Percutaneous septal sinus shortening

A novel procedure for the treatment of functional mitral regurgitation

Jason H Rogers, John A. Macoviak, David A. Rahdert, Patricia A. Takeda, Igor F. Palacios, Reginald Low

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

BACKGROUND - The septal-to-lateral (SL) mitral annular diameter is increased in functional mitral regurgitation (MR). We describe a novel percutaneous technique (the percutaneous septal sinus shortening system) that ameliorates functional MR in an ovine model. METHODS AND RESULTS - Sheep underwent rapid right ventricular pacing to obtain moderate to severe functional MR with SL enlargement. The percutaneous septal sinus shortening system was placed via standard interventional techniques consisting of a bridge (suture) element between interatrial septal wall and great cardiac vein anchors. Through progressive tensioning of the bridge element, direct SL shortening was achieved. Sheep underwent short-term (n=19) and long-term (n=4) evaluation after device implantation. In short-term studies, SL diameter decreased an average of 24% (32.5±3.5 to 24.6±2.4 mm; P<0.001), and MR grade significantly improved (2.1±0.6 to 0.4±0.4; P<0.001). Despite continued rapid pacing, chronic device implantation resulted in durable SL shortening (30.4±1.9 mm before implantation to 25.3±0.8 mm at 30 days; P=0.01) and MR reduction (1.8±0.5 before implantation to 0.2±0.1 at 30 days; P=0.01). Increased cardiac output, decreased wedge pressure, and decreased brain natriuretic peptide levels were observed in animals undergoing long-term device implantation. CONCLUSIONS - The percutaneous septal sinus shortening system is effective in ameliorating functional MR in an ovine tachycardia model. The procedure, which uses standard catheter techniques, can be deployed largely under fluoroscopic guidance. The unique bridge element appears durable and allows direct and precise SL shortening to a diameter optimal for MR reduction.

Original languageEnglish (US)
Pages (from-to)2329-2334
Number of pages6
JournalCirculation
Volume113
Issue number19
DOIs
StatePublished - May 2006

Fingerprint

Mitral Valve Insufficiency
Sheep
Equipment and Supplies
Pulmonary Wedge Pressure
Brain Natriuretic Peptide
Tachycardia
Cardiac Output
Sutures
Veins
Catheters

Keywords

  • Cardiomyopathy
  • Catheters
  • Echocardiography
  • Mitral valve
  • Regurgitation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous septal sinus shortening : A novel procedure for the treatment of functional mitral regurgitation. / Rogers, Jason H; Macoviak, John A.; Rahdert, David A.; Takeda, Patricia A.; Palacios, Igor F.; Low, Reginald.

In: Circulation, Vol. 113, No. 19, 05.2006, p. 2329-2334.

Research output: Contribution to journalArticle

Rogers, Jason H ; Macoviak, John A. ; Rahdert, David A. ; Takeda, Patricia A. ; Palacios, Igor F. ; Low, Reginald. / Percutaneous septal sinus shortening : A novel procedure for the treatment of functional mitral regurgitation. In: Circulation. 2006 ; Vol. 113, No. 19. pp. 2329-2334.
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abstract = "BACKGROUND - The septal-to-lateral (SL) mitral annular diameter is increased in functional mitral regurgitation (MR). We describe a novel percutaneous technique (the percutaneous septal sinus shortening system) that ameliorates functional MR in an ovine model. METHODS AND RESULTS - Sheep underwent rapid right ventricular pacing to obtain moderate to severe functional MR with SL enlargement. The percutaneous septal sinus shortening system was placed via standard interventional techniques consisting of a bridge (suture) element between interatrial septal wall and great cardiac vein anchors. Through progressive tensioning of the bridge element, direct SL shortening was achieved. Sheep underwent short-term (n=19) and long-term (n=4) evaluation after device implantation. In short-term studies, SL diameter decreased an average of 24{\%} (32.5±3.5 to 24.6±2.4 mm; P<0.001), and MR grade significantly improved (2.1±0.6 to 0.4±0.4; P<0.001). Despite continued rapid pacing, chronic device implantation resulted in durable SL shortening (30.4±1.9 mm before implantation to 25.3±0.8 mm at 30 days; P=0.01) and MR reduction (1.8±0.5 before implantation to 0.2±0.1 at 30 days; P=0.01). Increased cardiac output, decreased wedge pressure, and decreased brain natriuretic peptide levels were observed in animals undergoing long-term device implantation. CONCLUSIONS - The percutaneous septal sinus shortening system is effective in ameliorating functional MR in an ovine tachycardia model. The procedure, which uses standard catheter techniques, can be deployed largely under fluoroscopic guidance. The unique bridge element appears durable and allows direct and precise SL shortening to a diameter optimal for MR reduction.",
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T2 - A novel procedure for the treatment of functional mitral regurgitation

AU - Rogers, Jason H

AU - Macoviak, John A.

AU - Rahdert, David A.

AU - Takeda, Patricia A.

AU - Palacios, Igor F.

AU - Low, Reginald

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N2 - BACKGROUND - The septal-to-lateral (SL) mitral annular diameter is increased in functional mitral regurgitation (MR). We describe a novel percutaneous technique (the percutaneous septal sinus shortening system) that ameliorates functional MR in an ovine model. METHODS AND RESULTS - Sheep underwent rapid right ventricular pacing to obtain moderate to severe functional MR with SL enlargement. The percutaneous septal sinus shortening system was placed via standard interventional techniques consisting of a bridge (suture) element between interatrial septal wall and great cardiac vein anchors. Through progressive tensioning of the bridge element, direct SL shortening was achieved. Sheep underwent short-term (n=19) and long-term (n=4) evaluation after device implantation. In short-term studies, SL diameter decreased an average of 24% (32.5±3.5 to 24.6±2.4 mm; P<0.001), and MR grade significantly improved (2.1±0.6 to 0.4±0.4; P<0.001). Despite continued rapid pacing, chronic device implantation resulted in durable SL shortening (30.4±1.9 mm before implantation to 25.3±0.8 mm at 30 days; P=0.01) and MR reduction (1.8±0.5 before implantation to 0.2±0.1 at 30 days; P=0.01). Increased cardiac output, decreased wedge pressure, and decreased brain natriuretic peptide levels were observed in animals undergoing long-term device implantation. CONCLUSIONS - The percutaneous septal sinus shortening system is effective in ameliorating functional MR in an ovine tachycardia model. The procedure, which uses standard catheter techniques, can be deployed largely under fluoroscopic guidance. The unique bridge element appears durable and allows direct and precise SL shortening to a diameter optimal for MR reduction.

AB - BACKGROUND - The septal-to-lateral (SL) mitral annular diameter is increased in functional mitral regurgitation (MR). We describe a novel percutaneous technique (the percutaneous septal sinus shortening system) that ameliorates functional MR in an ovine model. METHODS AND RESULTS - Sheep underwent rapid right ventricular pacing to obtain moderate to severe functional MR with SL enlargement. The percutaneous septal sinus shortening system was placed via standard interventional techniques consisting of a bridge (suture) element between interatrial septal wall and great cardiac vein anchors. Through progressive tensioning of the bridge element, direct SL shortening was achieved. Sheep underwent short-term (n=19) and long-term (n=4) evaluation after device implantation. In short-term studies, SL diameter decreased an average of 24% (32.5±3.5 to 24.6±2.4 mm; P<0.001), and MR grade significantly improved (2.1±0.6 to 0.4±0.4; P<0.001). Despite continued rapid pacing, chronic device implantation resulted in durable SL shortening (30.4±1.9 mm before implantation to 25.3±0.8 mm at 30 days; P=0.01) and MR reduction (1.8±0.5 before implantation to 0.2±0.1 at 30 days; P=0.01). Increased cardiac output, decreased wedge pressure, and decreased brain natriuretic peptide levels were observed in animals undergoing long-term device implantation. CONCLUSIONS - The percutaneous septal sinus shortening system is effective in ameliorating functional MR in an ovine tachycardia model. The procedure, which uses standard catheter techniques, can be deployed largely under fluoroscopic guidance. The unique bridge element appears durable and allows direct and precise SL shortening to a diameter optimal for MR reduction.

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KW - Echocardiography

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