Abstract 2710: Percutaneous Mitral Annuloplasty through the Coronary Sinus: an Anatomical Point of View
Objectives: Percutaneous posterior mitral annuloplasty has been proposed to treat functional mitral regurgitation based on the proximity of the coronary sinus (CS) to the mitral annulus. However, concern remains on the ability to perform a trigone to trigone posterior annuloplasty and potential for compromise of the circumflex coronary artery. Anatomical relationships between mitral annulus and CS and circonflex artery was assessed on human cadaver hearts
Methods: Ten hearts were studied, after injection of expansible foam in the CS and circonflex artery. Mitral annulus perimeter, posterior intertrigonal (T1-T2) and intercommisural (C1-C2) distance and CS projection on the native annulus (S1-S2) were measured (figure⇓). Spatial geometry of the CS was correlated with circonflex artery route and distance with native mitral annulus
Results: Projection of CS annuloplasty achieves at best a commissure to commissure annuloplasty, 14.5 (6–24) mm behind each trigones : T1-T2=74 (56–114) mm, C1-C2=62.2 (48 – 80) mm, S1-S2= 59.5 (4 – 80) mm. CS was distant from the native annulus (8 to 14 mm at the CS ostium, 13.7 to 20.4 mm at the middle of the CS, 6.9 to 14 mm at the level of the great coronary vein). The circonflex artery crossed below the CS in 45.5% of cases.
Conclusion: This anatomical study highlights the threedimentionnal structure of the CS and its distance from native mitral annulus and fibrous trigones. Human anatomical studies are mandatory for further development of percutaneous mitral repair technology.