Coronary Angiography/Coronary Venography And Spiral CT Angiography Anatomic Was Studied In Predicting Success Rate Of Intra Operative Left Ventricular Lead

Objective Coronary angiography,Coronary venography,spiral CT angiography anatomic was used to observed anatomic features of cardiac venous system. Three methods was optimized and compared that predict intraoperative CRT success rate in left ventricular lead implantation.Methods 173 patients who correspond with the relevant treatment indications and no indications underwent coronary angiography or CRT/CRT-D surgical operation or 64-slice spiral CT coronary imaging was radommly selected at the First Affiliated Hospital of Kunming Medical College from July 2006 to April 2010 years. 89 cases were randomly selected as the groupe of coronary angiography On the basis of ruly coronary angiography: Contrast agent (8 to 12 ml)was injected respectively while film was recording in the left anterior oblique (LAO), anteroposterior (PA). The time of DSA film exposure was extended (5～10s) in order to capture the image of cardiac venous system when contrast agent back to cardiac venous system through the coronary artery and capillary. 36 cases were randomly selected as the groupe of coronary angiography. Catheter sheath were inserted into the coronary sinus by conventional methods. Venogram balloon catheter was located distal of MCV. Ensure that the venous blood return wew temporarily blocked as much as possible after the balloon inflated Contrast agent (5 to 8 ml)was quickly injected through the hole of catheterrespectively while film was recorded in the left anterior oblique (LAO). The time of DSA film exposure was 5～10s in order to to capture the image of GCV,upstream branch of cardiac venous system and downstream of cardiac venous system when contrast agent back to CS MCVand GCV through the side anastomosis branch..48 patients was radomyly selected as the groupe of CT coronary venography. On the basis of ruly coronary angiography of 64-slice spiral. Enhanced scan used with bolus- trackinbolus injection track trigger. Contrast agent was injected with twin-tube injector through antecubital vein. 90-120ml volume of contrast agent was injected with rate of 5ml/s.Then, 40ml volume of contrast agent was injected with equal rate. In the 10s of injection later, the same slice was scanned with the low-dose. Triggering interested area in coronary sinus of descending aorta. According to patient's cardiac function, the triggering threshold was 150-180Hu .The scan range was from carina to cardio. The scan time was 12-18s. The thickness of reconstruction slice was 0.75mm. The interval of reconstruction was 0.4mm.The time of tube- ball rotation was 0.42s .ball reconstruction pitch 0.4mm. According to patients' heart rate, automaticly selecting 0.2-0.3 pitch. Generate cross-sectional images by selecting the clearly coronary venography phase. Cross-sectional images was delieved to Syngo Multi Modality workstation. Three-dimensional of vascular images reconstructed and color printed. Three methods of coronary venography was respectly analysed about coronary sinus' location of the opening,size,shape,length and the number of the upstream branch.. Three methods of coronary venography was respectly analysed to GCV/MCV/LVPV and potential target vessel's the opening of location,angle,size,curvature,direction,distribution,with or without side anastomosis. Comparing the three methods of coronary venography advantages and disadvantages. Success rate of left ventricular pacemaker lead implantation in the groupe of 36 patients with CRT therapy was analysedResult(1)Successfull rate of coronary angiography was 98.9% . Overall incidence of radial artery spasm was 5.6%(5 / 89).Forearm tension hematoma were arised to two cases of patients. Arrhythmiain were arised two cases of patients. Successfull rate of coronary venography was 97% (35/36) Coronary sinus dissection were arised two cases patients. Incidence of arrhythmiain was 11.1 % (4/36) The incidence of puncture subclavian artery was 5.6% (2/36) .Successfull rate of coronary CT venography was 95.8% (46/48) Incidence of arrhythmiain was 2.1 % (1 /48) (2) The group of coronary angiography The rate of imaging is 98.9% in LVPV.. The rate of imaging is 100% in CS,MCV,LVPV. The group of coronary venograph: The rate of imaging is 100% in CS,MCV,LVPV. The group of 64-slice CT: The rate of imaging is 100% in CS,MCV,LVPV (3) Three methods wa showed: coronary sinus was behind the heart of coronary sulcus which was between left atrium and left ventricle. The opening of CS was in the right atriumwithin. CGV was continuatied to the coronary sinus, there was no angle. MCV was running in the hearts of posterior interventricular groove The angle between CS and MCV is the most of close to or less than 90 degrees . The opening of MCV is near the opening of CS. The number of LVPV,the angle between CS and LVPV is greater differencet. The average diameter of the opening of CS is 13.0±3.1mm.The average diameter of CS at MCV is 10.1±1.2mm. The average diameter of CS atLVPV is7.6±1.2mm, The average diameter of the opening of MCV is 6.1±0.9mm. The average diameter of the opening of LVPV is 4.4±0.7mm , The average diameter of the middle of LVPV is 3.9±0.6mm.. (4)The anatomy of the LVPV and distribution of left ventricular lead of implanting site in patients who was operated CRT surgery :19 cases have only one LVPV. 15 cases have 2 LVPV.1 case have 3 LVPV. 7 cases(20%) LVPV is tortuous. The angle between CS and LVPV is the most of close to or less than 90 degrees. 7cases's(20%) angle between CS and LVPV is greater than 90 degree ..29 patients (82.9%) Left ventricular lead was implanted in LVPV. 1 patients(2.9%) Left ventricular lead was implanted in MCV. 5 patients(14.3%) was utilized with right ventricular bifocal pacingConclusion1. Evaluation of cardiac veins with Coronary angiography and Coronary venography is feasible not only is invasive but also have rate of failure and complications2. Evaluation of cardiac veins with 64-slice CT could provide three-dimensional images of cardiovascular which is non-invasive and fewer complications except for a large number of large X-rays3. Three methods can predict the surgical success rate of CRT 4. Three kinds of coronary venography was studied on the the human coronary sinus and its tributaries. The location of the coronary sinus and its initial positions was defined. The number of branches,course,diameter,angle between CS and branches and the variation of CS was understood for the clinical left ventricular lead implantion5. 0.6% people were no target vein (left ventricular vein). 2.8% people can not find the opening of coronary sinus. 29.2% was failed to implant left ventricular lead becauseare the angle between LVPVand CS is too large and/or LVPV is tortuous.