Percutaneous mitral annuloplasty through the coronary sinus: an anatomic point of view.
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.
Lansac
Emmanuel
E
Department of Cardiovascular Surgery, Bichat University Hospital, Assistance Publique Hopitaux de Paris, France. emmanuel.lansac@bch.aphp.fr
Di Centa
Isabelle
I
Al Attar
Nawwar
N
Messika-Zeitoun
David
D
Raffoul
Richard
R
Vahanian
Alec
A
Nataf
Patrick
P
D002102:Cadaver; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods; D054326:Coronary Sinus / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012680:Sensitivity and Specificity