CRT-D IMPLANTATION IN PERSISTENT LEFT SUPERIOR VENA CAVA: OVERCOMING COMPLEX VENOUS ANATOMY WITH SNARE-ASSISTED LEAD DELIVERY TECHNIQUES
Researchers & Contributors
Dr. Jamal Yusuf
MD DM
Director Professor and Head
Department of Cardiology
Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
New Delhi, India
Dr. Ankur Gautam
MD DM
Specialist
Department of Cardiology
Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
New Delhi, India
Case Videos
VIDEO 1
Left subclavian venogram demonstrating persistent left superior vena cava with no communicating innominate vein.
VIDEO 2
Right subclavian venogram showing separate drainage into the right superior vena cava without a communicating vein.
VIDEO 3
Attempt to engage the lateral vein through persistent left superior vena cava using a Judkins Right guiding catheter; engagement was unsuccessful due to sharp angulation.
VIDEO 4
Successful engagement of the lateral vein using a 6 Fr Extra Back-Up guiding catheter.
VIDEO 5
A 0.014-inch hydrophilic guidewire advanced deeply into the lateral vein branch; a sub-selector catheter used to facilitate lead delivery.
VIDEO 6
Guidewire advanced into the right atrium through venous collaterals and subsequently snared via femoral venous access.
VIDEO 7
Maintenance of snare tension to create a stable veno-venous loop and improve support for lead delivery.
VIDEO 8
A coronary angioplasty balloon advanced through femoral access and inflated near the tip of the Judkins Right guiding catheter to stabilize the system.
VIDEO 9
Successful delivery of the quadripolar coronary sinus lead into the lateral vein.
VIDEO 10
Final position of all leads, including right atrial, right ventricular, and coronary sinus leads.