Anat Cell Biol.  2016 Mar;49(1):68-72. 10.5115/acb.2016.49.1.68.

Anatomical considerations of percutaneous transvenous mitral annuloplasty: a novel procedure for treatment of functional mitral regurgitation

• Mehra L
• Raheja S
• Agarwal S
• Rani Y
• Kaur K
• Tuli A

• KMID: 2308933
• DOI: http://doi.org/10.5115/acb.2016.49.1.68

Abstract

Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1-6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.

Keyword

Mitral valve annuloplasty; Mitral regurgitation; Coronary sinus; Great cardiac vein; Circumflex artery

MeSH Terms

Adult
Arteries
Cadaver
Coronary Sinus
Formaldehyde
Heart
Humans
Mitral Valve
Mitral Valve Annuloplasty*
Mitral Valve Insufficiency*
Myocardial Ischemia
Traction
Veins
Formaldehyde

Figure

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  Fig. 1 A longitudinal section of the heart showing coronary sinus related superiorly to the mitral valve annulus. The white line depicting the distance measured between coronary sinus (CS) and mitral valve annulus. CxA, crcumflex artery.

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  Fig. 2 Six longitudinal sections showing the sections of coronary sinus at point 1 to 4 and great cardiac vein (GCV) at point 5 and 6. The sections of the veins are marked by arrows. Arrowheads pointing at the sections of circumflex coronary artery. GCV is seen related superficially to the circumflex artery at point 6 and superior to it at point 5.

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  Fig. 3 Great cardiac vein (course marked by arrowheads) crossing the circumflex coronary artery (arrow) superficially.

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  Fig. 4 Great cardiac vein (course marked by arrowheads) crossing left marginal artery (LMA) superficially.

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  Fig. 5 Ventricular branches of circumflex coronary artery (white arrows) passing deep to the great cardiac vein (GCV) and coronary sinus (CS) to reach the left ventricle.

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