Coronary venous angioplasty to a ring- like stricture preventing left ventricular lead insertion

Cardiac resynchronization therapy (CRT) is an alternative therapy in patients with severe systolic heart failure with dyssynchronous ventricular contraction and severe symptoms (NYHA III-IV) despite optimal medical therapy. The operators sometimes confront limitations to implant left ventricular lead in coronary veins. These include unsuitable branching angle of coronary veins and tortuosity of coronary sinus anatomy, postoperative deformation, presence of venous valves, absence of vessel in target location, and coronary venous stenosis. We here describe coronary venous angioplasty before left ventricular lead insertion in a patient with coronary venous stenosis.