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Related Concept Videos

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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Introducer Development for Coronary Sinus Access From Parasternal Mediastinotomy.

Henry M Spotnitz1, Keith J Yeager, Santos E Cabreriza

  • 1From the Departments of *Surgery, †Biomedical Engineering, ‡Medicine, and §Radiology, Columbia University, New York, NY USA.

Innovations (Philadelphia, Pa.)
|July 17, 2015
PubMed
Summary

Parasternal mediastinotomy offers a new approach to the coronary sinus for cardiac procedures. Custom introducers, designed from CT scans, facilitate this novel technique for biventricular pacing and other interventions.

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Area of Science:

  • Cardiovascular Surgery
  • Medical Device Engineering
  • 3D Printing Applications

Background:

  • Right parasternal mediastinotomy is established for pacemaker insertion.
  • Accessing the coronary sinus via this approach is challenging due to a lack of specialized introducers and techniques.
  • This method could enable biventricular pacing and other interventions when conventional routes fail.

Purpose of the Study:

  • To develop and evaluate novel introducers for coronary sinus access using a parasternal mediastinotomy approach.
  • To investigate the feasibility of using patient-specific CT data for custom introducer design.

Main Methods:

  • Anatomically derived introducers were designed using 3D modeling and printing based on CT scans in pigs.
  • Surgical procedures in pigs demonstrated coronary sinus lead insertion with custom introducers.
  • Patient CT scans were analyzed to define optimal introducer curvatures and dimensions for human anatomy.

Main Results:

  • Fifty-one distinct introducer paths were defined, optimizing for anatomic feasibility and material constraints.
  • Key dimensions for introducers were established: average distance 67 mm, bend angle 47°, hook angle 39°, twist angle 20°.
  • A prototype cannula demonstrated successful fit in a human postmortem specimen.

Conclusions:

  • Parasternal mediastinotomy provides feasible access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation.
  • Patient-specific CT data can effectively guide the design of introducers for clinical application.