Direct visualization of coronary sinus ostium and branches with a flexible steerable fiberoptic infrared endoscope
Saman Nazarian1, Bradley P Knight, Timm L Dickfeld
1Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. snazari1@jhmi.edu
Insights
Direct visualization using infrared endoscopy facilitates coronary sinus cannulation. This technique aids electrophysiology catheter and pacing lead placement, especially in challenging cases.
Area of Science:
- Cardiovascular research
- Medical device innovation
- Minimally invasive procedures
Background:
- Coronary sinus catheterization is difficult in patients with dilated cardiomyopathy.
- Direct visualization may improve cannulation success rates.
- This study explores infrared endoscopy for coronary sinus navigation.
Purpose of the Study:
- To evaluate the feasibility of direct endocardial visualization using infrared endoscopy.
- To assess the utility of infrared endoscopy in navigating the coronary sinus.
Main Methods:
- Utilized a steerable fiberoptic infrared endoscope in a closed-chest canine model.
- Advanced the endoscope via internal jugular vein access, visualizing landmarks like the tricuspid valve.
- Confirmed localization with fluoroscopy, contrast injection, and pathology.
Main Results:
- Successfully visualized the tricuspid valve and inferior vena cava, enabling coronary sinus identification in all 10 dogs.
- Achieved successful coronary sinus engagement and branch visualization.
- Endoscopic images correlated well with pathological findings.
Conclusions:
- Infrared endoscopy enables direct visualization of the coronary sinus ostium and branches.
- This technique shows promise for facilitating coronary sinus engagement and navigation.
- Potential to improve pacing lead and catheter placement in the coronary sinus.
Background:
Placement of electrophysiology catheters and pacing leads in the coronary sinus is challenging in some patients, particularly those with dilated cardiomyopathy. We hypothesized that cannulation of the coronary sinus and its branches can be facilitated by direct visualization. This study reports our experience with navigation into and within the coronary sinus in a closed-chest animal preparation, using a flexible steerable fiberoptic infrared endoscope that allows visualization through flowing blood.
Objectives:
The purpose of this study was to assess the feasibility of direct visualization of endocardial structures through infrared endoscopy.
Methods:
Internal jugular venous access was obtained in 10 healthy mongrel dogs (weight 35-45 kg). The infrared endoscope (2900 fiber imaging bundle, wavelength 1,620 nm, frame rate 10-30/s, 320 x 256 pixels) was advanced to the coronary sinus ostium and branches by direct visualization of anatomic landmarks, such as the tricuspid valve and inferior vena cava. Localization was confirmed by fluoroscopy, contrast injection, and pathologic examination.
Results:
Structures such as the tricuspid valve and inferior vena cava were visualized at distances of 1 to 2 cm, allowing successful coronary sinus identification and engagement in all 10 dogs. Coronary sinus branch images closely resembled pathologic findings.
Conclusion:
Direct visualization of the coronary sinus ostium and branches is possible through infrared endoscopy. This technique likely will facilitate coronary sinus engagement and navigation for pacing lead and catheter placement.
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