重塑和静脉造影的重要性课件.ppt

* RAO of the same anatomy * * Ask student to label veins and tools. What view is this. AP? A=Middle Cardiac Vein B=Postero-Lateral Vein C=Anterior Interventricular Vein (AIV) D=coronary sinus * 1) If every patient had every vein, all implants would go well, but that is not the case. So this is what you could get. 2) Have student label A=Coronary Sinus B=Lateral vein C=AIV (anterior interventricular vein) D=Great Cardiac Vein * A=posterior branch B=coronary sinus C=AIV D= Lateral Branch E=Middle Cardiac Vein * 1) Venogram demonstrates that middle vein reaches all the way around, possibly could be used for a lateral position. Would probably need longer lead. A=Coronary Sinus B=Posterior Vein C D: C or D is lateral other branch is the AIV (hard to tell w/ only 1 view) [lateral branch typically branches off 1st, can’t tell which one comes off 1st] any other view would tell us E=Middle Cardiac Vein F=Great Cardiac Vein * Especially if physician needs to position balloon catheter distally in the CS. Potential to miss optimal branches if too distal so wait for collateral filling of all vessels. 1) Use of long, slower contrast injections (10-20 ml) allow for retrograde filling of vessels that would otherwise be missed (because the balloon is past them). 2) May be necessary if you have a dissection. 3) Shows importance of middle cardiac vein as possible target branch. Doesn’t matter where the subselected take off is, just matters where the lead ends up. Sometimes middle is best choice! Doesn’t matter what direction the lead is facing (you are capturing at the tip anyway). So many different anatomies too. * The target branches for the left lead are the lateral and posterior lateral branches. You want to pace the LV at the last activation site to try to make the ventricles contract together or synchronous. Draw clock around veins on chart paper. In LAO view, veins in the 2-5 o’clock positions are the best. It may not be necessary to discuss these studie