A 128-slice CT scanner helpful in localising coronary sinus ostium during CRT-D implantation – case report

BACKGROUND: Cardiac resynchronization therapy (CRT) has become a successful treatment option for symptomatic heart failure in patients with poor left ventricular (LV) systolic function and broad QRS complex in the surface electrocardiogram (ECG). CASE REPORT: In this report we present a case of a 70-year-old woman with advanced heart failure due to ischaemic heart disease who underwent an upgrade from VVIR stimulator (pacemaker, PM) to cardiac resynchronization therapy defibrillator (CRT-D). The first attempt was unsuccessful due to problems with inefficient cannulation of the orifice of the coronary sinus (CS). After performing a 3D reconstruction with a 128-slice CT scanner, it was possible to carry out the up-grade to CRT-D resulting in enormous clinical improvement. CONCLUSIONS: The case represents an example of the usefulness of 3D reconstruction with the 128-slice CT scanner used after failed CRT-D implantation due to difficulties with efficient cannulation of the coronary sinus orifice in a rare anatomical variant.