Identification of lateral cardiac veins for cardiac resynchronization therapy
Bibliographic record
Abstract
Coronary sinus (CS) venography is used to identify suitable, usually mid-lateral veins, for left ventricular (LV) lead placement. Once CS cannulation has been achieved, contrast injection through a balloon occlusion catheter allows visualization of the CS and its branches. We present a 59-year-old patient with long standing chronic heart failure with a previous single chamber implantable defibrillator referred for upgrade to resynchronization therapy. Initial images of the CS revealed no lateral veins (Figure 1). The catheter was withdrawn to the ostium and contrast injection proximally revealed the presence of a separate CS (Figures 2 and 3). Manipulation of the catheter eventually allowed cannulation of this vessel, imaging of the lateral branches (Figure 4), and successful lateral LV lead placement. Initial contrast venogram of coronary sinus identifying no lateral veins. Further contrast venography following withdrawal of the balloon occlusion catheter to the coronary sinus os suggesting a proximal origin of the lateral vein. Right anterior oblique view demonstrating separate origin to the venous system draining the lateral cardiac wall. Cannulation of the lateral venous system prior to placement of the left ventricular pacing lead. Occasionally, during the LV lead placement, contrast venography will reveal a CS that appears to have no lateral branches. This is usually a consequence of the injection catheter being advanced past the origin of the lateral veins. Withdrawing the sheath and balloon occlusion, catheter back towards the CS ostium and repeating the injection will allow the proximal branch to be imaged. In the present case, there appeared to be two CSs running parallel to each other. Imaging of this vessel required the removal of the sheath to the base of the right atrium. Lead placement during the cardiac resynchronization therapy can have a large influence on symptomatic benefit. Posterior-lateral positioning is thought to be associated with a greater chance of response. Therefore, every effort should be made to identify veins that pass over these regions, even if initial imaging does not identify them. The authors are grateful to Wilson Chan of the Cardiac Catheterisation Research Laboratory at Mount Sinai Hospital for help with preparation of the images.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".