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Updated: Jun 18, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Mimetic total coronary sinus occlusion due to superselection with the balloon catheter
Jin-Long Huang1, I-Chen Tsai, Chieh-Shou Su
1Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. golden@vghtc.gov.tw
Insights
Cardiac resynchronization therapy requires careful coronary sinus venography. Superselection of a side branch mimicked total occlusion, highlighting a potential procedural pitfall during device implantation for heart failure.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- A 77-year-old male patient presented with dilated cardiomyopathy, atrial fibrillation, prolonged QRS duration (140 ms), and NYHA class III heart failure.
- The patient was a candidate for cardiac resynchronization therapy (CRT) device implantation to improve cardiac function and symptoms.
Observation:
- Coronary sinus (CS) contrast venography was performed using a balloon catheter prior to CRT implantation.
- The venography appeared to show no visible tributary veins, suggesting a complete occlusion of the CS.
Findings:
- The apparent total occlusion of the CS was determined to be an artifact.
- This artifact resulted from the superselection of a CS side branch by the balloon catheter during the venography procedure.
Implications:
- This case highlights a critical technical consideration during CS venography for CRT procedures.
- Accurate visualization of the CS anatomy is essential for successful lead placement and CRT efficacy.
- Awareness of potential catheter-related artifacts can prevent misinterpretation and guide appropriate procedural adjustments.
Abstract:
A 77-year-old man with dilated cardiomyopathy, atrial fibrillation, QRS duration of 140 ms, and NYHA functional class III was referred for cardiac resynchronization therapy device implantation. Coronary sinus (CS) contrast venography by balloon catheter showed no evidence of tributary veins, mimicking total occlusion of the CS. It was found to be due to superselection of a side branch with the balloon catheter.
