Methods and apparatus for remodeling an extravascular tissue structure

1 . A method of manipulating the mitral valve, comprising:

providing a prosthesis having a proximal section, a central section and a distal section;

inserting the prosthesis into the venous system;

transluminally advancing the prosthesis into a coronary sinus; and

manipulating the prosthesis from a location outside the venous system to deflect the central section laterally with respect to the proximal and distal sections to selectively apply a compressive force along a region of tissue in the coronary sinus.

2 . A method as in claim 1 , wherein the prosthesis further comprises a forming element for manipulating the prosthesis.

3 . A method as in claim 1 , wherein the prosthesis further comprises a proximal anchor disposed on the proximal section and a distal anchor disposed on the distal section, and wherein the proximal and distal anchors are expanded to engage an inner wall of the coronary sinus before manipulating the prosthesis.

4 . A method as in claim 1 , further comprising measuring the coronary sinus and selecting an appropriately sized prosthesis prior to inserting the prosthesis into the venous system.

5 . A method as in claim 1 , further comprising measuring hemodynamic function after manipulating the prosthesis.

6 . A method as in claim 5 , further comprising determining an ongoing drug therapy after measuring the hemodynamic function.

7 . A method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall, comprising:

providing an elongate body having a forming element attached thereto;

positioning the elongate body in the vessel;

manipulating the forming element to cause a central section of the elongate body to move laterally with respect to a proximal and a distal section of the elongate body, thereby exerting a force against the adjacent tissue structure; and

detaching the forming element from the elongate body.

8 . A method as in claim 7 , wherein the positioning step is accomplished percutaneously.

9 . A method as in claim 7 , wherein the tissue structure comprises the mitral valve annulus.

10 . A method as in claim 7 , wherein the tissue structure comprises the left ventricle.

11 . A method as in claim 7 , wherein the vessel comprises a vein.

12 . A method of performing annuloplasty of the mitral valve comprising:

positioning a prosthesis in a curved portion of a coronary sinus;

engaging a proximal tissue anchor and a distal tissue anchor on the device into tissue on an inside radius of the curve;

manipulating a first portion of the device with respect to a second portion of the device to provide a compressive force on the inside radius of the curve in between the first and second anchors; and

securing the device to maintain the compressive force within the coronary sinus.

13 . A method as in claim 12 , further comprising the step of percutaneously accessing the venous system prior to the positioning step.

14 . A method as in claim 13 , wherein the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins.

15 . A method as in claim 12 , wherein the securing step comprises providing an interference fit.

16 . A method as in claim 12 , wherein the securing step comprises providing an adhesive bond.

17 . A method as in claim 12 , wherein the securing step comprises providing a knot.

18 . A method as in claim 12 , further comprising the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the positioning step.

19 . A method as in claim 12 , further comprising the step of measuring hemodynamic function following the manipulating step.

20 . A method as in claim 19 , further comprising the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function.