Modeling the Interaction Between the Coronary Sinus and the Proximal Anchor Stent in Percutaneous Transvenous Mitral Annuloplasty

Abstract

Surgical treatment of severe functional mitral regurgitation (MR) often involves mitral annuloplasty, a procedure where a flexible or rigid annuloplasty ring is used to downsize the dilated mitral valve annulus (MA) and improve leaflet apposition by posterior annular correction. Recently various minimally invasive percutaneous transvenous mitral annuloplasty (PTMA) devices have been tested in patients who are not suitable candidates for a surgical procedure involving a thoracotomy. The approach is based on the concept that by utilizing the parallel location of the coronary sinus (CS) to the mitral annulus, a device, that can reshape the annulus, can be percutaneously deployed within the coronary sinus (CS) and the great cardiac vein (GCV). When the implanted device deforms, it shortens the MA anterior-posterior dimension and decreases mitral regurgitation (MR) (Fig. 1). Although the approach has been shown to be promising, PTMA device dysfunction and fatigue fracture have been reported in several firstin-human clinical trials (1). We hypothesize that quantitative understanding of the biomechanical interaction between the venous tissue, the mitral improve the efficacy of the PTMA treatment of MR. In this study, we aim to model interactions between the PTMA proximal anchor and the CS using computational tools.