Roberto Neri, Antonio Silvio Cesario, PieroPalermo, DanielaBaragli, Maria Luisa d’Ettorre, Sergio Cavaglia, Giancarlo Gambelli.
Division of Cardiology G.B. Grassi Hospital, Rome, Italy
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BACKGROUND. Preformed tip shapes guiding catheters have been recently
proposed to simplify the coronary venous access during interventional procedures. However, the insertion may require
multiple attempts with an increasing risk of damaging the soft tissue of the right atrium and of the coronary sinus (CS).
In this study we evaluated effectiveness and safety of an over the wire technique for the introduction of a guiding
catheter into the CS.
METHODS. A 7F decapolar, canted tip, lumen catheter (DAIG Corp., Minneapolis, MN, USA) is introduced through the
right internal jugular vein into the CS. Contrast images of the CS in the left anterior oblique 60° projection are obtained
to identify the location of the CS ostium and displayed on a slave monitor. A standard 0.0032” guidewire is inserted in
the CS through the lumen catheter. After the removal of the lumen catheter a preformed tip 35 cm long sheath
assembled with its dilator (DAIG Corp., Minneapolis, MN, USA) is advanced over the guidewire under fluoroscopic
guidance and engaged into the CS ostium.
RESULTS. This procedure has been carried out in 20 advanced heart failure candidates to biventricular pacing (age
65±15 yrs, 15 males, LVEF 22±7%, QRS 139±2 ms, NYHA class III), undergoing right heart catheterization and retrograde
venography of the CS. The guiding catheter was successfully introduced in the CS in 16/20 patients (80%). The average
procedural time was 30±12 minutes and the average fluoroscopy time was 13±5 minutes. The four failures to introduce
the guiding catheter into the CS occurred mainly in the earlier cases and were due to guidewire dislodgement during
the attempts to engage the guiding catheter in the CS ostium. No complication occurred.
CONCLUSIONS. This over the wire technique allows safe and effective introduction in the CS of a guiding catheter that
can be used for different interventional or diagnostic procedures.
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