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Thebesian valve imaging with electron beam CT angiography: implications for resynchronization therapy
Jerold S Shinbane1, Marc J Girsky, Songshou Mao
1Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, California 90502-2064, USA.
Pacing and Clinical Electrophysiology : PACE
|November 18, 2004
Summary
A prominent Thebesian valve visualized by electron beam computed tomographic angiography blocked endocardial left ventricular pacing. Epicardial lead placement was used for resynchronization therapy, highlighting the value of CT angiography for planning such procedures.
Area of Science:
- Cardiovascular Imaging
- Electrophysiology
- Cardiac Anatomy
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Left ventricular (LV) lead placement is crucial for CRT efficacy.
- Anatomical variations can complicate CRT procedures.
Observation:
- A prominent Thebesian valve at the coronary sinus os was visualized using electron beam computed tomographic angiography.
- This anatomical anomaly impeded an endocardial approach for LV lead placement.
Findings:
- The Thebesian valve obstructed the intended pathway for transvenous LV lead implantation.
- An alternative epicardial approach was successfully employed for LV lead placement.
- Electron beam computed tomographic angiography provided detailed anatomical insights crucial for procedural planning.
Implications:
- Electron beam computed tomographic angiography is valuable for pre-procedural assessment in complex CRT cases.
- Understanding coronary sinus anatomy, including valves like the Thebesian valve, is essential for successful lead placement.
- This case demonstrates the utility of advanced imaging in overcoming anatomical challenges during cardiac interventions.