Percutaneous Mitral Valve repair – The role of coronary sinus approach (pp. 509-522)
Authors: (Saif Anwaruddin, and Stephen G Ellis)
Abstract: To appreciate the complexity of the mitral valve is to understand its intricate anatomical and physiologic properties. Disease of the mitral valve can be primarily valvular (rheumatic, degenerative) or secondary to other processes, particularly those affecting the myocardium. For several years now, standard of care for treatment of mitral valve disease, particularly severe mitral regurgitation, has been surgical. Surgical repair of the mitral valve has come to be regarded as a durable alternative to surgical replacement for degenerative disease [1, 2]. Evidence in favor of surgical repair has suggested improved operative mortality, long term survival and ejection fraction as compared to replacement . Treatment of functional mitral regurgitaiton, however, remains a challenge. Surgical repair of functional mitral regurgitation at the time of coronary artery bypass grafting (CABG) does not appear to provide long-term improvement in symptoms or survival .
Several percutaneous approaches to treating mitral regurgitation have emerged as possible alternatives to surgical treatment. It remains a challenge for percutaneous therapies to match the success reported with surgical repair of degenerative valve disease. However, treatment of patients with functional mitral regurgitation remains a problem without a well-defined solution. Theoretical advantages of percutaneous methods in treating functional mitral regurgitation include obviating the need for cardiopulmonary byapass and thoracotomy in patients who may be otherwise high risk for such open surgical procedures. The disadvantages include the inability to directly visualize the valve, relying instead on angiography and echocardiography.