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(Circulation. 2005;111:2183-2189.)
© 2005 American Heart Association, Inc.

Imaging

Percutaneous Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation

A Real-Time Three-Dimensional Echocardiographic Study in an Ovine Model

Masao Daimon, MD; Takahiro Shiota, MD; A. Marc Gillinov, MD; Motoya Hayase, MD; Marc Ruel, MD; William E. Cohn, MD; Steven J. Blacker, MS; John R. Liddicoat, MD

From the Cleveland Clinic Foundation, Cleveland, Ohio (M.D., T.S., A.M.G.); Beth Israel Deaconess Medical Center, Boston, Mass (J.R.L.); Massachusetts General Hospital, Boston (M.H.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.); Texas Heart Institute, Houston (W.E.C.); and Viacor, Inc, Wilmington, Mass (S.J.B.).

Correspondence to Takahiro Shiota, MD, Department of Cardiovascular Medicine, Desk F15, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail shiotat{at}ccf.org

Received September 24, 2004; revision received November 24, 2004; accepted December 7, 2004.

Background— Although surgical annuloplasty is the standard repair for ischemic mitral regurgitation (IMR), its application is limited by high morbidity and mortality. Using 2D and real-time 3D echocardiography in an ovine model of chronic IMR, we evaluated the geometric impact and short-term efficacy of a percutaneous transvenous catheter-based approach for mitral valve (MV) repair using a novel annuloplasty device placed in the coronary sinus.

Methods and Results— Six sheep developed IMR 8 weeks after induced posterior myocardial infarction. An annuloplasty device optimized to reduce anterior-posterior (A-P) mitral annular dimension and MR was placed percutaneously in the coronary sinus. Mitral annular A-P and commissure-commissure dimensions and MV tenting area (MVTa) in 3 parallel A-P planes (medial, central, and lateral) were assessed by real-time 3D echocardiography with 3D software. The annuloplasty device reduced MR jet area from 5.4±2.6 to 1.3±0.9 cm² (P<0.01), mitral annular A-P dimension in both systole and diastole (24.3±2.5 to 19.7±2.4 mm; P<0.03; 31.0±3.9 to 24.7±2.1 mm; P<0.001), and MVTa at mid systole in all 3 planes (153±46 to 93±24 mm², P<0.01; 140±47 to 88±23 mm², P<0.03; and 103±23 to 87±26 mm², P<0.03).

Conclusions— Percutaneous coronary sinus–based mitral annuloplasty reduces chronic IMR by reducing mitral annular A-P diameter and MVTa. This suggests the potential clinical application of a new nonsurgical therapeutic approach in patients with IMR.

Key Words: catheters • echocardiography • mitral valve • myocardial infarction • regurgitation

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