Zusammenfassung
Bei Patienten mit systolischer Herzinsuffizienz erhöht eine funktionelle Mitralklappeninsuffizienz (FMI) die Morbidität. Neben der medikamentösen Therapie und der chirurgischen Mitralklappenrekonstruktion rücken minimalinvasive Behandlungsansätze zunehmend in den Fokus. Mit dem Carillon™ Mitral Contour System™ (Cardiac Dimensions™) wurde ein neues katheterbasiertes Verfahren entwickelt, das durch Implantation einer Nitinolspange in den Koronarsinus (CS) zu einer Raffung des Mitralklappenanulus, zur Annäherung der dehiszenten Mitralsegel und damit zu einer Reduktion der FMI führt. Über einen zentralvenösen Zugang wird ein Delivery-System in den CS vorgebracht. Hierüber wird die Carillon™-Spange unter Durchleuchtung platziert. Die akute Reduktion der FMI wird hierbei mittels transösophagealer Echokardiographie dokumentiert. Bei erfolgreicher Reduktion der FMI und fehlender Kompromittierung der Koronarperfusion wird die Spange vom Delivery-System entkoppelt. Vor der Entkopplung kann die Carillon™-Spange, wenn notwendig, durch erneutes Vorschieben des Delivery-Systems geborgen werden. Auch nach Implantation des Carillon ™ Mitral Contour System™ besteht die Option, eine CS-Elektrode für ein kardiales Resychronisationstherapiesystem zu platzieren.
Abstract
Morbidity in patients with systolic heart failure is significantly increased by functional mitral valve regurgitation. In addition to pharmaceutical treatment or surgical reconstruction of the impaired valve, minimally invasive procedures have continuously advanced into the focus of interest. The Carillon ™ Mitral Contour System™ (Cardiac Dimensions™) is a new catheter-based method to converge dehiscent mitral valve leaflets with implantation of a nitinol clip into the coronary sinus, leading to a closer approach of the valve leaflets with subsequent decrease in mitral regurgitation. The device is implanted via a central venous catheter, using a special delivery system under fluoroscopy. The immediate success of minimizing mitral valve regurgitation is verified by online transesophageal echocardiography (TEE), device-related impairment of perfusion of contiguous coronary vessels is ruled out by coronary angiography performed simultaneously during deployment of the device. As soon as reduction of the mitral valve regurgitation is demonstrated in TEE, the Carillon™ System is disconnected from the delivery system, before, however, the Carillon™ device can be withdrawn into the delivery system as necessary. Following the successful implantation of the Carillon™ Mitral Contour System™, a left ventricular lead for cardiac resynchronization therapy can still be successfully placed alongside through the coronary sinus.
Literatur
Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845–53.
Badhwar V, Bolling SF. Mitral valve surgery in the patient with left ventricular dysfunction. Semin Thorac Cardiovasc Surg 2002;14:133–6.
Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–37.
Bax JJ, Braun J, Somer ST, et al. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation 2004;110:Suppl II:II-103–8.
Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Valvular Heart Disease). Circulation 2006:114:450–527.
Braun J, Bax JJ, Versteegh MIM, et al. Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation. Eur J Cardiothorac Surg 2005;27:847–53.
Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–50.
Choure AJ, Garcia MJ, Hesse B, et al. In vivo analysis of the anatomical relationship of coronary sinus to mitral annulus and left circumflex coronary artery using cardiac multidetector computed tomography: implications for percutaneous coronary sinus mitral annuloplasty. J Am Coll Cardiol 2006;48:1938–45.
Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539–49.
Gangemi JJ, Tribble CG, Ross SD, et al. Does the additive risk of mitral valve repair in patients with ischemic cardiomyopathy prohibit surgical intervention? Ann Surg 2000;231:710–4.
Hoppe UC, Brandt MC, Degen H, et al. Percutanous mitral annuloplasty leaves free access to cardiac veins for resynchronization therapy. Cathet Cardiovasc Interv 2009;74:506–11.
Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005;46:1116–43.
Leonhardt H, Tillmann B, Töndury G, et al. In: Rauber A, Kopsch F, Hrsg. Anatomie des Menschen, Lehrbuch und Atlas, Bd II: Innere Organe. Stuttgart-New York: Thieme 1987:52–8.
Maniu CV, Patel JB. Reuter DG, et al. Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty. J Am Coll Cardiol 2004;44:1652–61.
Maselli D, Guarracino F, Chiaramonti F, et al. Percutaneous mitral annuloplasty: an anatomic study of human coronary sinus and its relation with mitral valve annulus and coronary arteries. Circulation 2006;114:377–80.
Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–83.
Ortale JR, Gabriel EA, Iost C, et al. The anatomy of the coronary sinus and its tributaries. Surg Radiol Anat 2001;23:15–21.
Patel JB, Borgeson DD, Barnes ME. et al. Mitral regurgitation in patients with advanced systolic heart failure. J Card Fail 2004;10:285–91.
Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation — results of the CARILLON Mitral Annuloplasty Device European Union Study. Circulation 2009;120:326–33.
Shah AS, Hannish SA, Minalo CA, et al. Isolated mitral valve repair in patients with depressed left ventricular function. Ann Thorac Surg 2005;80:1309–14.
Tops LF, Van de Veire NR, Schuijf JD, et al. Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus: implications for percutaneous mitral annuloplasty. Circulation 2007;115:1426–32.
Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003;91:538–43.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Degen, H., Lickfeld, T., Stoepel, C. et al. Perkutane Mitralklappenanulorrhaphie mit dem Carillon™ XE2 Mitral Contour System™ von Cardiac Dimensions™. Herz 34, 451–457 (2009). https://doi.org/10.1007/s00059-009-3286-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-009-3286-6
Schlüsselwörter:
- Herzinsuffizienz
- Funktionelle Mitralklappeninsuffizienz
- Perkutane Mitralklappenanulorrhaphie
- Kardiale Resynchronisationstherapie