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Objectives: To assess the feasibility to place a left ventricular lead into the coronary sinus following percutaneous mitral annuloplasty., Background: Percutaneous coronary sinus-based mitral annuloplasty may reduce functional mitral regurgitation in chronic systolic heart failure. However, concerns have been raised whether the placement of an annular remodeling device in the coronary sinus might preclude subsequent lead placement for resynchronization therapy (CRT)., Methods: Three patients with ischemic cardiomyopathy included in the AMADEUS trial underwent CRT 7 to 8 months after implantation of a mitral valve annuloplasty device., Results: Fluoroscopy and control coronary angiography revealed a stable position of the annuloplasty device without any compromise of coronary blood flow. Intravascular ultrasound of the coronary sinus excluded any thrombus formation and demonstrated smooth endothelialization of the annular remodeling device. Access of the coronary sinus and placement of the left ventricular lead into a posterolateral cardiac vein was not at all compromised by the mitral valve annuloplasty device in any patient., Conclusions: Positioning a left ventricular pacing lead for CRT is feasible after permanent implantation of a coronary sinus-based mitral annuloplasty device in patients with dilated cardiomyopathy., (2009 Wiley-Liss, Inc.)

Aims : The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. Patients and Methods : A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning interstage catheter interventions up to the completion of the superior cavopulmonary shunt were collected. Results : Catheter interventions were performed in 62 of 94 patients (66%; 38 males). These included interventions on the aortic arch (n = 44), the branch pulmonary arteries (PAs) (n = 17), and the Sano shunt (n = 14). Multiple interventions and repeat interventions were common. The minimum aortic arch diameter (pre- versus posttreatment) increased from median 3.1 (2.3-3.3) mm to 5.1 (4.2-6.2) mm (P < 0.001). The catheter pullback gradient decreased from 40 (36-46) mmHg to 9 (5-10) mmHg (P < 0.001), and the echocardiographic gradient from 54 (45-64) mmHg to 12 (10-16) mmHg (P < 0.001). The branch PA diameters increased from 2.4 (2.1-3.0) mmHg to 4.7 (4.2-5.1) mmHg (P < 0.001). The minimum Sano shunt diameters increased from 2.0 (1.5-2.1) mm to 5.9 (5.8--6.0) mm (P < 0.001); this was associated with an improvement in systemic saturation from 63% (60%-65%) to 80% (79-82%) (P < 0.001). Unexpected interstage death at home occurred in two patients who had received no interventions. The remainder received a superior cavopulmonary shunt palliation. Conclusions : Catheter interventions were common. Systematic follow-up and a low threshold for reintervention are essential to the success of staged surgical palliation for this patient cohort. [ABSTRACT FROM AUTHOR]