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Although the use of personalized annuloplasty rings manufactured for each patient according to the size and morphology of their valve complex could be beneficial for the treatment of mitral insufficiency, this possibility has been limited for reasons of time-lines and costs as well as for design and manufacturing difficulties, as has been the case with other personalized implant and prosthetic developments. However, the present quality of medical image capture equipment together with the benefits to be had from computer-aided design and manufacturing technologies (CAD-CAM) and the capabilities furnished by rapid prototyping technologies, present new opportunities for a personalized response to the development of implants and prostheses, the social impact of which could turn out to be highly positive. This paper sets out a personalized development of an annuloplasty ring based on the combined use of information from medical imaging, from CAD-CAM design programs and prototype manufacture using rapid prototyping technologies.

Background-Implantation of devices into the coronary sinus (CS)/great cardiac vein (GCV) to reshape the mitral annulus (MA) is being investigated, despite these structures not being within the same plane and coronary arteries frequently traversing between them. Furthermore, dynamic changes in their relationship have never been studied. We analyzed the CS/GCV dimensions and its relationship with the MA and the coronary arteries. Methods and Results-Of 390 consecutive computed tomography angiographies reviewed, 56 met the inclusion criteria.Mean age of the patients was 68.9Ϯ13.1 years (26.8% men). The dimensions of the CS/GCV and the distance between this structure and the MA were measured at 10 different spatial points along the CS/GCV trajectory and at 3 different time points along the cardiac cycle (phases 0%, 40%, and 75% of the RR interval) by using curved multiplanar reconstruction technique. The CS/GCV was larger in phase 40% than in phase 75% and was smallest in phase 0% (PϽ0.001). The distance between the CS/GCV and the MA was longest in phase 40% and shortest in phase 0% (Pϭ0.013). The diameter of the MA was measured in oblique 2-and 4-chamber reconstructions, being largest in phase 0% and smallest in phase 40% (Pϭ0.019). A coronary artery traversed between the CS/GCV and the MA in 85.7% of the patients. Conclusions-This study demonstrated dynamic changes in the relationship between the CS/GCV and the MA and also that coronary arteries frequently traverse between both structures. Whether these findings are of clinical relevance for patients undergoing percutaneous mitral annuloplasty needs to be prospectively evaluated. (Circ Cardiovasc Interv. 2009;2:557-564.)

This method showed a high degree of inter-rater reliability and absolute agreement for AVAp diameters. Agreement was lower for AA-LV angle and distance to coronary artery measurements, emphasizing the need for software improvements and standardized image acquisition protocols.

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