title: Percutaneous mitral annuloplasty: an anatomic study of human coronary sinus and its relation with mitral valve annulus and coronary arteries.
abstract: BACKGROUND
  To allow performance of "stand-alone" mitral annuloplasty with minimal invasiveness, percutaneous techniques consisting of delivery into the coronary sinus (CS) of devices intended to shrink the mitral valve annulus have recently been tested in animal models. These techniques exploit the anatomic proximity of the CS and mitral valve annulus in ovine or dogs. Knowledge of a detailed anatomic relationship between the CS, coronary arteries, and mitral valve annulus in humans is essential to define the safety and efficacy of percutaneous techniques in clinical practice. We sought to determine the qualitative and quantitative anatomic relationships between CS and surrounding structures in human hearts.
  
  
  RESULTS
  The distance from the CS to the mitral valve annulus and the relationship between the CS and surrounding structures were studied in 61 excised cadaveric human hearts. Maximal distance from the CS to the mitral valve annulus was found to be up to 19 mm (mean, 9.7+/-3.2 mm). A diagonal or ramus branch, main circumflex artery, or its branches were located between anterior interventricular vein/CS and the mitral valve annulus in 16.4% and 63.9% of cases, respectively.
  
  
  CONCLUSIONS
  Surgical anatomy suggests that in humans the CS is located behind the left atrial wall at a significant distance from the mitral valve annulus. Percutaneous mitral annuloplasty devices probably shrink the mitral valve annulus only by an indirect traction mediated by the left atrial wall; a theoretical risk of compressing coronary artery branches exists. Chronic studies are needed to address this problem and to determine long-term efficacy of such methods.
authors.affiliation: Cardio-Thoracic Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. dmaselli@tiscali.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaramonti
authors.forename: Federica
authors.initials: F
authors.lastname: Mangia
authors.forename: Gabriele
authors.initials: G
authors.lastname: Borelli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Minzioni
mesh_terms: D002102:Cadaver; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003331:Coronary Vessels / Q000033:anatomy & histology* / Q000601:surgery; D006325:Heart Atria / Q000033:anatomy & histology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006353:Heart-Assist Devices; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000601:surgery / Q000628:therapy; D012849:Sinoatrial Node / Q000033:anatomy & histology* / Q000601:surgery