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

Emmanuel Lansac1, Isabelle Di Centa, Nawwar Al Attar

  • 1Department of Cardiovascular Surgery, Bichat University Hospital, Assistance Publique Hopitaux de Paris, France. emmanuel.lansac@bch.aphp.fr

The Journal of Thoracic and Cardiovascular Surgery
|February 5, 2008
PubMed

Insights

This study reveals the coronary sinus is distant from the mitral annulus, with the circumflex artery often between them. These findings are crucial for developing safe percutaneous mitral repair devices.

Area of Science:

  • Cardiovascular Anatomy
  • Interventional Cardiology

Background:

  • Percutaneous posterior mitral annuloplasty is proposed for functional mitral regurgitation.
  • Concerns exist regarding trigone-to-trigone annuloplasty and circumflex artery compromise.

Purpose of the Study:

  • To assess the 3D anatomic relationships between the mitral annulus, coronary sinus, and circumflex artery in human cadaver hearts.
  • To inform the development of percutaneous mitral repair technologies.

Main Methods:

  • Ten human cadaver hearts were dissected.
  • Expansible foam was injected into the coronary sinus and circumflex artery.
  • Measurements included mitral annulus perimeter, intertrigonal/intercommissural distances, and coronary sinus projection onto the annulus.

Main Results:

  • Coronary sinus annuloplasty achieved commissure-to-commissure annuloplasty, significantly behind the trigones.
  • The coronary sinus demonstrated considerable distance from the native mitral annulus.
  • The circumflex artery was found between the coronary sinus and mitral annulus in 45.5% of specimens.

Conclusions:

  • The coronary sinus has a complex 3D structure and is notably distant from the mitral annulus and fibrous trigones.
  • Further human anatomic studies are essential for advancing percutaneous mitral repair.
  • Understanding these spatial relationships is critical for device safety and efficacy.
Abstract

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