Percutaneous Coronary Sinus-Based Mitral Valve Repair Differentially Modulates Coronary Sinus to Mitral Valve Annulus Geometry and Topography

Figures

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  Figure 1. Transthoracic echocardiography and CTA at baseline and 3 months follow-up in an FMR responder and non-responder following Carillon device implantation. (A) Transthoracic echocardiographic at baseline and 3 months FU (follow-up) in an FMR responder following indirect mitral valve annuloplasty. Transthoracic and transesophageal echocardiography at baseline and 3 Months FU (follow-up) in an FMR non-responder following Carillon device implantation. (B, D) CTA prior index procedure at baseline of a responder (B) and non-responder (D). Blue Line: Coronary Sinus; Red Line: Mitral Valve Annulus; Purple and Green Dot: lateral and medial trigone. Distance and angulation of CS to MVA plane as indicated. (C, E) CTA post device implantation at follow-up of a responder (C) and non-responder (E). Blue Line: inner curvature of the Carillon device; Red Line: Mitral Valve Annulus; Purple and Green Dot: lateral and medial trigone. Distance and angulation of the Carillon device to MVA plane reflects the sinus mitral angle and distance (as indicated).

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  Figure 2. Clinical and echocardiographic response following percutaneous coronary sinus based mitral valve repair. (A) Quantitative echocardiographic assessment determining Vena contracta, effective regurgitant orifice area (EROA) and regurgitant volume at baseline, post implantation (implant) and 3 months Follow-up (FU) in responders and non-responders following Carillon device implantation. Mean ± SD. (B) Qualitative echocardiographic assessment (relative percentage) at baseline, post implant and 3 months FU in responder and non-responder. (C) New York Heart Association (NYHA) classification at baseline, post implant, and 3 months FU in responder and non-responder. (D) Distance and angle of coronary sinus (CS)/Carillon device plane and mitral annulus plane (MVA) in responders and non-responders of Carillon device implantation derived from CTA pre and post indirect mitral valve annuloplasty. #p < 0.05 vs. pre. *p < 0.05 vs. responder.

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  Figure 3. Dimensions of mitral valve annulus in responder and non-responder following Carillon device implantation. (A) CTA-derived parameters of mitral valve annulus dimensions (CC = Intercommisural diameter; AP = anterior-to-posterior diameter; TT = trigone-to-trigone diameter) in a responder and non-responder pre and post Carillon device implantation. (B–E) Perimeter, Anterior-Posterior diameter, CC diameter and Mitral Valve Annulus (MVA) area in responder or non-responder pre and post indirect mitral valve annuloplasty. *p < 0.05 compared to pre.

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  Figure 4. Potential mechanisms of echocardiographic FMR non-response following Carillon device implantation. (A) Favorable angle and distance prior to indirect mitral valve annuloplasty leading to reduced distance and unchanged angulation post procedure. (B) favorable angle and unfavorable distance (angle < 14.2° and distance > 7.8 mm) leading to decreased distance and markedly increased angulation. (C) unfavorable distance and angle (distance > 7.8 mm and angle >14.2°) leading to postinterventional reduced distance and increased angulation. (D) unfavorable angle and favorable distance (angle > 14.2° and distance < 7.8 mm) leading to a not significantly changed distance and angle after Carillon device implantation.