Coronary sinus mitral valve annuloplasty procedure and coronary artery and myocardial protection device
Devices and methods are disclosed for the treatment or repair of regurgitant cardiac valves, such as a mitral valve. An annuloplasty device can be placed in the coronary sinus to reshape the mitral valve and reduce mitral valve regurgitation. A protective device can be placed between the annuloplasty device and an underlying coronary artery to inhibit compression of the underlying coronary artery by the annuloplasty device in the coronary sinus. In addition, the protective device can inhibit compression of the coronary artery from inside the heart, such as from a prosthetic mitral valve that exerts radially outward pressure toward the coronary artery. The annuloplasty device can also create an artificial inner ridge or retaining feature projecting into the native mitral valve region to help secure a prosthetic mitral valve.
1. A method of repairing a mitral valve in a patient, the method comprising:
determining where a patient's coronary sinus passes over a coronary artery of the patient within a patient's heart;
introducing a tensioning device at least partially through the coronary sinus and over the coronary artery, wherein the tensioning device includes a bridge that is shaped to direct tension in the tensioning device away from the coronary artery;
locating the bridge over the coronary artery in order to reduce the application of pressure from the tensioning device on the coronary artery when the tensioning device is placed under tension; and
applying tension to the tensioning device to effect a change to the mitral valve of the patient.
2. The method of claim 1 , wherein the tensioning device includes suture material.
3. The method of claim 1 , wherein the tensioning device includes a ligature.
4. The method of claim 1 , wherein the determining step includes performing angiography of the coronary artery.
5. The method of claim 1 , wherein the introducing step includes introducing the tensioning device using a catheter.
6. The method of claim 1 , further comprising:
introducing a guidewire into the coronary sinus prior to introducing the tensioning device;
attaching a distal end of the tensioning device to a proximal of the guidewire; and
advancing the tensioning device into the coronary sinus.
7. The method of claim 1 , further comprising, prior to the introducing step:
percutaneously inserting a guiding catheter into a vasculature of the patient, wherein the guiding catheter has a proximal end, a distal end, and a lumen;
advancing the distal end of the guiding catheter through the vasculature to position the distal end of the guiding catheter adjacent the coronary sinus;
advancing a guidewire through the guiding catheter into the coronary sinus to a coronary vein branch wherein the coronary vein branch includes a proximal septal perforator vein, and then across myocardial or fibrous tissue of the heart to the right atrium or right ventricle; and
exchanging the wire to introduce the tensioning device through the coronary sinus to complete the introducing step.
8. The method of claim 1 , further comprising, prior to the introducing step:
percutaneously inserting a guiding catheter into a vasculature of the patient, wherein the guiding catheter has a proximal end, a distal end, and a lumen;
advancing the distal end of the guiding catheter through the vasculature to position the distal end of the guiding catheter adjacent the coronary sinus;
advancing a guidewire through the guiding catheter into the coronary sinus to a coronary vein branch wherein the coronary vein branch includes an anterolateral cardiac vein, and then across myocardial or fibrous tissue of the heart through the left ventricular chamber, and further across myocardium into the right ventricular or right atrial cavity; and
exchanging the wire to introduce the tensioning device through the coronary sinus to complete the introducing step.
9. The method of claim 1 , wherein applying tension alters the shape of the mitral valve so as to reduce valvular regurgitation.
10. The method of claim 1 , wherein applying tension alters the shape of the mitral valve so as to effect cardiac remodeling.
11. The method of claim 1 , wherein the tensioning element extends in an annuloplasty plane that is tilted toward a ventricular outflow tract of the patient.
12. The method of claim 1 , wherein the bridge defines a central arch between a proximal end and a distal end of the bridge, and further wherein the proximal and distal ends of the bridge form stabilizers that generally conform to a wall of the coronary sinus and retain the bridge in position over the coronary artery.
13. The method of claim 12 , wherein the stabilizers include stabilizing feet.
14. The method of claim 1 , wherein the bridge spans a linear distance at its base of about 0.5 inches to about 0.6 inches.
15. The method of claim 1 , wherein the bridge is about 0.15 inches to about 0.16 inches high.
16. The method of claim 1 , wherein the bridge includes shape memory material.
17. The method of claim 16 , wherein the shape memory material includes a nickel titanium alloy.
18. A method of repairing a mitral valve in a patient, the method comprising:
introducing an elongate tensioning device at least partially through the coronary sinus and over the coronary artery to surround the mitral valve;
forming a closed loop with the elongate tensioning device; and
applying tension to the closed loop to effect a change to the operation of the mitral valve of the patient, wherein the elongate tensioning device is introduced in manner such that it traverses a septal tricuspid valve commissure of the patient after the closed loop is formed.
19. The method of claim 18 , wherein the tensioning device includes suture material.
20. The method of claim 18 , wherein the tensioning device includes a ligature.
21. The method of claim 18 , further comprising assessing a change in at least one parameter of the heart of the patient using a non-invasive imaging technique.
22. The method of claim 21 , further comprising locking the tension in the closed loop after the assessing step.