A 68-year-old woman with severe functional mitral regurgitation was referred for a percutaneous transvenous mitral annuloplasty (PTMA) procedure. Multislice computed tomography was performed with 3-dimensional reconstruction and color rendering (A). Three rods were inserted inside the 7-F 3-lumen Viacor PTMA device to produce significant pressure on the posterolateral part of the mitral annulus (C, arrows). As evaluated by transoesophageal echocardiography, mitral regurgitation was acutely reduced (B to D). However, control angiography revealed complete occlusion of the circumflex artery (E to G). Occlusion persisted until removal of the 3 rods (H). The PTMA procedure was aborted, and the patient was continued on medical therapy. The circumflex artery courses between the mitral annulus and coronary sinus in ~25% of cases. Despite computed tomography imaging before the procedure, circumflex artery occlusion could not be anticipated. It is likely that circumflex artery compression will remain an issue with any PTMA device implanted in the cardiac venous system.
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