CRT植入与窍门技巧.pptVIP

* * * * Fluoroscopy in both AP and LAO 40 views were reviewed to verify the final locations of the leads. * * * * * Need to rotate the catheter counter clockwise and follow the Eustachian ridge into the CS. If you rotate clockwise you may run into the thebesian valve and the you will not be able to follow the Eustachian ridge into the CS in that direction. * If you rotate clockwise you may run into the thebesian valve. Remember from the Venogram lecture what those Thebesian valves looked like and how sometimes they can cover the entire ostium. If you cannot cannulate the CS, you should suggest an Epicardial approach, and see if that is appropriate for the patient. * Remember the cannulating technique of placing the catheter in the RV, then pulling back and rotating counterclockwise past the Tricuspid valve. MDT rep looks for PVC’s so you know you are crossing the valve. The Hub tab of the catheter of the catheter should be toward the patients back when you are advancing into the CS OS. * * Coronary Sinus Mapping with an EP catheter, like the MDT Marinr connected to Medtronic Analyzer can limit contrast load for patient by eliminating proof shots. May reduce CS cannulation time when used in conjunction with steep LAO views. In this example, the A wave is much smaller than the V wave indicating that the EP catheter is below the CS. * In this example, the A wave is larger than the V wave indicating that the EP catheter is above the CS. * In this example, the A wave and the V waves are similar in size, indicating that the EP catheter is right at the CS OS. You can now advance the EP catheter to cannulate the CS. Remember the EP catheter is a tool to aid in cannulating the CS. Now you need to advance your Guide catheter over the EP catheter to maintain access in the CS. Review the Marinr does not have a lumen, no wires or shooting contrast. You cannot deliver a lead through the Marnir. * Cs Angle Rotate.mpg As the heart enlarges, the CS take-off becomes