCT. It causes additional exposure to radiation, requires several particular technique to optimize the scan for visualization, and is inability to assess dysshynchrony. During the procedure for CRT implantation, how do we decide to select the adequate CV?
The next topics are How many optimal CVs does patient have.
If patient has single lateral vein, just target it. It is very simple.
However, if a patient has muliple lateral veins, we should select the best one. I already showed you this in the previous slide, this patient has multiple lateral veins. There are two ways to select optimal vein, guided by morphology of CV and by functional assessment.
I would like to present our experience and results in CRT implantation using morphological approach. This slide shows the methods in our study.
First, for LV pacing site selection, optimal site of LV lead was selected based on the angulation and/or the diameter of the branch.
Second, the evaluated parameters are selected coronary vein, the change in NYHA cardiac functional class, Echocardiographic evaluation for improvement of LVEF, LVESV, and re-hospitalization because of heart failure after CRT.