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Home | Alpha Telephone | Domain Names | Web Hosting | Get Traffic | xrEvidence | xrSoccer United States Patent
Methods and apparatus for remodeling an extravascular tissue structure A medical apparatus and method for remodeling a mitral valve annulus adjacent to the coronary sinus includes an elongate body having a proximal end and a distal end. The elongate body is movable from a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus.
Primary Examiner: Isabella; David J. Assistant Examiner: Chattopadhyay; Urmi Attorney, Agent or Firm: RELATED APPLICATIONS This is a continuation-in-part of U.S. application Ser. No. 10/066,302, filed Jan. 30, 2002, which is a continuation-in-part of U.S. application Ser. No. 09/774,869, filed Jan. 30, 2001, mow U.S. Pat. No. 6,537,314 and which also claims the benefit under 35 U.S.C. .sctn.119 to U.S. Provisional Application No. 60/265,995, filed Feb. 1, 2001, the entire disclosures of which are incorporated by reference herein. In addition, this application is a continuation-in-part of U.S. application Ser. No. 09/968,272, filed Oct. 1, 2001, now U.S. Pat. No. 6,709,456 which is a continuation of U.S. application Ser. No. 09/494,233, filed Jan. 31, 2000, U.S. Pat. No. 6,402,781, the entireties of which are incorporated by reference herein. Finally, this application claims priority under 35 U.S.C. .sctn.119 to U.S. Provisional Application No. 60/429,281, filed on Nov. 25, 2002, and U.S. Provisional Application No. 60/488,334, filed Jul. 18, 2003, entitled, "REMOTELY ACTIVATED MITRAL ANNULOPLASTY SYSTEM AND METHODS," the entire disclosures of which are expressly incorporated by reference herein. What is claimed is: 1. A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising: an elongate body, having a proximal end and a distal end, the elongate body being movable from a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus; and a forming element attached to the elongate body for manipulating the elongate body from the first delivery configuration to the second remodeling configuration; wherein the elongate body in the remodeling configuration comprises proximal and distal segments which are each concave in a first direction and a central segment which is concave in a second direction and wherein at least in the remodeling configuration the forming element extends outside the body along the central segment. 2. A medical apparatus as in claim 1, wherein the elongate body comprises a tube having a plurality of transverse slots therein. 3. A medical apparatus as in claim 1, further comprising a lock for retaining the body in the remodeling configuration. 4. A medical apparatus as in claim 1, wherein the apparatus is movable from the delivery configuration to the remodeling configuration in response to proximal retraction of at least a portion of the forming element. 5. A medical apparatus as in claim 1, wherein the apparatus is movable from the delivery configuration to the remodeling configuration in response to distal advancement of at least a portion of the forming element. 6. A medical apparatus as in claim 1, further comprising at least one anchor for engaging a site within a vessel. 7. A medical apparatus as in claim 6, wherein the anchor comprises at least one barb for piercing the wall of the vessel. 8. A medical apparatus as in claim 6, comprising a first tissue anchor at the proximal end and a second tissue anchor at the distal end. 9. A medical apparatus as in claim 1, wherein the apparatus has an axial length of no more than about 10 cm. 10. A medical apparatus as in claim 9, wherein the maximum cross sectional dimension through the apparatus is no more than about 10 mm. 11. An implant for positioning within a patient, comprising: a deployment catheter; an elongate flexible body having a proximal section, a central section and a distal section; a forming element extending through at least the proximal and distal sections of the body; and a detachable coupling on the body, for removably attaching the body to the deployment catheter; wherein manipulation of the forming element deflects the central section laterally with respect to at least a portion of the proximal and distal sections to selectively apply a compressive force along a region of tissue. 12. An implant as in claim 11, wherein the body comprises a tubular wall. 13. An implant as in claim 12, wherein the tubular wall is substantially noncompressible along a first side of the central section. 14. An implant as in claim 13 comprising a plurality of voids in the wall along a second side of the central section, thereby permitting axial shortening or elongation of the second side. 15. An implant as in claim 14 wherein at least some of the voids comprise slots through the wall, extending generally transverse to a longitudinal axis. 16. An implant as in claim 15 comprising at least 10 transverse slots in the wall of the second side. 17. An implant as in claim 16 comprising at least 20 transverse slots in the wall of the second side. 18. An implant as in claim 11, wherein the forming element comprises an axially movable element. 19. An implant as in claim 18, wherein the forming element comprises a pull wire. 20. An implant as in claim 11, wherein manipulation of the forming element introduces a first curve in the central section of the body which is concave in a first direction, and at least a second curve in one of the proximal and distal sections of the body concave in a second direction. 21. An implant as in claim 20, wherein manipulation of the forming element reshapes the body into a "w" configuration. 22. An implant as in claim 11, wherein the detachable coupling comprises a rotatable coupling disposed along the proximal section of the flexible body for removable attachment to the deployment catheter. 23. An implant as in claim 22, wherein the deployment catheter further comprises a rotatable driver along a distal end for removable attachment to the rotatable coupling and wherein rotation of the rotatable driver produces axial movement of the forming element relative to the flexible body. BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to intravascular prostheses for remodeling an extravascular anatomical structure. 2. Description of the Related Art Dilated cardiomyopathy occurs as a consequence of many different disease processes that impair myocardial function, such as coronary artery disease and hypertension. The left ventricle enlarges and the ejection fraction is reduced. The resulting increase in pulmonary venous pressure and reduction in cardiac output cause congestive heart failure. Enlargement of the mitral annulus and left ventricular cavity produce mitral valvular insufficiency. This in turn, causes volume overload that exacerbates the myopathy, leading to a vicious cycle of progressive enlargement and worsening mitral regurgitation. According to recent estimates, more than 79,000 patients are diagnosed with aortic and mitral valve disease in U.S. hospitals each year. More than 49,000 mitral valve or aortic valve replacement procedures are performed annually in the U.S., along with a significant number of heart valve repair procedures. Various surgical techniques have been developed to repair a diseased or damaged valve. One repair technique which has been shown to be effective in treating incompetence, particularly of the mitral and tricuspid valves, is annuloplasty, in which the effective size of the valve annulus is contracted by attaching a prosthetic annuloplasty ring to the endocardial surface of the heart around the valve annulus. The annuloplasty ring comprises an inner substrate of a metal such as stainless steel or titanium, or a flexible material such as silicone rubber or Dacron cordage, covered with a biocompatible fabric or cloth to allow the ring to be sutured to the heart tissue. The annuloplasty ring may be stiff or flexible, may be split or continuous, and may have a variety of shapes, including circular, D-shaped, C-shaped, or kidney-shaped. Examples are seen in U.S. Pat. Nos. 4,917,698, 5,061,277, 5,290,300, 5,350,420, 5,104,407, 5,064,431, 5,201,880, and 5,041,130, which are incorporated herein by reference. Annuloplasty rings may also be utilized in combination with other repair techniques such as resection, in which a portion of a valve leaflet is excised, the remaining portions of the leaflet are sewn back together, and a prosthetic annuloplasty ring is then attached to the valve annulus to maintain the contracted size of the valve. Other valve repair techniques in current use include commissurotomy (cutting the valve commissures to separate fused valve leaflets), shortening mitral or tricuspid valve chordae tendonae, reattachment of severed mitral or tricuspid valve chordae tendonae or papillary muscle tissue, and decalcification of the valve leaflets or annulus. Annuloplasty rings may be used in conjunction with any repair procedures where contracting or stabilizing the valve annulus might be desirable. Although mitral valve repair and replacement can successfully treat many patients with mitral valvular insufficiency, techniques currently in use are attended by significant morbidity and mortality. Most valve repair and replacement procedures require a thoracotomy, usually in the form of a median sternotomy, to gain access into the patient's thoracic cavity. A saw or other cutting instrument is used to cut the sternum longitudinally, allowing the two opposing halves of the anterior or ventral portion of the rib cage to be spread apart. A large opening into the thoracic cavity is thus created, through which the surgical team may directly visualize and operate upon the heart and other thoracic contents. Alternatively, a thoracotomy may be performed on a lateral side of the chest, wherein a large incision is made generally parallel to the ribs, and the ribs are spread apart and/or removed in the region of the incision to create a large enough opening to facilitate the surgery. Surgical intervention within the heart generally requires isolation of the heart and coronary blood vessels from the remainder of the arterial system, and arrest of cardiac function. Usually, the heart is isolated from the arterial system by introducing an external aortic cross-clamp through a sternotomy and applying it to the aorta to occlude the aortic lumen between the brachiocephalic artery and the coronary ostia. Cardioplegic fluid is then injected into the coronary arteries, either directly into the coronary ostia or through a puncture in the ascending aorta, to arrest cardiac function. The patient is placed on extracorporeal cardiopulmonary bypass to maintain peripheral circulation of oxygenated blood. Of particular interest in the present application are techniques for the repair and replacement of the mitral valve. The mitral valve, located between the left atrium and left ventricle of the heart, is most easily reached through the wall of the left atrium, which normally resides on the posterior side of the heart, opposite the side of the heart that is exposed by a median sternotomy. Therefore, to access the mitral valve via a sternotomy, the heart is rotated to bring the left atrium into an anterior position. An opening, or atriotomy, is then made in the right side of the left atrium, anterior to the right pulmonary veins. The atriotomy is retracted by means of sutures or a retraction device, exposing the mitral valve adjacent to the atriotomy. One of the previously identified techniques may then be used to repair or replace the valve. An alternative technique for mitral valve access has been used when a median sternotomy and/or rotational manipulation of the heart are inappropriate. In this technique, a thoracotomy is made in the right lateral side of the chest, usually in the region of the fourth or fifth intercostal space. One or more ribs may be removed from the patient, and other ribs near the incision are retracted outward to create a large opening into the thoracic cavity. The left atrium is then exposed on the posterior side of the heart, and an atriotomy is formed in the wall of the left atrium, through which the mitral valve may be accessed for repair or replacement. Using such open-chest techniques, the large opening provided by a median sternotomy or right thoracotomy enables the surgeon to see the mitral valve directly through the left atriotomy, and to position his or her hands within the thoracic cavity in close proximity to the exterior of the heart for cannulation of the aorta and/or coronary arteries to induce cardioplegia, manipulation of surgical instruments, removal of excised tissue, and introduction of an annuloplasty ring or a replacement valve through atriotomy for attachment within the heart. Mitral valve surgery, including mitral annuloplasty, is usually applied to patients with intrinsic disease of the mitral apparatus. As described, above, these patients may have scarring, retraction, tears or fusion of valve leaflets as well as disorders of the subvalvular apparatus. Definitive repair requires direct visualization of the valve. Patients who develop mitral regurgitation as a result of dilated cardiomyopathy do not always have intrinsic mitral valve disease. Regurgitation occurs as the result of the leaflets being moved back from each other by the dilated annulus. The ventricle enlarges and becomes spherical, pulling the papillary muscles and chordae away from the plane of the valve and further enlarging the regurgitant orifice. In these patients, correction of the regurgitation does not require repair of the valve leaflets themselves, but simply a reduction in the size of the annulus and the sphericity of the left ventricle. Mitral annuloplasty without repair of the leaflets or chordae has been shown to be effective in patients with dilated cardiomyopathy who are refractory to conventional medical therapy. Dr. Steve Bolling, at The University of Michigan and coworkers have operated on a cohort of such patients with New York Heart Association Class III and IV symptoms. Average symptom severity decreased from 3.9 preoperatively to 2.0 after surgery. Hemodynamics and ejection fraction improved significantly. Other investigators have achieved similar results as well. However, the morbidity, risks and expense of surgical annuloplasty are very high in patients with cardiomyopathy and congestive heart failure. Thus, a variety of new techniques for the treatment of congestive heart failure are being explored as adjuncts to drug therapy. Several cardiac restraint devices have been described. U.S. Pat. No. 5,702,343 to Alferness discloses a cardiac reinforcement device that is applied as a jacket over the epicardium in order to limit diastolic expansion. However, this requires an open chest operation to implant and does not directly affect the diameter of the mitral annulus. Another approach is disclosed in U.S. Pat. No. 5,961,440 to Schweich, et al., in which tension members are placed through opposite walls of the heart such that they span the ventricle. Less invasive and "minimally" invasive techniques for valve repair and replacement continue to evolve, both on a stopped heart and on a beating heart. These techniques may provide some benefits over open chest procedures, but they are still attended by significant morbidity and mortality risks. A need therefore remains for methods and devices for treating mitral valvular insufficiency, which are attended by significantly lower morbidity and mortality rates than are the current techniques, and therefore would be well suited to treat patients with dilated cardiomyopathy. Optimally, the procedure can be accomplished through a percutaneous, transluminal approach, using simple, implantable devices which do not depend upon prosthetic valve leaflets or other moving parts. SUMMARY OF THE INVENTION There is provided in accordance with one aspect of the present invention a medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus. The apparatus comprises an elongate body that includes a proximal end and a distal end. The elongate body is movable from a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus. The medical apparatus also comprises a forming element attached to the elongate body for manipulating the elongate body from the first delivery configuration to the second remodeling configuration. The elongate body in the second, remodeling configuration includes at least a first curve which is concave in a first direction and a second curve which is concave in a second direction. In one embodiment, the body when in the second configuration comprises a third curve which is concave in the second direction. The elongate body may comprise a tube having a plurality of transverse slots therein. In one embodiment, the medical apparatus further comprises a lock for retaining the body in the second configuration. The apparatus may be movable from the delivery configuration to the remodeling configuration in response to proximal retraction of at least a portion of the forming element. In one embodiment, the apparatus is movable from the implantation configuration to the remodeling configuration in response to distal advancement of at least a portion of the forming element. In one embodiment, at least a first portion of the forming element extends within the body and a second portion of the forming element extends along the outside of the body. In one embodiment, the medical apparatus further comprises at least one anchor for engaging a site within a vessel. The anchor may comprise at least one barb for piercing the wall of the vessel. In one embodiment, the medical apparatus comprises a first tissue anchor at the proximal end and a second tissue anchor at the distal end. In one embodiment, the apparatus has an axial length of no more than about 10 cm, and in one embodiment, the maximum cross sectional dimension through the apparatus is no more than about 10 mm. There is provided in accordance with another aspect of the present invention an implant for positioning within a patient. The implant comprises an elongate flexible body having a proximal section, a central section and a distal section. The implant also comprises a forming element extending through at least the proximal and distal sections of the body, and a detachable coupling on the body for removably attaching the body to a deployment catheter. Manipulation of the forming element deflects the central section laterally with respect to at least a portion of the proximal and distal section. In one embodiment, the body comprises a tubular wall. In another embodiment, the tubular wall is substantially noncompressible along a first side of the central section. The implant may comprise a plurality of voids in the wall along a second side of the central section, thereby permitting axial shortening or elongation of the second side. In one embodiment, at least some of the voids comprise slots through the wall, extending generally transverse to a longitudinal axis. In one embodiment, the implant comprises at least 10 transverse slots in the wall of the second side, and may comprises at least 20 transverse slots in the wall of the second side. The forming element may comprise an axially movable element. In another embodiment, the forming element comprises a pull wire. In one embodiment, manipulation of the forming element introduces a first curve in the central section of the body which is concave in a first direction, and at least a second curve in one of the proximal and distal sections of the body concave in a second direction. In one embodiment, manipulation of the forming element reshapes the body into a "w" configuration. There is provided in accordance with another aspect of the present invention a method of manipulating the mitral valve comprising the steps of providing a catheter having a prosthesis thereon, the prosthesis having a first tissue anchor and a second tissue anchor, inserting the catheter into the venous system, transluminally advancing the prosthesis into the coronary sinus, attaching the first and second tissue anchors to the wall of the coronary sinus, and manipulating the prosthesis to exert a lateral force on the wall of the coronary sinus in between the first and second tissue anchors. In one embodiment, the method further comprises the step of percutaneously accessing the venous system prior to the transluminally advancing step. In one embodiment, the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins. In one embodiment, the method further comprises the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the inserting step. In another embodiment, the method further comprises the step of measuring hemodynamic function following the manipulating step. In another embodiment, the method further comprises the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function. There is provided in accordance with another aspect of the present invention a method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall. The method comprises the steps of positioning a device in the vessel; rotating at least a part of a forming element within the device to cause a central portion of the device to travel laterally with respect to a proximal and a distal portion of the device, thereby exerting a force against the adjacent tissue structure; and deploying the device within the vessel. In one embodiment, the positioning step is accomplished percutaneously. In another embodiment, the tissue structure comprises the mitral valve annulus. In another embodiment, the tissue structure comprises the left ventricle. In yet another embodiment, the vessel comprises a vein. There is provided in accordance with another aspect of the present invention a method of performing annuloplasty of the mitral valve. The method comprises positioning a prosthesis in a curved portion of the coronary sinus; engaging a proximal tissue anchor and a distal tissue anchor on the device into tissue on an inside radius of the curve; manipulating a first portion of the device with respect to a second portion of the device to provide a compressive force on the inside radius of the curve in between the first and second anchors; and securing the device to maintain the compressive force within the coronary sinus. In one embodiment, the method further comprises the step of percutaneously accessing the venous system prior to the positioning step. In another embodiment, the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins. In another embodiment, the securing step comprises engaging a first threaded surface with a second threaded surface. In another embodiment, the securing step comprises providing an interference fit. In another embodiment, the securing step comprises providing an adhesive bond. In another embodiment, the securing step comprises providing a knot. In yet another embodiment, the securing step comprises providing a compression fit. In one embodiment, the method further comprises the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the positioning step. In one embodiment, the method further comprises the step of measuring hemodynamic function following the manipulating step. In yet another embodiment, the method further comprises the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function. There is provided in accordance with one aspect of the present invention a method of performing transluminal mitral annuloplasty. The method includes the steps of: providing a catheter, having a prosthesis thereon; inserting the catheter into the venous system; transluminally advancing the prosthesis into the coronary sinus; advancing at least one tissue anchor from a retracted position to an extended position; and manipulating a component of the prosthesis to cause the prosthesis to exert force on the mitral valve annulus. In one embodiment, the method further comprises the step of percutaneously accessing the venous system prior to the transluminally advancing step. In one embodiment, the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins. In one embodiment, the method further comprises the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the inserting step. The method may further comprise the step of measuring hemodynamic function following the manipulating a component of the prosthesis step. In another embodiment, the method further comprises the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function. In another embodiment, the advancing at least one tissue anchor step comprises advancing the anchor from an axial orientation to an inclined orientation. In another embodiment, the tissue anchor has a proximal end for piercing tissue and a distal point of attachment to the prosthesis, and the advancing at least one tissue anchor step comprises rotating the anchor about the point of attachment. In one embodiment, the method comprises advancing at least one tissue anchor to an extended position. The method may also comprise advancing at least two tissue anchors to an extended position. In one embodiment, the manipulating a component of the prosthesis step causes the prosthesis to transform into a curved configuration having a first side facing towards the mitral valve annulus and a second side facing away from the mitral valve annulus. In one embodiment, the method additionally comprises the step of advancing at least two tissue anchors in the direction of the mitral valve annulus. In another embodiment, a first tissue anchor inclines outwardly from the prosthesis in a distal direction and a second tissue anchor inclines outwardly from the prosthesis in a proximal direction. In another embodiment, the manipulating step comprises axially moving a forming element with respect to the prosthesis, to bend the prosthesis. In another embodiment, the method further comprises the step of locking the prosthesis to retain a force on the annulus following the manipulating step. In one embodiment, the locking step comprises moving an engagement surface from a disengaged configuration to an engaged configuration. In another embodiment, the locking step comprises providing an interference fit. In another embodiment, the locking step is accomplished with a threaded engagement. In one embodiment, the step of monitoring hemodynamic function is accomplished using transesophageal echo cardiography. In another embodiment, the step of monitoring hemodynamic function is accomplished using surface echo cardiographic imaging. The step of monitoring hemodynamic function may be accomplished using intracardiac echo cardiographic imaging, fluoroscopy with radiocontrast media, or left atrial or pulmonary capillary wedge pressure measurements. There is provided in accordance with another aspect of the present invention a method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall, the vessel wall having a first side and a second side. The method comprises the steps of positioning a device in the vessel; advancing a proximal tissue anchor from the device into the first side; advancing a distal tissue anchor from the device into the first side; and manipulating a forming element within the device to cause the device to exert a force against the first side of the wall of the vessel in between the proximal anchor and the distal anchor. In one embodiment, the positioning step is accomplished percutaneously. In another embodiment, the tissue structure comprises the mitral valve annulus, or the left ventricle. In one embodiment, the vessel comprises a vein. There is provided in accordance with another aspect of the present invention a method of performing annuloplasty of the mitral valve. The method comprises positioning a prosthesis in the coronary sinus; rotating a first portion of the device with respect to a second portion of the device to cause the device to bend into an arcuate configuration having a proximal concavity and a distal concavity both concave toward the mitral valve and a central concavity concave away from the mitral valve, to provide a compressive force on the mitral valve annulus; and securing the device in the arcuate configuration within the coronary sinus. In one embodiment, the method further comprises the step of percutaneously accessing the venous system prior to the positioning step. In one embodiment, the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins. In one embodiment, the securing step comprises engaging a first threaded surface with a second threaded surface. In another embodiment, the method further comprises the step of measuring hemodynamic function following the rotating step. In one embodiment, the method further comprises the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function. There is provided in accordance with another aspect of the present invention a medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus. The apparatus comprises an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions configured to move between a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus and a second remodeling configuration in which each of the proximal and distal end regions forms a curve which is open in the direction of the mitral valve; and a forming element for manipulating the elongate body between the first transluminal configuration and the second remodeling configuration. In one embodiment, the elongate body comprises a tube having a plurality of transverse slots therein. In another embodiment, the elongate body transforms into the remodeling configuration by changing the width of the slots. In another embodiment, the medical apparatus further comprises a coating on the body. In yet another embodiment, the apparatus is movable from the implantation configuration to the remodeling configuration in response to proximal retraction of the forming element. In one embodiment, the apparatus is movable from the implantation configuration to the remodeling configuration in response to distal advancement of the forming element. In another embodiment, the apparatus is movable from the implantation configuration to the remodeling configuration in response to rotation of a threaded shaft. In another embodiment, the medical apparatus further comprises an anchor for retaining the apparatus at a deployment site within a vessel. In yet another embodiment, the anchor comprises a distal extension of the apparatus, a surface structure for engaging the wall of the vessel, or at least one barb for piercing the wall of the vessel. In one embodiment, the medical apparatus comprises a first barb on the proximal end region and a second barb on the distal end region. There is provided in accordance with another aspect of the present invention an implant for positioning within a patient. In one embodiment, the implant comprises an elongate flexible body having a proximal end and a distal end, and a longitudinal axis extending therebetween, and first and second opposing sides extending along the implant body; the first side having at least one fixed axial length section, and the second side having at least one fixed axial length section, axially offset from the fixed axial length section on the first side; at least a first forming element extending through the body to a distal point of attachment to the body; and a detachable coupling on a proximal portion of the body, for removably attaching the body to a deployment catheter; wherein manipulation of the first forming element deflects at least a first portion of the body away from the longitudinal axis. In one embodiment, the body comprises a tubular wall. In another embodiment, the implant includes a plurality of voids in the wall along the second side, opposing the fixed axial length section on the first side, thereby permitting adjustment of the axial length of the second side. In another embodiment, at least some of the voids comprise slots through the wall, extending generally transverse to the longitudinal axis. In another embodiment, the implant comprises at least 10 transverse slots in the wall of the second side, or at least 20 transverse slots in the wall of the second side. In one embodiment, the first forming element comprises an axially movable element or a pull wire. There is provided in accordance with one aspect of the present invention a system for remodeling a mitral valve annulus. The system includes a delivery catheter, an implant and a control on the catheter. The implant is detachably carried by the delivery catheter. The implant is reversibly movable between a first, flexible configuration for delivery to a site adjacent the annulus of the mitral valve and a second, rigid configuration for remodeling the mitral valve annulus. The control on the catheter is for reversibly transforming the implant between the first flexible configuration and the second remodeling configuration. In one embodiment, the implant comprises an arc when in the remodeling configuration. In another embodiment, a best fit constant radius curve corresponding to the arc has a radius within the range of from about 10 mm to about 20 mm. In another embodiment, the implant comprises a compound curve when in the remodeling configuration. In one embodiment, the compound curve comprises a "w" configuration. In one embodiment, the system further comprises a coating on the implant. In another embodiment, the system further comprises an anchor for retaining the implant at a deployment site. In one embodiment, the anchor comprises a distal extension of the implant, a friction enhancing surface structure for engaging adjacent tissue, or at least one barb for piercing the wall of the vessel. In one embodiment, the barb is moveable between an axial orientation and an inclined orientation. Further features and advantages of the present invention will become apparent to those of skill in the art in view of the detailed description of preferred embodiments which follows, when considered together with the attached drawings and claims. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a schematic illustration of the heart, showing one embodiment of the mitral annuloplasty device of the present invention deployed within the coronary venous system. FIGS. 2A and 2B are schematic illustrations of the mitral annuloplasty device shown in FIG. 1, in second and first configurations. FIG. 3 is a side elevational view of an implant and deployment catheter according to the invention. FIG. 4 is a segmented view of the assembly shown in FIG. 3, and shows an enlarged fragmentary view of an implant attachment region of the assembly. FIG. 5 shows a transverse cross-sectional view taken along 5--5 in FIG. 4. FIG. 6 shows a perspective view of a proximal region of an implant according to the invention. FIG. 7 shows a partially cross-sectioned side view of a region of a device assembly similar to that shown in FIG. 6. FIG. 8A shows a partially cross-sectioned side view of an implant, in a first configuration during a first mode of use. FIG. 8B shows a similar view as that shown in FIG. 8A, with the implant in a second configuration during a second mode of use. FIGS. 9A B show side elevational schematic views of a distal end portion of a delivery assembly coupled to an elongate body, and show the elongate body during two modes of operation, respectively. FIG. 9C shows a side elevational view of a portion of the implant shown in FIG. 9A. FIG. 9D shows a cross sectional view taken along line 9D--9D in FIG. 9C, showing an interlocking transverse slot pattern. FIG. 9E shows a cross-sectional view through the line 9E--9E of FIG. 9D. FIG. 9F is a fragmentary cross sectional view of a connection between a forming or deflection element and an elongate body. FIG. 9G shows a fragmentary schematic view of two interlocking segments according to one specific mode for the elongate body shown in FIGS. 9A F. FIG. 10 is a bottom plan view of an alternative medical device including a delivery assembly, comprising a handle assembly and a shaft, and an implant configured for remodeling a mitral valve. FIG. 11 is a cross section of the shaft of the medical device of FIG. 10 taken along the view line 11--11 of FIG. 10. FIG. 12 is an enlarged view of a portion of the medical device of FIG. 10, including the implant and a connection assembly for removably connecting the implant to the delivery assembly. FIG. 13 is an enlarged view of the connection assembly of the medical device of FIG. 12. FIG. 13A is a cross section view of the male connector of FIG. 13. FIG. 13B is a cross section view taken along view line 13B--13B of FIG. 13. FIG. 13C is a partial cross section view taken along view line 13C--13C of FIG. 13. FIG. 13D is a cross section view taken along view line 13D--13D of FIG. 13. FIG. 14 is a plan view of a rotational driver of the delivery assembly of the medical device of FIG. 10, viewed apart from the medical device. FIG. 15 is an end elevational view of a hex-shaped distal end of the driver of FIG. 14, taken along the view line 15--15 of FIG. 14. FIG. 16 is a cross section view of a handle assembly of the medical device of FIG. 10. FIG. 17 is a cross sectional view taken along the view line 17--17 of FIG. 16. FIG. 18 is a plan view of a portion of the handle assembly of FIG. 16 taken along the line 18--18 of FIG. 16. FIG. 19 is a plan view of a slot pattern for an implant such as that of FIG. 10. FIG. 20 is an enlarged view of the slot arrangement of FIG. 19. FIG. 21 is a cross sectional view of another implant in accordance with the present invention. FIG. 22 is a side elevational view of the device of FIG. 21, in an actuated orientation. FIG. 23 is a side elevational view of an implant similar to that shown in FIG. 22, in the implanted configuration, having an expandable basket thereon for securement in a vessel. FIG. 24 is a side elevational fragmentary view of an implant, illustrating a plurality of axial foreshortening voids. FIG. 25 is a side elevational view of an implant in accordance with the present invention, having a plurality of compression elements and/or securement members thereon. FIG. 26 is a side elevational view of an implant in accordance with the present invention, having an alternate compression element thereon. FIG. 27 is a side elevational view of an alternative implant in accordance with the present invention. FIG. 28 is an enlarged fragmentary cross sectional view of a portion of the implant illustrated in FIG. 27. FIG. 29 is a cross sectional fragmentary view of a distal anchor assembly in accordance with the present invention. FIGS. 30A and 30B are schematic views of an alternate implant in accordance with the present invention. FIG. 31A is a side elevational view of an alternative implant in accordance with the present invention. FIG. 31B is a cross-sectional view taken along line 31B--31B of FIG. 31A. FIG. 31C is a plan view of a ratchet strip for use with the implant of FIGS. 31A and 31B. FIG. 31D is a plan view of a disconnect sub-assembly for use with the ratchet strip of FIGS. 31A C. FIG. 31E is a cross-sectional view taken along line 31E--31E in FIG. 31D. FIG. 31F is a plan view showing the catheter coupling of the implant of FIGS. 31A B FIG. 32A is a cross-sectional view of a proximal deployment handpiece. FIG. 32B is a partial cross-sectional view of the proximal deployment handpiece of FIG. 32A rotated 90 degrees. FIG. 33 is a side elevational view of an alternative implant in accordance with the present invention. FIG. 34 is a side elevational close-up view of the distal end of the implant of FIG. 33. FIG. 35 is a side elevational close-up view of the proximal end of the implant of FIG. 33. FIG. 36 is a side elevational cutaway view of an alternative implant in accordance with the present invention. FIG. 37 is a close-up view of the proximal end of the implant of FIG. 36. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT Preferred embodiments of the present invention include a method and apparatus for performing mitral annuloplasty and remodeling of the left ventricle using a device that may be introduced percutaneously, and placed within the coronary venous system of the heart. The device exerts compressive force on the mitral annulus and left ventricle, reducing the severity of mitral regurgitation and the size of the left ventricular cavity. The device thus enables reduction of the mitral annulus and constraint of the diastolic expansion of the left ventricle yet without the morbidity and other risks associated with open chest surgery. Additional details are disclosed in the parent application Ser. No. 10/066,302, filed on Jan. 30, 2002, the disclosure of which is incorporated in its entirety herein by reference. The present inventors have determined that the coronary sinus and veins provide an ideal conduit for the positioning of an intravascular prosthesis, or implant, for remodeling the mitral annulus, since they are positioned adjacent the mitral annulus and interventricular septum. As used herein, the term "implant" is a broad term, and should not be limited to a permanently introduced structure or device, but could additionally be a temporarily introduced device. The coronary sinus is contained within the atrioventricular groove, and is in close proximity to the posterior, lateral and anterior aspects of the mitral annulus. The coronary sinus and coronary veins are cannulated currently during any of a variety of percutaneous transvenous diagnostic and therapeutic procedures. Permanent placement of pacemaker and defibrillator leads within the coronary sinus and veins is both safe and well tolerated. The annuloplasty system consists of several components. Desirably, there is a delivery system intended to be introduced percutaneously into a central vein such as the internal jugular, subclavian or femoral veins and to cannulate the coronary sinus. The implant of the present invention is deployed from the delivery system, preferably a delivery catheter, into the coronary venous system or into a position within or adjacent the myocardium, to influence the annulus of the mitral valve. Additional tools may be placed through or along the delivery catheter to position the device, apply elements in place, and to control and/or cut tensioning elements (if provided) from the delivery system, as will be discussed in detail below. Referring to FIG. 1, there is illustrated a schematic view of the heart 10, having a preferred embodiment of a mitral annuloplasty and cardiac reinforcement device 40 positioned therein. The heart 10 generally comprises a right atrium 12, in communication with the superior vena cava 14 and inferior vena cava 16. The left ventricle 18 is positioned below the left atrial appendage 20. Relevant portions of the coronary vasculature include the coronary sinus 22, which extends from the ostium 24 to the junction 26 of the coronary sinus and the great cardiac vein 28. There may be anastomotic connections 29 between the great cardiac vein 28 and the middle cardiac vein 30, as is well understood in the art. One embodiment of a mitral annuloplasty and cardiac reinforcement device 40 is illustrated generally in the coronary sinus 22. In particular, the device 40 extends from a proximal end 42 to a distal end 44. The proximal end 42 lies against the posterior aspect of the interatrial septum 46. The midportion 48 of the device 40 is positioned within the coronary sinus 22. The transitional section 50 of the device 40 lies at the junction 26 of the coronary sinus 22 and the great cardiac vein 28. The distal end 44 of the device 40 is lodged in the great cardiac vein 28. The transitional region 50 is designed to reside in the proximal portion of the great cardiac vein 28. By deflecting out of a plane defined by the coronary sinus 22, it serves as an anchor 52 and prevents the device 40 from slipping out of the coronary sinus 22 when tension is applied. This embodiment of an anchor 52 is, preferably, very flaccid and flexible, thereby minimizing the risk of erosion of the device 40 through the wall of the great cardiac vein or other aspect of the coronary venous system. The proximal end 42 of the device 40 lies outside the ostium 24 of the coronary sinus 22 and is desirably curved upward so as to anchor against the posterior aspect of the interatrial septum 46. Advantageously, the proximal end 42 of the illustrated device 40 is semicircular in shape and elliptical in profile so that no edges will promote erosion of adjacent tissue. As an alternative anchor 52 to the distal extension of the device 40, any of a variety of structures may be provided. In general, the deployed device 40 will contact the wall of the coronary sinus 22 along the inside radius of its arcuate path. Thus, a tissue contacting surface 54 on the concave side of the deployed device 40 may be provided with any of a variety of friction enhancing surface structures, such as a plurality of transverse ridges, teeth or other projections, or modified surface textures to enhance friction. Alternatively, tissue engaging or piercing structures such as barbs may be provided on the surface 54 to engage the wall of the coronary sinus 22 to resist movement of the device 40, as will be discussed. While use of such structures as anchors may provide some benefit in certain applications, embodiments herein shown and described are believed to be particularly useful in one aspect specifically because they operate without the need for such aggressive tissue engagement. It will be apparent to one of ordinary skill based upon this disclosure that the present embodiments provide independent device manipulation and shape control that allow for sufficient forces to be applied to the mitral valve without requiring the possibly harmful effects of puncturing and grabbing tissue within the sinus for the remodeling process. In one regard, the independent action of a barbless design allows for adjustment in both the tightening and loosening directions with reduced risk of significant tissue damage or erosion. In another regard, devices 40 according to at least certain embodiments beneficially maintains its length throughout its modified range of shapes while the sinus and adjacent valve annulus reduce their dimensions under the force of remodeling. In still a further regard, the independent action and lack of tissue piercing and grabbing anchors allow for the device to be removed from the patient after initial implantation within the sinus, such as for example in the event of complications or in applications intended to be temporary remedial measures, such as for bridging a patient to surgery. Further to this regard, various shapes and sizes of devices may be required in a given patient before the appropriate one is found according to the observed in vivo response to implantation. The specific dimensions, construction details and materials for the mitral annuloplasty and cardiac reinforcement device 40 can be varied widely, as will be appreciated by those of skill in the art in view of the disclosure herein. For example, dimensional adjustments may be made to accommodate different anatomical sizes and configurations. Materials and construction details can be varied to accommodate different tensioning mechanisms and other considerations. In general, the device 40 defines an overall length from proximal end 42 to distal end 44. Preferably, the length is within the range of from about 2 cm to about 10 cm in an embodiment such as that illustrated in FIG. 2 in which the anchor 52 comprises a distal extension of the body 66 for lodging within the great cardiac vein 28. One embodiment of the device 40 includes an elongate flexible body 66 about eight centimeters in length. In such an embodiment, the body 66 may be elliptical in cross section so that it will bend in a single plane when force is applied to the tensioning element within it, as will be discussed below. Distally the device 40 tapers and transitions to a round cross-section. Referring to FIGS. 2A B, there is illustrated an embodiment of the device 40 having a forming element 56, such as a wire, therein. Manipulation of the forming element 56 allows the device to be moved from a flexible orientation to enable percutaneous insertion into the vascular system and navigation into the coronary sinus (FIG. 2B), to an arcuate configuration for compressing at least a portion of the mitral annulus (FIG. 2A). The device 40 may be advanced from the first, flexible configuration to the second, arcuate configuration by either axial proximal retraction or distal advancement of the forming element 56 with respect to the body 66, depending upon the particular design. In general, the device 40 comprises an elongate flexible support 58, extending from a proximal end 42 at least as far as a point of attachment 60. The support 58 may be a portion of the body 66 or may be a distinct component as will be discussed. The support 58 has a fixed length, and is substantially axially non-compressible and non-expandable. Thus, proximal axial retraction of the forming element 56 relative to the proximal end of the support 58 will desirably cause the support 58 to deflect in a first direction, tending to bend the body 66 about an axis transverse to the longitudinal axis of the body 66. Distal axial advancement of the forming element 56 with respect to the support 58 will cause lateral deflection of the support 58 in a second direction, tending to permit the body 66 to straighten due to the inherent resiliency of the support 58. This basic steering configuration can be embodied in many forms, which can be optimized by those of skill in the art to suit a particular construction for the body 66 depending upon the desired dimensions and clinical performance. The forming element 56 extends from the proximal end 42 through the device 40 to the point of attachment 60. At the point of attachment 60, the forming element 56 is mechanically coupled, and preferably, directly coupled to the support 58. Alternatively, other suitable methods of attachment may be used. A proximal extension 64 of the forming element 56 extends from the proximal end 42 of the device 40, such as through an aperture 62. Proximal retraction of the forming element 56 through the aperture 62 causes the device 40 to bend from an implantation, or delivery orientation, for navigating the coronary vasculature during implantation, to a formed, or remodeling orientation for compression and constraint of the coronary sinus 22 and adjacent structures. In the formed, remodeling orientation, the device 40 preferably provides a compressive force against the mitral annulus as has been discussed. This is desirably accomplished by forming the device into an arcuate configuration. Generally, the best fit curve of constant radius to which the formed device conforms has a radius within the range of from about 1.0 cm to about 2.0 cm. The forming element may comprise any of a variety of materials and constructions, such as a polymeric or metal wire or strand, a multi-filament braided or woven line, a metal or polymeric ribbon, or other structure capable of retaining the device 40 under tension in the coronary sinus 22. The device 40 further comprises a support 58, which may be the body 66 of the device 40 or a separate element positioned therein. In an embodiment in which the support 58 is a separate element contained within the device 40, support 58 may comprise any of a variety of generally axially non-compressible elements such as a metal or polymeric wire or column, ribbon, or "bottomed out" (e.g., fully compressed) spring which facilitates lateral bending but inhibits axial compression upon proximal retraction of forming element 56. A metal ribbon comprising stainless steel, nitinol, or other known materials may be desired in certain embodiments, due to its ability to influence the plane of curvature of the device 40 when in the formed orientation. In the presently illustrated embodiment, the proximal extension 64 of the forming element 56 extends proximally throughout the length of a deployment catheter, to a control or free end which remains outside of the patient during the deployment procedure. Following placement of the device 40 in the coronary sinus, proximal traction on the proximal extension 64 will reconfigure the device 40 into the formed orientation within the coronary sinus, as will be discussed in connection with the method of use of preferred embodiments. After a sufficient tension has been placed on the coronary sinus 22, the forming element 56 is preferably locked in a fixed axial position with respect to the device 40, to resist distal movement of the forming element 56 through aperture 62. Any of a variety of suitable lock arrangements may be provided. Preferably, the lock 70 is provided on or near the proximal end 42, and, in particular, at or about the aperture 62. The lock may comprise any of a variety of structures, such as a suture knot, locking clamp or ring, an interference fit, ratchet and pawl structures, threaded engagement, an adhesive bond, or a compression fit, as will be apparent to those of skill in the art in view of the disclosure herein. The lock 70 (on any of the embodiments herein) may be initially disengaged, so that the forming element 56 may be retracted or advanced freely through the aperture 62 while the physician adjusts the tension on the device 40. After the desired tension is achieved, the lock 70 is activated to engage the forming element in a manner which will depend upon the lock design. Alternatively, the lock 70 may be biased into an engaged configuration, such as with ratchet or cam structures, so that the forming element can only be retracted proximally. Preferably, however, the lock will allow the forming element to be released so that the physician can release tension on the device 40 in the event of momentary over tightening. The forming element 56 and support 58, with or without the tubular body discussed below, may be surrounded by a tubular jacket of ePTFE or a polyester fabric such as DACRON, or other material which is wrapped or stitched onto the forming element 56 to produce the final device 40. As a further alternative, the subassembly which includes the forming element 56, and, if present, support 58 may be positioned within a suitable length of tubing formed such as by extrusion. The tubing may be drawn down to a reduced diameter at the distal end 44. Additional post extrusion steps may be used to produce the desired cross-sectional configuration. Manufacturing techniques for the present invention will be apparent to those of skill in the art in view of the disclosure herein. Any of a variety of additional features may be added to the device 40, depending upon the desired clinical performance. For example, the outside surface of the body 66 may be provided with any of a variety of coatings, such as poly-paraxylene, sold under the trademark PARALENE, PTFE or others to improve lubricity; heparin or other antithrombogenic agents; elastomers such as silicone, neoprene, latex or others to soften the surface and reduce the risk of trauma to the vascular intima, and the like. Adhesion enhancing surfaces may be provided, such as ePTFE patches or jackets, to promote cellular ingrowth for long term anchoring. In addition, depending upon the deployment system design, the body 66 may be provided with a guidewire lumen extending axially therethrough, to allow the body 66 to be advanced distally over a guidewire during placement at the treatment site. The device 40 may be implanted within the coronary sinus 22 either through direct surgical (e.g., thoracotomy, with or without sternotomy) access, such as in combination with another surgical procedure, via port access, or remotely by way of a percutaneous or surgical cut down access to the venous system. Preferably, the device 40 is implanted in a transluminal procedure, such as by way of a percutaneous access at one of the internal jugular, subclavian, or femoral veins. FIGS. 3 8B illustrate an exemplary device assembly 200. In general, FIG. 3 is an overall view of assembly 200 that includes a delivery assembly 210 engaged to a prosthesis, or implant 250. According to similar overall delivery systems and methods elsewhere herein described, prosthesis 250 is adapted to be delivered in a first condition and shape into a vessel at least in part by manipulation of delivery assembly 210. Once in the desired region of the target vessel, prosthesis 250 is adapted to be adjusted to a second condition and shape within the vessel in order to influence an adjacent tissue structure. As also elsewhere herein described, a particularly beneficial mode of such operation places the prosthesis 250 within a coronary sinus for the purpose of influencing a mitral valve annulus, more specifically in order to influence the shape of the annulus in order to reduce mitral valve regurgitation. FIGS. 4 7 show the proximal aspects of device assembly 200, and in particular various details for delivery assembly 210 that includes an outer member 215 that is preferably tubular with an inner lumen 216 that is preferably sized to house an inner member 225. Inner member 225 in the variation shown is generally tubular and is substantially free to rotate within lumen 216, preferably by providing rotational force to inner member 225 proximally outside of the patient's body. According to the example shown, this rotational force is applied to inner member 225 via a thumbwheel 205 that is provided on proximal hub assembly 201 coupled to proximal end portion 211 of delivery assembly 210. Thumbwheel 205 is rotationally coupled to inner member 225 within hub assembly 201, which rotational coupling may be achieved according to a number of adaptations as would be apparent to one of ordinary skill. Rotation of inner member 225 is transmitted into rotation of a rotational coupler 280 that is engaged within a proximal end portion 252 of prosthesis 250 as follows. Inner member 225 has an aperture 228 on its distal end portion that provides a female counterpart of a mated key interface between the inner member 225 and a male counterpart, desirably provided by a shaped proximal end 281 of a rotational coupler 280 that is also rotationally engaged within a proximal end portion 252 of prosthesis 250. The keyed fitting between inner member 225 and rotational coupler 280 allows for transmission of rotational forces to rotational coupler 280. In order to maintain releasable axial engagement of this keyed coupling, a flexible member such as a filament 240 is looped through an aperture 283 through proximal end 281 of rotational coupler 280 with both filament ends 242 and 244 extending proximally through inner member 225 to a location in the proximal end of the catheter. The filament 240 is generally held in sufficient tension to keep the distal keyed fitting engaged, though it is further contemplated that the mere presence of the filament may provide an interference against uncoupling if there is a sufficiently tight tolerance in the male/female interface of the keyed fitting. Rotational coupler 280 is rotationally engaged within proximal end portion 252 of prosthesis 250 through a proximal port, or aperture 251, such that the rotational coupler 280 is adapted to rotate within and relative to the prosthesis 250. This relative rotation is converted to force a deflection of prosthesis 250 into the desired shape of the second configuration in situ as follows. According to one aspect of the rotational coupling, the prosthesis 250 is preferably held to resist rotation while rotational coupler 280 is rotated within the prosthesis 250. This may be achieved simply by frictional forces of surrounding tissue after the prosthesis 250 has been delivered into the desired vessel such as the coronary sinus. According to another example, this may be achieved by providing a releasable interface such as a friction fit between outer member 215 and proximal end portion 252 of prosthesis 250 wherein the frictional engagement of outer member 215 and prosthesis 250 are held in a relatively fixed position while inner member 225 and rotational coupler 280 are rotated. This embodiment is shown in FIG. 4. In addition, or in the alternative to the friction fit interface, a keyed interface may be employed as shown in FIGS. 6 7. According to this mode, a shaped proximal fitting 253 on the proximal end 252 of prosthesis 250 is adapted to mate as a male counterpart into a shaped aperture or fitting on the distal end 212 of outer member 215. This keyed interface allows for rotational coupling between the members in a similar manner as just described for the inner member 225 and rotational coupler 280, and may allow for a more releasable coupling with reduced friction upon axial detachment of the members. The rotational forces from rotational coupler 280 may be converted to deflection forces on the prosthesis 250 according to one example as illustrated in FIGS. 8A B. Prosthesis 250 includes a generally tubular wall or body 260 that has an inner lumen 262 and extends from the proximal end portion 252 to the distal end portion 254 of prosthesis 250. Secured along proximal end portion 252 is a nut fitting 263 that has a grooved inner bore 264 which communicates with inner lumen 262. Further to this specific embodiment, rotational coupler 280 is a screw member with outer helical threads 285 engaged within the mating threads of an inner surface (not shown) of a bore lumen such that a distal portion of screw threads 285 extends distally within lumen 262 and terminates at a second key fitting 287 similar to the shaped proximal end portion 282 and also having an aperture 288. Similar to the proximal end of rotational coupler 280, another flexible member or filament 290 is looped through aperture 288 such that two arms 292, 294 extend distally therefrom to an attachment point along distal end portion 254 of prosthesis 250. Because nut fitting 263 is fixed in relation to outer tubular body 260, and because that tubular body is held in a relatively fixed position as provided above, rotation of rotational coupler 280 moves coupler 280 proximally relative to body 260. This proximal axial translation of rotational coupler 280 puts tension on filament 290, which puts tension on the body 260 due to the distal attachment. This tension on outer body 260 forces a deflection of the body 260. Therefore, rotational force is converted into a tensile force which, in turn, causes radial deflection of the body 260 relative to the longitudinal axis L of the device 250. In other words, the body 260 is deflected about an axis that is transverse to the longitudinal axis L. See FIG. 8B. The forced deflection described immediately above may be controlled in a particular plane by providing a composite structure within prosthesis 250 that is engineered to respond, e.g., yield, to these forces in a prescribed way. In the specific embodiment shown, a relatively noncompressible column support or spine member 270 is provided within lumen 262 of outer tubular body 260. This spine member 270 is more rigid and more resistant to axial forces, especially tensile forces, than the material of outer tubular body 260 alone. Therefore, providing spine member 270 along only one radial position along the circumference of the prosthesis 250 creates a bias on the device 250 to deflect away from the spine 270 toward a more compressive region of the device 250. Such composite design may further include a laminate structure, a composite structure--such as an imbedded wire reinforced wall structure, or may be achieved by engineering material variations in the device, such as for example by thinning, thickening, hardening, or softening the material at one location along the outer tubular body 260 relative to another region to urge the body 260 to deflect at a desired location. As may be achieved by other controllable embodiments elsewhere herein described, deflection according to the present embodiment may be adjusted according to a healthcare provider's desires, and is adjustable in either direction--by either tightening the radius of curvature R or opening it. See FIG. 8B. According to this specific embodiment however, the adjustability of and choice between tightening and loosening of the deflection depends upon the direction and extent of rotation placed upon the rotational force transmission system. Once the desired deflection is achieved and desired therapeutic results are observed, the prosthesis 250 may be detached from the delivery assembly 210 by severing the torque or rotational force transmission system at the keyed fitting between the inner member 225 and the rotational coupler 280. This is accomplished by first releasing at least one arm 242, 244 of the proximal filament 240 while withdrawing the other arm, thereby threading the filament 240 through aperture 283 (as shown in bold arrows in FIG. 8B) until it is unthreaded completely from the aperture 283. This allows inner member 225 to be withdrawn proximally from rotational coupler 280 to detach and thereby implant the prosthesis 250. Alternatively, as with other adjustable deflection systems herein described, the prosthesis may be held in its therapeutic condition for a temporary period of time (which may nevertheless be prolonged during a hospital stay), during which time mitral valve regurgitation may be minimized, such as for example for the purpose of bridging the patient in a temporarily improved condition until other treatments may be performed, e.g. annuloplasty, valve surgery, heart transplant, etc. In this alternative temporary setting, at the appropriate time the deflected, contracted prosthesis may be adjusted back open from its cinched position around the valve, and then withdrawn without implantation by withdrawing the entire system, delivery assembly still engaged to the prosthesis. Moreover, it is further contemplated that such a temporary prosthesis may be modified to remove the detachment mechanisms herein described, which may provide for a simpler and lower cost device. Device assembly 200 is also shown in FIGS. 3 and 8A B to include a distal guidewire tracking member with a guidewire lumen 265 which is adapted to slideably engage a guidewire 230 in order to be placed in a percutaneous transluminal procedure into the desired vessel location, such as within the coronary sinus 22. The particular guidewire lumen shown is integral within the distal aspects of prosthesis 250 as a "rapid exchange" or "monorail" design that allows for relatively independent movement of the guidewire and catheter in vivo. Moreover, this design removes the need for the guidewire to ride coaxial through the entire device assembly 200, as would be the case for example in an "over the wire" type system. The type shown beneficially allows for detachable engagement of prosthesis 250, which is preferably achieved after withdrawing the optional guidewire 230 from the distal lumen 265. In each of the foregoing implantation methods, the physician preferably monitors the degree of regurgitation during the step of tightening the implant. Although any reduction in mitral regurgitation may be desirable, regurgitation is preferably reduced to something less than moderate (less than 2+). In any event, at least a one grade reduction is preferably achieved. On the other hand, reconfiguration of the implant 250 is desirably not accomplished to an extent sufficient to produce mitral stenosis, or any flow limitation of hemodynamic significance. Thus, the method of implantation preferably further comprises the steps of monitoring the degree of mitral regurgitation during, and preferably also before and following the implantation and/or reconfiguration steps. The degree of mitral regurgitation may be monitored such as by transesophageal echo cardiography, intracardiac echo cardiography, fluoroscopy using radiocontrast in the left ventricle (LVgram), or left atrial or pulmonary capillary wedge pressure tracings, as are understood in the art, during the incremental restriction of the mitral annulus and/or left ventricle step. Once a sufficient reduction in regurgitation has been achieved for a particular patient in the physician's judgement, the device 250 may be locked and the delivery assembly 210 detached from the device 250 and removed from the patient. The method may additionally comprise the step of measuring the coronary sinus 22 and/or other coronary vein, and selecting an appropriately sized implant 250 from an array of implants of varying sizes. Such parameters may include diameter, length, or radius of curvature of the arc of the |