Thank you!

PROCEDURE PERFORMED:
Upgrade of dual-chamber ICD to biventricular ICD.

PREOPERATIVE DIAGNOSIS:
Chronic systolic heart failure. Chronic RV pacing. Ejection fraction
less than 30%.

ANESTHESIA:
General.

ESTIMATED BLOOD LOSS:
None.

UNANTICIPATED EVENTS/COMPLICATIONS:
None.

APPROACH:
Upper left chest.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating suite, where the upper left
chest area was prepped and draped in usual sterile fashion. Adequate
general anesthesia was obtained by the Anesthesia Department. Venography
was performed, which does not completely ensure patency of the left
subclavian vein. In fact, I think there is a large collateral there.
We were successful in accessing this large collateral and then after
dilating up this area and manipulating it past with various wires gaining
access to the right heart, eventually a coronary sinus guide was introduced,
and with great difficulty an inferior lateral wall vein was chosen and
the St. Jude biventricular LV lead placed out. The left lateral wall
thresholds measured and found to be acceptable. Leads connected to
the new St. Jude biventricular ICD. The deep tissue checked for dryness
and closed with 3-0 Vicryl. Skin was closed with 4-0 Monocryl in a
running,
subcuticular fashion. Pressure was applied. The patient sent to recovery
room in stable condition.