Coronary sinus cannulation

A complete understanding of the gross and radiographic cardiac anatomy is essential for successful cardiac resynchronization. Appreciation of the right atrial anatomy is necessary for coronary sinus cannulation. It is also important to understand that the right atrial and coronary sinus anatomy can be quite... 

Table 4.13 Components of delivery system for coronary sinus cannulation.

Occasionally spasm as a result of irritation may cause coronary sinus constriction. In this case, coronary sinus cannulation should be attempted with an 035-in. guidewire instead of the deflectable electrophysiology catheter. 

The coronary sinus may be guarded or contain valves that may interfere with coronary sinus cannulation. In extreme circumstances, the coronary sinus may be catheterized via the femoral vein. Once the coronary sinus is cannulated with the femoral catheter, this catheter may be used to hold the valve open while the guiding catheter is introduced into the coronary sinus from above. 

Finally, as a general rule, if coronary sinus os cannulation proves to be extremely difficult, it is important to consider alternative catheters and methodology within a reasonable period of time. No more than 15 or 20 min. should be wasted on any given approach. In extreme instances, if a left-sided approach proves unsuccessful, one might consider right-sided venous access in coronary sinus cannulation. 

Fig 9 2 Using a right-sided approach, the electrophysiological catheter is directed to the lateral wall of the right atrium (a) successful cannulation of the coronary sinus in the same patient (b)... 

Fig. 5.5 An Alternative to Multiple Diagnostic Catheters in Fig. 5.4. This catheter with a deflectable tip permits multiple curvatures of the internal catheter within a long vascular sheath to facilitate cannulation of the coronary sinus. Once the long sheath is positioned into the coronary sinus, this catheter must then be removed before the left ventricular lead can be implanted.

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