This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 113/19/2329    most recent CIRCULATIONAHA.105.601518v1 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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rogers, J. H. Articles by Low, R. I. Search for Related Content PubMed PubMed Citation Articles by Rogers, J. H. Articles by Low, R. I. Related Collections Congestive Valvular heart disease Catheter-based coronary and valvular interventions: other Echocardiography Animal models of human disease Related Articles

(Circulation. 2006;113:2329-2334.)
© 2006 American Heart Association, Inc.

Valvular Heart Disease

Percutaneous Septal Sinus Shortening

A Novel Procedure for the Treatment of Functional Mitral Regurgitation

Jason H. Rogers, MD; John A. Macoviak, MD; David A. Rahdert, PhD; Patricia A. Takeda, MD; Igor F. Palacios, MD; Reginald I. Low, MD

From the Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento (J.H.R., P.A.T., R.I.L.); Ample Medical, Inc, Foster City, Calif (J.A.M., D.A.R.); and Massachusetts General Hospital, Boston (I.F.P.).

Correspondence to Dr Jason H. Rogers, Division of Cardiovascular Medicine, University of California, Davis Medical Center, 4860 Y St, Suite 2820, Sacramento, CA 95817. E-mail jason.rogers{at}ucdmc.ucdavis.edu

Received November 14, 2005; revision received February 21, 2006; accepted February 24, 2006.

Background— The septal-to-lateral (SL) mitral annular diameter is increased in functional mitral regurgitation (MR). We describe a novel percutaneous technique (the percutaneous septal sinus shortening system) that ameliorates functional MR in an ovine model.

Methods and Results— Sheep underwent rapid right ventricular pacing to obtain moderate to severe functional MR with SL enlargement. The percutaneous septal sinus shortening system was placed via standard interventional techniques consisting of a bridge (suture) element between interatrial septal wall and great cardiac vein anchors. Through progressive tensioning of the bridge element, direct SL shortening was achieved. Sheep underwent short-term (n=19) and long-term (n=4) evaluation after device implantation. In short-term studies, SL diameter decreased an average of 24% (32.5±3.5 to 24.6±2.4 mm; P<0.001), and MR grade significantly improved (2.1±0.6 to 0.4±0.4; P<0.001). Despite continued rapid pacing, chronic device implantation resulted in durable SL shortening (30.4±1.9 mm before implantation to 25.3±0.8 mm at 30 days; P=0.01) and MR reduction (1.8±0.5 before implantation to 0.2±0.1 at 30 days; P=0.01). Increased cardiac output, decreased wedge pressure, and decreased brain natriuretic peptide levels were observed in animals undergoing long-term device implantation.

Conclusions— The percutaneous septal sinus shortening system is effective in ameliorating functional MR in an ovine tachycardia model. The procedure, which uses standard catheter techniques, can be deployed largely under fluoroscopic guidance. The unique bridge element appears durable and allows direct and precise SL shortening to a diameter optimal for MR reduction.

---

 

CLINICAL PERSPECTIVE

Related Articles:

Issue Highlights
Circulation 2006 113: 2261. [Full Text]

Percutaneous Mitral Valve Repair: A Fertile Field of Innovative Treatment Strategies

Michael J. Mack
Circulation 2006 113: 2269-2271. [Full Text]

This article has been cited by other articles:

				T. K. Rosengart, T. Feldman, M. A. Borger, T. A. Vassiliades Jr, A. M. Gillinov, K. J. Hoercher, A. Vahanian, R. O. Bonow, and W. O'Neill Percutaneous and Minimally Invasive Valve Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, April 1, 2008; 117(13): 1750 - 1767. [Abstract] [Full Text] [PDF]

				J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]

				M. J. Davidson and D. S. Baim Percutaneous Catheter-Based Mitral Valve Repair Card. Surg. Adult, January 1, 2008; 3(2008): 1101 - 1108. [Full Text]

				T. Feldman and M. B. Leon Prospects for Percutaneous Valve Therapies Circulation, December 11, 2007; 116(24): 2866 - 2877. [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., July 17, 2007; 50(3): 270 - 285. [Full Text] [PDF]

				L. Coats and P. Bonhoeffer NEW PERCUTANEOUS TREATMENTS FOR VALVE DISEASE Heart, May 1, 2007; 93(5): 639 - 644. [Full Text] [PDF]

				T. C. Nguyen, A. Cheng, F. A. Tibayan, D. Liang, G. T. Daughters, N. B. Ingels Jr., and D. C. Miller Septal-lateral annnular cinching perturbs basal left ventricular transmural strains Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 423 - 429. [Abstract] [Full Text] [PDF]

				M. J. Mack Percutaneous Mitral Valve Repair: A Fertile Field of Innovative Treatment Strategies Circulation, May 16, 2006; 113(19): 2269 - 2271. [Full Text] [PDF]