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Perkutane Mitralklappenanulorrhaphie mit dem Carillon™ XE2 Mitral Contour System™ von Cardiac Dimensions™

Ein minimalinvasiver Therapieansatz zur Behandlung der funktionellen Mitralklappeninsuffizienz

Percutaneous Mitral Valve Annuloplasty with the Carillon™ Mitral Contour System™ by Cardiac Dimensions™. A Minimally Invasive Therapeutic Option for the Treatment of Severe Functional Mitral Valve Regurgitation

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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.

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Authors and Affiliations

  1. Medizinische Klinik I, Städtische Kliniken, Neuss – Lukaskrankenhaus – GmbH, Neuss, Germany

    Hubertus Degen, Thomas Lickfeld, Carsten Stoepel &  Michael Haude

  2. Chefarzt Medizinische Klinik I, Kardiologie, Internistische, Intensivmedizin und Nephrologie, Städtische Kliniken, Neuss – Lukaskrankenhaus – GmbH, Preussenstraße 84, 41464, Neuss, Germany

    Michael Haude

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  1. Hubertus Degen
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  2. Thomas Lickfeld
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  3. Carsten Stoepel
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  4. Michael Haude
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Correspondence to Michael Haude.

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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

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  • DOI: https://doi.org/10.1007/s00059-009-3286-6

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