Coronary Sinus in the Management of Functional Mitral Regurgitation

Abstract

The past 5 years have seen the introduction into the preclinical arena of myriad devices for the potential treatment of functional and ischemic mitral regurgitation by a percutaneous approach.1 A number of the device concepts have taken advantage of the relatively easy access to the posterior annulus of the mitral valve provided by the coronary sinus. Although attractive on initial consideration as a delivery route for devices that remodel the posterior mitral annulus, a number of potential shortcomings to this approach may ultimately limit its clinical success. Article p 377 Annular remodeling of the mitral valve for functional mitral regurgitation (FMR) has been demonstrated to have short-term and some intermediate-term efficacy in the clinical surgical setting.2 The pathophysiology of FMR in patients with dilated cardiomyopathy is central regurgitation caused by failure of mitral leaflet coaptation. The causes of this malcoaptation are multifactorial and include annular dilatation and ventricular dilation, which cause apical distraction of the papillary muscles, producing tethering of the mitral leaflets. Although the whole annulus has been demonstrated to dilate in FMR, there is a disproportionate increase in the anterior-posterior or septal-lateral diameter.3,4 The basic premise behind the surgical approach is that through the use of an undersized ring to overcorrect the dilation of the mitral annulus, both the annular dilatation and the tethering of the leaflets from apical papillary muscle displacement can be treated. The tenets for optimal surgical …