Resincronización ventricular: nueva técnica y dispositivo para el implante endocavitario de un catéter en el ventrículo izquierdo / Ventricular Resynchronization: A New Technique and Device for Endocardial Left Ventricular Lead Placement

Las dificultades inherentes a la técnica de implante de resincronizadores han generado la necesidad de buscar nuevas opciones, como el implante endocavitario en el ventrículo izquierdo por vía transeptal auricular desde la aurícula derecha. En tal sentido, en los últimos años ya se realizaron varias publicaciones. Si bien los resultados son satisfactorios, en todos los casos se utilizan técnicas "especiales", que tienen sus dificultades propias y requieren gran experiencia y una curva de aprendizaje por parte del operador. Es probable que ésta sea la razón por la cual estas técnicas no se "popularizaron", pese a sus buenos resultados. El procedimiento que se describe en esta presentación pretende establecer un método basado en técnicas de rutina en los laboratorios de electrofisiología de todo el mundo que permita un implante sencillo, efectivo, rápido y pasible de ser utilizado en forma segura con una curva de aprendizaje mínima. Básicamente, el procedimiento consiste en la introducción de un catéter endocavitario en el ventrículo izquierdo a través de una punción transeptal convencional por la vena femoral y su exteriorización por la vena subclavia (derecha o izquierda) para completar el implante en forma convencional.

The difficulties regarding the implantation of devices for cardiac resynchronization therapy have generated the necessity to look for alternative pacing techniques, such as endocardial left ventricular lead placement via the transseptal approach from the right atrium. In this sense, several studies have been published in the last years. Al-though all these studies have reported satisfactory outcomes, they all use "special" techniques with their own limitations, as the procedures should be performed by experienced op-erators who have overcome the learning curve. This might be the reason why these techniques have not become "popular" yet despite the favorable outcomes reported. The procedure here described intends to establish a methodology based on routine techniques used worldwide in the electrophysiology labs to allow a simple, effective, fast and safe lead placement with a minimum learning curve. The procedure consists in introducing an endocardial lead in the left ventricle through a conventional transfemorally performed transseptal puncture; the lead is then tunneled to the right or left subclavian vein and the implant is com-pleted in the conventional fashion.

Thin sectional anatomy of the cardiac septum and surrounding structure / 第三军医大学学报

Objective To study the sectional anatomy of the cardiac septum to provide the reference for clinical imageology and surgery. Methods Sixteen normal adult hearts without organic lesions were verified macroscopically. After vascular perfusion, the specimens were embedded with gel, fixed with 5% formalin, and cryopreserved for a week, and then were sectioned with the Digital Sectioner. Results A total of 1 608 slices (thickness: 0.2 mm) of the heart were obtained. Cardiac septum and the surrounding structures were shown clearly. The demarcation of connective and muscular tissues was clear. The diameters of the cardiac apex, fossa ovalis, brawny intraventricular septum, left ventricle, right ventricle, left and right fibrous trigone were measured with Photoshop6.0. Conclusion The clear images can display tiny structures that could be measured, which could provide anatomical references clinical imageology and surgery.