A multi-center study of the safety and efficacy of the percutaneous transvenous mitral annuloplasty system to reduce mitral valve regurgitation in patients with heart failure.

1. Patient has moderate functional MR: regurgitant orifice area >/= 0.20cm2 or regurgitant volume >/= 30 mL/beat or regurgitant fraction >/= 30%.
2. Symptomatic heart failure NYHA Class II to IV
3. LV dysfunction (25% < LVEF < 50% by echocardiography)
4. Age >/= 50 Years.
5. Patient has signed the informed consent agreement.

Exclusion Criteria
1. Mitral regurgitation of organic origin such as: degenerative disease (prolapse), rheumatic disease (commissural fusion, shortening and thickening of the subvalvular apparatus), endocarditis, flail segments, congenital mitral disease, significant annular calcification, significant pathology of the chords.
2. Severe mitral leaflet tethering.
3. Valvular apparatus cannot be visualized by 2D transthoracic echo. Valvular regurgitation cannot be quantified by 2D echo PISA or Doppler techniques.
4. Serious allergy to intravenous contrast agents or serious renal dysfunction (glomerular filtration rate less than 30 ccs/minute, as calculated by the Cockroft-Gult equation), or otherwise major contra-indication for contrast angiography.
5. History of myocardial infarct (MI) within 60 days prior to study procedure.
6. History of PCI within 60 days prior to study procedure.
7. Patient is not capable of walking 100 meters in 6 minutes.
8. Patient cannot complete the QOL survey with a meaningful score.
9. Indication of left-dominant coronary circulation with angiography.
10. Significant (>30% occluded) Left Main stenoses or proximal circumflex stents unless affected area has been by-passed surgically.
11. Indication of non-patent CSO or discontinuous CS-GCV-AIV with venography, MRI, or cardiac CT.
12. Planned CABG or mitral valve surgery or planned biventricular pacemaker requiring placement of leads in the coronary sinus.
13. Existing bi-ventricular pacemaker with leads in the coronary sinus or its tributaries. Presence of instrumentation that in the clinician*s judgment will either impede safe placement of the study device, and/or will be dislodged or will malfunction as a result of placement of the study device.
14. Existing prosthetic mitral valve implant or annuloplasty ring.
15. Acute systemic infection (including septicemia or leukocytosis greater than 15,000/dL), active infections including endocarditis or fever greater than 38.5° C.
16. Chronic steroid use or intravenous steroid use within the past 60 days.
17. Major organ system disease such as hepatic dysfunction including cirrhosis, esophageal varices, or severe chronic obstructive pulmonary disease (COPD), at least GOLD stage III or greater.
18. History of major thrombo-embolic event within past three months (i.e. cerebral-vascular event, stroke, pulmonary or arterial embolism).
19. Existing bleeding diathesis: elevated PT INR (>1.5), elevated aPTT, platelet count <100,000, unless this can be adjusted with a change to existing medication.
20. Patient refuses blood products.
21. Patient has a significant gastrointestinal (GI) bleed within the past three months.
22. Uncontrolled thyroid disease.
23. Severe autoimmune system disease or history of hypercoagulable state.
24. Participation in a drug or device trial if such participation would impact the PTMA* study and follow-up.
25. Life expectancy of less than 1 year or any condition which, based on the investigator*s clinical judgment, would prevent the patient from completing required study procedures, including follow-up.
26. Female patients of childbearing potential if lactating, or with a positive pregnancy test within 7 days of planned procedure.
27. Patient requires emergency surgery, or is clinically unstable due to such causes as hemodynamic instability or significant active and uncontrolled angina.
28. Known inability to comply with baseline and follow-up requirements for imaging studies.
29. Known inability to comprehend the required consent documentation.