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Updated: Jul 3, 2026
Rodent Inferior Vena Cava Venoplasty Balloon Model
Published on: May 24, 2024
Coronary vein rupture during venoplasty for LV lead placement
Seth J Worley1, Douglas C Gohn, Robert W Pulliam
1Lancaster Heart and Stroke Foundation, Lancaster General Hospital, Lancaster, Pennsylvania, USA. seth@mcworley.com
Insights
Coronary vein rupture during venoplasty for cardiac resynchronization therapy (CRT) can be serious. This case report details successfully placing a left ventricular lead despite balloon rupture and vein perforation in a patient with a virgin pericardium.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) requires left ventricular (LV) lead placement via the coronary sinus.
- Venoplasty is used to treat venous stenosis that impedes LV lead deployment.
- A virgin pericardium presents unique challenges in managing complications like cardiac perforation.
Observation:
- An elderly woman with a virgin pericardium underwent CRT.
- Venoplasty of a stenotic lateral coronary vein was attempted using a noncompliant balloon.
- The balloon ruptured and perforated the vein when pressure exceeded its rated limit.
Findings:
- Despite coronary vein perforation, the LV lead was successfully and safely placed.
- This highlights the potential for managing unexpected complications during CRT procedures.
- Hemodynamic impact was managed, suggesting resilience in specific patient scenarios.
Implications:
- This case demonstrates a successful strategy for managing coronary vein rupture during LV lead placement.
- It underscores the importance of preparedness for device-related complications in interventional cardiology.
- Further research may explore advanced techniques for managing venous stenosis and perforation during CRT.
Abstract:
Coronary vein rupture is a potential complication of venoplasty for LV lead placement. Vein rupture in a patient with a virgin pericardium would be anticipated to have a profound hemodynamic impact from bleeding into the pericardial space. This report describes an elderly woman with a virgin pericardial space who underwent cardiac resynchronization therapy (CRT). Venoplasty of a lead limiting venous stenosis was performed on the lateral coronary vein. The stenosis was unresponsive to a standard noncompliant balloon with side wire. When the inflation pressure was increased beyond the rated burst pressure the balloon ruptured, perforating the vein. We describe our experience in successfully placing the left ventricular lead safely despite the problems arising from these circumstances.
