A new technique for cannulation of the coronary sinus from the femoral vein

Previous techniques for cannulation of the coronary sinus have required entry into the right atrium from the superior vena cava. We describe a new technique for cannulation of the coronary sinus from the femoral vein using a standard, unmodified Simmons II catheter. This method was successful in 97% of the patients attempted. The method for using this catheter from the femoral route is described.     

Radiofrequency catheter ablation of postinfarction ventricular tachycardia from the proximal coronary sinus

Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57-year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible.     

非小细胞肺癌股静脉置管化疗并发血栓形成的临床观察

目的探讨股静脉置管化疗非小细胞肺癌并发血栓形成的临床特征、诊断、治疗方法及效果。方法回顾分析我科2007年1月至2010年7月行股静脉置管化疗的非小细胞肺癌患者发生血栓的情况及溶栓方法、效果。结果行股静脉置管化疗182次,发生股静脉血栓9例,右侧7例,左侧2例,置管化疗血栓发生率4.90%。临床表现为置管同侧下肢肿胀、疼痛,局部皮肤淤血,B超显示血流阻断。9例血栓形成后立即行溶栓治疗,其中2例行下腔静脉滤网放置。9例经溶栓、抗凝治疗后血管均通畅,下肢肿胀、疼痛减轻,复查血管B超显示血流通畅。结论肺癌行股静脉置管化疗存在一定血栓发生率,及时行溶栓治疗效果好,并发症少。     

Coronary sinus long sheath catheter system: A new device for transfemoral coronary sinus catheterization

Summary Coronary sinus catheterization requires an approach into the right atrium via the superior vena cava. This study contains information regarding a coronary sinus long sheath catheter (CS sheath) system, a new device for cannulation of the coronary sinus through the femoral approach. This method was successful in 96.9% of the cases attempted. Furthermore, cannulation using the CS sheath allowed us not only to insert several catheters into the coronary sinus for clinical use and investigation, but also to access the great and small cardiac veins easily and selectively.     

Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein

In 19 children with Kawasaki disease without any cardiac sequelae the coronary sinus was cannulated via the femoral vein with a specially designed flow catheter and coronary sinus blood flow was measured by the continuous thermodilution method. There was a statistically significant positive correlation between coronary sinus blood flow and age, body surface area, and left ventricular mass, but coronary sinus blood flow per left ventricular mass (100 g) was negatively correlated with age, body surface area, and left ventricular mass. Coronary vascular resistance was negatively correlated with age, body surface area, and left ventricular mass. Younger children require a much greater coronary blood flow per left ventricular mass and have a higher coronary vascular resistance than older children and adolescents. These results may indicate that coronary blood flow is less efficient in childhood than in adolescence or adulthood.     

Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein.

In 19 children with Kawasaki disease without any cardiac sequelae the coronary sinus was cannulated via the femoral vein with a specially designed flow catheter and coronary sinus blood flow was measured by the continuous thermodilution method. There was a statistically significant positive correlation between coronary sinus blood flow and age, body surface area, and left ventricular mass, but coronary sinus blood flow per left ventricular mass (100 g) was negatively correlated with age, body surface area, and left ventricular mass. Coronary vascular resistance was negatively correlated with age, body surface area, and left ventricular mass. Younger children require a much greater coronary blood flow per left ventricular mass and have a higher coronary vascular resistance than older children and adolescents. These results may indicate that coronary blood flow is less efficient in childhood than in adolescence or adulthood.     

New catheter design for cannulation of the anomalous right coronary artery arising from the left sinus of valsalva.

Cannulation of an anomalous right coronary artery during coronary angiography and percutaneous intervention poses significant technical difficulties using currently available catheter shapes. We describe a new catheter design and the cannulation technique for application of this catheter. The initial experience with this catheter in cases is reported.     

比较4F和6F造影导管经股动脉行冠状动脉造影

目的 比较使用4F及6F造影导管经股动脉径路行冠状动脉造影的可行性。方法 把疑诊冠心病病人409例分成两组,分别使用4F造影导管178例和6F造影导管231例行冠状动脉及左心室造影,对比两组病人手术成功率,术后止血压迫时间、开始活动时间、局部及全身并发症发生率等。结果 两组病例造影成功率及完成造影时间大致相同,4F组造影剂使用量、术后止血压迫时间、卧床时间、穿刺点伤口皮下血肿形成、皮下淤斑、迷走神经反射发生率均明显低于6F组（P＜0.01）。结论 与6F动脉鞘及造影导管比较,使用4F动脉鞘及造影导管经股动脉经路行冠状动脉造影具有方便、可靠、损伤小、并发症少,病人可早期活动、痛苦小、容易接受的优点,可作为诊断性造影、门诊造影和介入术后复查首选方法。     

Selective cannulation of the anterior interventricular vein and coronary sinus: Potential applications

A technique of cannulation of the anterior interventricular vein (AIV) selectively, along with selective cannulation of the coronary sinus, is described. The technique was successful in 61 of 82 patients (76%) in whom it was attempted. There were no serious complications. The technique allows one to obtain blood samples simultaneously from the anterior interventricular vein and the coronary sinus, so that the metabolism of the left ventricular anterior wall and that of the overall left ventricle can be studied. Possible clinical applications of simultaneous investigation of the left ventricular anterior wall and global myocardial metabolism are discussed.     

Permanent left atrial tachycardia: radiofrequency catheter ablation through the coronary sinus

The case of a 13-year-old child with an unusually localized "focal" permanent atrial tachycardia is reported. Electrophysiologic study showed that the earliest atrial activation occurred in the distal coronary sinus and preceded the atrial depolarization recorded along the endocardial side of the lateral part of the mitral annulus. Distal coronary sinus mapping revealed a fragmented, polyphasic atrial electrogram. Radiofrequency current delivery to the site permanently stopped the tachycardia.     

冠状动脉造影导管指导下左室电极导线植入研究

目的总结应用冠状动脉造影导管指导冠状静脉窦插管经验。方法符合心脏再同步化治疗(CRT)植入适应证患者分入电生理导管指导组(电生理组)和冠状动脉造影导管指导组(造影组),对比两组冠状窦插管操作时间、透视时间及射线剂量以及并发症发生情况。结果 30例均成功植入左室电极导线。造影组较电生理组在冠状窦插管时间、透视时间及射线剂量有下降趋势,但统计学无明显差异。两组均无并发症发生。结论冠状动脉造影导管指导冠状静脉窦插管安全、有效,可作为电生理导管的替代方法。     

Impact of catheter ablation of the coronary sinus on paroxysmal or persistent atrial fibrillation

Objectives: This study evaluated the impact of catheter ablation of the coronary sinus (CS) region during paroxysmal and persistent atrial fibrillation (AF).
Background: The CS musculature and connections have been implicated in the genesis of atrial arrhythmias.
Methods: Forty-five patients undergoing catheter ablation of AF were studied. The CS was targeted if AF persisted after ablation of pulmonary veins and selected left atrial tissue. CS ablation was commenced endocardially by dragging along the inferior paramitral left atrium. Ablation was continued from within the vessel (epicardial) if CS electrograms had cycle lengths shorter than that of the left atrial appendage.
RF energy was limited to 35 W endocardially and 25 W epicardially. The impact of ablation was evaluated on CS electrogram cycle length (CSCL) and activation sequence, atrial fibrillatory cycle length measured in the left atrial appendage (AFCL) and on perpetuation of AF.
Results: Endocardial ablation significantly prolonged CSCL by 17 ± 5 msec and organized the CS activation sequence (from 13% of patients before to 51% after ablation); subsequent epicardial ablation further increased local CSCL by 32 ± 27 msec (P < 0.001). AFCL prolonged significantly both during endocardial and epicardial ablation (median: 152 to 167 msec P = 0.03) and was associated with AF termination in 16 (35%) patients (46% of paroxysmal and 30% of persistent AF). AFCL prolongation ≥5 msec and/or AF termination was associated with more rapid activity in the CS region originally: P ≤ 0.04.
Conclusion: Catheter ablation targeting both the endocardial and epicardial aspects of the CS region significantly prolongs fibrillatory cycle length and terminates AF persisting after PV isolation in 35% of patients.     

A laser Doppler catheter for monitoring both phasic and mean coronary vein flow

Summary A new catheter-type laser Doppler velocimeter has been developed to monitor coronary vein flow. A thin graded-index multimode optical fiber (outer diameter of 125 µm) is set inside a 5-F catheter, and eight elastic silicon rubber spikes are arranged radially toward the vessel wall to fix the catheter tip in or near the axial region of the coronary vein. He-Ne laser light (wave length =632.8nm) is introduced into the blood through the optical fiber, and reflected light is collected by the same fiber. The Doppler signal is detected by a spectrum analyzer. To avoid any effect by the spikes on flow, the fiber is extended from the catheter tip by 3 mm at the time of measurement. Straight and curved tubing was used to examine the accuracy of flow measurement. The flow velocities recorded by the catheter, which were measured by an electromagnetic flowmeter, exhibited excellent linearity (r= straight: 0.982, curved: 0.996). The blood flow velocity in the great cardiac vein was measured by this method in five dogs. The predominantly systolic waveform, which is a characteristic of the coronary vein flow, was observed in all of the dogs. The great cardiac vein velocity increased around the beginning of the ventricular ejection and decreased gradually after the peak formation at mid- or end-diastole. In addition to this main peak, small flow components were frequently observed during isovolumic contraction and the atrial contraction phase, although these flow components varied in individual dogs. Following left anterior descending artery occlusion, the great cardiac vein flow velocity decreased significantly. Following reopening of the left anterior descending artery, the great cardiac vein flow velocity increased, showing a reactive hyperemic response, and then it returned to the control level. In conclusion, our catheter-type laser Doppler velocimeter holds promise for continuous monitoring of both mean and pulsatile coronary vein flow velocities in man.Supported by Grant Number 62211016 from the Ministry Of Education, Science and Culture, Japan.     

鞘管轨道在Inoue球囊导管进入股静脉中的应用

目的探讨自制鞘管轨道在解决经皮二尖瓣球囊扩张术（PBMV）中Inoue球囊导管沿左心房钢丝进入股静脉困难时的应用,并评价其可行性和安全性。方法 2008年1月至2014年6月在长海医院心内科住院的风湿性二尖瓣狭窄拟行经皮二尖瓣Inoue球囊扩张术的患者共136例,以术中出现Inoue球囊导管沿左心房钢丝进入股静脉困难的18例患者作为研究对象,采用7 F桡动脉血管鞘制作鞘管轨道引导Inoue球囊进入股静脉,观察Inoue球囊导入股静脉的成功率、手术成功率和穿刺处血管并发症。结果在鞘管轨道的辅助下,18例患者均成功将Inoue球囊导入股静脉,手术成功率100%,术后股静脉穿刺处未见静脉撕脱、皮下血肿等并发症发生。结论对于PBMV中Inoue球囊导管沿左心房钢丝进入股静脉困难的患者,使用鞘管轨道能够解决,顺利完成手术并避免穿刺部位出现血管并发症。     

经锁骨下静脉及股静脉途径置入冠状窦电极的比较

目的:比较经锁骨下静脉及股静脉途径放置冠状窦电极的有效性及安全性。方法:连续纳入2010年1月2012年5月行电生理检查及射频消融641例患者,分为2组:锁骨下静脉组(321例)穿刺锁骨下静脉放置固定弯十极冠状窦电极;股静脉组(320例)穿刺股静脉放置可调弯十极冠状窦电极。比较两组成功率及并发症发生率。结果:锁骨下静脉组中穿刺成功317例(穿刺成功率98.8%),其中3例术后检查出现气胸,1例因误置入6F鞘管到锁骨下动脉停止手术,气胸患者中1例因面积>30%行闭式引流,另2例未行特殊处理自行吸收,4例患者均未留下后遗症,该组并发症发生率为1.2%。该组置入鞘管的320例患者中307例成功放置固定弯冠状窦电极,置入电极成功率为95.9%。13例(4.1%)不成功者改经股静脉途径12例成功置入电极。股静脉组333例(锁骨下静脉组电极置入不成功者也改用股静脉途径,该组实际人数:320+13=333)均穿刺成功,其穿刺成功率为100%,3例未能成功置入冠状静脉电极,置入电极成功率为99.1%。此3例未能置入患者行逆行冠状静脉造影后经股静脉成功置入电极。股静脉组电极置入成功率显著高于锁骨下静脉组(99.1%vs.95.9%,P<0.01)。锁骨下静脉组并发症稍多于股静脉组,但差异无统计学意义。两组穿刺成功率和曝光时间[(77±40)s vs.(75±46)s],无显著差异。股静脉组总成功率显著高于锁骨下静脉组[99.1%vs.94.7%,P<0.01]。结论:两种途径放置冠状窦电极成功率均较高,并发症发生率较低,股静脉组总成功率显著高于锁骨下静脉组。     

冠状静脉向动脉转化的研究进展

冠状动脉粥样硬化性心脏病(CHD)病理特征为不稳定粥样硬化斑块破裂或糜烂基础上血小板聚集、并发血栓形成、冠状动脉痉挛收缩、微血管栓塞导致急性或亚急性心肌供氧的减少和缺血加重,有研究表明冠状静脉可向冠状动脉转化。本文综述了血管生成的分类、冠状静脉向动脉转化的过程、冠状静脉向动脉转化的临床意义和潜在治疗靶点的探索,为今后冠状动脉再生提供治疗依据。     

射频导管消融术阻滞经冠状静脉窦传导通路的实验研究

目的　探讨利用射频导管消融术阻滞经冠状静脉窦的电传导通路的方法及可行性。方法　冠状静脉窦口内 5～ 10mm处射频导管消融 ,低位右心房起搏下 ,观察最早激动部位、冠状静脉窦激动顺序和时间、房间隔激动时间、心房激动时间。结果　 (1)冠状静脉窦口或近端射频导管消融可造成经冠状静脉窦电传导通路的完全或部分阻滞。表现在消融前 ,低位右心房起搏时 ,窦口处的电激动明显早于Bachmann束。消融后 ,窦口处的电激动迟于Bachmann束或两者基本一致 ;(2 )消融前后 ,心房激动时间由 (6 1 14± 8 36 )ms延长至 (88 4 3± 19 2 2 )ms,说明低位心房起搏时冠状静脉窦是优势传导通路 ;(3)消融前后的房间隔激动时间及冠状静脉窦激动时间分别为 (2 6 4 3± 8 87)ms对(15 2 8± 10 13)ms和 (39 4 3± 9 78)ms对 (38 0 0± 5 86 )ms。结论　冠状静脉窦近端射频导管消融术阻断经冠状静脉窦的电传导通路的方法是可行的