HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nawwar Al Attar Richard Raffoul Patrick Nataf Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lansac, E. Articles by Nataf, P. Search for Related Content PubMed Articles by Lansac, E. Articles by Nataf, P. Related Collections Related Article

J Thorac Cardiovasc Surg 2008;135:376-381
© 2008 The American Association for Thoracic Surgery

Evolving Technology

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

^a Department of Cardiovascular Surgery, Bichat University Hospital, Assistance Publique Hopitaux de Paris, France
^d Department of Cardiology, Bichat University Hospital, Assistance Publique Hopitaux de Paris, France
^b Unit 698 Cardiovascular Hematology, Bio-engineering and Remodelings, Institut National de la Santé et de la Recherche Médicale, Paris, France
^c Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France.

Received for publication January 28, 2007; revisions received April 5, 2007; accepted for publication May 11, 2007.

^_* Address for reprints: Emmanuel Lansac, MD, Department of Cardiovascular Surgery, Bichat University Hospital, APHP, 46 Rue Henri Huchard, 75018 Paris Cedex, France. (Email: emmanuel.lansac{at}bch.aphp.fr).

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.

Related Article

Percutaneous treatment of mitral regurgitation: So near, yet so far!

Michael J. Mack
J. Thorac. Cardiovasc. Surg. 2008 135: 237-239. [Extract] [Full Text] [PDF]