Analysis of coronary sinus, coronary arteries and left ventricular function during carillon device implantation

Mitral valve annuloplasty via the coronary sinus (CS) is possible by the Carillon device which can create constricting force after insertion into the CS transmitted to the mitral valve and mitral annulus. To strategise this procedure the knowledge about the size and anatomy of the CS in relation to the mitral annulus is crucial.

30 consecutive patients with sinus rhythm were investigated by TEE to test the visualisation of CS and branches of the coronary arteries in the posterior region of the mitral annulus as well as the feasibility of speckle tracking of the left ventricle. An image acquisition protocol for sufficient analysis of these features should be worked out in these patients.

The ostium region of the CS, the middle part of the CS in the posterior mitral annulus as well as the distal CS between anterolateral mitral commissure and left atrial appendage can be acquired in ZOOM multidimensional data sets with highest spatial resolution. The completion of this proposed protocol was possible in 80% of the patients' cohort with sinus rhythm and in 6 of 8 Carillon patients. The complete CS visualisation succeeds in 70%, the determination of the coronaries in 50% and the TEE adjustment of the LV standardised views in 80% of patients' cohort with sinus rhythm. During the intervention the speckle tracking analysis was interfered by artefacts induced by the Carillon device.

CS mitral annulus analysis is feasible and helpful prior to the intervention to strategise these procedures in patients with severe mitral valve regurgitation. Thus, the importance of distinct TEE analysis of the CS and LV function is underlined prior and during Carillon interventions.