Methods and apparatus for remodeling an extravascular tissue structure

Abstract

A medical apparatus and method for remodeling a mitral valve annulus adjacent to the coronary sinus includes an elongate body having a proximal end and a distal end. The elongate body is movable from a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus.

1 . A method of manipulating the mitral valve, comprising: 
 providing a prosthesis having a proximal section, a central section and a distal section;    inserting the prosthesis into the venous system;    transluminally advancing the prosthesis into a coronary sinus; and    manipulating the prosthesis from a location outside the venous system to deflect the central section laterally with respect to the proximal and distal sections to selectively apply a compressive force along a region of tissue in the coronary sinus.    
   
   
       2 . A method as in  claim 1 , wherein the prosthesis further comprises a forming element for manipulating the prosthesis.  
   
   
       3 . A method as in  claim 1 , wherein the prosthesis further comprises a proximal anchor disposed on the proximal section and a distal anchor disposed on the distal section, and wherein the proximal and distal anchors are expanded to engage an inner wall of the coronary sinus before manipulating the prosthesis.  
   
   
       4 . A method as in  claim 1 , further comprising measuring the coronary sinus and selecting an appropriately sized prosthesis prior to inserting the prosthesis into the venous system.  
   
   
       5 . A method as in  claim 1 , further comprising measuring hemodynamic function after manipulating the prosthesis.  
   
   
       6 . A method as in  claim 5 , further comprising determining an ongoing drug therapy after measuring the hemodynamic function.  
   
   
       7 . A method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall, comprising: 
 providing an elongate body having a forming element attached thereto;    positioning the elongate body in the vessel;    manipulating the forming element to cause a central section of the elongate body to move laterally with respect to a proximal and a distal section of the elongate body, thereby exerting a force against the adjacent tissue structure; and    detaching the forming element from the elongate body.    
   
   
       8 . A method as in  claim 7 , wherein the positioning step is accomplished percutaneously.  
   
   
       9 . A method as in  claim 7 , wherein the tissue structure comprises the mitral valve annulus.  
   
   
       10 . A method as in  claim 7 , wherein the tissue structure comprises the left ventricle.  
   
   
       11 . A method as in  claim 7 , wherein the vessel comprises a vein.  
   
   
       12 . A method of performing annuloplasty of the mitral valve comprising: 
 positioning a prosthesis in a curved portion of a coronary sinus;    engaging a proximal tissue anchor and a distal tissue anchor on the device into tissue on an inside radius of the curve;    manipulating a first portion of the device with respect to a second portion of the device to provide a compressive force on the inside radius of the curve in between the first and second anchors; and    securing the device to maintain the compressive force within the coronary sinus.    
   
   
       13 . A method as in  claim 12 , further comprising the step of percutaneously accessing the venous system prior to the positioning step.  
   
   
       14 . A method as in  claim 13 , wherein the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins.  
   
   
       15 . A method as in  claim 12 , wherein the securing step comprises providing an interference fit.  
   
   
       16 . A method as in  claim 12 , wherein the securing step comprises providing an adhesive bond.  
   
   
       17 . A method as in  claim 12 , wherein the securing step comprises providing a knot.  
   
   
       18 . A method as in  claim 12 , further comprising the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the positioning step.  
   
   
       19 . A method as in  claim 12 , further comprising the step of measuring hemodynamic function following the manipulating step.  
   
   
       20 . A method as in  claim 19 , further comprising the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function.