CN104000625B - Tricuspid valve prosthetic appliance - Google Patents
Tricuspid valve prosthetic appliance Download PDFInfo
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- CN104000625B CN104000625B CN201310317260.7A CN201310317260A CN104000625B CN 104000625 B CN104000625 B CN 104000625B CN 201310317260 A CN201310317260 A CN 201310317260A CN 104000625 B CN104000625 B CN 104000625B
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- tricuspid
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Abstract
The invention provides a kind of equipment for treating tricuspid regurgitation and method.Specifically: the present invention provides equipment and the method for correct position location in tricuspid annulus at certain aspect；The present invention provides a kind of tricuspid annulus that passes in determined position in yet another aspect and arranges equipment and the method for wire；The present invention provide in yet another aspect a kind of through determined position, launch to organize the equipment of anchor and method；Meanwhile, the present invention additionally provides a kind of pulling force that applies on these tissue anchors two or more in yet another aspect to reduce equipment and the method for the girth of tricuspid annulus.Use method provided by the present invention, backflow injection can be reduced or eliminated.
Description
Technical field
The present invention instructs the equipment relating generally to be repaired valve by less invasive techniques.Some embodiment party that the present invention instructs
Formula relate to repair tricuspid equipment by less invasive techniques.
Background technology
Tricuspid valve disease relates to the shape of the valve cisco unity malfunction between two right cardiac cavities (i.e. right ventricle and right atrium)
Condition and would generally with occur other cardiac valve problems.One example of Tricuspid valve disease is tritubercular cycloid, wherein
Tricuspid valve can not normal switching-off and blood flowing right atrium.Another example is tricuspid stenosis, because Tricuspid valve is narrow,
Which reduce the blood volume flowing back to right ventricle.Another example is tricuspid atresia, and this is a kind of congenital heart disease, patient tissue
Solid wall plug blood flowing between two right cardiac cavities.Also having an example is Ebstein's anomaly (Tricuspid valve
Move down deformity Ebstein's anomaly), wherein the tricuspid position of deformity is less than the normal position of right ventricle, causes blood
Liquid stream returns right atrium.Other Tricuspid valve diseases that those skilled in the art know altogether and treatment embodiment, also letter includes in the present invention
Guidance in.
Tricuspid valve disease can be corrected by valve forming ring.In some cases, this equipment be better than surgical repair lack
The Tricuspid valve fallen into.Valve forming ring is the most correct a kind of solid (3D) ring, it is possible to the cardiac valve that coincide flexibly is opened
The structural requirement of mouth.The Tricuspid valve of the implanted existing defects of this ring reduces valve orifice.After correct implantation, valve forming
Ring can make valve normally open and close.
Tricuspid valve prosthesis can realize with any one in following two mode: Minimally Invasive Surgery or open heart hands
Art.Invasive methods is included in upper breast or pectus forms little otch and inserts valve repair system/device.Valve repair
After, this otch uses dissolubility stitching thread Guan Bi.The advantage of Wicresoft's method is that healing time is short, postoperative pain is less, can be earlier
Return to working condition and carry out normal daily routines.
Summary of the invention
The aspect that the present invention instructs provides a kind of for reducing three by Percutaneous Techniques (also referred to as " percutaneous ")
The method of cusp ring girth.The method includes multiple step, and the order of its step can change, and it can instruct in the present invention
In the range of omit or revise.One illustrative steps includes being positioned in right ventricle wire delivery conduit through Tricuspid valve.Separately
One illustrative steps is included in primary importance by the tricuspid annulus inside the distal contact right ventricle of wire delivery conduit.Another
Individual illustrative steps be included in first position by one end of wire from right ventricle through tricuspid annulus to right atrium, lead there
Line is through the axial lumen of wire delivery conduit.Another illustrative steps includes the capture device by launching inside right atrium
The end of capture wire.Another illustrative steps includes that proximad retraction capture device is with by outside the end lead body of wire.
Another illustrative steps includes the first tissue anchor delivery conduit following up on wire and extends this first tissue anchor delivery conduit
Cross tricuspid annulus, thus the far-end of the first tissue anchor delivery conduit is positioned at right ventricle.Another illustrative steps includes leading to
Cross the extremity so that the first tissue anchor inside right ventricle against tricuspid annulus location and the proximal portion of this tissue anchor from the right side
The first tissue anchor is launched against tricuspid annulus location inside atrium.Another exemplary step includes by the retracted of wire extremely
The axial lumen of wire delivery conduit.
Another illustrative steps is included in the second position and wire delivery conduit is positioned so that wire delivery conduit
Tricuspid annulus inside distal contact right ventricle.Another illustrative steps includes advancing through the end of wire from right ventricle
Tricuspid annulus is to right atrium.Another exemplary step includes the end being captured wire by the capture device launched in right atrium
End.Another illustrative steps includes that proximad retraction capture device is with by outside the end lead body of wire.Another is exemplary
Step includes the minor microstructure anchor delivery conduit on wire that follows up.Another illustrative steps be included in the second position extend this
Two tissue anchor delivery conduits are through tricuspid annulus, thus the far-end of minor microstructure anchor delivery conduit is positioned at right ventricle.Another
Illustrative steps includes by making the extremity of minor microstructure anchor position and this tissue against tricuspid annulus inside right ventricle
The proximal portion of anchor launches minor microstructure anchor against tricuspid annulus location inside right atrium.Another exemplary step includes reducing
Distance between first and second tissue anchors.
In other embodiments, a kind of method for percutaneous minimizing tricuspid annulus girth includes multiple step, its step
Rapid order can change, and can omit or revise in the range of the present invention instructs..One illustrative steps includes positioning
Conduit is positioned in right ventricle through Tricuspid valve.Another illustrative steps is included in remote by this location conduit of first position
Tricuspid annulus inside end in contact right ventricle.Another illustrative steps is included at first and advances wire delivery conduit to right
In atrium, relative and in right atrium interior side contacts tricuspid annulus with the far-end of location conduit by the far-end of wire delivery conduit.
Another illustrative steps is included in first position and the far-end of wire travels across from right atrium the right ventricle of tricuspid annulus,
Wire is through the axial lumen of wire delivery conduit there.Another illustrative steps includes the first tissue following up on wire
Anchor delivery conduit.Another illustrative steps includes that wherein the far-end of the first tissue anchor delivery conduit is positioned at through tricuspid annulus
Inside right ventricle.Another illustrative steps includes by making the extremity of the first tissue anchor against tricuspid inside right ventricle
The proximal portion of annulus location and this tissue anchor launches the first tissue anchor against tricuspid annulus location inside right atrium.Another
Individual illustrative steps includes in the axial lumen of the retracted of wire to wire delivery conduit.Another illustrative steps bag
Include in the second position by the tricuspid annulus in the distal contact right ventricle of location conduit is arranged location conduit.Another shows
Example step is included in second position positioning lead delivery conduit entrance right atrium makes the far-end of wire delivery conduit lead with location
The far-end of pipe is relative, and the tricuspid annulus inside contact right atrium.Another illustrative steps includes the far-end of wire from the right side
Atrium advances through tricuspid annulus to right ventricle.Another illustrative steps is included in second on second position follow-up wire
Tissue anchor delivery conduit, and through tricuspid annulus, wherein the far-end of minor microstructure anchor delivery conduit is positioned at inside right ventricle.Another
Individual illustrative steps includes by making the extremity of minor microstructure anchor position against tricuspid annulus inside right ventricle and be somebody's turn to do
The proximal portion of tissue anchor launches minor microstructure anchor against tricuspid annulus location inside right atrium.Another exemplary step bag
Include the distance reduced between the first and second tissue anchors.
In other embodiments, a kind of method for percutaneous minimizing tricuspid annulus girth includes multiple step, its step
Rapid order can change, and can omit or revise in the range of the present invention instructs.One illustrative steps includes wire
Delivery conduit is positioned in right ventricle through Tricuspid valve, and the most double fork conduits are slidably arranged in the tube chamber of wire delivery conduit
In, the first wire is slidably arranged in the first catheter component of double fork conduit, and the second wire is slidably arranged in double fork
In second catheter component of conduit.Another illustrative embodiments includes the far-end of the first catheter component is arranged in first
Put.Another illustrative steps be included in first position by one end of the first wire from right ventricle travel across tricuspid annulus to
Right atrium.Another illustrative steps includes the second catheter component extending double fork conduit.Another illustrative steps is included in
Remotely located against tricuspid annulus by the second conduit of second position.Another illustrative steps is included in second position will
One end of second wire travels across tricuspid annulus to right atrium from right ventricle.Another illustrative steps includes using capture to set
The end of standby capture the first and second wires.Another illustrative steps includes proximad retraction capture device and by first and
The end of two wires extends external.Another illustrative steps includes the first tissue anchor delivery conduit following up on the first wire
And the minor microstructure anchor delivery conduit that second on wire.Another illustrative steps includes through tricuspid annulus, wherein first
It is positioned at right ventricle with the far-end of minor microstructure delivery conduit.Another illustrative steps includes the first and second tissue anchors
Extremity is positioned against tricuspid annulus and by the proximal portion of the first and second tissue anchors inside right ventricle inside right atrium
The first and second tissue anchors are launched against tricuspid annulus.Another illustrative steps include reducing the first and second tissue anchors it
Between distance.
In other embodiments, a kind of method for percutaneous minimizing tricuspid annulus girth includes multiple step, its step
Rapid order can change, and can omit or revise in the range of the present invention instructs.One illustrative steps includes positioning
Conduit is positioned in right ventricle through Tricuspid valve, and the most double fork conduits are slidably disposed in the tube chamber of location conduit, and
This pair of fork conduit has the first catheter component and the second catheter component.Another illustrative steps includes the first catheter component
Remotely located in primary importance.Another illustrative steps is included in second position and extends the second conduit structure of double fork conduit
Part, and the far-end of the second catheter component is positioned against tricuspid annulus.Another illustrative steps includes leading first and second
Line delivery conduit marches in right atrium, wherein the far-end of the first and second wire delivery conduits and the first and second catheter components
Opposed.Another illustrative steps is included in the first and second positions and is in right atrium interior side contacts tricuspid annulus.Another shows
Example step is included in the first and second positions and from right atrium, the far-end of the first and second wires is travelled across tricuspid annulus
To right ventricle.Another illustrative steps includes the first and second tissue anchor delivery conduits following up on the first and second wires,
And through tricuspid annulus, wherein the far-end of the first and second tissue anchor delivery conduits is positioned at inside right ventricle.Another is exemplary
Step include by the extremity of the first and second tissue anchors inside right ventricle against tricuspid annulus location and by first and the
The proximal portion of two tissue anchors positions against tricuspid annulus inside right atrium, launches the first and second tissue anchors.Another shows
Example step includes reducing the distance etc. between the first and second tissue anchors.
Brief Description Of Drawings
Fig. 1 is the perspective view of the exemplary guider being percutaneously inserted right atrium instructed according to the present invention.
Fig. 2 a-2b is the perspective view of the exemplary lead delivery conduit inserting right ventricle instructed according to the present invention.
Fig. 3 a-3b is the perspective view of the exemplary acquisition equipment launched in right atrium instructed according to the present invention.
Fig. 4 a-4b is the perspective view of the exemplary lead through ring location instructed according to the present invention.
Fig. 5 is the perspective view of the capture instructed according to the present invention the exemplary lead being drawn through guider.
Fig. 6 is the perspective view of the exemplary lead through ring location instructed according to the present invention.
Fig. 7 a-7b is the perspective view of the exemplary location conduit inserting right ventricle instructed according to the present invention.
Fig. 7 c-7d is the perspective view of the exemplary lead through ring location instructed according to the present invention.
Fig. 8 a-8b is the perspective view of the exemplary location conduit inserting right ventricle instructed according to the present invention.
Fig. 9 is the perspective view of the exemplary lead through ring location instructed according to the present invention.
Figure 10 is the perspective view of the example organization anchor instructed according to the present invention.
Figure 11 a-11c is the perspective view of the example organization anchor launched through tricuspid annulus instructed according to the present invention.
Figure 12 a-12c is the perspective view of the example organization anchor launched through tricuspid annulus instructed according to the present invention.
Figure 13 a-13b is the exemplary side of exemplary second wire extending through tricuspid annulus instructed according to the present invention
The perspective view of method.
Figure 14 a-14b is the perspective of the exemplary minor microstructure anchor launched through tricuspid annulus instructed according to the present invention
Figure.
Figure 15 is the perspective view that two the example organization anchors launched through ring apply tension force instructed according to the present invention.
Figure 16 a-16f is to apply to open to the multiple example organization anchors launched through tricuspid annulus according to what the present invention instructed
The perspective view of the example of power.
Figure 17 is the perspective view of the exemplary pair of fork conduit instructed according to the present invention.
Figure 18 a-18b is, according to what the present invention instructed, by exemplary pair of fork conduit, two exemplary lead are passed tricuspid
The perspective view of the example that lobe is arranged.
Figure 19 a-19b is, according to what the present invention instructed, by exemplary pair of fork conduit, two exemplary lead are passed tricuspid
The perspective view of the example that lobe is arranged.
Detailed description of the invention
Describe below and some details illustrated in accompanying drawing explain each embodiment under the present invention instructs.
Various equivalent modifications can be implemented under present invention guidance in the case of lacking one or more details described herein
Other embodiments.Therefore, applicant be not intended to by scope of the following claims limit or limit by any way
Make to the specific descriptions of details.Although in an orderly manner the implementation process of each step having been carried out detailed retouching below with reference to accompanying drawing
State, but described step and sequence of steps and term thereof should not be regarded as all embodiment institutes of implementing present invention teach that
Necessary.
As used herein term: " tube chamber " represents the general tubular space in conduit, pipe or subject or chamber, including
Conduit, hollow needle, pipe, vascular, tremulous pulse, blood vessel, blood capillary, intestinal etc..
As used herein term: " nearside " represents Proximity operation person (less entering internal), " distally " represents remote
From operator (entering internal further).When being positioned in patients by armarium, " distally " represents away from conduit insertion position
The direction put, " nearside " represents the direction close on position.
As used herein term: " wire " can be line, rope, fiber, yarn, filament, cable, cotton thread etc., and this
A little terms can be used interchangeably.
As used herein term: " sheath " can also be described as " conduit ", therefore these terms can make interchangeably
With.
Describing below will be with reference to Fig. 1-19.Those of ordinary skill in the art need to understand that accompanying drawing and description thereof have referred to this
Each embodiment of bright guidance, unless be the most hereafter otherwise noted, does not limits scope of the following claims to accompanying drawing
And/or the description that it is done.
Illustrate unless otherwise specified, expression quantity, measured value and other attributes used in specification and claims
Or all numerals of parameter are construed as being modified by term " about " in all cases.Therefore, except as otherwise noted, it should
Know that the digital parameters illustrated in description below and appended claims is approximation, be according to the significant figure reported
The numerical value of word and for understanding rather than the application of doctrine of equivalents should being limited to claims of the technology that commonly rounds off
Scope..
The guidance of the present invention relate to a kind of equipment for treating tritubercular cycloid.The aspect that the present invention instructs carries
Supply at upper each embodiment (as shown in figures 1-19) positioning primary importance of tricuspid annulus (3).According to these embodiments,
Primary importance is near posterior lobe with every leaf joint or on the rear ring of posterior lobe and frontal lobe joint.
Other aspects that the present invention instructs provide each reality that wire is arranged on primary importance through tricuspid annulus (3)
Execute mode.According to the present invention instruct some embodiments, wire from right atrium to right ventricle (4) through tricuspid annulus (3) (as
Fig. 1 is to shown in 19).Some embodiments instructed according to the present invention, wire passes tricuspid annulus from right ventricle to right atrium (8)
(3) (if Fig. 1 is to shown in 19).The present invention direct tissue anchor (310a) is launched on wire (such as, as shown in fig. 11a) and
Through tricuspid annulus.Some embodiments instructed according to the present invention, interior at right ventricle (4) of extremity of tissue anchor (310a)
Side is launched, and the proximal portion of tissue anchor (310a) is launched in the inner side of right atrium (8).Some embodiment party instructed according to the present invention
Formula, the extremity of tissue anchor (310a) launches in the inner side of right atrium (8), and the proximal portion of tissue anchor (310a) is in right ventricle (4)
Inner side launch.
Other aspects that the present invention instructs provide and position the second position (30) in tricuspid annulus (3), by the second wire
Arrange through tricuspid annulus (3), then minor microstructure anchor (310b) (such as, as shown in figures 14a) launched through tricuspid annulus
Each embodiment.
Other aspects that the present invention instructs provide each embodiment reducing tricuspid annulus (3) girth.The present invention refers to
The illustrative methods led be by coming from suitable venous inlet position percutaneous access tricuspid annulus (3) from the beginning of.According to this
Some embodiments that invention is instructed, venous inlet position is positioned near jugular vein, is preferably from femoral vein entrance, closes from other
Suitable position entrance is time choosing.Some embodiments instructed according to the present invention, as schematically shown in Figure 1, by suitable guider
(12) guide to internal jugular vein, extend through right brachiocephalic vein, Superior vena cava arrival right atrium (8).Guider (12)
Far-end (10) is maintained in right atrium (8).The near-end (not shown) of guider (12) is maintained at external.Guider (12) has
There is the axial lumen (14) from the through whole length of its near-end to its far-end (10).The axial lumen (14) of guider (2) is used
Make conduit, it is allowed to one or more conduits are slidably disposed at wherein and provide the entrance entering right cardiac cavity.According to the present invention
Some embodiments instructed, guider (12) keeps location as schematically shown in Figure 1 during whole operation.According to the present invention
Some embodiments instructed, such as can be time during this operation, other appropriate device at such as wire keep this percutaneous entrance
Remove guider (12).According to some embodiments, guider (12) is the sheath of 12French (F).Real according to some
Executing mode, guider (12) is single-lumen sheath, and it can accommodate all further conduit and slide wherein.Some embodiment party
In formula, some guider is suitable alternative, and such as guider (12) is many tube chambers sheath.Those skilled in the art should
Understand that size and the specific configuration of guider (12) are not limited to depicted herein.
In some embodiments, the percutaneous reparation of Tricuspid valve (2) is to determine and to obtain to tricuspid annulus (3) upper first
The entrance put starts operation.Fig. 2-6 illustrates wire and obtains from right ventricle (4) to the entrance of Tricuspid valve (2) and travel across three
Cusp ring (3) enters some embodiments of right atrium (8).Then the far-end (10) of wire extends through from venous inlet position
The tube chamber (14) of guider (12) arrives right atrium (8), extends distally through Tricuspid valve (2) and arrives right ventricle (4), advances
Tube chamber (14) through Tricuspid valve (2) ring and proximally through guider (12) extends external.The two ends of wire are all at body
Outward.
Fig. 2 a shows that wire delivery conduit (20) is led to the embodiment of right ventricle (4).At an embodiment
In, wire delivery conduit is inserted through the tube chamber (14) of guider (12) from the near-end of guider (12), arrives right atrium
(8).As shown in Figure 2 a.Far-end (24) along with wire delivery conduit (20) extends beyond the far-end of guider (12), wire
Delivery conduit (20) extends the most further through Tricuspid valve (2) and arrives right ventricle (4).In right ventricle (4), wire is defeated
The distal portion (22) sending conduit (20) radially bends the longitudinal axis of deviation wire delivery conduit (20), presents curved profile.Some
In embodiment, the curved profile of wire delivery conduit (20) distal portion (22) in letter " J ", letter " U " or be in 90 ° extremely
The shape of any curvature as being labeled as " θ " in Fig. 2 a between 270 °.According to some embodiments, wire delivery conduit (20)
Distal portion (22) has preforming curve so that along with the far-end (24) of wire delivery conduit (20) departs from guider (12)
When constraint enters in right ventricle (4), the distal portion (22) of wire delivery conduit (20) recovers its curved profile.Implement according to some
Mode, wire delivery conduit (20) has deflectable distal portion (22), can forming curves profile by driving.Technical staff is permissible
Known that by this area some modes realize this driving altogether.According to some embodiments, wire delivery conduit (20) can be as
In Fig. 2 a, distally extending, proximad shown in double-headed arrow are retracted or axial rotation.
As Fig. 2 b illustrates further, the far-end (24) of wire delivery conduit (20) is suitable to position primary importance (32), so
Afterwards with tricuspid annulus (3) in right ventricle (4) side contacts.
Anatomically, right coronary artery is almost parallel with the circumference of Tricuspid valve (2).Frontal lobe and be approximately at right crown every leaf
The nearside halfbody of tremulous pulse.Tricuspid posterior lobe is approximately at the distally halfbody of right coronary artery, at right coronary artery pars intermedia and
Distal right coronary artery is between the changeover portion of rear descending artery.The pars intermedia of right coronary artery is approximately near frontal lobe and posterior lobe
Joint.Distal right coronary artery, to descending artery after the changeover portion or nearside of rear descending artery, is approximately near every Ye Hehou
The joint of leaf.Those skilled in the art it will be observed that the anatomical structure of different object hearts is different, so, this
Bright guidance and claims are not limited to the anatomical structure of any special object.
According to some embodiments, it is possible to true by injecting contrast stain in descending artery after right coronary artery and distally
Determine primary importance (32).It also is able to be replaced by by radiopaque wire travelling across right coronary artery to rear descending artery
Determine position.In each embodiment, contrast stain and/or radiopaque wire make right coronary artery in such as X-ray
Manifested under radiation imaging apparatus, magnetic resonance, ultrasonic, fluorescence or other imaging techniques.By visualization right coronary artery and
Rear descending artery, it is possible to determine position.
After determining primary importance (32), in each embodiment, as shown in Figure 2 b, it is defeated that clinician manipulates wire
The far-end (24) sending conduit to make wire delivery conduit (20) is aligned in tricuspid annulus (3) place, upwards prolongs in right atrium (8) inside
Stretch, and at primary importance (32) place contact tricuspid annulus (3).According to an embodiment, primary importance (32) is located on or near
Every leaf and the joint of posterior lobe.Equally, primary importance (32) is located on or near the joint of frontal lobe and posterior lobe.People in the art
Member should be understood that other positions along tricuspid annulus (3) can also act as primary importance.
In each embodiment, after the far-end (24) of wire delivery conduit (20) is aligned in this position (32), on the right side
Capture device (34) is disposed in inner side, atrium (8).Fig. 3 a illustrates capture device (40) and passes distally through guider (12) traveling
And enter the embodiment in right atrium (8).According to some embodiments, capture device (40) includes sheath (42) and capture basket
(44).In some embodiments, all anticipated as shown in fig. 3a, there is the capture basket (44) far-end in capture basket bar (46)
(48) place has variously-shaped memory metal net.According to some embodiments, capture basket (44) has and radially extends basket wheel
Exterior feature, for capture wire as mentioned below, and has elongate profile when being restricted in sheath (42).As shown in Figure 3 a
Capture basket (42) is adapted to slide through the axial lumen (41) of sheath (42), and the far-end in sheath (42) is pushed out (43), and from
The far-end (43) of sheath (42) is retracted.Along with the far-end (43) of sheath (42) is extended in capture basket (44), just recover its expansion
Profile.Along with capture basket (44) is retracted in sheath (42), it is just folded into elongate profile.Those skilled in the art should be bright
Capture basket (44) in vain only to use in the case of guider (12) there is no a sheath (42).Therefore, described here
Should not be regarded as limited.
In the example of use of this equipment, as shown in Figure 3 a, bootable sheath (42) is limited to catching of elongate profile
Obtain the capture device (40) tube chamber (14) through guider (12) of basket (44).According to some embodiments, protect with many tube chambers
When set is used as guider, the tube chamber that capture device (40) uses from wire delivery conduit (20) extends through this individual tubes
Chamber.According to some embodiments, during using single-lumen as guider, capture device (40) is with wire delivery conduit (20) side by side
Extend through the same tube chamber of this guider.Once the distal advancement of capture device (40) exceeds the remote of guider (12)
When end (10) arrives right atrium (8), capture basket (44) is pushed out to sheath (42) the most further, releases sheath (42) about
Bundle, capture basket (44) launches.The capture basket (44) launched or at least partly can fill the volume of right atrium (8).
Fig. 3 b illustrates another embodiment of capture device (50).According to some embodiments, capture device (50)
It is included in the capture basket (52) of the formation axial lumen at elongate body (56), far-end (54) place.It is slidably disposed at wire defeated
Send on conduit (20).Being similar to the embodiment shown in Fig. 3 a, capture basket (52) is adapted to slide through shown in guider (12)
Axial lumen (14).It is similar to the embodiment shown in Fig. 3 a, when capture basket (52) is in guider (12) tube chamber (14)
There is the elongate profile in constraint, and the basket profile of radial expansion when guider (12) is outside.Capture basket (52) can
It is made up of shape memory wire net.
According to some embodiments, capture device (50) is suitable in the upper slip of wire delivery conduit (20), through guiding dress
Put the tube chamber (14) of (12), be pushed out the far-end (10) of guider (12).Along with capture device (50) extends guider
(12) far-end (10), just recovers extended contour.Along with capture device (50) is retracted into the tube chamber (14) of guider (12),
Just elongate profile it is folded into.According to some embodiments, the motion of capture device independent of the motion of wire delivery conduit (20),
And according to another embodiment, the motion of capture device depends on the motion of wire delivery conduit (20).Some embodiment party
In formula, along with far-end (24) contact ring (3) of wire delivery conduit (20), capture basket (52) extend guider (12) and
In right atrium (8) fully deployed.Although Fig. 3 a and 3b shows some embodiment of capture basket (52), people in the art
Member understands can also be without departing from using other capture devices in the case of present invention teach that scope.Therefore, institute is described herein
Should not be regarded as limiting property.
According to a kind of embodiment, capture device also can have the sheath of extendible distal portion or net.This area skill
Art personnel should be understood that and can also use other kinds of suitable capture device as the case may be.So, here and figure
Should not be construed described in 3a-3b is determinate.
In each embodiment, by capture basket launch in right atrium (8) and wire delivery conduit (20) suitably
Location, wire (60a) just can be extended through tricuspid annulus (3) by clinician.With reference to Fig. 4 a, wire is introduced into, through leading
Line delivery conduit (20).In the embodiment that Fig. 4 a is illustrated, wire (60a) enters the axial lumen of delivery conduit (20)
(26), the most distally extending, contact tricuspid annulus (3), extend the most further, from right ventricle (4) side through ring
(3), enter in right atrium (8), and enter the space filled by capture basket (44,52).In some embodiments, wire by
Capture basket is captured.
According to some embodiments, as shown in fig. 4 a, wire (60a) has the puncture tip that can pierce through ring (3).Additionally
Embodiment in, wire (60a) has radio frequency (RF) energy delivery tip to assist it to pass tricuspid annulus (3).At other
In embodiment, suitable RF energy device (not shown) is coupled to wire.
According to some embodiments, as shown in Figure 4 b, wire delivery conduit (20) also includes extensible pin (28), and it can
Puncture tricuspid annulus (3).Wire (60a) enters the tube chamber (26) of this wire delivery conduit (20), extends through by conduit (20)
The perforate that produces of extensible pin (28) in right atrium (8), enter in the space filled by capture basket (44,52).One
In a little embodiments, wire is captured by capturing basket (44,52).It will be obvious to one with ordinary skill in the art that and can also use other
Method and apparatus implements to enter the operation (8) of right atrium.Therefore, here cited example should not be considered as the present invention and refer to
Lead limited range.
According to some embodiments, the extremity (62) of wire (60a) is designed as back deflecting or crimp to prevent tissue
Unexpected damage.The design of deflection or curling can pass through the geometric construction of wire (60a), and such as (62 make in flexible distal portion
The physical characteristic of the material of wire (60a) or realize by being used for making the shape memory characteristic of the material of wire (60a).This
Skilled person can test without excessive so that known technology and/or material realize this purpose.
With reference to Fig. 5, along with wire enters the space that right atrium (8) is filled, wire with the capture basket (44,52) being unfolded
Capture basket (44, the 52) capture of captured equipment (40,50).Clinician will capture basket (44) proximad indentation sheath (42) or
In guider (12), capture basket (44,52) is folded on wire (60a).The capture of retracting further of clinician's proximad sets
Standby (40,50), capture device (40,50) proximad tractive wire (60a), through the tube chamber (14) of guider (12) to body
Outward.
In each embodiment, clinician's further proximad retraction capture device (40), through guider
(12) official jargon (14) is to external.Described capture device (40), including the sheath (42) shown in Fig. 3 a and capture basket (55), or also
Including the slender member (56) with capture basket (52) shown in Fig. 3 b.In some embodiments, clinician can lead by tractive
Line (60a) is to external.Therefore, as shown in Figure 6, by being maintained at external by one end of wire (60a), the other end is from venous inlet
Position extends distally through the tube chamber (26) of wire delivery conduit (20), through right atrium (8), Tricuspid valve (2) and right ventricle
(4), extend through the tube chamber (14) of conduit (12) in primary importance (32) through tricuspid annulus (3) proximad, leave vein and enter
Port part.So, the two ends of wire the most in vitro, wire (60a) primary importance (32) keep through tricuspid annulus (3) logical
Road, to promote the expansion of tissue anchor (310a) as described below.
Fig. 7-9 shows that wire (160a) extends through tricuspid annulus (3) to the enforcement of right ventricle (4) from right atrium (8)
Mode.Wherein wire (160a) be proximally located at external, the far-end (162) of wire (160a) is positioned at right ventricle.
Fig. 7 a-7c shows by location conduit (100) manipulation wire delivery conduit (120) in right atrium (8) inner position
Each embodiment against tricuspid annulus (3).According to some embodiments, location conduit (100) extends distally through leads
Tube chamber (14) to device (12) enters in right ventricle (4).In some embodiments, location conduit (100) can be according to Fig. 2 a
Wire delivery conduit (20) embodiment similar with described by 2b enters in right ventricle.Carry out as literary composition describe identical really
Determine and after placement process, location conduit (100) is fixed against tricuspid annulus (3) in primary importance (32) in right ventricle (4) inner side
Position.According to some embodiments, position conduit (100) is configured similarly to wire delivery conduit (20) recited above.At certain
In a little embodiments, location conduit has curve distal portion (102) that is preformed or that drive.In some embodiments, fixed
Position conduit can be as retracted by the distally extending and proximad indicated by Fig. 7 a cathetus shape double-headed arrow.Implement at some
In mode, location conduit is suitable to the axial-rotation as indicated by shaped form double-headed arrow in Fig. 7 a.
With reference to Fig. 7 a, in each embodiment, the far-end (104) of location conduit (100) has magnet (106).Wire
Delivery conduit (120) distally advances the tube chamber (14) through guider (12), arrives the inner side of right atrium (8) and near three
Cusp ring (3).According to some embodiments, the far-end (124) of wire delivery conduit (120) also includes magnet (126).Location is led
Magnet (106,126) on pipe (100) and wire delivery conduit (120) has opposite polarity.Along with wire delivery conduit (120)
Near tricuspid annulus (3), the magnet (106) that the magnet in delivery catheter distal end is positioned on conduit (100) far-end (104) is inhaled
Draw.Once magnet (106,126) is locked, and tricuspid annulus (3) is then sandwiched between the far-end (124,102) of two conduits, such as figure
7b is illustrated.
In each embodiment, wire (160a) advances from right atrium (8), through tricuspid annulus (3) to right ventricle
(4).According to some embodiments, as shown in Figure 7 c, wire (160a) is along the axial lumen (122a) of wire delivery conduit (120)
Advance, after tricuspid annulus (3), enter the axial lumen (108) of location conduit (100).Along with location conduit (100) is to closely
Retracting in side, the far-end (162) of wire (160a) is maintained at right ventricle (4) inner side.According to some embodiments, as shown in figure 7d,
Wire (160a) is advanced, through tricuspid annulus along side or the eccentric axial lumen (122b) of wire delivery conduit (160a)
(3), after, the far-end (162) of wire (160a) enters right ventricle (4).According to some embodiments, wire delivery conduit (120) is also
There is deflectable distal portion (128), conduit can be positioned at the magnet (126) at wire delivery conduit (120) far-end (124) place
(100) magnet (106) at far-end (104) place makes this distal portion (128) radial deflection, as shown in Figure 7b when attracting.Equally, wire
Delivery conduit (120) can distally extending be retracted or axial rotation with proximad, as indicated by double-headed arrow.Real according to some
Execute mode, the shape of wire (160a) or be configured similarly to described in Fig. 4 a and 4b.
The further embodiment that the present invention that shows Fig. 8 a and 8b instructs, wherein wire delivery conduit (220) is by positioning
Equipment (210) guides.According to some embodiments, wire delivery conduit (220) has two axial lumen (222,224), and one
Individual for wire (260a), another is used for the equipment that positions (210).Wire delivery conduit (220) is by guider (12)
Tube chamber (14) enters right atrium (8).When keeping the wire delivery conduit (220) position inside right atrium (8), clinician's energy
Enough according to mode similar to wire delivery conduit (20) as herein described shown in Fig. 2 a with 2b, distally extending location equipment
(210) right ventricle (4) is entered through Tricuspid valve (2).Equally, location equipment (210) can have preformed or by clinician
The bending extremity (212) driven, as indicated by double-headed arrow in Fig. 8 a, it can be distally extending, or proximad is retracted, or
Axial rotation.
After entering right ventricle (4), in accordance with herein according to the method described by Fig. 2 a-2b and Fig. 7 a, location equipment (210)
Far-end (214) be positioned at primary importance (32) place.Maintain location equipment (210) position stable, towards tricuspid annulus (3) to far
Side advances wire delivery conduit (220) that ring (3) is sandwiched between conduit (220) and location equipment (210), such as Fig. 8 b institute
Show.Wire (260a) is distally advanced from guidewire lumen (224) and enters right ventricle (4) through tricuspid annulus (3), such as Fig. 8 b institute
Show.In some embodiments, the far-end (214) of location equipment (210) has opening or slit.In some embodiments,
When wire (260a) travels across tricuspid annulus (3), just enter the opening in location equipment (210) far-end (214) or slit
In.In some embodiments, the far-end (214) of location equipment (210) is configured to set in clinician's proximad retraction location
Time standby (210), will not disturbance wire (260a).According to some embodiments, the shape of wire (260a) and be configured similarly to this
Literary composition is according to described by Fig. 4 a and 4b.Those skilled in the art should be understood that the particular implementation of Fig. 8 a and 8b has been diagrammatically only by this
Bright some instructed aspects, and non-invention indication leads the whole of scope.
According to some embodiments, after wire (160,260) is positioned in tricuspid annulus through primary importance (32), wire
Delivery conduit (120,220), location conduit (100) and/or location equipment (210) just proximad are retracted to external.Fig. 9 shows
Wire (160,260) is distally extending from venous inlet position, and the tube chamber along wire delivery conduit (120,220) is advanced, and enters
Enter right atrium (8), through tricuspid annulus (3), arrive the enforcement pattern (4) of right ventricle.The near-end of wire (160,260) is maintained at
External, by clinician's control.The far-end (162,262) of wire (160,260) is maintained in right ventricle (4).Implement at some
In mode, wire (160,260) has the puncture tip allowing to pierce through tricuspid annulus (3), or has delivery of radio frequency energy to ring
Tissue is with the radio-frequency (RF) energy delivery tip piercing through tricuspid annulus (3).It addition, similar with according to described in Fig. 4 a and 4b, wire
Extremity is designed as back deflecting or bending, to prevent from organizing unexpected injury, as shown in Figure 9.
In each embodiment, in place through tricuspid annulus (3) by wire (60a, 160a, 260a), organize anchor
(310a) launch in certain position.At some embodiments, as shown in figs. 10-12, the first tissue anchor delivery conduit (300) is along wire
(60a, 160a, 260a) follows up, and through tricuspid annulus (3), enters right ventricle (4).In some embodiments, this tissue anchor is defeated
Send conduit (300) for tissue anchor (310a) is delivered to tricuspid annulus (3).
Any tissue anchoring arrangement known altogether from this area is different, and the particular organization's anchor (310a) during the present invention instructs is can
Fold, as shown in Figure 10.In each embodiment, tissue anchor includes multiple discrete, flat or anchor log of flexibility
(312), connect with flexible tension member (314).Anchor log (312) can by medical grade textile material (such as polymeric material, all
Such as DACRON etc.) make.In some cases, its design can promote tissue ingrowth so that anchor (310a) over time
Passage is at least partially embedded in tissue.Anchor log (312) connects tensile member (314), and it is stitching thread in embodiments,
By stitching thread being passed distally through anchor log (312) and proximally through anchor log (312), form Slipped Clove Hitch or other kinds of
Locking mechanism, so that when the close end of tractive tensile member (314), all of anchor log (312) is pulled together.As
Described herein, this leaves the length " tail " of a stitching thread leading to venous inlet position from anchor, and this length " tail " can be used in follow-up
Tension and folding.
The example of tissue anchor (310) described by accompanying drawing of the present invention and tissue anchor delivery conduit (300) with at 2008 11
That the moon 19 was submitted to, the United States Patent (USP) of entitled " Tissue Anchor and Anchoring System ", patent application serial numbers
12/273,670 and, entitled " Tissue Anchor, Anchoring System and that submit on July 5th, 2005
Methods of Using the Same " United States Patent (USP), patent application serial numbers 11/174,951 and on February 26th, 2013
That submit to, the United States Patent (USP) of entitled " Tissue Anchor and Anchoring System ", patent application serial numbers 13/777,
Having certain similarity described in 042, entire contents was incorporated herein by quoting already.Although some is not exemplary
Shown in accompanying drawing, but it is can to use suitably to organize anchor described in above-mentioned patent in embodiment as herein described.
Suitable tissue anchor described here includes but not limited to tissue fastener, tissue gauze or tissue pinning etc..
Figure 11-12 is that the first tissue anchor (310a) carries through tricuspid annulus (3) and launches example.Figure 11 a and 12a shows
Expose the process of the extremity (316a) of tissue anchor (310a).Figure 11 b and 12b shows the nearside exposing tissue anchor (310a)
The process in portion (318a).According to the embodiment described in Fig. 2-9, tissue anchor at position (32) place along wire (60a, 160a,
260a) follow-up.Figure 11 c and 12c shows the tissue anchor (310a) being positioned at position (32) place according to embodiment described in Fig. 2-9
The example launched, wherein tissue anchor follows up along wire (60a, 160a, 260a).
With reference to Figure 11 a and 12a, use tissue anchor delivery conduit (300), tissue anchor (310a) is maintained at longitudinal tube chamber
(302) in, and along wire (60a, 160a, 260a) follow-up through tricuspid annulus (3), right ventricle (4) is entered.With reference to Figure 11 a and
12a, tissue anchor (310a) is the most distad pushed out of the far-end (304) of tissue anchor delivery conduit (300).Once organize anchor
(310a) anchor log of extremity (316a) or q.s (312, Figure 10 shown in) is exposed to right ventricle (4) inner side, clinical
Doctor just stops distally advancing tissue anchor (310a) and proximad retracted tissue anchor delivery conduit (300), so that tissue anchor is defeated
Far-end (304) proximad sending conduit (300) moves, and returns in right atrium (4) through ring (3).Then, clinician is by such as
Further proximad retracted tissue anchor delivery conduit (300) shown by Figure 11 b and 12b, will organize the proximal portion of anchor (310a)
(318a) or the remainder of anchor log (312) of tissue anchor (310a) is exposed in right ventricle (4).
As shown in Figure 11 c and 12c, in order to launch tissue anchor (310a), clinician's's tractive tensile member (314) is near
Hold so that the anchor log (312) of tissue anchor (310a) is pulled in together against the opposition side of tricuspid annulus (3), and then by first
Tissue anchor (310a) is fastened to tricuspid annulus (3).Therefore, as shown in Figure 11 c and 12c, the first tissue anchor (310a) is through three
Cusp ring (3) launches at primary importance (32) place.Wherein organize the extremity (316) of anchor (310a) against tricuspid annulus (3)
Atrial side positions, and the proximal portion (318) of tissue anchor (310a) positions against the ventricular side of tricuspid annulus (3), the first tissue anchor
(310a) tensile member (314) proximad extends through the tube chamber (302) of tissue anchor delivery conduit (300) to external.According to
Some embodiments, at labelling primary importance (32) place, the wire of retaining ring path during the first tissue anchor (310a) launches
(60a, 160a, 260a) proximad is retracted to external, and the near-end of tensile member (314) is controlled in vitro by clinician.
The embodiment securely launched in first position through tricuspid annulus (3) by the first tissue anchor (310a),
Clinician can launch minor microstructure anchor (310b) in the second position.Figure 13-14 shows that minor microstructure anchor (310b) passes
Several examples that tricuspid annulus (3) is disposed at the second position (30) place.
To described in Fig. 2-6 in similar literary composition, according to some embodiments, clinician by wire delivery conduit (20) from the right side
Ventricle (4) inner side positions against tricuspid annulus (3) at the second position (30) place.Its embodiment includes as herein described or ability
The method that field technique personnel know altogether: handle (extend, retract, rotate) wire delivery conduit to second position against tricuspid annulus
Location.Being similar in literary composition the explanation to Fig. 2-6, one end of the second wire (60b) travels across tricuspid annulus (3), by Fig. 3 a and
The capture basket (44,52) that 3b is illustrated is captured, and is drawn through the tube chamber (14) of guider (12) to external by proximad.
Anticipating as depicted in fig. 13 a, this makes wire (60) be positioned at the second position (30) place, and the two ends of wire (60b) are the most in vitro.
Being similar to described in Fig. 7-9, clinician uses same embodiment by wire delivery conduit (20) from the right side
Inner side, atrium (8) positions against tricuspid annulus (3) at the second position (30) place.Mode described herein, instructs including this patent
, also include it is known by the man skilled in the art that and i.e. handle (extend, retract, rotate) wire delivery conduit (20) or location
Equipment (210) realizes the location to second position against tricuspid annulus.According to Fig. 7-9, wire delivery conduit (120,
220) it is positioned at the second position (30) place by magnetic pull or by the wire delivery conduit structure described in literary composition.Such as Figure 13 b institute
Showing, the second wire (160b, 260b) distally advances and arrives right ventricle (4) through tricuspid annulus (3).This result is in Figure 13 b
Show.Wherein one end of wire (160b, 260b) extends distally through the tube chamber (14) of guider (12) and arrives the right heart
Room (4).In other words, the far-end of the second wire (160b, 260b) is positioned at right ventricle (4), the second wire (160b, 260b) near
End is positioned at external.
In each embodiment, according to herein according to the embodiment described in Figure 11-12, minor microstructure anchor (310b)
Launch at the second position (30) place.Figure 14 a and 14b shows that minor microstructure anchor (310b) passes tricuspid annulus (3) at second
Put the embodiment that (3) place launches.Wherein the extremity (316b) of minor microstructure anchor (310b) is fixed against the ventricular side of ring (3)
Position, the proximal portion (318b) of minor microstructure anchor (310b) positions against the atrial side of ring (3), the stretching of minor microstructure anchor (310b)
Component (314) proximad extends through venous inlet to external.Now, the second wire (60b, 160b, 260b) can remove.
Figure 15 is the example of Tricuspid valve (2) two tipping.According to some embodiments, clinician tissue anchor (310a,
Pressure is applied, by two tissue anchor (310a) tractives each other on one or two in tensile member (314a, 314b) 310b)
Close, thus decrease the girth of tricuspid annulus (3).This will be by along tensile member (314a, 314b) towards tissue anchor
(310a, 310b) guides the operation (330) of locker complete and keep.Its locker include this area is known altogether with
And, invention entitled " Lockers for Surgical Tensile Members and that submit on May 25th, 2007
Methods of Using the Same to Secure Su rgical Tensile Members " United States Patent (USP), application
Serial number 11/753, those described in 921, its content is incorporated herein by quoting.By tensile member (314a, 314b)
Make snapping member (330) fasten, use sickle to remove the unnecessary tensile member (314a, 314b) of snapping member (330) nearside.
Described sickle such as submit to, invention entitled " the Suture Cutter and Method of on November 5th, 2007
Cutting Suture " U.S. Patent Application Serial Number 11/935, described in 054, its content is also contained in by quoting
This.Guider (12) then can together with all wire delivery conduits (20,120,220) and/or tissue anchor delivery conduit (300)
Proximad is retracted and removes.
Figure 16 a and 16b illustrates the process of two tipping.According to some embodiments, the first tissue anchor (310a) is deployed in
Posterior lobe and every the joint of leaf or neighbouring position, minor microstructure anchor (310b) be deployed in posterior lobe and the joint of frontal lobe or near
Position, as illustrated in fig 16 a.After decreasing the distance between two tissue anchors (310a, 310b), rear side ring shortens, and rear side is little
Leaf is effectively canceled, thus three flap are changed into two flap.In some cases, this process is referred to as two tipping, such as figure
Shown in 16b.
The embodiment using the present invention to instruct, decreases the girth of tricuspid annulus (3), promotes Tricuspid valve (2) lobule
Sew up, reduce or eliminate tritubercular cycloid injection.According to some embodiments, two tissue anchor (310a, 310b) all edges
Rear side ring location.According to some embodiments, at least a tissue anchor (310a) is placed on rear side ring, its hetero-organization anchor
(310b) it is placed on front side ring or spacer ring.According to other some embodiments, before at least a tissue anchor (310a) is placed in
Leaf and every leaf joint position or near, its hetero-organization anchor (310b) is placed in posterior lobe and every joint and the posterior lobe of leaf and front
Position between leaf joint.
According to some embodiments, two tissue anchors (310a and 310b) are disposed around ring circumference.According to some embodiments,
The tissue anchor (310a, 310b) of more than two can be disposed.Figure 16 c and 16d shows at posterior lobe with every leaf joint or it is attached
A tissue anchor (310a) that near position is disposed, the group disposed at posterior lobe and the joint of frontal lobe or the position near it
Knit anchor (310b) and about at the embodiment of both middle another tissue anchor (310c) disposed.Those skilled in the art
Need to understand that Figure 16 a-16d simply illustrates some embodiments under the present invention instructs, they are still able to come in other positions
Arrange tissue anchor (310a).Therefore, it is illustrated that in those of the quantity of position sum disposed for tissue anchor (310a) describe not
Should be viewed as a limitation property.
Although illustrate only three tissue anchors here, but more than three can also be used in the range of the present invention instructs
Tissue anchor.According to some embodiments, can in a organized way anchor apply pulling force, and fastened by locker.Also
Can illustrate according to other embodiments, such as Figure 16 e and 16f, every time to two applying pulling force in tissue anchor.
According to some embodiments, the deployment of tissue anchor can be carried out in an orderly manner.Specifically, according to the reality described in Fig. 2-15
Executing mode, clinician arranges wire (60,160,260) at primary importance (32) place, subsequently by the first tissue anchor (310a) portion
Administration, on wire (60,160,260), then handles same wire conveying mechanism, wire is placed in the second position (30),
Subsequently at wire (60,160,260) upper deployment minor microstructure anchor (310b).According to other embodiments, two can be disposed simultaneously
Or plural tissue anchor.Specifically, can use double fork conduit (400) simultaneously at two wires of two location arrangements, also
The conduit with more than two bifurcated can be used simultaneously at multiple location arrangements multiple conducting wires.
Figure 17-19 shows that the double fork conduit (400) of use arranges that two wires (460a, 460b) are through tricuspid annulus (3)
Embodiment.As shown in figure 17, according to an embodiment, double fork conduits (400) include the first catheter component (402a), its
There is the first tube chamber (404a) for the first wire (460a)；Second catheter component (402b), it has for the second wire
(460b) the second tube chamber (404b).First and second wires (460a, 460b) are respectively slidably disposed in first and second
In conduit cavity (404a, 404b).Have predetermined between the first catheter component (402a) and the second catheter component (402b)
Lateral separation " L ".
According to some embodiments, double fork conduits (400) are delivered to right ventricle (4), and by wire delivery conduit (20)
Position against tricuspid annulus (3), as shown in Figure 2 a.It is similar in literary composition, according to described in Fig. 2-6, according to some embodiments, leading
Line delivery conduit (20) is after right ventricle (4) inner side positions against tricuspid annulus (3), through the pipe of the first catheter component (402a)
The first wire (460a) that chamber (404a) extends is arranged through tricuspid annulus (3).Wire delivery conduit (20) proximad is retracted, cruelly
Expose second catheter component (402b) of double fork conduit (400), as shown in figure 18 a.Once it is in wire delivery conduit (20) remote
Hold (24) outward, the second catheter component (402b) horizontal expansion preset distance, leaves the first catheter component (402a).Do not losing
In the case of one wire (460a) location, clinician can rotate this pair of fork conduit (400) and/or wire delivery conduit (20)
So that the second catheter component (402b) is positioned at the second position (30).Follow steps described herein and such as Fig. 4 a and 4b institute
Showing, the second wire (460b) travels across tricuspid annulus (3).
According to some embodiments, two wires (460a, 460b) are captured by capture device, then, and two wires
The far-end of (460a, 460b) is retracted into external through the tube chamber (14) of guider (12).Anticipate as shown in fig. 18b.Two wires
Be placed in two positions, this facilitate that two tissue anchors follow procedures described above with according to shown in Figure 11 a-11c with described
Dispose.
According to the embodiment anticipated as shown in figure 19a, double fork conduits or equipment (500) are carried through location conduit
(100) tube chamber is to right ventricle (4).Along with the far-end (104) of location conduit (100) positions against ring (3), the first catheter component
(502a) being positioned at primary importance (32), it affects the first wire delivery conduit (510a), promotes the first wire (560a)
Location.Location conduit (100) proximad is retracted, and exposes second catheter component (502b) of double fork conduit (500), such as Figure 19 a
Illustrated.Once being in outside location conduit (100) far-end (104), the second catheter component (502b) is just away from the first conduit structure
Part (502a) horizontal expansion preset distance.In the case of not losing the first wire delivery conduit (510a) location, clinician
This pair of fork conduit (400) and/or location conduit (100) can be rotated so that the second catheter component (402b) is positioned at second
Put (30).Second catheter component (502b) attracts (affecting) second wire delivery conduit (510b) to promote the second wire (560b)
Through the location of tricuspid annulus (3), as shown in fig. 19b.
According to some embodiments, double fork conduits first have to be placed in two positions, and two wires or are worn in an orderly manner simultaneously
Cross tricuspid annulus location.The most herewith managing, first the first catheter component of double fork conduits is positioned at primary importance, and the first wire is worn
Cross tricuspid annulus to arrange；Second catheter component of double fork conduits is positioned at the second position, and the second wire is annularly-distributed through Tricuspid valve
Put.
This is as shown in Figure 18 b and 19b, and two wires are placed in two positions, then according to the step according to Figure 11-16 and
Embodiment specifically described herein disposes two tissue anchors.
Above example only show the enforcement of double fork conduit, and those skilled in the art can instruct essence without departing from the present invention
In the case of god, use the conduit of three or more bifurcateds.The present invention instructs the double forks described by accompanying drawing or multiple-limb to lead
Pipe and submit to, invention entitled " the Systems and Methods for Introducing on March 13rd, 2007
Elements Into Tissue " United States Patent (USP), patent application serial numbers 11/685,239 with that submit on March 13rd, 2007,
The United States Patent (USP) of invention entitled " Tissue Anchors, Systems, and Methods, and Devices ", application sequence
Number on March 13rd, 11/685,240 and 2007 submits to, invention entitled " Devices and Methods For
Introducing Elements into Tissue " United States Patent (USP), patent application serial numbers 11/685,242 and in 2011
October 26 submitted to, invention entitled " Hand Operated Device for Controlled Deployment of a
Tissue Anchor and Method o f Using the Same " United States Patent (USP), in patent application serial numbers 13/282,139
The double fork of described those or multiple-limb conduit there is similarity, it is involved in this full content and is all contained in by quoting
This
The embodiment instructed according to the present invention, can use radiation impermeability labelling or grain surface can pass through to make
With the radiation imaging apparatus of such as X-ray, magnetic resonance, the imaging technique equipment such as ultrasonic to realize the visualization of operation.Institute herein
Disclosed labelling can be applicable to any part of guider, conduit or equipment disclosed during the present invention instructs.Radiation can not
Permeability labelling can be sewn, bond, press or arrange in other manners (fastening) at guider, conduit and/or respectively
On equipment.Radiation impermeability labelling is selected from the material of tantalum, tungsten, platinum, iridium, gold and alloy thereof, or those skilled in the art
The other materials known altogether is made.Radiation impermeability labelling can also be by cobalt, fluorine etc. or other paramagnetic materials and ability
Other MR visible material that field technique personnel know altogether are made.It addition, the contrast agent injected in atrium, ventricle or tremulous pulse also is able to use
Location is determined under at fluorescence.
Unless otherwise defined, technology used herein and scientific terminology have the present invention and instruct the technology people of art
The identical meanings that member understands.Similar or identical to method described herein and material can be used in the present invention instruct enforcement or
In test.When the understanding such as concept, definition is clashed, then take as the leading factor with patent specification.It addition, material described in literary composition
Material, method and example are all only schematically, and its purport is not intended to limit.
Claims (15)
1. a cardiac prosthesis devices, comprising:
First tissue anchor, it includes extremity and proximal portion；
The extremity of the first tissue anchor primary importance can launch inside right ventricle；
The proximal portion of the first tissue anchor can be launched inside primary importance right atrium；
Minor microstructure anchor, it includes extremity and proximal portion；
The extremity of minor microstructure anchor the second position can launch in right ventricle；
The proximal portion of minor microstructure anchor can be launched inside right atrium in the second position；
By making the extremity of the first tissue anchor position and the nearside of this tissue anchor at tricuspid annulus from inside right ventricle
Portion launches the first tissue anchor from inside right atrium against location at tricuspid annulus；
By making the extremity of minor microstructure anchor position the proximal portion with this tissue anchor from inside right ventricle at tricuspid annulus
From launch against location at tricuspid annulus inside right atrium minor microstructure anchor with change between the first and second tissue anchors away from
From.
2. the equipment described in claim 1, in wherein said primary importance and the second position, at least one is in tricuspid annulus.
3. the equipment described in claim 1 or 2, is included in described primary importance and is advanced through tricuspid annulus from right ventricle by wire
To right atrium.
4. the equipment described in claim 3, including being captured by described wire and being drawn out external.
5. the equipment described in claim 4, including advancing tissue anchor conduit through wire to primary importance.
6. the equipment described in claim 1 or 2, be included in described primary importance advance wire from right atrium through tricuspid annulus to
Right ventricle.
7. claim 1-2 and the equipment according to any one of 4-5, the location of the wherein said second position is to organize anchor first
After expansion.
8. the equipment described in claim 6, the location of the wherein said second position is before the first tissue anchor launches.
Equipment the most according to claim 7, wherein said equipment is for improving the symptom of Tricuspid valve disease.
10. a Tricuspid valve prosthetic appliance, comprising:
One wire delivery conduit, it includes far-end and axial lumen；
One wire, it includes end；
Capture device；
First tissue anchor delivery conduit, it includes far-end；
First tissue anchor, it includes extremity and proximal portion；
Minor microstructure anchor delivery conduit, it includes far-end；
Minor microstructure anchor, it includes extremity and proximal portion；
Wire delivery conduit and is incited somebody to action through Tricuspid valve to right ventricle
The far-end of wire delivery conduit positions in the first position of right ventricle interior side contacts tricuspid annulus；
In first position along one end of the axial lumen propelling wire of delivery conduit, pass tricuspid annulus to the right side from right ventricle
Atrium；
The end of wire is captured by the capture device being deployed in right atrium；
Proximad retraction capture device and then wire end is withdrawn from external；
First tissue anchor delivery conduit is inserted internal along wire, by the far-end of the first tissue anchor delivery conduit through Tricuspid valve
Ring is placed in right ventricle；
By making the extremity of the first tissue anchor position and the nearside of this tissue anchor at tricuspid annulus from inside right ventricle
Portion launches the first tissue anchor from inside right atrium against location at tricuspid annulus；
By in the axial lumen of the retracted of wire to wire delivery conduit；
The far-end of wire delivery conduit is positioned in the second position of right ventricle interior side contacts tricuspid annulus；
By the end of wire from right ventricle through tricuspid annulus to right atrium；
The end of wire is captured by the capture device being deployed in right atrium；
Proximad retraction capture device and then wire end is withdrawn from external；
Minor microstructure anchor delivery conduit is inserted internal, in second position, by minor microstructure anchor delivery conduit along wire
Far-end passes tricuspid annulus, is placed in right ventricle；
By making the extremity of minor microstructure anchor position the proximal portion with this tissue anchor from inside right ventricle at tricuspid annulus
From launch against location at tricuspid annulus inside right atrium minor microstructure anchor with reduce between the first and second tissue anchors away from
From.
11. 1 kinds of Tricuspid valve prosthetic appliances, comprising:
One location conduit, it includes far-end；
One wire delivery conduit, it includes far-end and axial cavity；
One wire, it includes end；
First tissue anchor delivery conduit, it includes far-end；
First tissue anchor, it includes extremity and proximal portion；
Minor microstructure anchor delivery conduit, it includes far-end；
Minor microstructure anchor, it includes extremity and proximal portion；And
Distance between transformable first and second tissue anchors；
By this location conduit through Tricuspid valve to right ventricle, and the far-end of this location conduit is placed in right ventricle interior side contacts tricuspid
The primary importance of annulus；
This wire delivery conduit is advanced in right ventricle, makes far-end primary importance inside right atrium of this wire delivery conduit
Place's contact tricuspid annulus is the most relative with the far-end of location conduit；
First position along wire delivery conduit axial lumen advance a wire far-end so that it is pass from right atrium
Tricuspid annulus is to right ventricle；
The first tissue anchor delivery conduit is advanced so that it is organize the remote of anchor delivery conduit through tricuspid annulus and by first along wire
End is placed in right ventricle；
By making the extremity of the first tissue anchor position and the proximal portion of this tissue anchor against tricuspid annulus inside right ventricle
The first tissue anchor is launched against tricuspid annulus location inside right atrium；
By in the axial lumen of the retracted of wire to wire delivery conduit；
By making the far-end of location conduit arrange location conduit in the second position of right ventricle interior side contacts tricuspid annulus；
Wire delivery conduit is placed in right atrium, makes far-end second position contact inside right atrium of wire delivery conduit
Tricuspid annulus, and relative with the far-end of location conduit；
The far-end advancing wire makes it from right atrium through tricuspid annulus to right ventricle；
Minor microstructure anchor delivery conduit is advanced so that it is in second position through tricuspid annulus and by minor microstructure anchor along wire
The far-end of delivery conduit is placed in right ventricle；
By making the extremity of minor microstructure anchor position and the proximal portion of this tissue anchor against tricuspid annulus inside right ventricle
Minor microstructure anchor is launched against tricuspid annulus location inside right atrium；
Reduce the distance between the first and second tissue anchors.
12. 1 kinds of Tricuspid valve prosthetic appliances, comprising:
One wire delivery conduit, it includes tube chamber；
One double fork conduit, the first catheter component and the second catheter component, wherein the first catheter component includes a far-end, second
Catheter component includes a far-end；
First wire, it includes end；
Second wire, it includes end；
One capture device；
First tissue anchor delivery conduit, it includes far-end；
First tissue anchor, it includes extremity and proximal portion；
Minor microstructure anchor delivery conduit, it includes far-end；
Minor microstructure anchor, it includes extremity and proximal portion；And
Distance between transformable first and second tissue anchors；
Being positioned in right ventricle through Tricuspid valve by wire delivery conduit, the most double fork conduits are slidably arranged in wire conveying
In the tube chamber of conduit, and the first wire is slidably arranged in the first catheter component of double fork conduit, and the second wire is slidably
The second catheter component being arranged in double fork conduit in；
The far-end of the first catheter component is arranged in primary importance；Additionally advance one end of the first wire from the right side in first position
Ventricle is through tricuspid annulus to right atrium；
Extend the second catheter component of double fork conduit, in remotely located against Tricuspid valve by the second catheter component of second position
Ring；
Advance one end of the second wire from right ventricle through tricuspid annulus to right atrium in second position；
Capture device is used to capture the end of the first and second wires；
The end of the first and second wires is also extended external by proximad retraction capture device；
Along the first wire by the first tissue anchor delivery conduit through tricuspid annulus, defeated along the minor microstructure anchor on the second wire
Sending conduit to pass tricuspid annulus, wherein the far-end of the first and second tissue anchor delivery conduits is positioned at inside right ventricle；
By first and second tissue anchors extremity from inside right ventricle at tricuspid annulus location with by first and second
The proximal portion of tissue anchor launches the first and second tissue anchors from inside right atrium in location at tricuspid annulus；To reduce
Distance between one and minor microstructure anchor.
13. equipment according to claim 12, wherein said equipment is used for treating Tricuspid valve disease.
14. equipment according to claim 13, wherein said Tricuspid valve disease selected from tricuspid regurgitation, tricuspid stenosis,
Tricuspid atresia and Ebstein's anomaly.
15. 1 kinds of Tricuspid valve prosthetic appliances, comprising:
One location conduit, it includes tube chamber；
One double fork conduit, the first catheter component and the second catheter component, wherein the first catheter component includes a far-end, second
Catheter component includes a far-end；
First wire, it includes far-end；
Second wire, it includes far-end；
One capture device；
First tissue anchor delivery conduit, it includes far-end；
First tissue anchor, it includes extremity and proximal portion；
Minor microstructure anchor delivery conduit, it includes far-end；
Minor microstructure anchor, it includes extremity and proximal portion；And
Distance between transformable first and second tissue anchors；
Being positioned in right ventricle through Tricuspid valve by location conduit, the most double fork conduits are slidably disposed at the pipe of location conduit
In chamber, this pair of fork conduit has the first catheter component and the second catheter component；
Remotely located in primary importance by the first catheter component；
Extend the second catheter component of double fork conduit, and in second position by the far-end of the second catheter component against tricuspid annulus
Location；
Advancing the first and second wire delivery conduits in right atrium, wherein the far-end of the first and second wire delivery conduits is
One and second position opposed with the first and second catheter components, and in right atrium interior side contacts tricuspid annulus；
Advance the far-end of the first and second wires to pass tricuspid annulus to right ventricle from right atrium in the first and second positions；
Respectively along the first and second wires, advance the first and second tissue anchor delivery conduits so that it is through tricuspid annulus, wherein
The far-end of the first and second tissue anchor delivery conduits is positioned at inside right ventricle；
By the extremity of the first and second tissue anchors is positioned against tricuspid annulus and by first and the inside right ventricle
The proximal portion of two tissue anchors launches the first and second tissue anchors against tricuspid annulus location inside right atrium；Reduce by the first He
Distance between minor microstructure anchor.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US201361769738P | 2013-02-26 | 2013-02-26 | |
| US61/769,738 | 2013-02-26 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN104000625A CN104000625A (en) | 2014-08-27 |
| CN104000625B true CN104000625B (en) | 2016-11-30 |
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Effective date of registration: 20180307 Address after: No. 8, Rong Jingdong street, Beijing economic and Technological Development Zone Patentee after: Beijing Tide Pharmaceutical Co., Ltd. Address before: Massachusetts Patentee before: Mitralign Inc. |
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Effective date of registration: 20200810 Address after: 7 / F, block B, building 8, No. 8, Rongjing East Street, Beijing Economic and Technological Development Zone, Daxing District, Beijing 100176 Patentee after: Beijing caditai Medical Device Technology Co., Ltd Address before: 100176 No. 8 Rong Jingdong street, Beijing economic and Technological Development Zone. Patentee before: Beijing Tide Pharmaceutical Co.,Ltd. |