冠状窦血管成形术:CRT-D左室电极植入开口狭窄的靶静脉1例

Coronary sinus angioplasty:a report of CRT-D left ventricle lead implanted through the stenosed target vein

1病例资料患者,男,64岁,反复胸闷气短10余年,冠状动脉搭桥术后2年。20天来胸闷、气短症状加重。入院BNP 2264pg/ml,心电图:窦性心律,完全左束支传导阻滞,QRS间期160ms。经胸心脏超声提示全心增大,左房内径(LAD)59mm,左室舒末内径(LVED)68mm,左室下后壁心肌变薄伴向心运动异常,左室射血分数(LVEF):34%。诊断:冠心病,陈旧性下壁心肌梗死,冠状动脉搭桥术后。缺血性心肌病,心功能不全(NYHAⅢ级)。心律失常,完全性左束支传导阻滞。高血压病3级(很高危)。患者经规范药物治疗不能控制病情,符合心脏再同步治疗(CRT)的Ⅰ类适应证[1],经患者及家属知情同意后,限期行CRT-D植入术。

There was one 64 years old patient with ischemic cardiomyopathy,EFrHF and LBBB undergoing cardiac resynchronization therapy in this article.During the operation,we found that the distal of target vein was satisfied for implantation of left ventricle lead while the proximal was stenosis.Then we put the lead into the target vessel through the stenosed lesion successfully by coronary sinus angioplasty.The patient got better with decreased QRS duration,decreased heart size and increased LVEF after CRT-D implatation in one month follow-up.