Letter: Cardiac CT prior to percutaneous coronary sinus-based mitral annuloplasty with the Carillon device

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

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Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computed tomography for chronic coronary total occlusion

European Heart Journal ◽

10.1093/ehjci/ehaa946.2568 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Habara ◽

E Tsuchikane ◽

K Shimizu ◽

T Kawasaki

Keyword(s):

Computed Tomography ◽

Success Rate ◽

Cardiac Ct ◽

Cardiac Computed Tomography ◽

Coronary Intervention ◽

Puncture Site ◽

Total Occlusion ◽

Percutaneous Coronary ◽

Failure Point ◽

Procedural Success

Abstract Objective This study was performed to evaluate the efficacy of cardiac computed tomography (CT) for antegrade dissection re-entry (ADR) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background Although PCI of CTO is a rapidly evolving field, procedure success rate remains suboptimal. Recently, ADR with Stingray device for CTO-PCI has also evolved to one of the pillar technique of the hybrid algorithm. Although the success rate of the device could be improved, it also remains not always high especially as first crossing strategy. Methods Forty eight patients with total occlusion suitable for revascularization evaluated by baseline coronary angiography and cardiac CT were enrolled in this study from April 2017 to April 2019 from 30 enrolled centers. The primary observation was procedural success. Furthermore, all puncture point with Stingray were analyzed by cardiac CT. In each point, 1) plaques on the isolated myocardial side at distal puncture site (+1 point), 2) any plaques excluded above definition at distal puncture site (+2 points), 3) calcification on both 1 and 2 at distal puncture site (+1 point) were analyzed and calculated the score (Score 0–3) (Figure 1). Results Overall procedure success rate was 95.8% (46/48) and antegrade success rate was 91.3% (42/46). Sixteen cases were succeeded with single guidewire escalation and 32 cases were attempted ADR with Stingray system. Within them, 25 cases were succeeded and 7 cases were observed puncture failure. And 3cases were succeeded with IVUS guide and 2 cases were with retrograde appTechnical success rate with stingray was 78.1% (25/32). Cardiac CT was analyzed 60 puncture sites in 32 cases which were attempted ADR with stingray system (1.88 sites/case). CT score at ADR success point was significantly smaller compare to that at ADR failure point (0.68±1.09 vs 1.77±1.09, p<0.0001). Conclusions Pre procedure Cardiac CT and CT score might be useful for ADR technique in CTO PCI not only for case selection but also for puncture site selection. Figure 1 Funding Acknowledgement Type of funding source: None

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Percutaneous Coronary Sinus Catheterization With the ProPlege Catheter Under Transesophageal Echocardiography and Pressure Guidance

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.01.035 ◽

2015 ◽

Vol 29 (3) ◽

pp. 598-604 ◽

Cited By ~ 7

Author(s):

Cataldo Labriola ◽

Francesco Greco ◽

Maurizio Braccio ◽

Pier Paolo Dambruoso ◽

Giuseppe Labriola ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Coronary Sinus ◽

Percutaneous Coronary

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TCTAP C-156 Successful Percutaneous Coronary Intervention of a Left Circumflex Artery Departing from the Right Coronary Sinus

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.359 ◽

2018 ◽

Vol 71 (16) ◽

pp. S225-S226

Author(s):

Bakhrom Alyavi ◽

Jamol Uzokov

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Sinus ◽

Coronary Intervention ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Percutaneous Coronary ◽

The Right

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Cardiac CT in Detecting a Dislodged Stent in Right Coronary Artery after Primary Percutaneous Coronary Intervention

Journal of Cardiovascular Imaging ◽

10.4250/jcvi.2019.27.e2 ◽

2019 ◽

Vol 27 (1) ◽

pp. 68

Author(s):

Tariq Ashraf ◽

Parveen Akhter ◽

Abdul Samad Achakzai ◽

Naveedullah Khan ◽

Tahir Saghir ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Primary Percutaneous Coronary Intervention ◽

Cardiac Ct ◽

Coronary Intervention ◽

Percutaneous Coronary

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Simulated Deployment of Percutaneous Transvenous Mitral Annuloplasty Device Into Human Coronary Sinus Vessel

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53851 ◽

2011 ◽

Cited By ~ 1

Author(s):

Thuy M. Pham ◽

Qian Wang ◽

Milton DeHerrera ◽

Wei Sun

Keyword(s):

Coronary Sinus ◽

Ventricular Dysfunction ◽

Surgical Repair ◽

Critical Role ◽

Cost Effective ◽

Mitral Annulus ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Patient Specific ◽

Mitral Annuloplasty

Functional mitral regurgitation (MR) is the consequence of left ventricular dysfunction occurring after ischemic heart disease and often has poor prognosis. Surgical repair and replacement of the mitral valve are currently being used to treat severe functional MR However, the technique carries high mortality rate [1] and is not suitable for patients with comorbidities and advanced age [2]. Recently, a new non-surgical intervention, percutaneous transvenous mitral annuloplasty (PTMA), is emerging as an attractive endovascular alternative that is less invasive, less recovery time, and cost effective. The device is delivered percutaneously into the coronary sinus (CS) vessel and once embedded, it contracts and shortens the septo-lateral distance of the mitral annulus, hence improve MR. However, despite of its feasibility, current clinical trials reported severe adverse events, such as device fracture [3]. The biomechanical interaction between the CS wall and the stent plays a critical role in the outcome of the deployment and the device performance. In this study, we proposed to analyze this interaction by developing Finite Element (FE) models of the CS vessel and the PTMA anchors and analyzing the peak stresses, strains, interaction forces (shear, normal) after the deployment of the proximal and distal anchors into a realistic patient-specific CS model.

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