Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty
Calin V. Maniu, MD*,
Jeetendra B. Patel, MD*,
David G. Reuter, MD, PhD ,
Donna M. Meyer*,
William D. Edwards, MD ,
Charanjit S. Rihal, MD* and
Margaret M. Redfield, MD*,*
* Division of Cardiovascular Disease, Mayo Clinic and Foundation, Rochester, Minnesota
Division of Pathology, Mayo Clinic and Foundation, Rochester, Minnesota
Cardiac Dimensions, Inc., Kirkland, Washington
Manuscript received November 21, 2003;
revised manuscript received March 2, 2004,
accepted March 25, 2004.
* Reprint requests and correspondence: Dr. Margaret M. Redfield, Mayo Clinic and Foundation, Cardiorenal Laboratory, Guggenheim 9, 200 First Street SW, Rochester, Minnesota 55905 (Email: redfield.margaret{at}mayo.edu).
OBJECTIVES: We sought to determine acute and chronic efficacy of a percutaneous mitral annuloplasty (PMA) device in experimental heart failure (HF). Further, we evaluated the potential for adverse effects on left ventricular (LV) function and coronary perfusion.
BACKGROUND: Reduction of mitral annular dimension with a PMA device in the coronary sinus may reduce functional mitral regurgitation (MR) in advanced HF.
METHODS: Study 1: a PMA device was placed acutely in anesthetized open-chest dogs with rapid pacing-induced HF (n = 6) instrumented for pressure volume analysis. Study 2: in 12 anesthetized dogs with HF, fluoroscopic-guided PMA was performed, and dogs were followed for four weeks with continuing rapid pacing.
RESULTS: Study 1: percutaneous mitral annuloplasty reduced annular dimension and severity of MR at baseline and with phenylephrine infusion to increase afterload (MR jet/left atrial [LA] area 26 ± 1% to 7 ± 2%, p < 0.05). Pressure volume analysis demonstrated no acute impairment of LV function. Study 2: no device was placed in two dogs because of prototype size limitations. Attempted PMA impaired coronary flow in three dogs. Percutaneous mitral annuloplasty (n = 7) acutely reduced MR (MR jet/LA area 43 ± 4% to 8 ± 5%, p < 0.0001), regurgitant volume (14.7 ± 2.1 ml to 3.1 ± 0.5 ml, p < 0.05), effective regurgitant orifice area (0.130 ± 0.010 cm2 to 0.040 ± 0.003 cm2, p < 0.05), and angiographic MR grade (2.8 ± 0.3 device to 1.0 ± 0.3 device, p < 0.001). In the conscious state, MR was reduced at four weeks after PMA (MR jet/LA area 33 ± 3% HF baseline vs. 11 ± 4% four weeks after device, p < 0.05)
CONCLUSIONS: Percutaneous mitral annuloplasty results in acute and chronic reduction of functional MR in experimental HF.
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Abbreviations and Acronyms
| | CS = coronary sinus | | CX = left circumflex coronary artery | | ERO = effective regurgitant orifice | | HF = heart failure | | LA = left atrium/atrial | | LV = left ventricle/ventricular | | MR = mitral regurgitation | | PISA = proximal isovelocity surface area | | PMA = percutaneous mitral annuloplasty |
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