Key result
Real-time left coronary injection enables successful CS lead implantation in Ebstein anomaly with mechanical tricuspid valves.
Why the study?
Right ventricular endocardial pacing is partially contraindicated with a mechanical tricuspid valve, but anatomical variations in Ebstein anomaly create difficulties in hooking the coronary sinus for preferred pacing.
Does real-time left coronary injection facilitate successful coronary sinus lead implantation in patients with Ebstein anomaly and a mechanical tricuspid valve?
Case Report
Does real-time left coronary injection facilitate successful coronary sinus lead implantation in patients with Ebstein anomaly and a mechanical tricuspid valve?
Real-time left coronary injection can facilitate coronary sinus lead implantation in patients with Ebstein anomaly and a mechanical tricuspid valve where anatomical variations make CS hooking difficult.
May aid difficult CS cannulation in Ebstein anomaly; leaves open need for prospective validation before clinical adoption.
Right ventricular endocardial pacing is partially contraindicated in the presence of mechanical tricuspid valve. Occurrences of atrioventricular block are commonly associated in postoperative period in Ebstein anomaly repaired with mechanical tricuspid valve. Coronary sinus (CS) pacing is the preferred site in this scenario. However, the anatomical variations in Ebstein anomaly leads to difficulties in hooking the CS. With the help of real time left coronary injection enabled in understanding the anatomical orientation of CS ostium take off, leading to successful CS lead implantation.
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Doddaka et al. (2021) conducted a case report in Ebstein anomaly with mechanical tricuspid valve and atrioventricular block. Coronary sinus lead implantation guided by real-time left coronary injection was evaluated on Successful coronary sinus lead implantation. Real-time left coronary injection enabled successful coronary sinus lead implantation by clarifying the anatomical orientation of the CS ostium in Ebstein anomaly with a mechanical tricuspid valve.
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