Patent Publication Number: US-7914577-B2

Title: Apparatuses and methods for heart valve repair

Description:
This application is a continuation of U.S. patent application Ser. No. 10/739,554 titled “Apparatuses and Methods for Heart Valve Repair” filed on Dec. 17, 2003 now U.S. Pat. No. 7,226,477, which is a continuation-in-part of U.S. patent application Ser. No. 10/295,714 filed on Nov. 15, 2002 now U.S. Pat. No. 7,485,143. Both of these aforementioned patent applications are hereby incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention involves annuloplasty devices and delivery devices for the annuloplasty devices that are used for treating a medical condition such as a defective mitral valve. 
     2. Discussion of Related Art 
       FIG. 1A  illustrates a heart  10 . There are four valves in the heart  10  that serve to direct the flow of blood through the two sides of the heart  10  in a forward direction. The four valves are a mitral valve  20 , an aortic valve  18 , a tricuspid valve  60 , and a pulmonary valve  62  as illustrated in  FIG. 1A . The mitral valve  20  is located between the left atrium  12  and the left ventricle  14 . The aortic valve  18  is located between the left ventricle  14  and the aorta  16 . These two valves direct oxygenated blood coming from the lungs, through the left side of the heart, into the aorta  16  for distribution to the body. The tricuspid valve  60  is located between the right atrium  22  and the right ventricle  24 . The pulmonary valve  62  is located between the right ventricle  24  and the pulmonary artery  26 . These two valves direct de-oxygenated blood coming from the body, through the right side of the heart, into the pulmonary artery  26  for distribution to the lungs, where it again becomes re-oxygenated and distributed to the mitral valve  20  and the aortic valve  18 . 
     All of the heart valves are complex structures. Each valve consists of moveable “leaflets” that are designed to open and close. The mitral valve has two leaflets and the tricuspid valve has three. The aortic and pulmonary valves have leaflets that are more aptly termed “cusps” and are shaped somewhat like a half-moon. The aortic and pulmonary valves each have three cusps. 
     Blood flows into the left ventricle  14  through the mitral valve  20  that opens during diastole. Once the left ventricular cavity has filled, the left ventricle  14  contracts during systole. The mitral valve  20  closes (the leaflets of the mitral valve  20  re-approximate) while the aortic valve  18  opens during systole allowing the oxygenated blood to be ejected from the left ventricle  14  into the aorta  16 . A normal mitral valve allows blood to flow into the left ventricle and does not allow leaking or regurgitating back into the left atrium and then into the lungs during systole. The aortic valve allows blood to flow into the aorta and does not allow leaking (or regurgitating) back into the left ventricle. The tricuspid valve  60  functions similarly to the mitral valve to allow deoxygenated blood to flow into the right ventricle  24 . The pulmonary valve  62  functions in the same manner as the aortic valve  18  in response to relaxation and contraction of the right ventricle  24  in moving de-oxygenated blood into the pulmonary artery and thence to the lungs for re-oxygenation. 
     With relaxation and expansion of the ventricles (diastole), the mitral and tricuspid valves open, while the aortic and pulmonary valves close. When the ventricles contract (systole), the mitral and tricuspid valves close and the aortic and pulmonary valves open. In this manner, blood is propelled through both sides of the heart. 
     The anatomy of the heart and the structure and terminology of heart valves are described and illustrated in detail in numerous reference works on anatomy and cardiac surgery, including standard texts such as Surgery of the Chest (Sabiston and Spencer, eds., Saunders Publ., Philadelphia) and Cardiac Surgery by Kirklin and Barrett-Boyes. 
     In chronic heart failure (CHF), the size of the heart becomes enlarged. This enlargement can cause the annular size of the valves that separate the atria from the ventricles to also become enlarged. The mitral valve is generally the most affected and has the most serious effects on patient health.  FIG. 1B  illustrates a sectional view of the positions of the cardiac valves such as the mitral valve  20  present in the heart  10 . The annular enlargements can become so pronounced that the leaflets of the valve(s) are unable to effectively close. 
     The annular enlargement most profoundly affects the posterior leaflet  25  of the mitral valve  20 .  FIG. 1C  illustrates a sectional view of the expansion of the annulus  28  of the mitral valve  20 . As shown, the annulus  28  expands from a cross-sectional size indicated by the number  21  to the expanded cross-sectional size indicated by the number  23 . The expansion/enlargement typically affects the posterior leaflet  25  of the mitral valve  20 . During systole, due to the annular enlargement, the valve leaflets do not meet (valve not fully closed, no coaptation), thus some amount of blood flows the wrong way back through the valve from the ventricle and back into the atrium (valve regurgitation) where it raises the pressure in the atrium. This is termed “Mitral Valve Regurgitation” or MVR. MVR reduces the amount of blood pumped by the heart to the body. This reduction in blood flow can be life threatening, especially in patients that have lost ventricular tissue (i.e. heart attack victims), have contraction synchronization problems and/or other problems that reduce the heart&#39;s ability to act as a pump. 
     Regurgitation is common, and is occurring in about 7% of the population. Mitral valve regurgitation is caused by a number of conditions, including genetic defects, infections, coronary artery disease (CAD), myocardial infarction (MI) or congestive heart failure (CHF). Most cases are mild and if the symptoms are bothersome, they can usually be controlled with drugs. 
     In more serious cases, the faulty or defective valve can be repaired with a surgical procedure such as an annuloplasty. As illustrated in  FIG. 1D , an annuloplasty  30  is a surgical procedure in which a synthetic ring  32  is placed around the valve rim (annulus)  34 . Sutures  38  are put into the valve annulus  34  and the synthetic ring  32 . This causes proper closing by shrinking the size of the valve opening  36 . The synthetic ring  32  also reduces and reshapes the annulus  34  to move the posterior leaflet toward the anterior leaflet.  FIGS. 1E-A  through  1 E-E illustrate another surgical procedure in which a heart valve such as the mitral valve  20  is repaired by reconstruction. First, in  FIG. 1E-A , a section P 2  from the posterior leaflet  40  of the mitral valve  20  is excised. Then, sequentially as shown in  FIGS. 1E-A  through  1 E-E, sections P 1  and P 3  of the posterior leaflet  40  are sutured together. The reconstruction shrinks the size of the valve opening  36 . In some instances, a faulty or defective valve must be surgically replaced with a new valve. Examples of new valves include homograft valves (valves harvested from human cadavers), artificial mitral valves, and mechanical valves. 
     All of the procedures above are typically major surgical procedures that require the opening of the chest by stemotomy or at best through small incisions in the chest wall, performing a heart lung bypass and stopping the heart beat. While surgical procedures such as those mentioned can successfully reconstruct the valve back to a non-regurgitant state, this problem is often associated with Chronic Heart Failure (CHF) and/or other debilitating diseases and thus, the sufferers of the regurgitant valve are often unable to tolerate the required open heart surgery. In CHF patients, the heart is progressively less able to pump sufficient blood to meet the body&#39;s needs, usually due to the continuing enlargement of the left ventricle (and adjacent structures) in response to high blood pressure, high heart rate, ECG conduction/timing problems and/or insults to the ventricular tissue, such as Myocardial Infarct (MI). As the body&#39;s cardiac compensatory mechanisms act to maintain blood flow (cardiac output), the increased stress and metabolic impacts cause further cardiac enlargement and other detrimental changes. The onset of mitral valve regurgitation further reduces cardiac output and, thus accelerates the CHF process. Therefore, there is a need for a less invasive and traumatic way to treat mitral valve regurgitation (MVR). 
     SUMMARY 
     The exemplary embodiments of the present invention disclose apparatuses and methods for treating a valve such as a defective heart valve. The exemplary embodiments of the present invention also disclose annuloplasty devices and delivery devices used to deliver/deploy the annuloplasty devices to treat such a valve. 
     One exemplary embodiment pertains to a medical device that comprises a delivery sheath, an implantable device moveably disposed within the delivery sheath, and an actuator releasably coupling to the implantable device. The implantable device further comprises a distal expandable basket, a proximal expandable basket, and a connecting member coupling at a first end to the distal expandable basket and at a second end to the proximal expandable basket. The distal expandable basket and proximal expandable basket are deliverable in a compressed state and deployed to an expanded state. The actuator is used to facilitate the deployment of the implantable device. 
     Another exemplary embodiment pertains to a method of deploying an implantable device in a blood vessel. The method comprises providing a medical device that comprises a delivery sheath, an implantable device moveably disposed within the delivery sheath, and an actuator releasably coupling to the implantable device. The implantable device comprises a distal expandable basket, a proximal expandable basket, and a connecting member coupling at a first end to the distal expandable basket and at a second end to the proximal expandable basket. The method further comprises deploying the implantable device into a blood vessel with the distal expandable basket and the proximal expandable basket in a collapsed state. When the distal expandable basket is in a proper position, the delivery sheath is withdrawn to allow the distal expandable basket to expand and rest against the inner wall of the blood vessel. The proximal expandable basket is then deployed while tension is applied to the actuator. Once the proximal expandable basket is pulled to a proper position along the blood vessel, the delivery sheath is withdrawn to allow the proximal expandable basket to expand to rest against the inner wall of the blood vessel. The implantable device is, after deployments of the distal expandable basket, proximal expandable basket, and the connecting member, capable of reshaping the blood vessel. In another embodiment, the blood vessel has a first curvature and when the implantable device is deployed, the implantable device changes the first curvature to a second curvature wherein the second curvature is smaller than the first curvature. The blood vessel may be a coronary sinus in one embodiment. 
     The methods of treating mitral valve using the exemplary embodiments of the present invention are also disclosed and other exemplary embodiments are disclosed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention is illustrated by way of example and not limitation in the figures of the accompanying drawings, in which like references indicate similar elements and in which: 
         FIG. 1A  is an illustration of a heart; 
         FIGS. 1B-1C  illustrate a normal mitral valve and an enlarged mitral valve, respectively; 
         FIG. 1D  is an illustration of an annuloplasty procedure to constrict a valve (e.g., a mitral valve); 
         FIGS. 1E-A  through  1 E-E are illustrations of a reconstruction procedure to reduce the size of a defective valve; 
         FIG. 2A  is an illustration of an exemplary embodiment of an annuloplasty device deployed within a coronary sinus; 
         FIG. 2B  is an illustration of how the annuloplasty device of  FIG. 2A  works to reduce the curvature of the coronary sinus and the mitral valve annulus; 
         FIGS. 2C-2D  are illustrations of another exemplary embodiment of an annuloplasty device; 
         FIG. 3A  is an illustration a telescoping assembly that can be used for an annuloplasty device in accordance with the embodiments of the present invention; 
         FIGS. 3B-3C  are illustrations of exemplary embodiments of mechanical interferences that can be used for an annuloplasty device in accordance with the present invention; 
         FIGS. 4-6  illustrate exemplary embodiments of force distribution members that can be used for an annuloplasty device in accordance with the embodiments of the present invention; 
         FIGS. 7-10  illustrate other exemplary embodiments of force distribution members that can be used for annuloplasty devices in accordance with the embodiments of the present invention; 
         FIGS. 11-14 ,  15 A- 15 B,  16 A- 16 D, and  17 - 18  illustrate exemplary embodiments of distal anchoring members that can be used for annuloplasty devices in accordance with the embodiments of the present invention; 
         FIGS. 19A-19B ,  20 ,  21 A- 21 D, and  22 A- 22 B illustrate exemplary embodiments of proximal anchoring members that can be used for annuloplasty devices in accordance with the embodiments of the present invention; 
         FIG. 23  is an illustration of an annuloplasty device disposed within a delivery device that can be delivered into a coronary sinus in accordance with the embodiments of the present invention; 
         FIGS. 24A-24B  illustrate exemplary embodiments of position-locking devices that can be used for annuloplasty devices in accordance with the embodiments of the present invention; 
         FIG. 25  is an illustration of an annuloplasty device disposed in a delivery device that can be delivered into a coronary sinus in accordance with the embodiments of the present invention; 
         FIGS. 26-28  illustrate another exemplary embodiment of a annuloplasty device in a delivery device that can be delivered into a coronary sinus in accordance with the embodiments of the present invention; 
         FIG. 29  illustrates an exemplary annuloplasty device deployed within a coronary sinus having anchoring members attached to cardiac tissue proximate the coronary sinus to reduce the curvature of the mitral valve annulus; 
         FIG. 30  is an illustration of an exemplary annuloplasty device in accordance with the present invention that can be deployed as shown in  FIG. 29 ; 
         FIGS. 31-33  illustrate exemplary embodiments of a balloon system that can be used to deploy an expandable structure of an annuloplasty device in accordance with the present invention; 
         FIGS. 34-36  illustrate exemplary embodiments of an expandable structure of an annuloplasty device in accordance with the present invention; 
         FIGS. 37A-37C  illustrate exemplary embodiments of the expandable structure shown in  FIGS. 34-36  with curvature; 
         FIGS. 38-39  illustrate exemplary embodiments of the expandable structure shown in  FIGS. 34-36  with curvature; 
         FIG. 40  illustrates an exemplary embodiment of the expandable structure shown in  FIGS. 38-39  in a fully expanded state; 
         FIG. 41  illustrates an exemplary embodiment of a backbone that can be used to form the curvature for the expandable structure; 
         FIG. 42  illustrates an exemplary embodiment of a straightening device that can be used to temporarily straighten out the expandable structure during deployment; 
         FIGS. 43-45  illustrate a balloon system that can be used to deploy the expandable structure; 
         FIGS. 46-50  illustrate exemplary embodiments of an expandable structure that can be made to curve to one side; 
         FIG. 51  illustrates an exemplary embodiment of a delivery device that can be used to deliver an exemplary annuloplasty device of the present invention; 
         FIG. 52  illustrates an exemplary embodiment of an annuloplasty device of the present invention; 
         FIG. 53  illustrates an exemplary embodiment of a delivery device that can be used to deliver an exemplary annuloplasty device of the present invention; 
         FIGS. 54A-54D  illustrate how an exemplary annuloplasty device of the present invention can be deployed; 
         FIGS. 55A-55C  illustrate an exemplary embodiment of an annuloplasty device in accordance with the present invention; 
         FIGS. 56-58  illustrate exemplary embodiments of a distal anchoring member and a proximal anchoring member that can be used for the annuloplasty device shown in  FIGS. 55A-55C ; 
         FIGS. 59A-59D  illustrate exemplary embodiments of a spring-like spine in various configurations that can be used for the annuloplasty device shown in  FIGS. 55A-55C ; 
         FIG. 60  illustrates an exemplary embodiment of an annuloplasty device comprising coiled anchoring members; 
         FIGS. 61A-61F  illustrate exemplary embodiments of coiled anchoring members; 
         FIGS. 62A-62E  illustrate an exemplary embodiment of an annuloplasty device having distal and proximal expandable baskets connected by a connecting member; 
         FIG. 63  illustrates an exemplary embodiment of a connecting member to connect an actuator to the annuloplasty device shown in  FIGS. 62A-62D ; 
         FIG. 64  illustrates another exemplary embodiment of a connecting member to connect an actuator to the annuloplasty device shown in  FIGS. 62A-62D ; 
         FIGS. 65A-65C  illustrate exemplary embodiments of a distal or proximal expandable basket for the annuloplasty device shown in  FIGS. 62A-62D ; and 
         FIG. 66  illustrates the annuloplasty device shown in  FIGS. 62A-62D  with a distal stop and a proximal lock. 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the present invention pertain to novel annuloplasty devices, delivery devices to deploy/deliver the annuloplasty devices, and methods of using these annuloplasty devices to treat medical conditions such as defective or faulty heart valves. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It will be evident, however, to one skilled in the art, that the present invention may be practiced without these specific details. In other instances, specific apparatus structures and methods have not been described so as not to obscure the present invention. The following description and drawings are illustrative of the invention and are not to be construed as limiting the invention. 
     In some exemplary embodiments of the present invention, an annuloplasty device used for treating a faulty heart valve such as those seen in MVR includes an annuloplasty device that reduces the cross-sectional size of the annulus of the mitral valve or brings the leaflets of the valves closer to each other. For example, the annuloplasty devices move the posterior annulus of the mitral valve toward the anterior annulus of the mitral valve. Alternatively, the annuloplasty device can reshape the cross-sectional size of the mitral valve annulus. Reshaping includes at least one of reducing, reforming, or adjusting the mitral valve annulus in ways that cause the leaflets of the mitral valve to move closer to each other. 
     Reshaping may also include increasing the curvature (or reducing the radius along at least a portion of the curvature) of the coronary sinus that substantially encircles that mitral valve annulus thereby reshaping the mitral valve or the mitral valve annulus. Reshaping may also include decreasing the curvature (or increasing the radius along at least a portion of the curvature) of the coronary sinus in a way that exerts pressure on the mitral valve annulus or the mitral valve and flattening a portion or a side of the mitral valve annulus or the mitral valve. 
     The term coronary sinus can also includes the coronary vein or great cardiac vein as the name changes as one goes further up in the coronary sinus. 
     There are numerous different embodiments described below, which can perform at least one of these treatments. For example, a medical device that includes a first and a second anchoring member, in one embodiment, reshapes the mitral valve annulus from the first anchoring member to the second anchoring member due to the flexural properties (e.g., long term stiffness) of the device which causes the mitral valve annulus to be reshaped to conform to the shape of this medical device. In this embodiment, there is no tightening in the sense of a significant force applied along the longitudinal axis of the device, between the two anchoring members. This type of medical device may not require anchors attached to or included with the anchoring members (e.g., hooks, barbs, screws, corkscrews, helixes, coils, flanges, etc. . . . ) to hold the anchoring members in place. 
     In another embodiment, a medical device, which includes a first anchoring member, a second anchoring member, and a connection between the anchoring members, that reshapes the mitral valve annulus from anchoring member to anchoring member by the medical device being cinched (tightened) by a cord/cord and position-locking mechanism in the connection or having a fixed length cord or tube which connects the anchoring members and which is shorter than the existing (dilated) annulus. In this another embodiment, the medical device normally has a low or insignificant long-term flexural modulus (and thus it is moderately to highly flexible), and the medical device normally includes anchors such as hooks, barbs, or flanges, to name a few, to hold the anchoring members in place in order to resist the longitudinal cinching forces. 
     In yet another embodiment, a medical device includes a first anchoring member and a second anchoring member, which are coupled together by a connection, such as a telescoping assembly or a bellow-like member. The connection, of this yet another embodiment, reshapes the mitral valve annulus from anchoring member to anchoring member due to its flexural properties (e.g., long-term stiffness), and the medical device also reshapes the mitral valve annulus due to its being cinched (tightened) by a cord/cord and position-locking mechanism. Anchors may be used or otherwise included in the anchoring members of this yet another embodiment to ensure that the anchoring members remain in place. However, it may possible to balance the long-term stiffness and tightening so that the anchors are not required. 
     These different embodiments may be deployed percutaneously with a catheter device, which has a distal end having a preferred orientation (due to axial flexural modulus differences) in a curved conduit, such as the coronary sinus. The preferred orientation can be used to orient the medical device within the coronary sinus. 
       FIG. 2A  illustrates one embodiment in which an annuloplasty device  200  is deployed within a coronary sinus (CS)  208 , which substantially encircles or is adjacent to a mitral valve  210 . Throughout the disclosure, the terminology “coronary sinus” covers not only the coronary sinus such as the CS  208  but also a proximate extension of the coronary sinus, (e.g., a near branch or flow that ends into the CS, the Great Cardiac Vein, or the Middle Cardiac Vein). An annuloplasty device includes at least a device that can reshape a blood vessel such as the CS  208 , the mitral valve, and/or the mitral valve annulus. An annuloplasty device can also be deployed or delivered in, near, at, or within the CS  208  using methods such as percutaneous delivery or surgical installation. 
     Although the discussion below emphasizes on the deployment of the annuloplasty device  200  within the coronary sinus, the annuloplasty device  200  can be deployed within another blood vessel, vein, or artery to treat a different medical condition without departing from the scope of the present invention. Throughout the discussion, various exemplary embodiments of the annuloplasty device  200  can be understood to be deployable in the CS  208 . 
     The annuloplasty device  200  includes a distal anchoring member  202 , a proximal anchoring member  204 , and a telescoping assembly  206  coupling to the distal anchoring member  202  and the proximal anchoring member  204 . The annuloplasty device  200  can be percutaneously delivered and/or deployed (e.g., through a catheter) into the CS  208  through a blood vessel, a vein, or an artery, or alternatively, it may be delivered through a conventional surgical technique. The annuloplasty device  200  is capable of reshaping the CS  208  and/or reducing the mitral valve annulus or the mitral valve that has been enlarged or is otherwise not properly sealed. 
     Additionally, the annuloplasty device  200  is capable of reshaping a ventricle (e.g., the left ventricle) that has been enlarged due to a faulty valve (e.g., mitral valve regurgitation or MVR). In some cases, MVR causes the left ventricle to enlarge causing the papillary muscles (not shown) to move away from the mitral valve  210  and the chordae (not shown) attached between the papillary muscles and the leaflets (not shown) of the mitral valve  210 . 
     This enlarged ventricle causes the mitral valve  210  to be held open (or referred to as “tethering”). The annuloplasty device  200  may reduce regurgitation by moving the posterior leaflet (not shown) nearer to the anterior leaflet (not shown) and prevents enlargement of the mitral valve  210 . 
     The distal anchoring member  202  is configured to be deployed within the CS  208  as shown in  FIG. 2A . Upon deployment, (or after deployment is complete) at least a portion of the distal anchoring member  202  anchors or attaches to the inner wall of the CS  208 . Additionally, upon deployment, at least a portion of the distal anchoring member  202  may also penetrate the wall of the CS  208  and may anchor or attach to a cardiac tissue (or myocardial tissue) proximate the portion of the CS  208  where the distal anchoring member  202  is deployed. The distal anchoring member  202  may be deployed in the great cardiac vein, which is an extension or part of the CS  208 . In one embodiment, at least a portion of the distal anchoring member  202  anchors or attaches to an area proximate the left trigone (not shown) adjacent the mitral valve  210  or to an annulus tissue. Portions of the distal anchoring member  202  may penetrate the wall of the CS  208  and anchor to the left trigone, the annulus tissue, or the area proximate the CS  208 . 
     The proximal anchoring member  204  is configured to be disposed within or at the entrance  216  of the CS  208  as shown in  FIG. 2A . The entrance  216  of the coronary sinus is the junction of the coronary sinus and the right atrium; in other words, this entrance is the point where deoxygenated blood from the heart enter the right atrium. At least a portion of the proximal anchoring member  204  anchors or attaches to a cardiac tissue proximate another portion of the CS  208  where the proximal anchoring member  204  is deployed. For example, at least a portion of the proximal anchoring member  204  anchors or attaches to an area at the entrance  216  of the CS  208 . Alternatively, at least a portion of the proximal anchoring member  204  anchors or attaches to an annulus tissue or a myocardial tissue near the entrance  216  of the CS  208 . 
     The telescoping assembly  206  is deployable within the CS  208 . The telescoping assembly  206  includes at least two members (e.g., tubes) wherein one is moveably (e.g., slidably) fitted within another. A telescoping assembly, in certain embodiments, is referred to as a member that includes at least two sections, such as two cylindrical tubes or sections that can slide/move inward and outward in an overlapping manner. In one embodiment, and as shown in  FIG. 2A , the telescoping assembly  206  includes a distal tube  212 , a center tube  218 , and a proximal tube  214  wherein the distal tube  212  is coupled to the distal anchoring member  202  and the proximal tube  214  is coupled to the proximal anchoring member  204 . The telescoping assembly  206  is able to reduce the distance between the distal anchoring member  202  and the proximal anchoring member  204  once the annuloplasty device  200  is fully deployed by bringing the distal tube  212  and the proximal tube  214  closer to each other (sometimes referred to as “telescoping”). For example, as shown in  FIG. 2B , the distal tube  212  slides in the direction  213  into the center tube  218 . Likewise, the proximal tube  214  slides in the direction  215  into the center tube  218 . As the distal tube  212  and the proximal tube  214  slide into the center tube  218 , the telescoping assembly  206  becomes shorter. 
     Reducing the distance between the distal anchoring member  202  and the proximal anchoring member  204  (after they are anchored in the coronary sinus) reduces or shortens portions of the CS  208 . The annuloplasty device  200  thus is able to reshape at least a portion of the CS  208  thereby reshaping the cross-sectional size of the annulus  209  of the mitral valve  210  that is substantially encircled by the CS  208 . 
     Typically, the CS  208  and the annulus  209  of the mitral valve  210  near the CS  208  are elastic in nature and are stretched by internal pressures generated by the heart. When the telescoping assembly  206  reduces/shortens the distance between the distal anchoring member  202  and the proximal anchoring member  204 , some portions of the CS  208  and the annulus of the mitral valve  210  will be taken up as the pressure of the telescoping assembly  206  acts against the internal pressure and negates it. In some examples, the shortening of the CS  208  returns the tissue of the CS  208  to its “rest” dimension (which is smaller than its “enlarged” dimension caused by a faulty mitral valve or MVR). As the CS  208  shortens, the CS  208  applies pressure on the annulus  209  of the mitral valve  210  causing the posterior leaflet of the mitral valve  210  to be brought closer to the anterior leaflet effectively reducing or reshaping the cross-sectional size of the annulus  209 . As the CS  208  shortens, the CS  208  flattens and the curvature of the CS  208  is reduced which causes the CS  208  to flatten portions of the annulus  209  of the mitral valve  210  as shown in  FIG. 2B . Thus, the posterior leaflet of the mitral valve  210  is pushed toward the relatively fixed anterior leaflet. Since the posterior and anterior leaflets are moved closer together, the gap between them gets smaller or disappears and regurgitation is reduced or eliminated. 
     In one embodiment, reducing the distance between the distal anchoring member  202  and the proximal anchoring member  204  increases the curvature radius (or decrease the curvature) along at least a portion of the curvature of the mitral valve annulus  209  as shown in  FIG. 2B . In  FIG. 2A , the telescoping assembly  206  has been deployed but has not acted to reduce the distance between the distal anchoring member  202  and the proximal anchoring member  204 ; the CS  208  has a curvature radius R 1 . In  FIG. 2B , the telescoping assembly  206  reduced or shortened the distance between the distal anchoring member  202  and the proximal anchoring member  204 ; the CS  208  now has a curvature radius R 2 , which is larger than the curvature radius R 1 . 
     As can be seen, one reason for having the telescoping assembly  206  is that the telescoping assembly  206  may comprise of at least two members (e.g., the distal tube  212  and the proximal tube  214 ) wherein one smaller tube can slide into a larger tube. The telescoping assembly  206  can reduce the distance between the distal anchoring member  202  and the proximal anchoring member  204  with a telescoping action. Additionally, the telescoping assembly  206  can shorten a portion of the CS  208  thereby reshaping and reducing the curvature of the CS  208  and the annulus  209  of the mitral valve  210 . 
     It will be appreciated that the telescoping assembly  206  is not the only structure that performs the functions mentioned above. In one embodiment, the telescoping assembly  206  is replaced by a bellow-like member  254  shown in  FIGS. 2C-2D . In this embodiment, the bellow-like member  254  comprises a plurality of pleats  256 , which allows that bellow-like member  254  to be compressed and extended. In one embodiment, the bellow-like member  254  is made of a shaped-memory material (e.g., Nitinol) such that during deployment, the bellow-like member  254  can be extended as shown in  FIG. 2D . The bellow-like member  254  can also be made out of a polymer. The extended bellow-like member  254  allows the distal anchoring member  202  and the proximal anchoring member  204  to be deployed. Once deployment is complete, the bellow-like member  254  is allowed to return to its original shape (unextended) as shown in  FIG. 2C . In one embodiment, the bellow-like member  254  is a tube having a bellow-like structure or wall. In one embodiment, a stiffening member (not shown) is disposed in the inner diameter or over the outer diameter of the bellow-like member  254  to increase flexural modulus for the bellow-like member  254 . 
       FIGS. 3-10  illustrate various exemplary embodiments of a telescoping assembly that can be used for the telescoping assembly  206 .  FIGS. 11-18  illustrate various exemplary embodiments of the distal anchoring member that can be used for the distal anchoring member  202 .  FIGS. 19-22  illustrate various exemplary embodiments of the proximal anchoring member that can be used for the proximal anchoring member  204 . 
       FIG. 3A  illustrates an exemplary embodiment of a telescoping assembly  220  that can be used for the telescoping assembly  206  of the annuloplasty device  200  shown in  FIGS. 2A-2B . The telescoping assembly  220  includes a distal tube  228 , a center tube  226 , and a proximal tube  230 . It is to be understood that in alternative embodiments, only two tubes are necessary or more than three tubes can be used. In one embodiment, each of the distal tube  228 , the center tube  226 , and the proximal tube  230  is made of a flexible material. The distal tube  228 , the center tube  226 , and the proximal tube  230  are dimensioned such that the distal tube  228  is slidably fitted inside the center tube  226  from one end of the center tube  226  and the proximal tube  230  is slidably fitted inside the center tube  226  from the other end of the center tube  226 . In one embodiment, the distal tube  228  and the proximal tube  230  can slide into the center tube  226 . In an alternative embodiment, the center tube  226  may be slidably fitted inside the distal tube  228  or the proximal tube  230  or both. The center tube  226  thus slides into the distal tube  228 , the proximal tube  230 , or both. 
     Each of the distal tube  228 , the center tube  226 , and the proximal tube  230  may have any suitable cross-sectional shape. For example, the tubes may be circular, oval, or rectangular in cross-section. The chosen shape should be one that provides that most surface area for the telescoping assembly  220  to be deployed against the wall of the CS  208  without a substantial blockage of the flow (to prevent stenosis and clotting) within the CS  208 . 
     The distal tube  228  further includes a bent portion such as a U-shaped portion  232  that is relatively stiff. The U-shaped portion  232  is useful when the annuloplasty device  200  needs to be positioned over an area that has other artery or blood vessel crossing below. In one embodiment, the U-shaped portion  232  is useful when the annuloplasty device  200  needs to be placed over the circumflex coronary artery. The U-shaped portion  232  allows the annuloplasty device to avoid compressing the circumflex coronary artery when the annuloplasty device  200  is in position and fully deployed. In one embodiment, the U-shaped portion  232  is made of a flexible material. Other bent portions having other shapes (e.g., an S-shape or a V-shape) may be used instead of the U-shaped. 
     In one embodiment, the U-shaped portion  232  may include a telescoping feature similar to the telescoping assembly  220 . Thus, the U-shaped portion  232  itself may include at least two members or tubes that can slide inward or outward into each other. 
     In one embodiment, at least one cord  224  is disposed through the inner diameters of the telescoping assembly  220 . The cord  224  functions to adjust the length of the telescoping assembly  220 . In one embodiment, the cord  224  couples to the distal end portion  231  of the U-shaped portion  232  and extending from the U-shaped portion  232  through the proximal tube  230 . The cord  224  could also be coupled to any portion of the distal tube  225  or any portion of the telescoping assembly  220 . The distal end of the cord  224  may also attach to or engage with a distal anchoring device (not shown) such as the distal anchoring member  202  shown in  FIG. 2A . The proximal end of the cord  224  attaches to or engages with a proximal anchoring device (not shown) such as the proximal anchoring member  204  shown in  FIG. 2B . When the cord  224  is pulled proximally relative to the proximal tube  230  (or the proximal anchoring member), the cord  224  is placed in tension, causing the distal tube  228  and the proximal tube  230  to move closer together and telescope into the center tube  226 . Alternatively, when the cord  224  is pulled distally relative to the distal tube  228  (or the U-shaped portion  232 ), the cord  224  is placed in tension, causing the distal tube  228  and the proximal tube  230  to move closer together and telescope into the center tube  226 . 
     The cord  224  can be made of metal, metal alloy, NiTi, Nitinol, and etc. The cord  224  can be made of an elastic material such as silicone/silastic, nitrile, polyurethane, neoprene, and fluorosilicone, and etc. The cord  224  can be made out of or coated with a low friction material, like a fluorocarbon, Acetal, PE, or Nylon. The cord  224  may have any suitable cross-sectional shape, rectangular, circular, oval, etc. 
     In one embodiment, the distal tube  228 , the proximal tube  230  and the center tube  226  contain mechanical interferences such that the distal tube  228  will not disengage from the inner diameter of the center tube  226  and the proximal tube  230  will not disengage from the inner diameter of the center tube  226 . Examples of suitable mechanical interferences include o-rings, lips, flanges pins, projections, or slots created into or attached to the tubes. 
     In one embodiment, a suitable mechanical interference includes a flange/lip type interference  370  as shown in  FIG. 3B . In this embodiment, the distal tube  228  includes lips/flanges  372  and the center tube  226  includes lips/flanges  374 . The lips/flanges  372  and  374  engage each other to prevent disengagement as the distal tube  228  and the center tube  226  slide into and away from each other. The same interference  370  can be used to apply to other tubes of the telescoping assembly  220 , for example, the proximal tube  230  could also include the same interference  370 . 
     In one embodiment, a suitable mechanical interference includes a pin/projection type interference  371  as shown in  FIG. 3C . In this embodiment, the distal tube  228  includes at least one pin/projection  376 , which engages at least one slot  378  created into the center tube  226  to prevent the distal tube  223  from disengaging the proximal tube  226 . The same interference  371  can be used to apply to other tubes of the telescoping assembly  220 , for example, the proximal tube  230  could also include the same interference  370 . 
     In one embodiment, the distal tube  228  (including the U-shaped portion  232 ), the proximal tube  230  and the center tube  226  are made of a low friction material, like a fluorocarbon, Acetal, PE or Nylon to limit the friction (for example, to make the telescoping action easier). 
     In another embodiment, to prevent disengagement of the tubes of the telescoping assembly  220 , an extension-limiting cord (not shown) is disposed within or through the inner diameters of each of the distal tube  228 , the proximal tube  230 , and the center tube  226 . The extension-limiting cord is attached between adjacent tubes. For example, one portion of the extension-limiting cord is attached to both the distal tube  228  and the center tube  226  and another portion of the extension-limiting cord is attached to both the proximal tube  230  and the center tube  226 . The extension-limiting cord can be divided into two extension-limiting cords wherein one extension-limiting cord is attached to the distal tube  228  and the center tube  226  at each end of the cord; and, the other extension-limiting cord is attached to the proximal tube  230  and the center tube  226  at each end of the cord. The length of the extension-limiting cord(s) is fixed such that if one adjacent tube is moved away from another adjacent tube, the extension-limiting cord dictates the maximum length or distance that the tubes can move away from each other. The extension-limiting cord(s) has a length that prevents the distal anchoring member and the proximal anchoring member from disengaging with the center tube  226 . The extension-limiting cord may be made out of a thin and flexible material such as nylon, Vectran® (Vectran® is a registered trademark of Hoechst Celanese and is manufactured by companies such as Dupont and Allied Signal), Kevlar® (Kevlar® is a registered trademark of Dupont and is manufactured by Dupont), or other suitable materials. One advantage of using the extension-limiting cord is that the various tubes of the telescoping assembly  220  can have smaller inner diameters which overall, allows for smaller annuloplasty devices. 
     In one embodiment, the distal tube  228  and the proximal tube  230  are biased to be a predetermined distance (a minimum distance) away from each other during delivery/deployment. A compression spring(s) (not shown) may be placed inside the inner diameter of the center tube  226  to bias the ends of the distal tube  228  and the proximal tube  230 . During delivery/deployment, the compression springs keep the distal tube  228  and the proximal tube  230  apart. In some embodiments, the compression springs keep the distal anchoring member  228  and the proximal anchoring member  230  from disengaging from the center tube  226 . Additionally, in some embodiments, the compressions springs may act to keep the distal tube  228  engaging to a least a portion of the distal anchoring member (not shown) and the proximal tube  230  engaging to at least a portion of the proximal anchoring member (not shown). 
     In one embodiment, the telescoping assembly  220  has differential stiffness along the various sections and tubes of the telescoping assembly  220 . One advantage for the differential stiffness is that it allows the annuloplasty device to have orientation, curve, and shape that make reshaping the mitral valve annulus  209  easier. A section that has a high stiffness is sometimes referred to as having a high flexural modulus. A section that has a low stiffness is sometimes referred to as having a low flexural modulus. Each of the distal tube  228 , the proximal tube  230 , and the center tube  226  may have variable flexural modulus. The flexural modulus of various tubes of the telescoping assembly  220  has a pronounced effect on the amount of tension or force that is required to be applied to the cord  224  to adjust the length and/or curvature of the mitral valve annulus  209 . For instance, very low flexural modulus (low stiffness) tubes makes device delivery easier, but will require a higher tension be applied to the cord  224  to reform the mitral annulus such that the leaflets will coaptate (or close) reliably and eliminate mitral valve regurgitation. Very high modulus (high stiffness) tubes makes device delivery difficult, but will require a much lower tension to be applied to the cord  224  to reform the mitral annulus such that the leaflets will coaptate (or close) reliably and eliminate mitral valve regurgitation. 
     In one embodiment, the flexural modulus is optimized such that delivery of the annuloplasty device that contains the telescoping assembly  220  is relatively or sufficiently easy while not too high of a tension is needed to change the length of the telescoping assembly  220 . In one embodiment, the distal tube  228 , the center tube  226 , and the proximal tube  230  are made of low flexural modulus materials. The sections that the distal tube  228  and the center tube  226  overlap are maximized. Likewise, the sections that the proximal tube  230  and the center tube  226  overlap are also maximized. When the annuloplasty device is being deployed or delivered, the distal tube  228 , the center tube  226 , and the proximal tube  230  are at the farthest extension, which gives the telescoping assembly  220  an overall low flexural modulus characteristic, which eases the delivery/deployment process. Once fully deployed, the distal tube  228  and the proximal tube  230  are telescoped together (or retracted) into the center tube  226  as close as possible to give the telescoping assembly  220  the most overlapping sections and to also shorten the length of the telescoping assembly  220 . The telescoping assembly  220  thus will have a high flexural modulus characteristic. Thus, a lower tension is required to be exerted on the cord  224 , which is used to reshape the mitral valve annulus  209 . 
     In one embodiment, each of the distal tube  228 , the center tube  226 , and the proximal tube  230  itself has sections with variable flexural modulus or stiffness. The variable flexural modulus in each of the tubes further enhances the ease of adjusting, reducing, reforming, or reshaping the mitral valve annulus  209 . Methods to provide differential or variable modulus to a structure are well known in the art. 
     In one embodiment, the telescoping assembly  220  includes at least one force distribution member.  FIGS. 4-6  illustrate cross-sectional views of exemplary configurations of force distribution members  240  and  250 , which can be incorporated into the telescoping assembly  220 . As shown in  FIG. 4 , in one embodiment, a portion of the force distribution member  240  is coupled to the side of the telescoping assembly  220  that contacts the blood vessel (e.g., the CS  208 ). The force distribution member  240  may be a solid structure as shown in  FIG. 4  or may include a lumen  251  as shown in the force distribution member  250  of  FIGS. 5-6 . The telescoping assembly  220  may be placed outside of the lumen  251  as shown in  FIG. 5  or inside of the lumen  251  as shown in  FIG. 6 . 
     The force distribution members  240  and  250  allow the use of a minimum sized circular cross-section for the telescoping assembly  220 . A minimum size cross-section for the telescoping assembly  220  causes less interference with the flow or the blood flow in the blood vessel. Without the force distribution members, the outer diameter of the telescoping assembly  220  needs to be larger so as to not allow the force or tension of the cord  224  to cut through the blood vessel that the annuloplasty device is deployed within. The force distribution members provide a large surface area to distribute the force exerted on the blood vessel by the telescoping assembly  220  and/or the cord  224  over the blood vessel wall (or the wall of the CS  208 ) preventing damage to the blood vessel wall that may be caused by a high and/or focused force applied on the wall. 
     In one embodiment, the force distribution members  240  and  250  may include support members (such as a stiffening skeleton, struts, braid(s), flattened coil(s), etc.) as a part of their structure and/or be made of a variable thickness and/or width materials to facilitate the more even distribution of the force over the surface of the vein, as is well know to those skilled in the art. The force distribution members may have variable flexural modulus along each force distribution member or among one another. The force distribution members may also have variable dimensions (e.g., lengths and widths). Each of the force distribution members may be made of different material or design type. 
     If desired, a force distribution member may cover a large section or the entire telescoping assembly  220 . In one embodiment, at least a portion of the telescoping assembly  220  is covered by a large force distribution member  234  as shown in  FIG. 7 . Alternatively, various portions along the telescoping assembly  220  are covered by several force distribution members  236  and  238  as shown in  FIG. 8 . The force distribution members  236  and  238  may cover portions or the entire telescoping assembly  220  with gaps between each distribution member. Alternatively, the telescoping assembly  220  may be covered with several force distribution members  242 ,  244 , and  246  with sections of force distribution members overlapping one another. Additionally, when the distribution members contain lumens, one distribution member may slide into another distribution member (as shown in  FIG. 9 ) in the same manner that the various tubes of the telescoping assembly slide into one another. Adjacent force distribution members  242 ,  244 , or  246  may slide over or inside one another. The force distribution members may have an oblong shape as shown in  FIG. 7 , a rectangular shape as shown in  FIGS. 8-9 , or a circular shape as shown in  FIG. 10 . 
     In one embodiment, the force distribution members (e.g., the force distribution members  240 ,  250 ,  234 ,  236 ,  238 ,  242 , and  244 ) may have projections or anchors (not shown). These projections or the anchors may engage adjacent force distribution members and function to control or adjust the length of the telescoping assembly  220 . For instance, when the telescoping assembly  220  is replaced by the bellow-like member  254  as shown in  FIGS. 2C-2D , the force distribution members control the extension of the bellow-like tube  254  to a predetermined length. The projections or anchors may also aid (or even replace) the various tubes of the telescoping assembly  220  when necessary. For example, the force distribution members with anchors may allow replacing the telescoping assembly  220  with a single member/tube with no telescoping capability. These projections or anchors may face the wall of the blood vessel and may provide engagement with the blood vessel wall in a manner that causes length changes to be directed to a desired portion of the blood vessel wall. The projections or anchors may aid in the anchoring of the annuloplasty device that contains the telescoping assembly  220 . The projections or anchors may also aid in the anchoring of the distal anchoring member  202  and the proximal anchoring member  204 . 
       FIGS. 11-18  illustrate exemplary embodiments of a distal anchoring member that can be used for the distal anchoring member  202  shown in  FIGS. 2A-2B . The distal anchoring members described below can be deployed into the CS  208 . The distal anchoring members may be deployed percutaneously using conventional delivery device or a delivery device that will be described below (e.g.,  FIGS. 23 ,  25 , and  26 ). 
       FIG. 11  illustrates a side view of an exemplary distal anchoring member  302 . The distal anchoring member  302  may have conventional stent designs or configurations typically used for cardiac related treatment such as angioplasty or carotid stenting. Thus, the distal anchoring member  32  may resemble a tube like cylinder which is hollow. An example of such a stent includes an AccuLink™ self-expending stent made by Guidant Corporation). The distal anchoring member  302  is expandable and may or may not be self-expandable. 
     In one embodiment, the distal anchoring member  302  is self-expandable and may be made of a shaped-memory material such that upon deployment, the distal anchoring member  302  returns or expands back to its original shape and size as allowed by the blood vessel that it is placed in (e.g., the CS  208 ). Examples of a shaped-memory material suitable for the distal anchoring member  302  include Nitinol or other material that has a memory of their original shapes. In one embodiment, the distal anchoring member  302  is made of a superelastic material such as Nickel Titanium alloys, CuZnAl alloys, CuAlNi alloys, FeMnSi alloys, InTi alloy, MnCu alloys, AgCd alloys, AuCd alloys, etc. 
     Alternatively, the distal anchoring member  302  may be expanded by mechanisms well known in the art, for example, by an inflatable or dilatable balloon. The distal anchoring member  302  is sized to fit within the blood vessel that it is being deployed within. In one embodiment, the distal anchoring member  302  is sized to fit within a coronary sinus or a great cardiac vein, such as the CS  208  shown in  FIGS. 2A-2B . In one embodiment, once fully deployed within the CS  208 , the distal anchoring member  302  is deployed against the inner wall of the CS  208 . In one embodiment, the distal anchoring member  302  is deployed such that its outer wall (outer diameter) presses against the inner wall (inner diameter) of the CS  208 . 
       FIG. 12  illustrates a side view of an exemplary distal anchoring member  402 . The distal anchoring member  402  is similar to the distal anchoring member  302  shown in  FIG. 11  except that the distal anchoring member  402  includes a plurality of projections or anchors  403 . The anchors  403  may be configured to shape like helixes, coils, hooks, barbs, corkscrews, screws, flanges, or any other suitable anchoring device. The anchors  403  are designed to penetrate the wall of the CS  208  and attach or anchor to a cardiac tissue proximate the CS  208 . In one embodiment, the anchors  403  penetrate the wall of the CS  208  and anchor into the left trigone proximate the CS  208 . The anchors  403  thus provide additional support for the distal anchoring member  402  to allow a secure deployment of the distal anchoring member  402  within the CS  208  at a particular location along the CS  208 . The anchors  403  may have shape or arcs that are suitable for definitive anchoring of the distal anchoring member  402 . 
       FIG. 13  illustrates a side view of an exemplary distal anchoring member  502  which is similar to the distal anchoring member  402  except that a plurality of projections or anchors  503  are distributed over the outer diameter of the distal anchoring member  502 . The anchors  503  can be the same as the anchors  403  described above. The addition of more anchors improves the anchoring capability of the distal anchoring member  502 . The anchors  503  may be distributed over the outer diameter of the distal anchoring member  502  in any convenient manner, location, and number. 
       FIG. 14  illustrates a side view of an exemplary distal anchoring member  602 , which is similar to the distal anchoring member  402  except that the anchors have barbed shapes, as illustrated by anchors  603 . Additionally, the anchors  603  are also distributed along one side of the distal anchoring member  602 . In some applications, the distal anchoring member needs to be anchored only on one side. For example, when the distal anchoring member  602  is deployed within the CS  208 , the distal anchoring member  602  needs to penetrate only one side of the CS  208  to be anchored to an area in the left trigone, an area proximate the CS  208 , or in the annulus tissue of the mitral valve  210  that is adjacent the CS  208 . Thus, it is only necessary to distribute the anchors  603  only on the side of the distal anchoring member  602  that will be the anchoring side. 
       FIGS. 15A-15B  illustrate sectional views of an exemplary distal anchoring member  702 .  FIG. 15A  is a side view and  FIG. 15B  is a cross-sectional view. The distal anchoring member  702  is similar to the distal anchoring member  602 . The distal anchoring member  702  includes a plurality of projections or anchors  703  distributed and oriented toward one side of the distal anchoring member  702 . In one embodiment, the anchor support relies on the anchors  703  that penetrate the cardiac tissue, the annulus tissue, or the left trigone through the wall of the CS  208 . The anchors  703  may be required only on one side of the distal anchoring member  702 . In one embodiment, a proper orientation may be necessary such that the anchors  703  are oriented toward the anchoring site. This will required that the distal anchoring member  702  be properly oriented within the coronary sinus. 
     In one embodiment, the distal anchoring member  702  is composed of differential stiffness (variable flexural modulus). The side  705  of the distal anchoring member  702  that does not include any anchors  703  is made stiffer than the side  707  of the distal anchoring member  702  that includes the anchors  703 . In one embodiment the distal anchoring member  702  is deployed within the CS  208 , which curves around the mitral valve  210  shown in  FIGS. 2A-2B . The distal anchoring member  702  also curves during and after its deployment within the CS  208 . The lowest storage energy state of the distal anchoring member  702  is with the stiffer side  705  toward the outside of a curved CS  208 . In other orientations of higher energy storage, the produced energy gradient tends to twist the distal anchoring member  702  and the delivery device/catheter used to deliver the distal anchoring member  702  toward the lowest energy state which directs the distal anchoring member  702  toward the desired anchoring site/orientation (e.g., the mitral valves annulus tissue, the myocardium, and the left trigone) and away from the free wall of the CS  208  or other less desirable anchor orientations. In one embodiment, the variable flexural modulus of the distal anchoring member  702  is provided by adding more material and/or a pattern on the side  705  than the side  707  such that the side  705  has a higher flexural modulus. Suitable patterns that will provide a higher flexural modulus to the distal anchoring member  702  are well known and understood by those skilled in the art. 
     In one embodiment, the distal anchoring member  702  is deployed within the CS  208  using a delivery catheter. At least a portion of the delivery catheter&#39;s distal end, proximate to the distal anchoring member  702  has a higher flexural modulus on one side than the other. Thus, when the delivery catheter is inserted into a curved CS  208 , its lowest energy storage state will be with the higher flexural modulus side toward the outside of the blood vessel&#39;s curve. In other orientations of higher energy storage, the produced energy gradient tends to twist the delivery device toward the orientation of the lowest energy state. The orientation for the distal anchoring member  702  is controlled by the orientation of the delivery catheter. Thus, mounting the distal anchoring member  702  in or on the delivery catheter in a controlled orientation relative to the delivery catheter&#39;s higher flexural modulus side directs the distal anchoring member (as previously described) or other features of the distal anchoring member  702  toward the desired anchoring site/orientation (e.g., the mitral valves annulus tissue, the myocardium, and the left trigone) and away from the free wall of the CS  208  or other less desirable anchor orientations. 
       FIGS. 16A-16D  illustrates a cross section of a distal anchoring member  802  that comprise of an outer part  805  and an inner part  822 . It is to be appreciated that the configuration of the distal anchoring member  802  can be applied to other anchoring members that include at least one projection or anchor. The outer part  805  can be a protective sheath that is disposed outside of the inner part  822  that has a plurality of anchors  803 . Alternatively, the outer part  805  can be the distal anchoring member itself while the inner part  822  is the structure that includes the anchors  803 . In one embodiment, the outer part  805  is a stent-like device that is expandable and/or self-expandable. The outer part  805  includes a plurality of openings (e.g., holes or slots)  812  cut into it. During deployment, the outer part  805  keeps the anchors  803  in a non-deployed position (non-projecting or non-anchoring position). The outer part  805  prevents the anchors  803  from damaging the wall of the blood vessel as the distal anchoring member  802  is being deployed. When the distal anchoring member  802  is being deployed, the anchors  803  are contained/constrained by the outer part  805 . Once the distal anchoring member  802  reaches the proper location for deployment and anchoring, the outer part  805  is slightly moved away from the inner part  822  such that the end of the anchors  803  engage or can be made to engage the openings  812 . Once the anchors  803  pass through the openings  812 , the anchors  803  project out and penetrate the wall of the blood vessel and anchor themselves into a myocardium tissue proximate the blood vessel (e.g., the left trigone or the mitral valve annulus tissue). After deployment, the anchors  803  anchor the distal anchoring member  802  into the blood vessel. 
       FIGS. 17-18  illustrate a sectional view of a distal anchoring member  902 . The distal anchoring member  902  is similar to those distal anchoring members described above with an addition of a tension cord  906  attaching to the distal anchoring member  902 . The tension cord  906  may include a plurality of branches  908  each of which is attached to a point at the distal end  910  of the distal anchoring member  902 . In one embodiment, the tension cord  906  extends along the distal anchoring member  902  and through the telescoping assembly (not shown) that is coupled to the distal anchoring member  902 . The tension cord  906  can also act as the cord  224  to telescope the various tubes of the telescoping assembly such as the telescoping assembly  220  while exerting compression forces on the distal anchoring member  902 . 
     In one embodiment, the distal anchoring member  902  is configured so that a compression force caused by the tension cord  906  expands the outer diameter of the distal anchoring member  902 . For example, when the tension cord  906  is pulled in the direction D 1 , the outer diameter of the distal anchoring member  902  increases from the OD 1  to OD 2  wherein OD 2 &gt;OD 1 . Enlargement of the outer diameter helps ensure that the distal anchoring member  902  is securely deployed against the inner diameter of the CS  208 . When tension is applied to the tension cord  906  proximally, the length of the distal anchoring member  902  is decreased from length L 1  to length L 2 . In one embodiment, the tension cord  906  is the same as the cord  224  used to adjust the length of the telescoping assembly  220  described above. The tension longitudinally compresses the distal anchoring member  902  to the shorter length L 2  thereby making the outer diameter of the distal anchoring member  902  larger. The tension cord  906  ensures an increased pressure of the distal anchoring member  902  against the blood vessel. This increased pressure causes the distal anchoring member  902  positioned in the blood vessel to be better retained at its deployment location. The configuration of the distal anchoring member  902  is especially useful when the distal anchoring member does not include a projection or an anchor. Although not shown, the distal anchoring member  902  may also include anchors (e.g., hooks, barbs, or screws) for better attachment. 
     In one embodiment, any of the distal anchoring members described may incorporate materials/coatings/drugs that encourage their attachment or biological incorporation into the cardiac tissue to prevent displacement of the distal anchoring members. Additionally, any of the distal anchoring members described may incorporate coatings/materials/drugs that help keep the inner diameter of the CS  208  clear and open. 
       FIGS. 19-23  illustrate sectional views of exemplary embodiments of a proximal anchoring member that can be used for the proximal anchoring member  204  shown in  FIGS. 2A-2B . It will be appreciated that the proximal anchoring member may have the configurations of any of the distal anchoring members previously described as alternatives to the configurations in  FIGS. 19-23  described below. 
       FIGS. 19A-19B  illustrate an exemplary proximal anchoring member  304 .  FIG. 19A  is a side view of a proximal anchoring member, and  FIG. 19B  is a view from the distal end of the proximal anchoring member. The dimensions and shapes of the proximal anchoring member  304  may be varied and corners/sharp edges may be blended or radiused as necessary. In one embodiment, the proximal anchoring member  304  comprises a distal portion  308  and a flange portion  306 . In one embodiment, the proximal anchoring member  304  is deployed in the entrance  216  to the CS  208  (shown in  FIGS. 2A-2B ). The distal portion  308  is deployed inside the CS  208  and the flange portion  306  is deployed outside the CS  208  (e.g., near the junction of the CS  208  and the right atrium) such that it prevents the proximal anchoring member  304  from being displaced distally within the CS  208  as a result of forces applied to the proximal anchoring member  304  by the telescoping assembly such as the telescoping assembly  206  shown in  FIGS. 2A-2B  or the telescoping assembly  220  shown in  FIG. 3A . In some embodiments, the distal portion  308  may be very short or omitted entirely, but this is not recommended, as the danger of blocking flow from the CS  208  may be increased. The distal portion  308  may be made similar to the distal anchoring members previously described. The distal portion  308  may include anchors (not shown) such that upon deployment, the anchors attach to the wall of the CS  208 . The distal portion  308  is expandable or self-expandable similar to the distal anchoring member previously described. The distal portion  308  is sized so that its outer diameter engages the inner diameter of the CS  208  in order to prevent blocking to a venous flow path. The distal portion  308  may incorporate drugs, coatings, or materials that help keep the entrance to the CS clear and open. 
     In one embodiment, the flange portion  306  engages the right atrium (RA) wall (not shown). In one embodiment, the flange portion  306  is circular (but need not be circular) as shown in  FIG. 19A . The flange portion  306  may have its shape modified to avoid interference with the function of the Tricuspid valve (not shown) or to concentrate support to the regions of the right atrium that is in closer proximity to the right trigone (not shown). The flange portion  306  is expandable or self-expandable. The flange portion  306  may incorporate features (e.g., anchors, hooks, barbs, or screws, etc.), materials, coatings, or drugs that encourage its attachment or biologic incorporation into the right atrium wall. The flange portion  306  may also be made of a porous material, a reinforced porous material, coated with a porous material and/or drug coated to encourage its incorporation into the right atrium wall. In one embodiment, the flange portion  306  is collapsible such that during deployment, the flange portion is folded to fit within the delivery device and after deployment, the flange portion  306  expands to engage and remain at or just proximal to the entrance of the CS  208 . In one embodiment, the flange portion  306  may be discontinuous and/or formed to appear as two or more separate arms or bands. 
     In one embodiment, as shown in  FIG. 20 , the flange portion  306  may be formed of a plurality of arms  408  that upon deployment, the arms  408  spring out to form a globe-like structure that prevents the proximal anchoring member  304  from being displaced distally within the CS  208  as a result of forces applied to the proximal anchoring member  304  by the telescoping assembly such as the telescoping assembly  206  shown in  FIGS. 2A-2B  or the telescoping assembly  220  shown in  FIG. 3A . The arms  408  may have the shapes of curved bands. The multiple curved bands are joined to each other at two points or to two rings  410  and  412  to form the globe-like structure that is sufficiently large so as to not be able to enter the CS  208 . The ring  410  may replace the distal portion  308  of the proximal anchoring member  304  or may be attached to the distal portion  308  (not shown here). 
     The number of the arms  408  may be any desired number, but a number greater than 2 provides the most stable form for the flange portion  306 . The arms  408  may have a rest shape (or a natural shape) that is curved. This curve need not be circular as shown in  FIG. 20 , but may have some curve that is convenient for the control of the collapsing and the expansion of the flange portion  306 . The curve orientation of the arms  408  may be as shown in  FIG. 20  in which the arms  408  have concave sides toward one another. The curve orientation of the arms  408  may have other forms, for example, convex forms or the combination of convex and concave forms. 
     In one embodiment, the arms  408  have spiral forms (not shown). In this configuration, when the arms  408  are confined inside a tube (for delivery), the arms  304  form a spring-like configuration that is very flexible. The spiraled arms  408  also increase the ease of delivery. 
       FIG. 21A-21D  illustrate an exemplary embodiment of a proximal anchoring member  309  that includes a plurality of anchors, anchors  503  and anchors  501 . In one embodiment, the proximal anchoring member  309  resides upon the right atrium wall and near or at the right trigone. The anchors  501  and  503  enable the proximal anchoring member  309  to penetrate the right atrium and engage the right trigone or the area near the right trigone. The anchors  501  and  503  also enable a flange portion  346  of the proximal anchoring member  309  to anchor to the entrance of the CS  208 . The anchors may be helixes, coils, hooks, barbs, screws, rivets, flanges, or corkscrews as some are shown in  FIGS. 21A-21D . 
     The proximal anchoring member  309  also includes telescoping members  347  and  348 , which can slide into each other, or telescope together as shown in  FIGS. 21A-21B  where the telescoping member  347  slides into the telescoping member  348 . The telescoping members  347  and  348  function much like the telescoping assembly  220  previously described. The anchors  501  are attached to the telescoping member  347  and are biased by their rest configuration (curvature) and/or the manner in which their ends are sharpened. The anchors  501  are curved at rest and are constrained within the inner diameter of the telescoping member  348 , such that they begin their deployment in a relatively straighter or less curved condition. The telescoping member  347  contains a mechanical interference  349  that engages with the telescoping member  348  (much similar to previously described) such that the deployment of the anchors  501  is limited to a predetermined length (telescoping length) and that the telescoping member  347  will not disengage from the telescoping member  348 . When deployed, the anchors  501  penetrate or attach to the right trigone. 
     The telescoping section  348  is attached to a flange  346 . The flange  346  contains an opening (not shown) to allow the anchors  501  to pass through for deployment. The flange  346  includes the anchors  503  on the side of the flange  346  that contacts the right atrium. The flange  346  distributes the forces applied to proximal anchoring member  309  over an area of the right atrium during the deployment of the anchors  503 . The flange  346  may be configured to have a wide variety of shapes (oval or flat). The flange  346  may have a shape that facilitates the delivery of the proximal anchoring member  309  to the right atrium wall. The flange  346  may be made of a porous material, a reinforced porous material, coated with a porous material and/or drug coated to encourage its incorporation into the right atrium wall. 
     Additionally, the anchors  501  and the anchors  503  may be made of or coated with a porous material and/or drugs to encourage their incorporation into adjacent tissue. Further yet, the proximal anchoring member  309  may include radiopaque marker(s) in any of its portion to aid in the delivery visualization and in orienting of the proximal anchoring member  309  such that the anchors  503  and  501  point toward the side of the CS  208  that faces the mitral valve annulus  209 . 
     The proximal anchoring member  309  can be used as the proximal anchoring member  204  of the annuloplasty device  200 . The proximal anchor member  204  may be attached or coupled to the telescoping assembly  220  previously described. 
       FIGS. 22A-22B  illustrate a proximal anchoring member  307  that can be used for the proximal anchoring member  204  shown in  FIGS. 2A-2B . The proximal anchoring member  307  is similar to the proximal anchoring member  304  previously described except that the flange portion  306  of the proximal anchoring member  304  is now replaced with an arm  316  that includes a plurality of anchors  503 . The proximal anchoring member  307  includes a distal tube  308  similar to the proximal anchoring member  304 . The anchors  503  are useful when it is necessary to penetrate the right trigone to gain desired support levels to provide an effective therapy. In some cases, it is desired that the locations of any anchors  503  that are directed to the right trigone be controlled. Controlling the length of the arm  316  controls the placement of the anchors  503 . The desired length of the arm  316  may be determined dependant upon the distance from the entrance  216  of the CS  208  to the right trigone. The distance from the entrance  216  of the CS  208  to the right trigone may be obtained using conventional methods such as TEE (Transesophageal Echo) and TTE (Transthoracic Echo). The proximal anchoring member  307  with the arms  316  may be provided with the arms  316  having various lengths to accommodate anatomy/disease state variations. In one embodiment, the proximal anchoring member  307  comprises at least one radiopaque marker to aid in the orientation/placement of the arm  316 . The arm  316  and the distal portion  308  can be coated with materials, coatings, or drugs that encourage the incorporation or anchoring of the proximal anchoring member  307 . 
       FIGS. 23-28  illustrate cross-sectional views of exemplary embodiments of delivery devices that can be used to deliver and deploy a telescoping assembly (e.g., the telescoping assembly  220 ), a distal anchoring member (e.g., the distal anchoring member  302 ), and a proximal anchoring member (e.g., the proximal anchoring member  304 ) that can be used to treat mitral valve regurgitation. 
       FIG. 23  illustrates an exemplary medical device  200 A that can be used to treat mitral valve regurgitation. Although the discussion below focuses on treating mitral valve regurgitation, the medical device  200 A can be used to treat other conditions that require reforming, reshaping, or reducing a blood vessel. The medical device  200 A comprises an annuloplasty device  201  and a delivery device  203 . The annuloplasty device  201  is deployed near, at, in, or within the CS  208  while the delivery device  203  is used to deliver the annuloplasty device  201  to the CS  208 . 
     In one embodiment, the annuloplasty device  201  of the medical device  200 A comprises a distal tube  100 , a proximal tube  101 , a distal anchoring member  102 , a proximal anchoring member  103 , a position-locking device  104 , a cord assembly  105  (only a portion of which is visible) and a detaching mechanism  106 . 
     The delivery device  203  of the medical device  200 A comprises an outer sheath  107 , an inner sheath  108 , an atraumatic distal tip  110 , an inner shaft  109 , and a guidewire lumen  111 . In one embodiment, the outer sheath  102  includes the atraumatic distal tip  110  and the guidewire lumen  111 . 
     The delivery device  203  is used to introduce the annuloplasty device  201  to the treatment site. The delivery device  203  is withdrawn after the distal tube  100 , the proximal tube  101 , the distal anchoring member  102 , and the proximal anchoring member  103  are deployed. Note that the outer sheath  107 , the inner sheath  108 , the inner shaft  109 , and the detaching mechanism  106  are shown in sectional side view in  FIG. 23  to expose the annuloplasty device  201 . 
     In one embodiment, a portion of the detaching mechanism  106  belongs to the annular device  201  and a portion of the detaching mechanism  106  belongs to the delivery device  203 . Thus, the detaching mechanisms  106  may contain portions that remain with the annuloplasty device  201  that is delivered or deployed in the CS  208 . 
     In one embodiment, the cord assembly  105  includes a lumen (not shown). A guidewire can be disposed through this lumen thus eliminating the need for having a guidewire lumen  111  in the outer sheath  107  to guide the annuloplasty device  201  of the medical device  200 A into the CS  208 . 
     In one embodiment, both the distal anchoring member  102  and proximal anchoring member  103  are configured as self-expanding structures. The distal anchoring member  102  can be any of the distal anchoring members previously described. The proximal anchoring member  103  can be any of the proximal anchoring members previously described. In one embodiment, the proximal anchoring members comprise anchors (not shown); these anchors are not oriented distally relative to the proximal anchoring members to prevent the anchors from penetrating into the inner sheath  108  of the delivery device  203  and prevents the withdrawal of the inner sheath  108 . In another embodiment, the proximal anchoring members comprise anchors that may be oriented distally and another delivery device such as those shown in  FIGS. 26-28  (see below) can be used to deliver/deploy the annular device with these proximal anchoring members. 
     Continuing with  FIG. 23 , the distal tube  100  and the proximal tube  101  form a telescoping assembly much like the telescoping assembly  220  previously described except only two tubes are used instead of three tubes as in the telescoping assembly  220 . The proximal tube  101  and the distal tube  100  can slide inward and outward from each other. In one embodiment, the proximal tube  101  enters the inner diameter of the distal tube  100  for a short distance, forming a telescoping section. The distal end of the distal tube  100  is further attached to one side of the distal anchoring member  102 . The proximal end of the proximal tube  101  is attached to one side of the proximal side of the proximal anchoring member  103 . 
     Still referring to  FIG. 23 , in one embodiment, the proximal portion of the cord assembly  105  is attached to the proximal end or any other portion of the proximal tube  101 . In another embodiment, the proximal portion of the cord assembly  105  is attached to the proximal end of the detaching mechanism  106 . The distal end of the cord assembly  105  goes through the position-locking device  104 . The cord assembly  105  extends some distance out of the position-locking device  104 . The bulk of the cord assembly  105  (not visible) runs through the inner diameters of the distal tube  100  and the proximal tube  101 . The cord assembly  105  is used by the operator (e.g., a physician) to adjust the length and/or tension of the annuloplasty device  201  of the medical device  200 A. 
     For example, pulling on the cord assembly  105  moves the distal tube  100  and the proximal tube  101 , thereby telescoping the tubes, one relative to the other, thereby adjusting the length of the device. The cord assembly  105  may be used to apply tension upon the distal anchoring member  102  or the proximal anchoring member  103 . For example, when the cord assembly  105  is also attached to an end of the distal anchoring member  102 , pulling on the cord assembly  105  adjusts the length of the annuloplasty device  201  of the medical device  200 A when the cord assembly  105  is relatively inelastic. Pulling on the cord assembly  105  adjusts its length and (installed) tension, when the cord assembly  105  is relatively elastic. With the CS  208  being curved, the deployed/delivered annuloplasty device  201  tends to curve to the curvature of the CS  208 . When the annuloplasty device  201  is placed under tension (as caused by pulling the cord assembly  105 , a force is applied to the annuloplasty device  201  and hence, the CS  208 , reducing the curvature of the CS  208  and pushing the posterior leaflet closer to the anterior leaflet as previously described. 
     In one embodiment, an extension-limiting cord (not shown) is disposed within the inner diameters of each of the distal tube  100  and the proximal tube  101 . One end of the extension-limiting cord is attached to the distal tube  100  and one end of the extension-limiting cord is attached to the proximal tube  101 . The length of the extension-limiting cord is fixed such that if the distal tube  101  and the proximal tube  100  are moved away from each other, the extension-limiting cord dictates the maximum length or distance that the distal tube  100  and the proximal tube  101  can move away from each other. 
     After all the necessary adjustment, the cord assembly  105  is locked in position by the position-locking device  104 . In one embodiment, the position-locking device  104  is attached to the distal end of the distal tube  100 . 
     The position-locking device  104  can be an interference locking ratchet-like mechanism well known in the art that can be used to lock the cord assembly  105 . The position-locking device  104  may include an opening created in an elastic diaphragm and the cord assembly  105  may include beads. The cord assembly  105  may be pulled in one direction, for example, distally with respect to the position-locking device  104 . One of the beads on the cord assembly  105  would be trapped at the opening thereby locking the cord assembly  105  into a position, which prevents the cord assembly  105  from moving backward (e.g., proximally). Each of these configurations of the position-locking device  104  operates to allow the cord assembly  105  to be pulled in one direction and locked in position. Correcting or adjusting the cord assembly  105  in the event of over tightening is difficult in these configurations. For instance, a great deal of force must be applied to pull the cord assembly  105  in the opposite direction. However, since the position-locking device  104  is on the distal end of the annuloplasty device  201  as shown in  FIG. 23  and is relatively accessible to the physician, a tool may be provided to facilitate the correction of an over-tightening situation. When the cord assembly  105  has been properly adjusted for the patient&#39;s anatomy, the physician may clip off any excess at the distal end of the cord assembly  105 . 
     In one embodiment, the position-locking device  104  comprises of a housing  357 , an arm  358  and a pivot  359  as shown in  FIGS. 24A . The housing  357  is shown partially cut-away and the cord assembly  105  is shown inserted into the housing  357 . One side of the cord assembly  105  rides against the inside surface  360  of the housing  357 . In one embodiment, the cord assembly  105  may be guided and/or held (slidably proximal and distal) in this position by features of the housing  357  or features attached to the housing  357  such as slots or holes (not shown). 
     Continuing with  FIGS. 24A , the arm  358  is rotatably attached to the inner diameter of the housing  357  by the pivot  359 . The pivot  359  may be a separate component, such as a pin or shaft, or it may be incorporated into the features of the housing  357  and the arm  358 . For instance, the arm  357  may be molded with cylindrical projections that engage holes in the housing  357  to perform the functions of the pivot  359 . The lever portion  361  of the arm  358  is constructed such that the area  362  of the lever portion  361  is elastically deformed when the cord assembly  105  is inserted into the housing  357 , as shown. This elastic deformation imparts a force on the arm  358  such that it will rotate on the pivot  359 , causing the surface  363  of the arm  358  to contact the cord assembly  105 , as shown. 
     The lever portion  361  and the surface  364  of the housing  357  may be designed and/or constructed and/or coated in a manner such that the friction between them is low. This allows the portion  361  to move relative to the surface  364  as the arm  358  pivots. The surface  363  is constructed such that its distance from the pivot  359  increases distally. Thus, if the cord assembly  105  is moved distally (relative to the position-locking device  104 ), the engagement/friction of the cord assembly  105  with the surface  363  will rotate the surface  363  clockwise causing the contacting surface of the surface  363  to tend to move away or disengage from the cord assembly  105 . Thus the cord assembly  105  may be pulled distally. Conversely, if the cord assembly  105  is moved proximally (relative to the position-locking device  104 ), the engagement of the cord assembly  105  with the surface  363  will rotate the surface  363  counterclockwise causing the contacting surface of the surface  363  to pinch the cord assembly  105  between the surface  363  and the housing surface  360 . This pinching constrains the cord assembly  105  from moving proximally. 
     In one embodiment, the surface  363  and/or the applicable surface of the cord assembly  105  may be coated with or made of materials to increase the friction between them and/or be contoured to mechanically engage (like gear teeth of various configurations) and thus assure that pinching reliably occurs. In one embodiment, the position-locking device  104  is configured such that the surface  363  engages the housing surface  360 , if the cord assembly  105  is not present. This keeps the position-locking device  104  in a state such that the cord assembly  105  may be easily inserted into the position-locking device  104 . 
     In one embodiment, prior to insertion into the body, the physician may grasp the distal end of the outer sheath  107  and pull on the distal end of the cord assembly  105  to set the length and/or tension (depending upon the elasticity of the cord assembly  105 ) of the annuloplasty device. There may be indicator markings/colors on the distal end of the cord assembly  105  or the outer sheath  107  may be see-through and contain a scale or a scale may be placed on tube  101  to facilitate the proper and repeatable setting. 
     In one embodiment, the length and/or tension of the annuloplasty device  201  of the medical device  200 A is adjusted prior to being introduced into a patient. To adjust the annuloplasty device of the medical device  200 A prior to introducing it into the patient, an operator (e.g., a physician) needs to know the length and curve that the annuloplasty device of the medical device  200 A needs to be at in order to reshape the mitral valve annulus or the mitral valve. Methods such as TEE (Trans-Esophageal Echo) or TTE (Transthoracic Echo) imaging devices and methods can be used by the operator or the physician to diagnose mitral valve anomalies and to size the annuloplasty device  201  of the medical device  200 A accordingly. Other methods that help the physician determine the anomalies of the mitral valve may also be used. The physician may use the image information to determine the desired length and/or shortening force of the annuloplasty device  201  of the medical device  200 A. The annuloplasty device  201  of the medical device  200 A can then be adjusted outside of the patient and be deployed into the patient with the proper length or tension. 
     Returning to  FIG. 23 , the distal end of the delivery device  203  of the medical device  200 A is shown in a cutaway section. The outer sheath  107  can be a catheter having at least one elongate lumen. The outer sheath  107  includes a slitted/slotted distal tip  110  and the guidewire lumen  111 . One function of the outer sheath  107  is to constrain the distal anchoring member  102  in a pre-delivery or pre-deployment state. The inner diameter of the outer sheath  107  constrains the outer diameter of the distal anchoring member  102 . The outer diameter of the distal anchoring member  102  should be constrained to the smallest outer diameter practical given the outer diameter of the distal tube  100 . The outer sheath  107  may also incorporate a radiopaque marker(s) (not shown) to provide fluoroscopic positioning information. 
     The inner sheath  108  is slidably disposed within the inner diameter of the outer sheath  107 . The inner sheath  108  is also elongate and contains at least one lumen. The distal end of the inner sheath butts up against the proximal end of the tube  100 . One function of the inner sheath  108  is to constrain the proximal anchor  103  in a pre-delivery or pre-deployment state. The inner diameter of the inner sheath  108  constrains the outer diameter of the proximal anchoring member  103 . The outer diameter of the proximal anchoring member  103  should be constrained to the smallest outer diameter practical. The inner sheath  108  may also contain a radiopaque marker(s) (not shown) to provide fluoroscopic positioning information. 
     An inner shaft  109  is slidably contained within the inner diameter of the inner sheath  108 . The distal end of the inner shaft  109  contains features that allow it to be attached and detached from the detaching mechanism  106 . The detaching mechanism  106  comprises a distal and proximal portion. The distal portion is attached or incorporated into the proximal end of the telescoping assembly, the proximal tube  101 . The proximal portion is attached or incorporated into the distal end of the inner shaft  109 . The detaching mechanism  16  is used to detach the delivery device  203  from the annuloplasty device  201  after the annuloplasty device  201  has been deployed into its final position in the CS  208 . For instance, the detaching mechanism  106  could contain screw threads, in which case the distal end of the inner shaft  109  would contain the mating threads. The detaching mechanism  106  could be a loop, in which case the distal end of the inner shaft  109  could be hollow and containing an engaging loop. The loop can be a cord, wire, filament, or a hook, to name a few. There are many engagement/disengagement mechanisms that rely on rotary and/or longitudinal motion and/or the release of one end of a cord. 
     In one embodiment, the distal anchoring member  102  is deployed in the CS  208 . The distal anchoring member  102  is deployed before the proximal anchoring member  103  is deployed. To deploy the distal anchoring member  102 , the outer sheath  107  is withdrawn proximally relative to the inner sheath  108 . The outer sheath  107  is also withdrawn proximally relative to the proximal anchoring member  103 . During deployment, the distal anchoring member  102  remains stationary. One reason for that is that the distal anchoring member  102  is attached to the distal tube  100 , which is held stationary by being butted up against the inner sheath  108 . Thus, the inner sheath  108  is held stationary while the outer sheath  108  is pulled proximally, thereby exposing the distal anchoring member  102  and the distal tube  100  and the proximal tube  101 . The outer sheath  107  can be withdrawn proximally over the distal anchoring member  102  and the tubes  100  and  101  while the distal anchoring member  102  and the tubes  100  and  101  remain in place in the CS  208  because of the opening in the slitted/slotted distal tip  110  which opens enough to allow the outer sheath  107  to be slid over the distal anchoring member  102  and the tubes  100  and  101 . 
     Once the distal anchoring member  102  is deployed, the proximal anchoring member  103  must be pulled proximally into position near or at the entrance to the CS  208  for deployment. Pulling the proximal anchoring member  103  may deform and/or reposition the anatomy of the heart as well as other anatomical structures along the path of the annuloplasty device  201  of the medical device  200 A especially when the annuloplasty device  201  has already been pre-sized to have a length that is sufficiently short to reduce or reform the mitral valve annulus. The desired position of the proximal anchoring member  103  is attained prior to deployment using a balloon on a guide catheter shaft  112 . The delivery device  203  is disposed within the inner diameter of the guide catheter shaft  112 . The guide catheter shaft  112  couples to a dilatable/inflatable balloon  113 . The guide catheter shaft  112  may have any of the constructions common to guides and/or introducer sheaths/catheters. The guide catheter shaft  112  includes a lumen  114  to inflate or dilate the balloon  113 . The lumen  114  is in communication with the proximal end of the guide catheter in a manner that facilitates the inflation and deflation of the balloon  113 . Any of the common angioplasty balloon materials may be used. In one embodiment, the balloon  113  is made of nylon (e.g., Pebax blend or nylon/Pebax blend materials that are commonly use in guide/introducer construction) balloon materials. 
     Once the distal anchoring member  102  is deployed, the proximal anchoring member  103  is positioned by first inflating the balloon  113 . The inner shaft  109  is pulled proximally with one hand, while grasping the proximal end of the guide catheter shaft  112  with the other hand and pushing in the opposite direction. This forces the guide catheter shaft  112  to move distally such that the distal end of the inflated balloon  113  pushes against the right atrium wall. From that point on, the bulk of the force and longitudinal displacement applied between the inner shaft  109  and the guide catheter shaft  112  is applied mainly to the distance between the distal anchoring member  102  and the balloon  113  contact areas around the entrance to the CS  208 . Once the correct position for the proximal anchoring member  103  is attained, the inner shaft  109  is withdrawn to deploy the proximal anchoring member  103 . 
     In one embodiment, the annuloplasty device  201  is delivered into the CS  208  using the following procedure. First, the operator (e.g., a physician) gains access to a vein (e.g., femoral, jugular, subclavian, etc. . . . ) in a patient&#39;s body using a cut-down or an introducer sheath procedure. The vein is used to introduce the medial device  200 A into the right atrium and then into the CS  208 . In the introducer sheath procedure, the physician introduces the introducer sheath into the vein through the patient&#39;s skin percutaneously. A needle or a similar puncture device provides entry into the vein. The proximal end of the needle remains outside of the introducer sheath and is withdrawn. A distal end of the catheter guide shaft  112  with a flexible guidewire (not shown) in its inner diameter is inserted into the proximal end of the introducer sheath and advanced therethrough until the distal end of the guidewire or the guide catheter shaft  112  reaches the vicinity of the CS  208 . 
     Second, the guidewire and the catheter shaft  112  are manipulated to gain access to the entrance to the CS  208 . Once the guide catheter shaft  112  is inserted into the CS  208  a short distance, the guidewire may be withdrawn proximally from the guide catheter shaft  112  and replaced with another guidewire (not shown) that is suitably sized for the lumen  111  of the outer sheath  107 . This other guidewire is inserted into the proximal end of the guide catheter shaft  112  until its distal end is distal to the desired position of the distal anchoring member  102 . 
     Third, the length of the annuloplasty device  201  of the medical device  200 A is adjusted to a desirable length outside of the patient using the cord assembly  105 . Excess portion of the cord assembly  105  may be cut off. The physician may also flush the delivery system, the guide catheter  112  and the annuloplasty device  201  of the medical device  200 A. 
     Fourth, the annuloplasty device  201  disposed within the delivery device  203  is inserted into the guide catheter  112  and over the guidewire. The guidewire is inserted within the guidewire lumen  111  so that the annuloplasty device  201  of the medical device  200 A can be inserted over it and into the inner diameter of the guide catheter shaft  112 . The annuloplasty device  201  of the medical device  200 A is advanced until the distal portion of the annuloplasty device  201  reaches an area in the CS  208  where the distal anchoring member  102  is to be deployed, for example, in the vicinity of the left trigone. 
     Fifth, the physician withdraws this other guidewire and deploys the distal anchoring member  102 . The physician withdraws the guidewire proximally and removes it from the proximal end of the guide catheter shaft  112 . The physician withdraws the outer sheath  107  to deploy the distal anchoring member  102 . The outer sheath  107  is withdrawn proximal to the proximal anchoring member  103 . 
     Sixth, the physician positions and deploys the proximal anchoring member  103 . The guide catheter shaft  112  is withdrawn until the distal tip of the guide catheter shaft  112  is not in the CS  208 . The balloon  113  is inflated, for example, by air, water, saline, contrast, gas, etc. . . . The guide catheter shaft  112  is advanced distally until the guide catheter  112  contacts the right atrium wall. In one embodiment, the physician grasps the proximal end of the guide catheter shaft  112  in one hand and the proximal and of the inner shaft  109  in the other hand and moves them apart. This action moves the proximal anchoring member  103  to the desired location, for example, at the entrance of the CS  208 . The inner sheath  108  is then withdrawn to deploy the proximal anchoring member  103 . 
     Seventh, after deploying the distal anchoring member  102  and the proximal anchoring member  103 , the balloon  113  is deflated. The physician manipulates the detaching mechanism  106  to release the annuloplasty device  201  from the inner shaft  109 . The physician may then withdraw and remove the delivery device  203  proximally form the guide catheter shaft  112 . The physician may then withdraw and remove the introducer sheath from the patient. The length and resistance to curvature (flexural modulus) of the telescoping assembly then acts to reshape the CS  208  thereby reshaping the mitral valve annulus  209 . In one embodiment, reshaping the mitral valves annulus  209  includes moving the posterior leaflet of the mitral valve toward the anterior leaflet of the mitral valve and thus reduces or eliminates regurgitation. 
     The annuloplasty device need not have its length or tension pre-adjusted prior to introducing it into the patient. In one embodiment, the position-locking device  104  is attached to the proximal end of the proximal tube  101  or to the proximal anchoring member  103  to allow for adjustment of the length or tension of the annuloplasty device after its deployment into the CS  208 . Such an embodiment is a medical device  200 B illustrated in  FIG. 25  below. The position-locking device  104  for the annuloplasty device of the medical device  200 B is oriented in the opposite direction (see  FIG. 24B ) from the one for the annuloplasty device  201  of the medical device  200 A described above. 
       FIG. 25  illustrates an exemplary embodiment of a medical device  200 B that can be used to treat mitral valve regurgitation. Although the discussion below focuses on treating mitral valve regurgitation, the medical device  200 B can be used to treat other conditions that require re-shaping or reducing a blood vessel. The medical device  200 B is similar to the medical device  200 A described above except that the annuloplasty device of the medical device  200 B has the position-locking device  104  attached to the proximal end of the telescoping assembly and that the annuloplasty device of the medical device  200 B allows for adjustment to the length and/or tension of the annuloplasty device of the medical device  200 B after the annuloplasty device of the medical device  200 B has been introduced into the patient. 
     As illustrated in  FIG. 25 , the medical device  200 B comprises an annuloplasty device  205  and a delivery device  207 . The annuloplasty device  205  comprises a distal anchoring member  42 , a telescoping assembly  74 , a proximal anchoring member  35 , a cord assembly  105 , and a position-locking device  104  which is not visible in  FIG. 25  but which is attached to the proximal end of the proximal anchoring member  35  or the proximal tube  80 . 
     The telescoping assembly  74  can also be the telescoping assembly  220  previously described, but for simplicity only two tubes are included in  FIG. 25 . The telescoping assembly  74  of the annuloplasty device  205  may comprise a distal tube  76  and a proximal tube  80 . The distal tube  76  can slide into the proximal tube  80 , similar to that previously described for the telescoping assembly  220 . The inner diameter of the distal tube  76  is shown with two steps in its inner diameter that will interfere with the outer diameter step  79  on the distal end of the proximal tube  80 , such that the outer diameter step  79  is captured. The proximal tube  80  thus only telescopes between the two inner diameter steps of the distal tube  76 . The outer diameter step  79  is shown up against the inner diameter step of the distal tube  76 , and therefore, the full device is shown in  FIG. 25  at its shortest length, which should be chosen to be shorter than the deployed device length and to preferably also be the target minimum modified annulus length. In another embodiment, the telescoping assembly  74  may be mounted in the annuloplasty device  205  of the medical device  200 B such that it is at or near its longest length to provide the greatest flexibility to the distal section  70  and thus provide the easiest delivery to the CS  208 . 
     The delivery device  207  delivers and deploys the annuloplasty device  205  to the treatment site (e.g., the CS  208 ) to reshape the mitral valve annulus  209 . The delivery device  207  of the medical device  200 B comprises an outer sheath  67  and an inner sheath  73 . In one embodiment, the outer sheath  67  (shown as a cutaway section) is slidably mounted over the outer diameter of the inner sheath  73 . The distal end of the outer sheath  67  may be withdrawn proximally to a position that is proximal to the distal end of inner sheath  73 . Similar to the annuloplasty device  201  of the medical device  200 A, the proximal withdrawal of the outer sheath  67  allows the annuloplasty device  205  of the medical device  200 B to be deployed. The delivery device  207  further includes a distal tip  77 , a distal section  70  and a proximal section  71 . The distal tip  77  is part of the outer sheath  67  and is attached to the distal section  70  to provide an atraumatic tip to the outer sheath  67 . The atraumatic distal tip  77  may include one or more cut slots/slits  78  (or cuts or partial cuts), such that when the outer sheath  67  is withdrawn over the inner sheath  63 , the tip  77  opens and passes over the distal end of the inner sheath  73 . In another embodiment, the atraumatic distal tip  77  may be incorporated into the distal end of the telescoping assembly of the annuloplasty device  205 , or if present, the position-locking device. 
     In one embodiment, the outer sheath  67  has variable wall thickness/flexural modulus. For example, the distal portion  70  of the outer sheath  76  has a side  69  and a side  68  wherein the side  69  has a higher flexural modulus (higher stiffness) than the side  68 . The high flexural modulus on the side  69  allows for orientation control of the delivery device  207  and thereby, the annuloplasty device  205  as previously described. Controlling the orientation of the delivery device  207  allows the anchoring members and the telescoping assembly  74  to be deployed in a proper orientation (e.g., these elements are in contact with the wall of the CS  208  which faces the mitral valve annulus  209 ). In one embodiment, some portions of the distal section  70  include in its construction stiffer materials in the form of wires, rods, partial tube sections and other shapes to provide the desired change in flexural modulus. 
     In one embodiment, the outer sheath  67  includes a guidewire lumen  75  at the distal portion  70 . The guidewire lumen  75  may be located on the side  69  of the distal portion  70 . The guidewire lumen  75  accommodates a guidewire (not shown) to facilitate the delivery of the annuloplasty device  205  of the medical device  200 B. Also, the incorporation of the guidewire lumen  75  into the outer sheath  67  requires the addition of material that may provide the differential flexural modulus in the distal section  70  that provide the orientation control previously described. In one embodiment, the outer sheath  67  includes at least one radiopaque marker  72  that aids in the positioning of the deployment of the annuloplasty device  205  of the medical device  200 B. 
     In one embodiment, the distal tube  76  is attached to the distal anchoring member  42  and the proximal tube  80  is attached to the proximal anchoring member  35 . The distal anchoring member  42  and the proximal anchoring member  35  can be any of the anchoring members previously described. 
     In one embodiment, the telescoping assembly  74  is disposed on the inner diameter of the outer sheath  67  on the side that curves to the curve of the CS  208  such that the distal anchoring member  42 , the telescoping assembly  74 , and the proximal anchoring member  35  are in contact with the wall of the CS  208  that faces the mitral valve annulus. Delivering the annuloplasty device  205  in this manner ensures that subsequent tension on the cord  105  will not introduce undesirable forces on the distal anchoring member  42  and the proximal anchoring member  35 . 
       FIG. 24B  illustrates a position-locking device  104  that can be used for the annuloplasty device  205  of the medical device  200 B. This position-locking device  104  is the same as previously described in  FIG. 24A  except that the position of the arm  358  is opposite from the one shown in  FIG. 24A . 
     In one embodiment, the position-locking device  104  enables adjustment of the cord assembly  105 . The position-locking device  104  may be manipulated in several simple ways to allow the cord assembly  105  to be released in the event of over-tightening. In one embodiment, a pin/wire is inserted through the inner sheath  73  and pushed out to engage the surface  366  of area  362 , and then the arm  358  will pivot away from the cord assembly  105  releasing it. In another embodiment, a similar pin or catheter end portion may engage and push on the surface  365  of the lever  361  to cause the arm  358  to pivot away from the cord assembly  105  to releasing the cord assembly  105 . An example of such a pin/wire is a push wire  81  shown in  FIG. 25 . The amount of force/pressure required for release can be reduced dramatically by also pulling the cord assembly  105  proximally slightly. Once released the amount of force/pressure on the surface  365  or  366  required to keep the cord assembly  105  released will be near this lower level. Thus either of the previously described release methods may be combined with a small proximal pull, then release of the cord assembly  105  relative to the engaging catheter to release the cord assembly  105  from the position-locking device  104  using a minimal force/pressure. 
     In one embodiment, the position-locking device  104  is attached to or interferes with the proximal anchoring member  35  in a convenient manner such that the cord assembly  105  is routed through the inner diameter of proximal tube  80 . In another embodiment, the position-locking device  104  is attached to or interferes with the proximal tube  80  in a convenient manner such that the cord assembly  105  is routed through its inner diameter. 
     In one embodiment, when the outer sheath  67  is withdrawn, the distal anchoring member  42 , the telescoping assembly  74 , and the proximal anchoring member  34  will be exposed and thus deployed. The distal end of the inner sheath  73  engages the position-locking device  104  (which is attached to the proximal tube  80 ), as previously described. In one embodiment, the inner sheath  73  comprises at least two lumens (not shown), which accommodate the cord puller  83  and the lock release push wire  81 . The proximal end of the cord assembly  105  is formed as a loop  82  and puller cord  83  goes through that loop. When the two ends of puller cord  83  are pulled, then the cord assembly  105  is tightened. When only one end of the puller cord  83  is pulled, its unpulled end is pulled through the inner diameter of one of the lumens of the inner sheath  73  and through the loop  82  disengaging the full annuloplasty device from inner sheath  73 . In one embodiment, the push wire  81  acts as previously described to allow the unlocking of the cord assembly  105  from the position-locking device  104  for adjustment in the event of over tightening. 
     In one embodiment, the cord assembly  105  and the surface  360  of the housing  357  are designed and/or constructed and/or coated in a manner such that the friction between them is not an appreciable portion of the desirable tension for the cord assembly  105  during tightening. This provides the physician with tactile feedback or the tightening monitoring of the annuloplasty device of the medical device  200 B. The tactile feedback for the tightening monitoring is useful when the tightening of the cord assembly  105  occurs while the annuloplasty device of the medical device  200 B is deployed/delivered inside the body. 
     In one embodiment, the inner sheath  73  comprises a metallic braid, coil(s) and/or slotted tube in its wall to aid the inner sheath  73  in resisting compression during device deployment and still keep the necessary flexibility for deliverability and the desirable thin walls to make the delivery system as small in outer diameter as practical. 
     In one embodiment, the delivery device portion of the medical device  200 A or  200 B is configured to have a preferred orientation that is similar to the curve of the blood vessel (or the CS  208 ). For example, as mentioned above, the outer sheath  107  of the delivery device  203  of the medical device  200 A or the outer sheath  67  of the delivery device  207  of the medical device  200 B has sections with variable flexural modulus. The suitable delivery device may have sides or sections that have a higher flexural modulus such that one side of the delivery device is stiffer than the opposite side. Such a delivery device helps aligning the distal anchoring and the proximal anchoring members with the delivery device&#39;s preferred orientation. One advantage for the orientation is that the anchors that may be present in the distal anchoring or the proximal anchoring members are oriented to the inside of the curve. Delivery devices for the medical devices  200 A or  200 B with differential stiffness or variable flexural modulus can be made using well known methods in the art. In an embodiment where the outer sheath of the delivery device includes a hollow shaft, the wall of the hollow shaft may have its wall made thicker on one side than the other. In an embodiment where the delivery device includes an extruded tube that is made with its wall on one side thicker than the other. In one embodiment, the delivery device includes a shaft that is made out of two different grades of similar (miscible) plastics, where one grade is stiffer than the other grade, either by co-extrusion or other melt processes, such as melting cut lengths of the two materials (in a properly formed condition) within a shrink tubing over a mandrel. In one embodiment, the delivery device may have a stiffer material inserted/melted into one side of the delivery device. 
     Additionally, orienting the distal anchoring and the proximal anchoring members in a particular orientation (e.g., toward the inside curve of the CS  208 ) aids the anchors that may be included in the distal anchoring and the proximal anchoring members to project toward and/or penetrate toward the inside of the curve of the blood vessel as discussed above. Also, the anchors may be oriented in any other direction that will prevent the anchors from damaging other vessels or other thinner sections of the heart. 
     The annuloplasty device  205  of the medical device  200 B can be deployed using the following exemplary procedure. Using conventional methods, the CS  208  is accessed by a guide catheter (or guide catheter with an occluding balloon and/or deflection capabilities) and a guidewire. Using angiography (with the guide catheter and contrast injections through the guide catheter) and/or previously obtained or concurrent echo data, the desired position of the distal anchoring member  42  is determined. Fluoroscopic/angiographic observation methods can be used to aid the physician in deploying the annuloplasty device  205  of the medical device  200 B. These methods are well known in the art. 
     The annuloplasty device  205  disposed within the delivery device  207  is advanced over the guidewire using the lumen  75  until the distal end of the distal anchoring member  42  is in the desired position, for example, an area in the CS  208  that is proximate the left trigone. The guidewire is withdrawn/removed from the CS  208 . To deploy the distal anchoring member  42 , the inner sheath  73  is used to hold the distal anchoring member  42  in position (via the telescoping assembly  74 ) while the outer sheath  67  is withdrawn until the marker  72  and the distal tip  77  pass the proximal end of the distal anchoring member  42 . Once the distal anchoring member  42  is deployed, it engages the inner wall of the CS  208  and is fixed in position. The push wire  81  is then advance to release the cord assembly  105  from the position-locking device  104 , as described above and the proximal end of the delivery device  207  is withdrawn proximally, lengthening the telescoping assembly  74 , until the proximal anchoring member is at the desired position in the CS  208 . The proximal anchoring member  35  is then deployed at the entrance to the CS as the outer sheath  67  is further withdrawn. The inner sheath  73  is used to hold the proximal anchoring member  35  in position while the outer sheath  67  is withdrawn until the marker  72  and the distal tip  77  pass the proximal end of the proximal anchoring member  35 . The length and tension of the annuloplasty device  205  of the medical device  200 B is then adjusted by pulling on both ends of the puller cord  83  relative to the inner sheath  73  to place tension/longitudinal motion on the cord assembly  105 . When the cord assembly  105  has been given the proper amount of tension, shortening and/or the valve regurgitation has been eliminated or reduced to the target amount, one end of the puller cord  83  is released and withdrawal of the puller cord  83  is continued until it releases the cord assembly  105 . The delivery device  207  of the medical device  200 B is then removed in a conventional manner. 
       FIGS. 26-28  illustrate an exemplary medical device  200 C. The configuration of the medical device  200 C is similar to the medical device  200 B and includes most of the features of the medical device  200 B described above. The medical device  200 C includes an annuloplasty device  209  and a delivery device  211  which are similar to the annuloplasty device  205  and the delivery device  207  of the medical device  200 B.  FIG. 26  illustrates the distal end of the annuloplasty device  209  of the medical device  200 C as it would be inserted into a guide and into the CS  208  wherein the annuloplasty device  209  is not yet deployed. 
     Similar to the annuloplasty device  205  of the medical device  200 B, the annuloplasty device  209  of the medical device  200 C comprises a distal anchoring member  42 , a proximal anchoring member  35 , and a telescoping assembly  88 , which includes a center tube  87 , a distal tube  90 , and a proximal tube  91 . The distal tube  90  and the proximal tube  91  can telescope into the center tube  87 . Additionally, the annuloplasty device  209  of the medical device  200 C includes a spring  89  which functions to bias the distal tube  90  and the proximal tube  91  to a minimal distance away from each other. For example, the spring  89  provides a small biasing force to cause the other tubes  90 ,  91  (shown in cutaway sectional views) to remain as far apart as possible in the absence of other forces. Without this biasing force the distal end of inner sheath  73  would not remain engaged with the position-locking device (not shown) on the proximal anchoring member  35  during deployment of the proximal anchoring member  35  on the right atrium wall. 
     All other features of the annuloplasty device  209  of the medical device  200 C are similar to the annuloplasty device  207  of the medical device  200 B previously described. 
     The delivery device  211  of the medical device  200 C is similar to the delivery device  207  of the medical device  200 B. The delivery device  211  comprises an inner sheath  73 , an outer sheath  67 , a distal tip  77 , and at least one radiopaque marker  72 . Additionally, the delivery device  211  includes a protective sheath  84  as illustrated in  FIGS. 26-28 . The distal tip  77  also includes a slit  78 . 
     The outer sheath  67  of the delivery device  211  is of the same design as previously described for the delivery device  207  of the medical device  200 B. The outer sheath  67  also includes a guidewire lumen  75  that is away from the viewer and, therefore, is not seen in this sectional view. The outer sheath  67  includes a radiopaque marker  72  and a distal tip  77 , shown with the slot  78  to allow it to be withdrawn similar to the delivery device  207  of the medical device  200 B. The sheath  67  also performs the orientation control which functions similarly to previously described. The inner sheath  73  of the delivery device  209  is also of the same design as previously described for the delivery device  207  of the medical device  200 B. 
     As will be apparent with the discussion below, in one embodiment, the protective sheath  84  functions to constrain and shield the anchors  49  (e.g., barbs) that are present on the proximal anchoring member  35  from interfering with the withdrawal of the outer sheath  67  during deployment. Without this protection, the anchors  49 , being directed distally, would engage the outer sheath  67  and prevent its withdrawal. The protective sheath  84  is cut longitudinally by a slit  85  and folded over into the shape of a tube. The protective sheath  84  presses up against the inner diameter of the outer sheath  67  in its slit portion. The distal end of the protective sheath  84  engages the proximal end of the distal anchoring member  42  and prevents the distal anchoring member  42  from moving proximally as the outer sheath  67  is withdrawn during deployment. The proximal portions of protective sheath  84  (not shown) may be a simple tube (containing no slit) that occupies the space between the inner diameter of the outer sheath  67  and the outer diameter of the inner sheath  73 . As the outer sheath  67  is withdrawn just proximal to the distal anchoring member  42 , the distal anchoring member  42  is deployed in the CS  208  or other blood vessel. Once the proximal anchoring member  35  is in position, the outer sheath  67  is withdrawn proximal to the proximal anchoring member  35  and the protective sheath  84  opens up as shown in  FIG. 27 . The protective sheath  84  may then be withdrawn proximal into the outer sheath  67  to not interfere with the rest of the deployment procedure. 
     In one embodiment, the slit portion of the protective sheath  84  includes elastic members  86  to aid the slit portion of the protective sheath  84  to open for the deployment of the proximal anchoring member  35 . Often, even though the slit portion of the protective sheath  84  was molded or shaped to be relatively flat when unconstrained, after being shaped back into an arc or a tube form for a period of time, the protective sheath  84  may take back its original shape, arc or tube, due to the creep properties of many polymers. Thus, when the outer sheath  67  is withdrawn, the protective sheath  84  may not open up to deploy the proximal anchoring member  35  in the desired manner. The elastic members  86  are made of material(s) that will resume its shape in a way that helps that protective sheath  84  in opening up as the outer sheath  67  is withdrawn. 
     In one embodiment, when the outer sheath  67  is withdrawn, the opening of the protective sheath  84  is not necessarily all the way to a flat cross-section, some residual curvature may be desirable for its subsequent withdrawal into the outer sheath  67 . Withdrawal of the protective sheath  84  into the outer sheath  67  causes the protective sheath  84  to refold into a tube-like cross-section. 
     In one embodiment, the opening up of protective sheath  84  allows the proximal anchor  35  to unfold in a manner that directs its anchors  49  away from the protective sheath  84 . As can be understood, if the protective sheath  84  was not folded over the proximal anchoring device  35 , then the anchors  49  would engage the inner diameter of the outer sheath  67  when it is withdrawn. In one embodiment, the slit  85  is oriented such that protective sheath  84  unfolds to a position behind the anchors  49 . The protective sheath  84  can be subsequently withdrawn, as shown in  FIG. 28 . The opening up of protective sheath  84  behind the anchors  49  and toward the outside of the curve of the CS  208  may further aid in the orientation control of the delivery device  211  and thereby the annuloplasty device  209  of the medical device  200 C. 
     As can be readily appreciated by one skilled in the art, the annuloplasty device  209  of the medical device  200 C can be deployed using a procedure very similar to that previously described for delivering the annuloplasty device  205  of the medical device  200 B but modified with the previously described steps to deal with the protection sheath  84  and to account for the telescoping assembly  88  being biased in its most extended condition. 
       FIG. 29  illustrates an exemplary embodiment of an annuloplasty device  601  that comprises a distal anchoring member  604 , a proximal anchoring member  606 , a ligature  600 , and an expandable structure  602 . The term ligature is used to include at least a strap, string, cord, wire, bond, thread, suture, backbone, or other connector. The ligature  600  is deployed within the CS  208  along one side of the CS  208  wall. The expandable structure  602  is deployed within the CS  208 . The expandable structure  602  may be a stent-like structure that is deployed against the inner diameter of the CS  208 . The distal anchoring member  604  anchors into a cardiac tissue that is proximate the CS  208 , for example, the left trigone  608 . The proximal anchoring member  606  anchors into a cardiac tissue that is proximate the CS  208  and near the entrance  216  of the CS  208 , for example, the right trigone  610 . 
     In one embodiment, once the annuloplasty device  601  is fully deployed, the annuloplasty device  601  reshapes the annulus  209  of the mitral valve  208 . 
       FIG. 30  illustrates three-dimensional views of the annuloplasty device  601 . In one embodiment, the ligature  600  is made of a material that could be manufactured in a specific shape, such as a c-shape. The material could be flexible to allow the ligature to be straightened and held in a straightened conformation by the delivery system that is employed to deliver the annuloplasty device  601  into the CS  208 . In another embodiment, the ligature  600  is made of a polymeric material, an elastic material, a shape memory metal or a shrinkable material. In one embodiment, the ligature  600  is made of a material that could be shrunk after it is deployed by an energy source such as IR, RF, an Inductive, UV, or Ultrasound. In yet another embodiment, the ligature  600  is configured to be mechanically shortened such as by folding, bending, or flexing of the structural members of the ligature  600 , or by flexing of joins or hinges designed into the ligature  600 . 
     Still referring to  FIG. 30 , the expandable structure  602  is made of a material that would allow it to be expandable (e.g., by an inflatable balloon) or self-expandable. The expandable structure  602  may also only need to be made of a material that provides only a minimal amount of redial strength. The expandable structure  602  may be deployed against only the inner diameter of the CS  208  but need not hold open the CS  208  such as in the case of a stent used in an angioplasty procedure where the stent is used to open a clogged or closed artery. The expandable structure  602  needs not be rigid, but may be, depending on the application of the annuloplasty device  601 . The expandable structure  602  could be made of polymeric materials, flexible materials, shape memory materials or metals. The expandable structure  602  could be made from materials and designs that are used to make conventional stents. The expandable structure  602  may be divided into a plurality of expandable rings  602 A to enhance shaping of the CS  208 . The expandable structure  602  may include one expandable ring  602 A or a plurality of the expandable rings  602 A. 
     In one embodiment, the ligature  600  has a predetermined curvature that is used to reshape the mitral valve annulus  209 . The ligature  600  is made of a shaped-memory material that will hold the curvature once the annuloplasty device  601  is deployed. In this embodiment, the expandable structure  602  is capable of maintaining a curvature, for example the predetermined curvature. When the expandable structure  602  is expanded, it adds force or support to maintain or to reinforce the predetermined curvature of the curved ligature  600 . 
     The distal anchoring member  604  and the proximal anchoring member  606  may have configuration of coils, helixes, anchors, hooks, barbs, screws, flanges, and other features that allow the anchoring members to penetrate or attach to a myocardial tissue (or cardiac tissue). It is to be appreciated that each of the distal anchoring members  604  and  606  may include a plurality of anchors. For instance, the distal anchoring member  604  may include three anchors  604   a ,  604   b , and  604   c  and the proximal anchoring member  606  may include three anchors  606   a ,  606   b , and  606   c  as shown in  FIG. 30 . 
     The ligature  600 , the expandable structure  602 , the distal anchoring member  604 , and the proximal anchoring member  606  may be made from the same material. For example, these structures can be cut out of a tube or a structure and formed into the appropriate configurations. Alternatively, these structures may be laser welded together or otherwise adhered together by using materials such as adhesive or methods well known in the art. The methods of making these structures will be evident to those skilled in the art. 
     There are several ways of deploying the expandable structure  602  as illustrated in  FIGS. 31-33 . 
     In one embodiment, as illustrated in  FIG. 31 , a balloon  11  is used to expand the expandable structure  602 . The balloon  11  includes a distal end  5 , a proximal end  15 , and a guidewire lumen  20  extending from the distal end  5  to the proximal end  15 . A guidewire  13  is disposed in the inner diameter of the guidewire lumen  15 . The guidewire  13  is a straight guidewire. The balloon  11  is configured to inflate into a curved balloon upon proper inflation. The balloon  11  has variable thickness along the wall of the balloon  11  thus, upon inflation, the balloon  11  can take on the curved shape. In this embodiment, the expandable structure  602  is disposed on the outside of the balloon  11  and upon inflation, the curved balloon  11  helps expanding the expandable structure  602  into the desired curve and shape. 
     In one embodiment, as illustrated in  FIG. 32 , the balloon  11  is used to expand the expandable structure  602 . The balloon  11  includes a distal end  5 , a proximal end  15 , and a guidewire lumen  20  extending from the distal end  5  to the proximal end  15 . A guidewire  13  is disposed in the inner diameter of the guidewire lumen  15 . The guidewire  13  is a curved guidewire that is shaped to a desired curve that the expandable structure  602  needs to have. As the guidewire  13  is disposed within the balloon  11 , the balloon  11  curves as shown in the figure. The balloon  11  is configured to inflate into a curved balloon conforming to the curve of the guidewire  13  upon proper inflation. The balloon  11  has variable thickness along the wall of the balloon  11  to allow the balloon  11  to take the curve of the guidewire  13 . In this embodiment, the expandable structure  602  is also disposed on the outside of the balloon  11  and upon inflation, the curved balloon  11  helps expanding the expandable structure  602  into the desired curve and shape. 
     In one embodiment, as illustrated in  FIG. 33 , a balloon  30  is used to expand the expandable structure  602 . The balloon  30  includes a distal end  5 , a proximal end  15 , and a guidewire lumen  20  extending from the distal end  5  to the proximal end  15 . The balloon  30  is formed to have a curve shape that the expandable structure  602  needs to have. A guidewire  13  is disposed in the inner diameter of the guidewire lumen  15 . The guidewire  13  is a straight guidewire that straightens out the curved balloon  30  for easy delivery into the CS  208 . As the guidewire  13  is disposed within the balloon  30 , the balloon  30  straightens out as shown in the figure. After the balloon  30  is delivered to the proper position for deploying the expandable structure  602 , the guidewire  13  is removed and the balloon returns to its original curved shape. Upon a proper inflation, the balloon  30  inflates to expand the expandable structure  602 . The balloon  30  has variable thickness along the wall of the balloon  30  to allow the balloon  30  to have the curved shape. The balloon  30  may also be made of shape-memory material or may include a tension strap that will help returning the balloon  30  to the curved shape after the guidewire  13  is withdrawn. In this embodiment, the expandable structure  602  is also disposed on the outside of the balloon  30  and upon inflation, the curved balloon  30  helps expanding the expandable structure  602  into the desired curve and shape. 
       FIGS. 34-36  illustrate exemplary configuration of the expandable structure  602 . The expandable structure  602  comprises of a series of expandable rings  612  having wave-like shape or sinusoidal shape in their unexpanded state. The expandable rings  612  are held together by a tension mechanism  620 . The tension mechanism  620  is made of a shaped-memory material that allows the tension mechanism  620  to have a predetermined curvature. The predetermined curvature is configured to force the expandable structure  602  to conform to the curvature. In one embodiment, the predetermined curvature has the curvature of the CS  208 . In one embodiment, the tension mechanism  620  is a filament or a backbone that is inserted through an aperture  622  created in each of the expandable rings  612 . Each of the expandable rings  612  includes a portion  614  that includes a flat surface in one embodiment. A distance G s  separates one portion  614  of one ring  612  from another portion  614  of another ring  612 . An angle θ s  separates one portion  614  of one ring  612  from another portion  614  of another ring  612 . 
     In one embodiment, tension is applied to the tension mechanism  620 , which causes the expandable structure  602  to bend in a curved fashion. In one embodiment, the expandable structure  602  is curved to a shape and size and that is desirable for reforming, reshaping, or reducing the annulus  209  of the mitral valve  210 . As shown in  FIGS. 37A-37C  and  FIGS. 38-39 , as tension is applied to the tension mechanism  620 , the tension mechanism  620  pulls the rings  612  closer to each other on the sides of the rings  612  that include the tension mechanism  620 . The expandable structure  602  is brought to the curved shape as the tension mechanism  620  works to pull the expandable rings  612  closer to each other. Because tension is only applied on one side of each of the expandable rings  612  by the tension mechanism  620 , the expandable structure  602  curves toward that side. As shown in  FIG. 37A , when the expandable structure  602  is in a non-curved shape, the distance G s  between each expandable ring  612  at the portion  614  is larger than the distance G c1  between each expandable ring  612  in a curved shape (G c1 &lt;G s ) as shown in  FIG. 37B . 
     In one embodiment, as shown in  FIGS. 37A-37C , when the expandable structure  602  is in a non-curved shape, the angle θ s  between each expandable ring  612  at the portion  614  is larger than the angle θ c1  between each expandable ring  612  in a curved shape (θ c1 &lt;θ s ). And, in another embodiment, as shown in  FIG. 37C , as the tension mechanism  620  applies enough tension, the expandable structure  602  is in its most curved state wherein the distance and angle between each expandable rings  612  at portions  614  is near zero “0.” In this configuration, every expandable ring  612  is positioned adjacent to the next ring with no distance between them. 
       FIGS. 38-39  illustrate other perspective views of the expandable structure  602  in its curved position. In one embodiment, the expandable rings  612  are not yet fully expanded at this point. These figures also show that the expandable structure  602  includes sealing members  624  located at the end of the tension mechanism  620  to keep the expandable rings  612  from being detached from each other. 
       FIG. 40  illustrates the expandable rings  612  in their fully expanded state. In one embodiment, the rings  612  are fully expanded to have the shape of circular rings. When the rings  612  are fully expanded, each of the rings  612  has a diameter D 20  that is greater than the diameter D 10  of each ring  612  when they are not fully expanded as shown in  FIG. 39 . In other embodiments, the rings  612  can be fully expanded to have shapes such as oval, oblong, or rings with wave-like shapes. 
     In one embodiment, to provide the expandable structure  602  with a curve shape, a curved-shape backbone  630  shown in  FIG. 41  is used. In one embodiment, the curved-shape backbone  630  is a shaped-memory structure that has a natural curve shape that conforms to the curve of the CS  208 . As shown in  FIG. 42 , the backbone  630  is first coupled to one side of the expandable structure  602 . Coupling the backbone  630  to the expandable structure  602  will cause the expandable structure  602  to take on the curved shape of the backbone  630 . In this embodiment, the backbone  630  may replace the tension mechanism  620  of the embodiments shown in  FIGS. 34-39 . In order to deploy the expandable structure  602  into the CS  808 , the expandable structure  602  is temporarily straightened so that the expandable structure  602  can fit into a conventional delivery device (e.g., a balloon on a catheter). As shown in  FIG. 42 , a straightening wire  626  is disposed within the inner diameter of the expandable structure  602 . Each of the rings  612  may have a groove, a slot, or an aperture on one side where the straightening wire  626  can be disposed therethrough. The expandable structure  602  is thus temporarily straightened. The expandable structure  602  of this embodiment can be deployed and expanded with a balloon. Exemplary embodiments of the balloon delivery system that can be used include the embodiments shown in  FIGS. 31 and 33 . 
     In one embodiment, as shown in  FIG. 43 , a curved expandable structure  602  (e.g., as curved by the backbone  630  or by the tension mechanism  620 ) that is temporarily straightened with a straightening wire  626  is disposed on the outer diameter of a balloon  11 . The balloon  11  is “passive” and will take the curve shape of the curved expandable structure  602  when the straightening wire  626  is removed after the curved expandable structure  602  is delivered to the inner diameter of the CS  208 . 
       FIG. 44  illustrate the curved expandable structure  602  after it is delivered to the inner diameter of the CS  208  and the straightening wire  626  is removed. The curved expandable structure  602  is shown to return to the curve shape, and in this figure, that is conforming to the curve shape of the curved shape backbone  630 .  FIG. 45  illustrates an example of the curved expandable structure  602  in its fully expanded state as the balloon  11  is inflated by conventional methods. The balloon is then deflated, leaving the curved expandable supporting structure in place to reshape the CS  208 . 
     In one embodiment, to provide the expandable structure  602  with a curve shape, various links of various linear lengths are used to hold the expandable rings  612  together as shown in  FIGS. 46-47 . Using links of different linear lengths would expand the expandable structure  602  into a curved structure such that one side can curve in more than the other. 
     In one embodiment, the various links with different linear lengths include a plurality of coiled/helical links  632  and a plurality of coiled/helical links  634 . The coiled/helical links  632  and  634  are similar except that one may have more coils, turns, or period per unit length than the other. In one embodiment, the coiled/helical links  632  is a coiled structure that has more turns, coils, and periods per unit length than that of the coiled/helical links  634 . For example, the coiled/helical links  632  has four turns while the coiled/helical links  634  has only 1 turn. The coiled/helical links  634  has fewer curves and no turn. The coiled/helical links  632  has a longer linear length than the coiled/helical links  634  when the coiled/helical links  632  is stretched. 
     The plurality of coiled/helical links  632  is placed the side  636  of the expandable structure  602  to connect one ring  612  to another ring  612 . The plurality of coiled/helical links  634  is place on the side  638  that is opposite the side  636 . 
     When expanded (or stretched) the lengths on the side  636  and the side  638  are different due to the difference in the linear lengths. The side  638  is shorter than the side  636  thus, the expandable structure  602  is curved toward the side  638  as shown in  FIGS. 48-49 . The expandable structure  602  with this configuration can be deployed in the CS  208  using method previously described (e.g., see  FIG. 43 ). 
     In one embodiment, the coiled/helical links  632  and  634  shown in  FIGS. 46-49  may have the same configurations (not shown). Both the coiled/helical links  632  and  634  may have the same number of coils, periods, or turns and essentially, the same linear length. Each of the coiled/helical links  632  and  634  is made of a different material or a material having a different tension property. Each of the coiled/helical links  632  and  634  thus has a different tension strength from each other. When the same force is used to expand the expandable structure  602 , the sides of the expandable structure  602  expands differently. For example, the side  638  may have the coiled/helical links  632  that is made of a thicker material that has a higher tension strength while the side  636  may have the coiled/helical links  634  that is made of a thinner material that has a lower tension strength. When expanded, the expandable structure  602  curves toward the side  638 . 
     In one embodiment, to provide the expandable structure  602  with a curve shape, wave-like links of different linear lengths are used to hold the expandable rings  612  together as shown in  FIG. 50 . The expandable rings  612  are held together by a first plurality of wave-like links  640  and a second plurality of wave-like links  642 . The first plurality of wave-like links  640  is placed on the side  646  of the expandable structure  602 . The second plurality of wave-like links  642  is placed on the side  648  of the expandable structure  602 . 
     Each of the first plurality of wave-like links  640  has a fully stretched length that is longer than each of the second plurality of wave-like links  642 . Each of the first plurality of wave-like links  640  includes more sinusoidal waves than each of the second plurality of wave-like links  642 . Alternatively, each of the first plurality of wave-like links  640  has greater linear length along the path between two links than each of the second plurality of wave-like links  642 . When the rings  612  are held together by these two different lengths of links,  640  and  642 , the expandable structure  602  curves toward the side  648  where the links  642  are shorter. The expandable structure  602  with this configuration can be deployed in the CS  208  using a method previously described (e.g., see  FIG. 43 ). 
     In one embodiment, the links  640  and  642  shown in  FIG. 50  may have the same configurations (not shown). Each of the links  640  and  642  is made of a different material or a material having a different tension property. Each of the links  640  and  642  thus has a different tension strength from each other. When the same force is used to expand the expandable structure  602 , the sides of the expandable structure  602  expands differently. For example, the side  648  may have the links  642  that is made of a thicker material that has a higher tension strength while the side  646  may have the links  640  that is made of a thinner material that has a lower tension strength. When expanded, the expandable structure  602  curves toward the side  648 . 
       FIG. 51  illustrates an exemplary delivery device  650  that can be used to deliver the annuloplasty device  601  that includes the expandable structure  602  and the ligature  600  to the CS  208  to reshape the annulus  209  of the mitral valve  210 . The delivery device  650  is one type of a rapid exchange catheter well known in the art. It is to be understood that other methods can be used to deliver the annuloplasty device  601  without departing from the scope of the present invention. 
     The delivery device  650  includes an expandable balloon  11  for deploying the annuloplasty device  601  which resides in the CS  208  (not shown here but see  FIG. 29 ). The delivery device  650  further includes a guidewire  13  to guide portion (the distal portion) of the delivery device  650  into the CS  208 . As shown in  FIG. 51 , the annuloplasty  601  comprising the ligature  600  couples to an expandable structure  602 , a distal anchoring member  604 , and a proximal anchoring member  606  are disposed within the delivery device  650 . In one embodiment, the annuloplasty device  601  as described above is disposed within a protective sheath  652  of the delivery device  650 . In one embodiment, the distal anchoring member  604  anchors into the left trigone and the proximal anchoring member  606  anchors into the right trigone. 
     In one embodiment, the delivery device  650  further includes handle section  660  located proximally of the delivery device  650 . The delivery device  650  includes a retracting mechanism  662  for retracting the protective sheath  652 . The delivery device  650  includes a port  664  for pressurizing a lumen of the delivery device  650  that communicates with the lumen of the inflatable balloon  12 . The port  664  thus enables the balloon  12  to be inflated, for example by pressure or fluid. The delivery device  650  includes a port  666  that allows access to the guidewire lumen of the delivery device  650  for the guidewire  13  to pass through. The port  666  also enables control of the guidewire  13  as the guidewire  13  is advanced into the CS  208 . 
     In one embodiment, the guidewire  13  is inserted into a vein the body of a patient through an introducer (not shown) as is well known in the art. A guide catheter  654  is placed over the guidewire  13  through the introducer into the vessel lumen (the vein). The guidewire  13  and the guide catheter  654  are advanced through the vessel to the right atrium and into the coronary sinus. The annuloplasty device  601  within the protective sheath  652  is then loaded on or over the guidewire  13  and within the inner diameter of the guide catheter  654  and delivered to a location in the CS  208  adjacent to the mitral valve  210 . The protective sheath  652  is then retracted slightly and proximally relative to the annuloplasty device  601  to expose the distal anchoring member  604 . The distal anchoring member  604  is then inserted or anchored into the left trigone. The protective sheath  652  is further retracted proximally to expose the proximal anchoring component  606 . The proximal anchoring component  606  is inserted anchored into the right trigone. At this point, the ligature  600  is deployed within the CS  208 . The expandable balloon  11  is then inflated to deploy the expandable structure  602  in the inner diameter of the CS  208 . In one embodiment, the expandable structure  602  is deployed against the inner diameter of the CS  208 . The expandable structure  602  thus ensures that CS  208  stays open and unobstructed by the annuloplasty device  601 . The expandable structure  602  does not necessarily function in opening up the CS  208 . 
     In one embodiment, the distal end portion of the protective sheath  652  may contain a slit or cutaway section (not shown) to allow the protective sheath  652  to expand an opening, which will slide over the annuloplasty device  601  as the protective sheath  652  is retracted during deployment. 
     In one embodiment, the protective sheath  652  also acts as a straightening device (replacing the need for the straightening wire  626 ) to temporarily straighten the expandable structure  602  during delivery and deployment. The protective sheath  652  also acts as a straightening device to temporarily straighten the ligature  600 . Once the ligature  600  and the expandable structure  602  is placed in the CS  208 , the withdrawal of the protective sheath  652  allows the expandable structure  602  that is curved to conform or return to a particular curve to return to its curved shape. In another embodiment, once fully deployed, the expandable structure  602  acts to maintain or support the curvature of the ligature  600 . 
     After the annuloplasty device  601  is fully deployed, the ligature  600  and the expandable structure  602  is fully deployed within the CS  208 , the distal anchoring member  604  anchored into an area in the left trigone, and the proximal anchoring member  606  anchored into an area in the right trigone. In one embodiment, the ligature  600  is pressed against the inner wall of the CS  208  on the side that faces the mitral valve annulus  209 . In one embodiment, the curvature of the ligature  600  reshapes the size of the mitral annulus  209 . In one embodiment, the curvature of the ligature  600  together with the curvature of the expandable structure  602  reshapes the size of the mitral annulus  209 . 
     It is to be understood that the delivery device  650  can be made from materials and designs similar to current stent delivery systems. The delivery device  650  could be of the over-the-wire or rapid-exchange styles of stent delivery systems as known in the art. The delivery device  650  also could include materials or be made of materials that are compatible with X-ray, ultra sound of Magnetic Resonance Imaging (MRI) methods for the purpose of visualizing the delivery, placement and deployment of the annuloplasty device  601 . 
       FIG. 52  illustrate an exemplary annuloplasty device  701  which can be deployed in the CS  208  to reshape the mitral valve annulus  209 . The annuloplasty device  701  is similar to the annuloplasty device  601  previously described. The annuloplasty device  701  however does not include the expandable structure  602 . 
     Similar to the annuloplasty device  601 , the annuloplasty device  701  includes a ligature  600 , a distal anchoring member  604  and a proximal anchoring member  606  which may be coils, helixes, anchors, hooks, barbs, screws, flanges, and other feature that allow the anchoring members to penetrate and attach to a myocardial tissue (or cardiac tissue). Again, it is to be appreciated that each of the distal anchoring member  604  and  606  may include a plurality of anchors. For instance, the distal anchoring member  604  may include three anchors  604   a ,  604   b , and  604   c  and the proximal anchoring member  606  may include three anchors  606   a ,  606   b , and  606   c . In one embodiment, the ligature  600  extends into the distal anchoring member  604  and the proximal anchoring member  606 . In other words, the ligature  600 , the distal anchoring member  604 , and the proximal anchoring member  606  are made of the same piece. 
     The ligature  600  is sufficient sized to have a surface area that will prevent the ligature  600  from cutting through the wall of the blood vessel (e.g., the CS  208 ) once the distal anchoring member  604  and the proximal anchoring member  606  are deployed. In one embodiment, the ligature  600  includes a flat and wide surface  609  and/or a flat and wide surface  611 . One of these surfaces ( 609  and  611 ) is the side that is in immediate contact with the inner wall of the CS  208 , for example, the surface  611  is deployed to be in immediate contact with the inner wall of the Cs  208 . Since the surface  611  is sufficiently wide and flat, the ligature  600  is prevented from cutting through the wall of the CS  208 . 
     In one embodiment, the ligature  600  includes a plurality of openings  613  created into the ligature  600 . In one embodiment, the openings  613  facilitate the anchoring of the ligature  600  onto the inner wall of the CS  208 . 
     All other aspects of the annuloplasty device  701  are similar to the annuloplasty device  601 . The annuloplasty device  701  can be deployed using a delivery catheter  651  illustrated in  FIG. 53 . The delivery catheter  651  is similar to the delivery catheter  650  previously described with the addition of an inner sheath  653 . The delivery device  651  can be a type of a rapid exchange catheter well known in the art. It is to be understood that other methods can be used to deliver the annuloplasty device  701  without departing from the scope of the present invention. 
     To deploy the annuloplasty device  701 , the guidewire  13  is inserted into a vein the body of a patient through an introducer (not shown) as is well known in the art. A guide catheter  654  is placed over the guidewire  13  through the introducer into the vessel lumen (the vein). The guidewire  13  and the guide catheter  654  are advanced through the vessel to the right atrium and into the coronary sinus. The annuloplasty device  701  is disposed within the protective sheath  652  of the delivery device  651 . The protective sheath  652  is then loaded on or over the guidewire  13 , within the inner diameter of the guide catheter  654 , and delivered to a location in the CS  208  adjacent to the mitral valve  210 . The protective sheath  652  is then retracted slightly and proximally relative to the annuloplasty device  604  to expose the distal anchoring member  604  of the ligature  600  as shown in  FIGS. 54A-54B . The distal anchoring member  604  is then inserted or anchored into the left trigone. The protective sheath  652  is further retracted proximally to expose the proximal anchoring member  606  of the ligature  600  as shown in  FIG. 54C . The proximal anchoring component  606  is inserted anchored into the right trigone. Then, the annuloplasty device  701  can be completely released from the delivery device  651  as shown in  FIG. 54D . A pushpin or a mechanism (not shown) can be included within the delivery device  651  to release the annuloplasty device  701 . 
     In one embodiment, the distal end portion of the protective sheath  652  may contain a slit or cutaway section (not shown) to allow the protective sheath  652  to expand and open to allow the protective sheath  652  to slide over the annuloplasty device  701  as the protective sheath  652  is retracted during deployment. 
     In one embodiment, the protective sheath  652  also acts as a straightening device to temporarily straighten the annuloplasty device  701  during delivery and deployment. Once the annuloplasty device  701  is placed in the CS  208 , the withdrawal of the protective sheath  652  allows the supporting structure that is curved to a particular curve to return to its curved shape as shown in  FIG. 54D . 
     After the annuloplasty device  701  is fully deployed, the distal anchoring member  604  anchored into an area in the left trigone, the proximal anchoring member  606  anchored into an area in the right trigone, and the ligature  600  is pressed against the wall of the CS  208  on the side that faces the mitral valve annulus  209 . In one embodiment, the curvature of the ligature  600  reshapes the mitral annulus  209 . In one embodiment, the curvature of the ligature  600  together with the curvature of the expandable structure  602  reshapes the mitral annulus  209 . 
     It is to be understood that the delivery device  651  can be made from materials and designs similar to current stent delivery systems. The delivery device  651  could be of the over-the-wire or rapid-exchange styles of stent delivery systems as known in the art. The delivery device  651  also could include materials or be made of materials that are compatible with X-ray, ultra sound of Magnetic Resonance Imaging (MRI) methods for the purpose of visualizing the delivery, placement and deployment of the annuloplasty device  701 . 
       FIGS. 55A-55B  illustrate cross-sectional views of an exemplary annuloplasty device  900  that can be deployed in the CS  208  to reshape the mitral valve annulus  209 . In one embodiment, the annuloplasty device  900  reduces the diameter of the arc that the CS  208  circumscribes. 
     The annuloplasty device  900  comprises a distal anchoring member  902 , a proximal anchoring member  904 , and a spring-like spine  906 . The spring-like spine  906  is constructed from a shape-memory alloy (e.g., Nitinol), which, generate a cinching force that is required to reduce the diameter of the CS  208  and the mitral valve annulus  209 . During deployment, the spring-like spine  906  is stretched out for easy delivery as shown in  FIG. 55A . After deployment, the spring-like spine  906  returns to the original shape as shown in  FIGS. 55B and 55C . The spring-like spine  906  may be constructed to have the original shape as shown in  FIG. 55C  or a more expanded shape as shown in  FIG. 55B . The spring-like spine  906  may be constructed of a single unit by laser cutting using Nitinol or other shape-memory material. The spring-like spine  906  can be welded together with the distal anchoring member  902  and the proximal anchoring member  904  using conventional methods (e.g., laser welding). The spring-like spine  906  can also be cut from a cylindrical tube or wound with wire using methods well known to those skilled in the art. 
     The distal anchoring member  902  and the proximal anchoring member  904  are similar to previously described for the annuloplasty device  601 . The distal anchoring member  902  and the proximal anchoring member  904  function to grip and pull onto the venous tissue as the spring-like spine  906  resumes its shape after deployment. In one embodiment, each of the distal anchoring member  902  and the proximal anchoring member  904  is formed much like a conventional stent with modification so that each includes a link  908  that allows it to be attached to the spring-like spine  906 . Additionally, each of the distal anchoring member  902  and the proximal anchoring member  904  can be made slightly larger than the inner diameter of the CS  208  such that when deployed, there is sufficient force for the distal anchoring member  902  and the proximal anchoring member  904  to grip, anchor, or deploy against the inner diameter of the CS  208 . 
     In one embodiment, each of the distal anchoring member  902  and the proximal anchoring member  904  includes the link  908  that is constructed to be thicker than other links typically present in a conventional stent as shown in  FIG. 56 . The thickness of the link  908  should be sufficient for the spring-like spine  906  to be attached to each of the distal anchoring member  902  and the proximal anchoring member  904 . 
     In one embodiment, each of the distal anchoring member  902  and the proximal anchoring member  904  is constructed to have crowns  910  with out-of-plane expansions or fish-scaling effects as shown in  FIG. 57 . This feature can be accomplished by adjusting the thickness of the struts  912  relative to the width ratio of the crowns  910 .  FIG. 57  represents, in one embodiment, an enhancement to traditionally cut stents which will allow the distal and proximal anchors to grip the tissue in the presence of the cinching force generated by the constriction of the spine. This figure illustrates the use of barbs or hooks that may be welded to the links and/or struts of the distal and proximal anchoring devices. These would function in a fashion similar those described for other embodiments of the anchoring members. 
       FIG. 58  illustrates that in one embodiment, the crowns  910  on the distal anchoring member  902  are pointed toward the proximal end of the annuloplasty device  900 . The crowns  910  on the proximal anchoring member  904  are pointed toward the distal end of the annuloplasty device  900 . The orientation of the crowns  910  in the manner mentioned ensured that the distal anchoring member  902  and the proximal anchoring member  904  are embedded deeper into the tissue of the wall of the CS  208  as the spring-like spine  906  resumes its original shape. One advantage for orienting the crowns  910  as depicted in  FIG. 58  is to take advantage of the fish-scaling effect mentioned above. When an anchoring member (e.g., the distal anchoring member  902  or the proximal anchoring member  904 ) is expanded, the crowns  910  will expand out of the cylindrical plane defined by the main body of the anchoring member as seen in the side views of  FIG. 58 . Adjusting the crown width to thickness ratio controls the degree of out-of-plane deformation. The crown width and thickness have been labeled  1  and  2 , respectively, in  FIG. 58 . When the annuloplasty device  900  is fully deployed, the cinching force generated by the contraction of the spring-like spine  906  will cause the anchoring members to further embed themselves into the tissue much like barbs or hooks. 
     In one embodiment, each of the distal anchoring member  902  and the proximal anchoring member  904  includes at least one anchor  914  as shown in  FIG. 57 . The anchor  914  further aid the distal anchoring member  902  and the proximal anchoring member  904  in anchoring into the tissue of the wall of the CS  208 . 
       FIG. 59A  represents the spring-like spine  906  as if it were flattened onto the plane of the page. This embodiment of the spring-like spine  906  has a pure sinusoidal shape (which resembles a sine wave shape). The spring-like spine  906  is not restricted to a sinusoidal shape, but may also take on the repeating keyhole-like shape of a typical stent ring in order to exploit flexibility, strength, expansion and contraction characteristics. In an alternative embodiment, the spring-like spine  906  is a spine  936  that has the repeating keyhole-like shape of a typical stent ring as illustrated in  FIG. 59D . 
       FIG. 59B  illustrates the spring-like spine  906  wrapped around the x-axis as if the spine  906  has been cut from a cylindrical tube.  FIG. 59C  depicts the final structure of the spine  906  in a top view and a front view. The spring-like spine  906  is transformed from the configuration shown in  FIG. 59B  by wrapping itself around the y-axis.  FIG. 59C  represents the final shape of the spring-like spine  906 , which has a predetermined curvature. The spring-like spine  906  may be characterized as a tubular spring that has been wrapped around the y-axis such that it circumscribes a particular arc (e.g., the arc of the CS  208 ). 
     The spring-like spines described may have features are adjusted to achieve specific functionality. For example, the spring-like spines could be modified by adjusting the period or frequency of the repeating pattern, the amplitude of the repeating pattern, or the number of repeating patterns along the length of the spines. 
     The annuloplasty device  900  can be delivered into the CS  208  using a conventional method and a conventional delivery device or the delivery devices previously described. 
       FIG. 60  illustrates an exemplary annuloplasty device  1000  that can be deployed in the CS  208  to reshape the mitral valve annulus  209 . In one embodiment, the annuloplasty device  1000  reduces the diameter of the arc that the CS  208  circumscribes thereby reshaping the mitral valve annulus  209 . 
     The annuloplasty device  1000  comprises a distal anchoring member  1002 , a proximal anchoring member  1004 , and a ligature  1010 . In one embodiment, the ligature  1010  is constructed from a shape-memory alloy (e.g., Nitinol), which, generate a cinching force that is required to reduce the diameter of the CS  208  and the mitral valve annulus  209 . During deployment, the ligature  1010  may be stretched out for easy delivery. After deployment, the ligature  1010  returns to the original shape which may have a predetermine curvature for which the CS  208  and the mitral valve annulus  209  are to conform to as shown in  FIG. 60 . 
     The annuloplasty device  1000  may be constructed of a single unit by laser cutting using Nitinol or other shape-memory material. The annuloplasty device  1000  can also be cut from a cylindrical tube or wound with wire using methods well known to those skilled in the art. Alternatively, the ligature  1010  may be welded together with the distal anchoring member  1002  and the proximal anchoring member  1004  using conventional methods (e.g., laser welding). 
     The distal anchoring member  1002  and the proximal anchoring member  1004  are similar to previously described for the annuloplasty device  601 . The distal anchoring member  1002  and the proximal anchoring member  1004  function to grip and pull onto the venous tissue as the ligature  1010  resumes its shape after deployment. In one embodiment, each of the distal anchoring member  1002  and the proximal anchoring member  1004  is configured to have a coiled or helical shapes as shown in  FIGS. 61A-61E . The coiled/helical shaped anchoring members ( 1002  and  1004 ) can be delivered at a small profile and expand into the CS  208 . The ends of the coiled/helical shaped anchoring members can protrude through the CS  208  and into the left or the right trigone, the annulus tissue, or other myocardial tissue proximate the CS  208  for better anchoring. Alternatively, at least one anchor can be attached or included to the ends of the coiled/helical shaped anchoring members as shown in  FIG. 60 . In  FIG. 60 , the distal anchoring member  1002  includes an anchor  1006  and the proximal anchoring member  1004  includes an anchor  1008 . The anchor can be a barb, hook, helix, coil, flange, screw, staple, and rivet, to name a few. 
       FIG. 61A  illustrate an embodiment of the annuloplasty device with the proximal anchoring member  1004  and the distal anchoring member  1002  having coils that turn in opposite direction. The proximal anchoring member  1004  and the distal anchoring member  1002  are essentially mirror image of each other. In one embodiment, the distal anchoring member  1002  has a clockwise rotation while the proximal anchoring member  1004  has a counter-clockwise rotation. As can be seen, the distal anchoring member  1002 , the ligature  1010 , and the proximal anchoring member  1004  are parts of one continuous structure made of the same material. 
     Pulling on the ligature  1010  induces the coil stacking of the distal anchoring member  1002  and the proximal anchoring member  1004  which provide more anchoring force and support for the aniuloplasty device  1000 . In one embodiment, the ligature  1010  begins at the most distal end portion of the distal anchoring member  1002  and at the most proximal end portion of the proximal anchoring member  1004  as illustrated in  FIG. 61B . 
     In an alternative embodiment, the annuloplasty device  1000  includes multiple structures as shown in  FIG. 61C . In this embodiment, the distal anchoring member  1002  includes at least two coils wound in the same direction and the proximal anchoring member  1004  also includes at least two coils wound in the same direction. The ligature  1010  can be a single-stranded structure as shown in  FIG. 61C . Alternatively, the ligature  1010  can be a double-stranded structure as shown in  FIG. 61D . The annuloplasty device  1000  with at least two coils provides additional support to the distal anchoring member  1002  and the proximal anchoring member  1004 . 
     In another alternative embodiment, the annuloplasty device  1000  includes multiple coils each turning an opposite direction and interlocking one another as illustrated in  FIG. 61E . In this embodiment, the ligature  1010  can be a single-stranded structure as shown in this figure or a double-stranded structure similar to the one shown in  FIG. 61D . 
     In one embodiment, the ligature  1010  itself could include coiled or helical turn to form a ligature  1014  as shown in  FIG. 61F . Pulling on the ligature  1014  exerts more torques onto the distal anchoring member  1002  and the proximal anchoring member  1004  thus, providing more radial anchoring force to these anchoring members. 
     The annuloplasty device  1000  can be delivered into the CS  208  using a conventional method and a conventional delivery device or the delivery devices previously described. 
       FIGS. 62A-62D  illustrate an exemplary embodiment of the present invention that can be used to treat a defective heart valve such as that seen in a mitral valve regurgitation condition. As previously discussed, anchoring members may be placed or anchored in the coronary sinus at two opposite ends with a connecting member that can pull the anchoring members toward each other in order to change the shape of the mitral valve annulus. In many instances, adjustability and removability of the anchoring members without complication (e.g., surgery) are desirable. The embodiments shown in the  FIGS. 62A-62D  describe the use of expandable baskets as anchoring members to deploy in the coronary sinus (or other blood vessel). 
     In  FIGS. 62A-62D , an implantable device  2202 , which can be an annuloplasty device, is moveably disposed within a delivery sheath  2204 . The implantable device  2202  includes a distal expandable basket  2230  and a proximal expandable basket  2236  connected by a connecting member  2242 . The distal expandable basket  2230  and the proximal expandable basket  2236  are delivered in their collapsed or compressed state. The delivery sheath  2204  functions to constrain the distal expandable basket  2230  and the proximal expandable basket  2236  in their collapsed state. Once delivered to their respective and desired location, the distal expandable basket  2230  and the proximal expandable basket  2236  are allowed to expand and deploy against the inner wall of the coronary sinus (or blood vessel), in one embodiment. To deploy the distal expandable basket  2230  and the proximal expandable basket  2236 , the delivery sheath  2204  is withdrawn to allow the distal expandable basket  2230  and the proximal expandable basket  2236  to expand. 
     The implantable device  2202  is releasably coupled to an actuator  2206  at a junction  2208 . The actuator  2206  is coupled to the implantable device by coupling to the proximal end of the connecting member  2242 . The actuator  2206  is used to facilitate the deployment of the implantable device  2202 . The actuator  2206  is also used to apply tension on the distal expandable basket  2230 , the proximal basket  2236 , and the connecting member  2242  in order to reshape the blood vessel or the coronary sinus, in one embodiment. 
       FIG. 62A  shows the implantable device  2202  contained in the delivery sheath  2204 . As shown in this figure, the distal expandable basket  2230  and the proximal expandable basket  2236  are in their collapsed state. 
       FIG. 62B  shows the distal expandable basket  2230  being deployed. Once the device  2202  is in position and the distal expandable basket  2230  is in the desired location within the blood vessel or the coronary sinus, the delivery sheath  2204  is retracted to allow the distal expandable basket  2230  to expand and anchor or deploy against the inner wall of the blood vessel (or other vessel) at the desired location. 
       FIG. 62C  shows the proximal basket  2236  being deployed. The proximal expandable basket  2236  is deployed while tension is applied to the actuator  2206  (e.g., as is needed to change the shape of the blood vessel, the coronary sinus, and/or the mitral valve annulus). After the proximal expandable basket  2236  is placed in the desired location, with tension being applied, the delivery sheath  2204  is retracted further proximally to allow the proximal expandable basket  2236  to expand and anchor or deploy. In one embodiment, the proximal expandable basket  2236  is deployed within the blood vessel similarly to the distal expandable basket  2230 . In another embodiment, the proximal expandable basket  2236  is deployed outside of the ostium of the coronary sinus in the right atrium and held against the ostium as shown in  FIG. 62E . 
     When there is need for adjustment or repositioning of the proximal expandable basket  2236  or the distal expandable basket  2230 , the delivery sheath is advanced over the proximal expandable basket  2236  or the distal expandable basket  2230  to collapse the proximal expandable basket  2236  or the distal expandable basket  2230  to allow for repositioning or adjustment. 
       FIG. 62D  shows the removal of the actuator  2204  and the delivery sheath  204  after proper positioning of the distal expandable basket  2230  and the proximal expandable basket  2236  is achieved. After the distal expandable basket  2230  and the proximal expandable basket  2236  are deployed or anchored in place, the connecting member  2242  applies tension to pull on the baskets  2230  and  2236 . The tension is sufficient to reshape the coronary sinus or the blood vessel. The connecting member  2242  may be positioned on or proximate a side of the inner wall of the blood vessel or the coronary sinus. 
       FIGS. 63-64  illustrate enlarged views of the junction  2208 , which is the connecting point for the actuator  2206  and the implantable device  2202 . In one embodiment, the actuator  2206  is coupled to the implantable device  2202  through a connection mechanism  2218  as shown in  FIG. 63 . The connection mechanism  2218  includes a screw thread structure  2220  and a complimentary screw thread structure  2222 . The screw thread structure  2220  couples to or extends from the actuator  2206  at the distal end section  2252  of the actuator  2206 . The screw thread structure  2222  couples to or extends from the implantable device  2202  at the proximal end section  2250  of the implantable device  2202 . One of the screw thread structure  2220  and the screw thread structure  2222  can be a female thread structure while the other can be a complimentary male thread structure. In  FIG. 63 , the screw thread structure  2222  is a female thread structure and the screw thread structure  2220  is a male thread structure. The screw thread structure  2220  and screw thread structure  2222  engage one another to couple the implantable device  2202  to the actuator  2206 . The screw thread structure  2220  and the screw thread structure  2222  disengage one another to release or detach the actuator  2206  from the implantable device  2202 . Thus, during deployment, the screw thread structure  2220  and the screw thread structure  2222  engage one another to allow the actuator  2206  to move the implantable device  2202  and after the deployment, the screw thread structure  2220  and the screw thread structure  2222  disengage one another to allow the actuator  2206  to be detached from the implantable device  2202 . 
     It is to be appreciated that there are many connection mechanisms that rely on a rotary and/or longitudinal motion and/or release of the implantable device  2202 . Alternatively, the actuator  2206  can be coupled to the implantable device  202  using a loop connection system  2224  as illustrated in  FIG. 64 . The proximal section  2250  of the implantable device  2202  may include a loop, opening, or a slot  2228 . The distal section  2252  of the actuator  2206  may include a wire loop  2226  that can be inserted through the slot  2228 . The wire loop  2226  keeps the actuator  2206  coupled to the implantable device  2202  until the removal of the wire loop  2226  from the slot  2228 . The wire loop  2226  may be removed by releasing one end of the wire loop  2226  while pulling on the other end of the wire loop  2226 . The wire loop  2226  holds the implantable device  2202  against the actuator  2206  such that the implantable device  2202  can be pushed or pulled by the actuator  2206 . The wire loop  2226  may simply act to couple the implantable device  2202  to the actuator  2206  while the actuator  2206  is the member that performs the controlling or moving of the implantable device  2202 . 
     The delivery sheath  2204  is made out of a biocompatible material such as those typically used for a catheter. The delivery sheath  2204  can be made out of a polymer commonly used in catheter construction such as Nylon, Pebax, Polyurethane, PEEK, Polyolefin, etc. . . . The delivery sheath  2204  is flexible but need not be and can be made to have preformed curvature to facilitate the maneuvering of the delivery sheath  2204  into the target blood vessel (e.g., a coronary sinus). In one embodiment, the delivery sheath  2204  is substantially smaller compared to the blood vessel that the delivery sheath  2204  is to be inserted into. The delivery sheath  2204  introduces the implantable device  2202  to a treatment site (e.g., a site within the blood vessel). The treatment site can be a coronary sinus that substantially encircles a mitral valve and mitral valve annulus (previously shown). 
     The delivery sheath  2204  constrains the implantable device  2202  in the pre-delivery or pre-deployment state. In one embodiment, in the pre-deployment state, the distal expandable basket  2230  and the proximal expandable basket  2236  are in a collapsed state as shown in  FIG. 62A  that allows them to be conveniently disposed within the delivery sheath  2204 . As discussed, retraction of the delivery sheath  2204  allows the distal expandable basket  2230  and the proximal expandable basket  2236  to be deployed to their non-compressed state. 
     In one embodiment, to deliver the implantable device  2202  to the blood vessel, a sub-selective sheath (not shown) is used. Sub-selective delivery is known in the art. In this embodiment, the sub-selective sheath is advanced over a guidewire into the blood vessel (or the coronary sinus) using conventional technique. The sub-selective sheath is advanced over the guidewire to the anchor site for the distal expandable basket  2230 . The guidewire is then withdrawn. The implantable device  2202  constrained in the delivery sheath  2204  is advanced to the anchor site through the sub-selective sheath. To deploy the implantable device  2202 , the sub-selective sheath is retracted proximally to allow sufficient room for the deployment. After the distal expandable basket  2230  is in position, the delivery sheath  2204  is retracted as previously discussed. Then, with tension applied, after the proximal expandable basket  2236  is in position, the delivery sheath  2204  is also retracted as previously discussed. The sub-selective sheath can be withdrawn completely when deployment is achieved. 
     In other embodiments, the delivery sheath  2204  can be configured to include a lumen that can accommodate a guidewire. With this configuration, the delivery sheath  2204  can be advanced into the blood vessel and to the anchor site without the sub-selective sheath. In such embodiments, the delivery sheath  2204  can be advanced over the guidewire into the blood vessel. The deployment can then be carried out as previously discussed. In other embodiments, the connecting member  2242  is configured with an atraumatic tip  2241  to prevent injury during advancement especially when the delivery sheath  2204  is used to deliver the implantable device  2202 . 
     During deployment, the implantable device  2202  can be flushed with a fluid to lubricate the implantable device  2202  and the inner space of the delivery sheath  2204  to minimize friction between the implantable device  2202  and the delivery sheath  2204  so as to allow the distal and proximal expandable baskets  2230  and  2236  to move out of the delivery sheath  2204  for deployment. The implantable device  2202  may be also coated with a lubricious material that facilitates the movement of the distal and proximal expandable baskets  2230  and  2236  in and out of the delivery sheath  2204 . 
     The delivery sheath  2214  may also include radiopaque markers (not shown) to provide positioning information. The delivery sheath  2214  may also include other type of markers compatible with various types of imaging techniques known in the art such as echo imaging, infrared illuminations x-ray, and magnetic resonance imaging. 
     The actuator  2206  may be a hollow or a solid member, rod, or wire and may be coated with a lubricious material that facilitates the movement of the actuator  2206  in and out of the delivery sheath  2204 . The actuator  2206  is releasably coupled to the implantable device  2202  in a way that allows the actuator  2206  to engage or disengage, attach to or detach from the implantable device  2202  when desired. For deployment of the implantable device  2202 , the actuator  2206  engages the implantable device  2202  to move and/or facilitate in deploying the implantable device. After the deployment of the implantable device  2202 , the actuator  2206  disengages the implantable device  2202  and can be withdrawn from the blood vessel or the coronary sinus. 
       FIGS. 65A-65C  illustrate exemplary embodiments of the distal expandable basket  2230  and the proximal expandable basket  2236 . The distal expandable basket  2230  and the proximal expandable basket  2236  are similar. Each of the distal expandable basket  2230  and the proximal expandable basket  2236  comprises an expandable strut assembly  3024  which possesses spring-like or self-expanding properties and can move from a compressed or collapsed position as shown in  FIG. 62A  to an expanded or deployed position shown in  FIGS. 62B-62D . 
     In  FIG. 65A , expandable strut assembly  3024  includes an elongated cylindrical center portion  3034  and proximal and distal end portions  3036  and  3038  which are shaped as truncated cones, terminating at proximal and distal, hollow, cylindrical, collars  3040  and  3042 . Starting from the proximal collar  3040 , the strut assembly  3024  comprises a plurality of individual struts  3044  which taper upward to form the proximal truncated cone portion  3036  of the of the strut assembly  3024 . The struts  3044  continue, extending longitudinally, to form the elongated, straight, center portion  3034  of the strut assembly. The struts  3044  then taper downward forming the distal truncated cone portion  3038  of the strut assembly and terminate at the distal collar  3042 . Arrow  3046  shows the angle that the distal truncated cone portion  3038  makes with the center portion  3034 . While the figures show only four individual struts, the expandable basket is not limited to this configuration as strut assemblies containing more or less struts are practical. 
       FIG. 65B  illustrates an alternative configuration of the individual struts  3044 . The struts  3044  in  FIG. 65A  have straight shapes. The struts  3044  in  FIG. 65B  have spiral shapes, which can make the collapsing or compressing of the expandable baskets easier. The struts  3044  can have other suitable shapes not shown here. 
       FIG. 65C  illustrates yet another alternative configuration of each of the distal expandable basket  2230  and the proximal expandable basket  2236 . Each of the distal expandable basket  2230  and the proximal expandable basket  2236  includes a proximal strut assembly  3042  which includes a number of self-expanding struts  3044  that extend radially outward from the unexpanded position, to an expanded, implanted position as previous discussed. The proximal strut assembly  3042  is coupled to a distal strut assembly  3046 , which also includes a number of self-expanding struts  3044  that extend radially out once placed in the expanded position. The proximal strut assembly  3042  and distal strut assembly  3046  are coupled together by intermediate links  3050  which provide a region of increased bendability and flexibility to the basket. In this regard, the intermediate links  3050  act similarly to a mechanical hinge to allow the proximal strut assembly  3042  and distal strut assembly  3046  to move freely relative to each other when negotiating tortuous curves in the patient&#39;s anatomy. Enhanced flexibility of the intermediate links  3050  can be achieved by decreasing the strut width or the strut thickness from that used for the proximal or distal strut assembly. 
     The struts  3044  of the proximal strut assembly  3042  are attached to a collar  3052  which can be rotatably attached to the connecting member  2242 . The opposite ends of each strut  3044  are in turn attached to a deployment ring  3054 , also made from a self-expanding material, which aids in the expansion of the proximal assembly  3042 . The deployment ring  3054  is shown having a number of pleats  3056  which helps when collapsing the ring  3054  to its delivery position. The distal strut assembly  3046  may likewise include a deployment ring  3054  attached to the ends of the struts  3044 . In a like manner, this deployment ring  3054  serves to expand the distal assembly as well. The deployment rings  3054  are shown having a zigzag pattern which forms peaks  3043  and valleys  3045  and other patterns such an undulations. Generally, the intermediate links  3050  are connected to the peaks  3043  of the deployment rings  3054  with the ends of the struts  3044  being connected to the valleys  3045  of the ring  3054 . As a result, each of the baskets  2230  and  2236  will enter the delivery sheath  2242  in a smoother fashion. 
     Each of the strut assemblies described may be produced by several methods including electro-discharge machining and chemical etching. One method is to laser machine a thin-walled tubular member, such as a hypotube. In this procedure, a computer controlled laser cuts away portions of the hypotube following a pre-programmed template to form the desired strut pattern. Methods and equipment for laser machining small diameter tubing may be found in U.S. Pat. No. 5,759,192 (Saunders) and U.S. Pat. No. 5,780,807 (Saunders), which have been assigned to Advanced Cardiovascular Systems, Inc. 
     The tubing used to make the strut assembly may be made of any biocompatible spring steel or shape memory alloy. The 300 series stainless steel alloys are well suited to this application as is type 316L stainless steel per ASTM F138-92 or ASTM F139-92 grade 2. Other suitable materials include nickel-titanium alloys, such as Nitinol, including nickel-titanium alloys with optional ternary element added, and wherein the alloy may be processed to varying degrees to achieve different stress-strain behavior such as superelasticity or linear pseudoelasticity. The ternary elements include, for example, platinum, palladium, chromium, iron, cobalt, vanadium, manganese, boron, aluminum, tungsten, or zirconium. 
     Each of the distal expandable basket  2230  and the proximal expandable basket  2236  is coupled to the connecting member  2242  at the center of each basket. The connecting member  2206  thus runs through the center of each of the baskets  2030  and  2036 . In one embodiment, distal expandable basket  2230  is fixed at one end (e.g., the distal end of the distal expandable basket  2230 ) on the connecting member  2242  and not at the other end (e.g., the proximal end of the distal expandable basket  2230 ). As shown in  FIG. 66 , the distal expandable basket  2230  is coupled to the connecting member  2242  at the distal end  2030 -D. The proximal end  2030 -P of the distal expandable basket  2230  is disposed over the connecting member  2242  but is not fixed to the connecting member  2242 . The proximal end  2030 -P thus can slide along the connecting member  2242 . This allows the distal expandable basket  2230  to easily expand and compress over the connecting member  2242 . Similarly, the proximal expandable basket  2236  is coupled to the connecting member  2242  at the distal end  2236 -D. The proximal end  2236 -P of the proximal expandable basket  2236  is disposed over the connecting member  2242  but is not fixed to the connecting member  2242 . The proximal end  2236 -P thus can slide along the connecting member  2242 . This also allows the proximal expandable basket  2236  to easily expand and compress over the connecting member  2242 . 
     In one embodiment, the proximal expandable basket  2236  is somewhat slideable over the connecting member  2242 . Both the distal end  2236 -D and the proximal end  2236 -P of the proximal expandable basket are not fixed on the connecting member  2242 . This embodiment provides an implantable device  2202  with a wider range of adjustability. For example, one implantable device  2202  can be used for various length and/or size of the blood vessel or the coronary sinus. In this embodiment, a distal stop  2235  can be placed on the connecting member  2242 . The distal stop  2235  defines the distal travel distance for the proximal expandable basket  2236  (e.g., the proximal expandable basket  2236  will not be able to travel pass the distal stop  2235 ). The distal stop  225  can be a ring, a band, or other suitable feature created on the connecting member  2242  as is known in the art. 
     In one embodiment, a proximal end lock  2237  is included in the implantable device  2202 . The proximal end lock  2237  functions to allow for additional tension to be applied on the implantable device  2202  after the distal expandable basket  2230  and the proximal expandable basket  2236  are deployed. The proximal end lock  2237  also functions to lock or fix the position of the proximal expandable basket  2236  on the connecting member  2242 , especially when the proximal expandable basket  2236  is not fixed on the connecting member  2242 . 
     Examples of a proximal end lock  2237  can be found in U.S. Pat. No. 6,402,781 or publication WO 01/54,618. Configuration of a locking device that can be incorporated into the implantable device  2202  is known in the art. 
     In one embodiment, the implantable device  2202  is an annuloplasty device that can reshape a mitral valve and/or a mitral valve annulus. In one embodiment, the implantable device  2202  reduces the radius of the arc that a defective coronary sinus has thereby reshaping a mitral valve annulus that is adjacent the coronary sinus. In another embodiment, the implantable device reduces the curvature of the coronary sinus thus allowing the coronary sinus to exert pressure or force onto the mitral valve annulus, thus, bringing the leaflets of the mitral valve closer to each other. 
     In one embodiment, a method for deploying a device percutaneously into the coronary sinus (e.g., such as any one the methods described herein) may be combined with a percutaneous method of deploying a device on the mitral valve (e.g., such as a support annulus around the mitral valve annulus or a set of joined clips which attach to the mitral valve&#39;s leaflets). In this embodiment, a general technique would include percutaneously deploying (e.g., with a first catheter) a device into the coronary sinus (e.g., near the mitral valve) and percutaneously deploying (e.g., with a second catheter) a device onto the mitral valve (e.g., a support annulus). Device which may be deployed onto the mitral valve or into the coronary sinus are described in several co-pending U.S. Patent Applications which are hereby incorporated herein by reference, these applications beings: (1) Apparatus and Methods for Heart Valve Repair, by inventors Gregory M. Hyde, Mark Juravic, Stephanie A. Szobota, and Brad D. Bisson, filed Nov. 15, 2002, (2) Heart Valve Catheter, by inventor Gregory M. Hyde, filed Nov. 15, 2002, (3) Valve Adaptation Assist Device, by inventors William E. Webler, James D. Breeding, Brad D. Bisson, Fira Mourtada, Gregory M. Hyde, Stephanie A. Szobota, Grabiel Asongwe, and Jefferey T. Ellis, filed Nov. 15, 2002, (4) Valve Annulus Constriction Apparatus and Method, by inventors Peter L Callas and Richard Saunders, filed Nov. 15, 2002, and (5) Apparatuses and Methods for Heart Valve Repair, by inventor Gregory M. Hyde, filed Oct. 15, 2002. 
     A kit (e.g., a kit of multiple catheters with instructions for use thereof) may be used to perform the combination of (a) percutaneously deploying (e.g., with a first catheter) a device into the coronary sinus (e.g., near the mitral valve) and (b) percutaneously deploying (e.g., with a second catheter) a device onto the mitral valve. For example, a first catheter, such as the medical device  200 A ( FIG. 23 ), may be combined in a kit with a second catheter designed to percutaneously apply a member near the mitral valve, such as a support annulus to be attached on the mitral valve to reshape the mitral valve or a set of joined clips which grasp (e.g., attach to) the mitral valve leaflets. 
     In one embodiment, a support annulus (or clips, ligature) percutaneously placed near a mitral valve region, or a device placed in the coronary sinus to treat the mitral valve, may be used to deliver or release a drug or therapeutic agent to treat mitral valve regurgitation. Various drugs are known in the art for treating mitral valve regurgitation. For example, administering nitroprusside (a vascular smooth muscle relaxant) may effectively diminish the amount of mitral regurgitation, thereby increasing forward output by the left ventricle and reducing pulmonary congestion. Inotropic agents such as dobutamine may also be administered to increase the force of contraction of the myocardium. In one embodiment, a percutaneous medical device to treat mitral valve regurgitation, such as a support annulus for resizing a mitral valve annulus, clips to ligate the mitral valve leaflets, or a device placed in the coronary sinus near the mitral valve region, may be coated with these exemplary drugs for delivery near the mitral valve region. The drugs may have timed-release features to be released slowly over a certain period of time. The drug eluting support annulus or other devices may also have the drug or agent dispersed on the surface of the support annulus or other devices, or co-dissolved in a matrix solution to be dispersed on the support annulus. Methods to coat the support annulus with a therapeutic drug include dip coating, spin coating, spray coating, or other coating methods commonly practiced in the art. 
     In some cases, patients with defective heart valves may have concomitant coronary artery disease (CAD). As such, it may be advantageous for a support annulus to deliver a drug to treat occlusions in the artery or other related CAD such as vulnerable plaque. The drug to treat CAD may be delivered alone or in combination with drugs to treat mitral valve regurgitation. Drugs to treat CAD include, but are not limited to, statins, lipid lowering agents, antioxidants, extracellular matrix synthesis promoters, inhibitors of plaque inflammation and extracellular degradation, estradiol drug classes and its derivatives. 
     In one embodiment, the drugs to treat CAD may be coated on a support annulus or other device using methods such as dip coating, spin coating, spray coating or other coating methods known in the art. The drug may alternatively be encapsulated in microparticles or nanoparticles and dispersed in a coating on the support annulus or other device. A diffusion limiting top-coat may optionally be applied to the above coatings. The active agents may optionally be loaded on a support annulus or other device together either by adding them together to the solution of the matrix polymer before coating, or by coating different layers, each containing a different agent or combination of agents. The drug eluting support annulus or other device may alternatively have an active agent or a combination of agents dispersed in a bioerodable annulus-forming polymer. 
     The foregoing description describes percutaneous methods (e.g., catheter based techniques) for delivering the annuloplasty devices described herein. It will be appreciated that surgical (non-percutaneous) techniques may alternatively be used to deploy/deliver these annuloplasty devices.