Use of a low profile ultrasound transducer for coronary sinus cannulation: a pilot study.

Background: Cardiac resynchronization therapy with biventricular pacing has been shown to be beneficial in improving heart failure in patients with prolonged QRS duration (≥120 ms) and low ejection fraction (≤35%). Unsuccessful cannulation of the coronary sinus (CS) has been reported in up to 10% of cases. The feasibility of the transthoracic continuous cardiac imaging for coronary sinus cannulation has not been previously demonstrated.

Methods And Results: We developed a 2.5-MHz hemi-spherical continuous cardiac imaging transducer (CONTISON), mounted in an external housing, to permit steering in 360°. The transducer was attached to the chest wall using an adhesive ring. The CS was easily imaged by echocardiography by placing the transducer just medial to the apex and tilting it dorsally. The feasibility study was done in 11 patients. CS ostium and body were imaged in all patients. Cannulation was successfully achieved in nine patients with a mean cannulation time of 1 minute 16 seconds. In two patients, poor image quality precluded adequate visualization of CS. Fluoroscopy was not used for cannulation.

Conclusion: We demonstrated the feasibility of using the CONTISON echography transducer for the guidance CS cannulation. This technique could expedite CS cannulation and reduce radiation exposure. Further studies comparing ultrasound versus fluoroscopy for CS cannulation appear warranted.