Therapeutic percutaneous transluminal angioplasty with a stenting procedure of a stenosed great cardiac vein in a patient with dilated cardiomyopathy submitted to biventricular pacemaker implantation

Cardiac resynchronization therapy (CRT) is recommended for select patients with dilated cardiomyopathy (DCM). Here, we describe the case of a 62-year-old patient with non-ischemic dilated cardiomyopathy, of functional class NYHA III, with left bundle branch block (LBBB) and 90% stenosis of the great cardiac vein (GCV), which was revealed as a result of coronary sinus venography during a CRT-P implantation procedure. A left-ventricular electrode was introduced to the posterolateral vein. Following CRT-P implantation a partial improvement was observed. In view of the patient's remaining apical segment contractility disorder and the coexistence of great cardiac vein stenosis, a hypothesis was put forward that the cause of these disorders was passive hyperemia of a portion of the left ventricle. Successful GCV angioplasty and BMS implantation was followed by clinical and echocardiographic improvement.Two months after the angioplasty, occlusion of the vein was detected, but repeated percutaneous treatment was unsuccessful.