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Use of a low profile ultrasound transducer for coronary sinus cannulation: a pilot study
Premindra A Chandraratna1, Erol Kosar, Ranil Gajanayaka
1Cardiology Division, Torrance Memorial Hospital, Torrance, CA, USA.
Insights
Continuous cardiac imaging using the CONTISON transducer successfully guided coronary sinus cannulation in most patients, potentially speeding up the procedure and reducing radiation exposure for cardiac resynchronization therapy.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure in patients with prolonged QRS duration and low ejection fraction.
- Coronary sinus (CS) cannulation is crucial for CRT device placement.
- Up to 10% of CS cannulation attempts are unsuccessful, highlighting the need for improved techniques.
Purpose of the Study:
- To evaluate the feasibility of using transthoracic continuous cardiac imaging for guiding coronary sinus cannulation.
- To assess the efficacy and safety of the CONTISON echography transducer in CS cannulation.
Main Methods:
- Development of a 2.5-MHz hemi-spherical continuous cardiac imaging transducer (CONTISON) with 360° steering.
- External housing and adhesive ring for chest wall attachment.
- Echocardiographic imaging of the CS by transducer placement near the apex and dorsal tilting.
Main Results:
- CS ostium and body were visualized in all 11 feasibility study patients.
- Successful cannulation was achieved in 9 out of 11 patients (82%) with a mean time of 1 minute 16 seconds.
- Fluoroscopy was not utilized during the cannulation procedures.
Conclusions:
- Transthoracic continuous cardiac imaging with the CONTISON transducer is feasible for guiding CS cannulation.
- This ultrasound-guided technique may expedite CS cannulation and reduce reliance on fluoroscopy.
- Further comparative studies of ultrasound versus fluoroscopy for CS cannulation are warranted.
Background:
Cardiac resynchronization therapy with biventricular pacing has been shown to be beneficial in improving heart failure in patients with prolonged QRS duration (≥120 ms) and low ejection fraction (≤35%). Unsuccessful cannulation of the coronary sinus (CS) has been reported in up to 10% of cases. The feasibility of the transthoracic continuous cardiac imaging for coronary sinus cannulation has not been previously demonstrated.
Methods And Results:
We developed a 2.5-MHz hemi-spherical continuous cardiac imaging transducer (CONTISON), mounted in an external housing, to permit steering in 360°. The transducer was attached to the chest wall using an adhesive ring. The CS was easily imaged by echocardiography by placing the transducer just medial to the apex and tilting it dorsally. The feasibility study was done in 11 patients. CS ostium and body were imaged in all patients. Cannulation was successfully achieved in nine patients with a mean cannulation time of 1 minute 16 seconds. In two patients, poor image quality precluded adequate visualization of CS. Fluoroscopy was not used for cannulation.
Conclusion:
We demonstrated the feasibility of using the CONTISON echography transducer for the guidance CS cannulation. This technique could expedite CS cannulation and reduce radiation exposure. Further studies comparing ultrasound versus fluoroscopy for CS cannulation appear warranted.
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