COMPARATIVE STUDY
JOURNAL ARTICLE

Percutaneous mitral annuloplasty through the coronary sinus: an anatomic point of view

Emmanuel Lansac, Isabelle Di Centa, Nawwar Al Attar, David Messika-Zeitoun, Richard Raffoul, Alec Vahanian, Patrick Nataf
Journal of Thoracic and Cardiovascular Surgery 2008, 135 (2): 376-81
18242272

OBJECTIVE: We assessed the anatomic relationships among the mitral annulus, coronary sinus, and circumflex artery in human cadaver hearts.

METHODS: Percutaneous posterior mitral annuloplasty has been proposed to treat functional mitral regurgitation on the basis of the proximity of the coronary sinus to the mitral annulus. However, concern remains about the ability to perform a trigone-to-trigone posterior annuloplasty and the potential for compromise of the circumflex coronary artery. Ten hearts were studied after injection of expansible foam into the coronary sinus and circumflex artery. The mitral annulus perimeter, posterior intertrigonal (T1-T2) and intercommissural (C1-C2) distance, and coronary sinus projection on the native annulus (S1-S2) were measured. The spatial geometry of the coronary sinus was correlated with the circumflex artery route and the distance with the native mitral annulus.

RESULTS: The projection of coronary sinus annuloplasty achieves at best a commissure-to-commissure annuloplasty 14.5 (6-24) mm behind each trigone: T1-T2: 74 (56-114) mm, C1-C2: 62.2 (48-80) mm, S1-S2: 59.5 (40-80) mm. The coronary sinus was distant from the native annulus (8-14 mm at the coronary sinus ostium, 13.7-20.4 mm at the middle of the coronary sinus, 6.9-14 mm at the level of the great coronary vein). The circumflex artery was located between the coronary sinus and the mitral annulus in 45.5% of cases.

CONCLUSIONS: This anatomic study highlights the 3-dimensional structure of the coronary sinus and its distance from the native mitral annulus and fibrous trigones. Human anatomic studies are mandatory for the further development of percutaneous mitral repair technology.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
18242272
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.