Cardiac computed tomography based analysis of mitral annulus, coronary sinus and left circumflex artery in patients with mitral regurgitation: Implications for transcatheter mitral annuloplasty techniques

•A comprehensive analysis of coronary sinus (CS), left circumflex artery (LCX) and mitral annulus (MA) anatomy and geometry in mitral regurgitation (MR) was performed by 3-D reconstruction of cardiac CT images.•Secondary MR had a significantly greater MA perimeter than primary MR.•A device with more than two anchors for indirect transcatheter mitral annuloplasty (ITMA) may be more effective in applying external circumferential pressure around the entire annulus for secondary MR.•The majority of patients with secondary MR had a CS-MA plane angle <14.2°, amenable to ITMA.•To prevent LCX compression, extra caution should be taken while maneuvering and implanting devices at the AC and P1 planes where LCX crossed CS mostly.•For a better annuloplasty effect, design of new devices should allow the radian formed by the arch between the two anchors of a device after ITMA to match the significantly increased MA radian in secondary MR.