ArticleJACC. Case reports2026
Balloon Venoplasty in Collateral-Assisted Venous Remodeling to Facilitate Left Ventricular Lead Delivery in Complex Anatomy.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOptimal left ventricular (LV) lead placement is pivotal for the success of cardiac resynchronization therapy with defibrillator; however, tortuous, small, or sharply angulated coronary venous anatomy often frustrate standard delivery. CASE SUMMARY: A 60-year-old woman with ischemic cardiomyopathy (ejection fraction: 23%) and NYHA functional class III symptoms was referred for cardiac resynchronization therapy with defibrillator implantation. A markedly narrowed, hairpin lateral vein prevented antegrade LV lead advancement. By exploiting a collateral from the middle cardiac vein into the lateral vein, we created a retrograde "through-and-through" rail that slightly straightened the bend; thereafter, multiple sequential balloon venoplasty of the collateral and target vein enlarged the lumen and enabled antegrade delivery of a quadripolar LV lead. Postimplant QRS duration narrowed from 160 to 120 milliseconds and symptoms improved to NYHA functional class II at 1 month. DISCUSSION: Collateral-assisted retrograde wiring paired with multiple balloon venoplasty can safely remodel coronary sinus branches, transforming impassable anatomy into a navigable route for LV lead placement. TAKE-HOME MESSAGE: When hostile venous anatomy blocks antegrade LV lead delivery, opportunistic collateral wiring plus balloon venoplasty offers a safe, effective bailout by straightening bends and enlarging the vessel lumen.
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