心后静脉X线解剖及其在心脏再同步化治疗中的应用

Angiographic anatomy of posterior ventricular vein and its application in cardiac resynchronization therapy

目的:研究心后静脉的X线解剖特征,探索其在心脏再同步化治疗左室导线植入中的应用价值。方法:球囊逆行造影并通过交通支显影对78例患者的心后静脉直径及其与冠状静脉窦主干的角度进行观测,对成功植入左室导线的病例分析起搏参数。结果:所有患者均成功进行冠状静脉窦逆行造影,平均每位患者直径超过4F的分支血管有(1.63±0.49)个;40例(51.3%)患者可见心后静脉,22例(28.2%)患者成功植入左室起搏导线至心后静脉内。心后静脉直径(2.03±0.57)mm,其开口距离冠状静脉窦开口为(6.73±6.25)mm,与冠状静脉窦开口方向成角为(127.0±27.1)°;交通支显影方法有利于显示心后静脉,超选插管能显示心后静脉的分支,增加左室导线植入成功率。成功植入心后静脉的22例患者起搏阈值为(1.1±0.4)V。结论:心后静脉开口靠近冠状静脉窦口,交通支显影方法有利于显示心后静脉,心后静脉可作为左室电极导线植入路径。

Objective：To study the venographic characteristics of posterior ventricular vein（PVV） and explore its value in left ventricular lead implantation in cardiac resynchronization therapy（CRT）.Methods：Retrograde cardiac venography with balloon through the communication branch was performed in 78 consecutive patients.Number of branches of cardiac coronary vein,the diameter of PVV,the distance of PVV to the coronary sinus ostium were measured.The pacing threshold of left ventricular lead implanted in PVV was recorded.Results：Retrograde coronary sinus venography was successfully done in all 78 patients.In average,these patients had 1.63 ± 0.49 vessel branches with diameter over 4French.PVV was seen in 40（51.3%） patients.Left ventricular leads were successfully implanted in 22（28.2%） patients in PVV.The average diameter of PVV was（2.03 ± 0.57） mm;the distance of PVV to the coronary sinus ostium was（6.73 ± 6.25） mm,with an angle of（127 ± 27.1）°.Communication branch imaging method was conducive to show PVV,ultra-elective insertion of the sheath into the PVV increased the success rate of left ventricular lead implantation.Pacing threshold of left ventricular lead in the 22 patients was（1.1 ± 0.4）V.Conclusion：The PVV joins the coronary venous near the coronary sinus ostium;communication branch imaging methods is conducive to show PVV.PVV is suitable for left ventricular lead implantation in cardiac resynchronization therapy.