Coronary sinus venography

Fig 9 5 Coronary sinus venography showing stenosis at the middle part of the main vessel (left anterior oblique in precluding left ventricular (LV) lead advancement. Angioplasty balloon inflation (b). Over-the-wire implantation of the LV lead in a lateral branch of the coronary sinus (c)... 

Coronary Sinus Venography and Development of Lead Implant Strategy... 

The importance of coronary sinus venography cannot be overstated. Examples where venography has proven invaluable include situations with coronary sinus venous branches near parallel to the coronary sinus (Fig. 5.8) or in the case of an unusually large vein of Marshall or post-operative patients (Fig. 5.9). 

If occlusive coronary sinus venography is performed, care must be exercised to assure the relatively stiff tip of the balloon catheter does not engage a small lateral branch vessel or dissect the wall of the coronary sinus before balloon... 

Fig 9 6 Right anterior oblique projection showing the absence of coronary sinus branches at venography... 

LV pacing has undergone considerable evolution in its short history. Initially, pacemaker electrodes were placed in the coronary sinus using a stylet-driven technique. This has evolved to the currently acceptable use of a guiding catheter contrast venography for either a stylet-driven or some form of guidewire-assisted placement. 

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