Image in Cardiology
Snare system for left ventricular lead placement in cardiac resynchronization therapy
Utilização de sistema de extração Snare para implantação de eletrocateter ventricular esquerdo na ressincronização cardíaca
Andreia Magalhães
, Miguel Menezes, Nuno Cortez-Dias, João de Sousa, Pedro Marques
Corresponding author
Serviço de Cardiologia, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
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He was in NYHA functional class III under optimized medical therapy, with left ventricular ejection fraction of 25%, mean QRS of 160 ms, and left bundle branch block.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After the coronary sinus was accessed, venography showed the target lateral vein (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The guide wire was introduced up to the distal portion of the vein and the left ventricular lead was advanced, but the proximal region of the vessel could not be crossed. It was decided to advance the guide wire from the lateral vein via a posterior collateral vessel up to the coronary sinus ostium (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). A snare system was introduced through a sheath via the left subclavian vein up to the atrium (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A) and the end of the guide wire was gradually pulled towards the skin surface. Thus, both ends of the guide wire were under the operator's control (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B) and the lead could be advanced to the desired position by pulling the guide wire (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). CRT parameters were satisfactory without diaphragmatic stimulation. There were no complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Correct positioning of the left ventricular lead is crucial to a favorable response to CRT, but venous anatomy often hinders this goal, and alternative and sometimes technically challenging approaches must be adopted to obtain the greatest clinical benefit, as described here.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 1 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-30" "fechaAceptado" => "2014-11-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Magalhães A, Menezes M, Cortez-Dias N, de Sousa J, Marques P. Utilização de sistema de extração <span class="elsevierStyleItalic">Snare</span> para implantação de eletrocateter ventricular esquerdo na ressincronização cardíaca. Rev Port Cardiol. 2015;34:221–222.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 1503 "Tamanyo" => 132388 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Venography showing the target lateral vein. SC: coronary sinus; Veia alvo: target vein.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1638 "Ancho" => 1505 "Tamanyo" => 121078 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Advancing the guide wire from the lateral vein via a posterior collateral vein up to the coronary sinus ostium (arrows).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 959 "Ancho" => 2508 "Tamanyo" => 207071 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) The snare system inside the atrium capturing the end of the guide wire; (B) both ends of the guide wire on the skin surface in two sheaths. Bainha no SC: sheath in the coronary sinus; Fio guia: guide wire.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1421 "Ancho" => 1504 "Tamanyo" => 110491 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Final position of the leads of the cardiac resynchronization system with defibrillator.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000003/v2_201504010220/S2174204915000288/v2_201504010220/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000003/v2_201504010220/S2174204915000288/v2_201504010220/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915000288?idApp=UINPBA00004E" ]
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