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Ann Thorac Surg 2002;74:1254-1256
© 2002 The Society of Thoracic Surgeons

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Case report

Transesophageal echocardiography guided placement of a coronary sinus pacing lead

^a Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, New York, USA
^b Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Accepted for publication April 30, 2002.

* Address reprint requests to Dr Spotnitz, Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University MHB 7-435, 177 Fort Washington Ave, New York, NY 10032 USA
e-mail: hms2{at}columbia.edu

Cardiac resynchronization therapy for the treatment of medically refractory heart failure requires coronary sinus lead placement for left ventricular pacing. Coronary sinus lead placement is technically difficult with success rates reported between 53% to 98% and implantation times ranging from 90 minutes to 5 hours. We report the use of intraoperative transesophageal echocardiography to guide coronary sinus lead placement when conventional fluoroscopy failed. Transesophageal echocardiography may improve the success rate with coronary sinus lead placement and decrease the operative time required. This should be used with caution, however, as sedation, possible intubation, and esophageal manipulation have potentially morbid consequences in patients with advanced congestive heart failure.

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