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
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Figure 1 Illustration of the annuloplasty device. The distal and proximal anchors are collapsed before insertion and the device is delivered to the coronary sinus (CS) via a guide catheter. The distal anchor is deployed in the distal coronary sinus and locked. Tension is then applied via the delivery system until satisfactory acute efficacy with stable coronary perfusion is documented. The proximal anchor is then deployed and locked in the proximal CS. The delivery system is then uncoupled and removed.
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Figure 2 Effect of annuloplasty device on annular dimension and mitral regurgitation (MR) in Study 1. Epicardial echocardiographic images in the absence (a,b) or presence (c,d) of phenylephrine (PE) infusion. Arrows = MR jet. LA = left atrium; LV = left ventricle.
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Figure 3 Effect of annuloplasty device on left ventricular (LV) volumes and hemodynamics. Above are shown LV pressure-volume loops before (black) and after (red) cinching of the device and the corresponding LV and left atrial (LA) pressures. Below are LV pressure-volume loops and LV and LA pressure tracings before and after cinching of the device during phenylephrine (PE) infusion. ECG = electrocardiogram.
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Figure 4 Variableproximal circumflex coronary artery (CX) and distal coronary sinus (CS) anatomy in dogs with experimental heart failure (A to C) and coronary angiography demonstrating intact CX anatomy after device (D). See text for explanation. D Anc = distal anchor; LAD = left anterior descending artery; MV = mitral valve; P Anc = proximal anchor; other abbreviations as in Figures 2 and 3.
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Figure 5 Effect of variable distal anchor placement on coronary flow (A,C) and corresponding coronary anatomy (B) in a single dog with experimental HF. Red numbers on C indicate the level at which the sections of the AV groove (B) were taken. Black arrow in C indicates luminal irregularity in CX compared with D. See text for explanation. Abbreviations as in Figure 4.
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Figure 6 Effect of variable distal anchor placement on coronary flow with and without tension in A (top and bottom) and C (left and right) and corresponding coronary anatomy (B) in a single dog with experimental HF. See text for explanation. Abbreviations as in Figure 5.
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Figure 7 Acuteeffects of percutaneous mitral annuloplasty in dogs in Study 2. Grouped data for all parameters of mitral regurgitation (MR) severity at baseline and post-device are shown in A (*p < 0.05 vs. baseline). Representative examples of contrast ventriculography (B), MR jet area/left atrial area (C) and proximal isovelocity surface area measurements (D) before and after device placement in a single dog are shown. In B, arrows indicate reflux of contrast into pulmonary veins. ERO = effective regurgitant orifice.
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