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Coronary vein balloon angioplasty forleft ventricular pacemaker lead implantation

Bert Hansky, MD^*,*, Barbara Lamp, MD, Kazutomo Minami, MD^*, Johannes Heintze, MD,, Leon Krater, MD, Dieter Horstkotte, MD, Reiner Koerfer, MD^* and J.ürgen Vogt, MD

^* Department of Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
Department of Cardiology, Heart Center NRW, University of Bochum, Bad Oeynhausen, Germany

View larger version (93K): [in a new window]   Figure 1 Patient no. 1. (A) Posterolateral target vein before initial lead implantation. (B) In the same vessel, intraluminal adhesions and stenoses secondary to the lead falsely suggest an extraluminal course of the lead. (C) After lead extraction. (D) Balloon angioplasty of narrowed segment. (E) Intraluminal adhesions continue to be visible, even after balloon dilation of the central stenosis.

View larger version (154K): [in a new window]   Figure 2 Patient no. 2. (A) Posterolateral target vein with spontaneous proximal stenosis (<2 mm). (B) Balloon angioplasty of the narrowed venous segment. (C) Angioplasty result. (D) Successful lead placement after dilation of the narrowed segment.

View larger version (79K): [in a new window]   Figure 3 Patient no. 4. (A) Mid section of the lateral target vein narrowed to <2.0 mm (arrow). (B) Angioplasty of the narrow segment (Cordis Europass, 2.5 mm).

View larger version (127K): [in a new window]   Figure 4 Patient no. 5. (A) Small, tortuous lateral target vein. (B) Coronary vein balloon angioplasty (Cordis Europass, 2.5 mm). (C) Successfully implanted lead (Medtronic OTW 4193).