Balloon angioplasty of cardiac vein in CRT patient

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Cardiac resynchronization therapy (CRT) reduces mortality and hospitalization in patients with symptomatic heart failure and left bundle branch block (LBBB) on optimal drug therapy. Among all, the reasons for “non-response” to CRT pacemaker could be the failure to achieve optimal left ventricular(LV) lead position, due to severe curve or stenosis/occlusion of target vein. Case report. We present a of male patient, age 79, NYHA class III, with atrial fibrillation, chronic coronary syndrome (CCS), prior myocardial infarction, who underwent coronary artery bypass surgery and mechanical prosthetic aortic valve implantation, indicated for CRT in whom venogram revealed ostial/proximal severe curve and stenosis of posterolateral vein, the only vein of coronary sinus leaded to anatomical optimal LV segment for stimulation. After the balloon angioplasty of curved and stenotic portion of target vein with compliant balloon 4.0 x 30 mm, satisfactory and stable position of quadripolar LV lead was achieved. Conclusion. Compliant balloon angioplasty could be safe and efficient way how to override severe coronary vein stenosis in some CRT cases.

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