CN203935281U - The guiding catheter handled with preform curved shape - Google Patents

Abstract

This utility model relates to a kind of guiding catheter handled with preform curved shape.In one embodiment, can handle guiding catheter comprises handle and is connected to the elongated axostylus axostyle that handle extends from handle towards outside.This axostylus axostyle has the far-end that is in reverse to handle.The second preform bending section that this axostylus axostyle far-end also has the first preform bending section and locates at the first preform bending section nearside.These two preform bending sections can enough molding processes be manufactured, such as " baking " molding effectively in conduit axostylus axostyle of these two preform bending sections.Described guiding catheter also has for controllably handling at least operating mechanism of the first preform bending section of far-end.Described operating mechanism is connected between handle and elongated axostylus axostyle, and its driving causes that the first preform bending section is at least two plane inner bendings.

Description

The guiding catheter handled with preform curved shape

Technical field

This utility model relates to be organized fasteningly, specifically, relates to organizing of using that manual operation apparatus carries out with Wicresoft and percutaneous mode fastening.Described manual operation apparatus comprises and steerablely can be used for delivery guidewire to annulus of mitral valve tissue and cause the guiding catheter of this annulus of mitral valve tissue fold.Described handle that guiding catheter can also not describe at this utility model for other organize fastening.

Background technology

With reference to Fig. 1-4 only for understanding heart 10, the anatomical structure of left side, left atrium (LA) 12 and the left ventricle (LV) 14 of heart 10 specifically.The Oxygenated blood that aorta 16 receives from left ventricle 14 by aortic valve 18, aortic valve 18 is for stoping blood backflow to be back to left ventricle 14.Bicuspid valve 20 is positioned between left atrium 12 and left ventricle 14, guarantees the one-way flow of Oxygenated blood from left atrium 12 to left ventricle 14.

Bicuspid valve 20, it will be described in more detail below, and comprises the frontal lobe 22 and the posterior lobe 24 that are connected to valve chordae tendineae 26,28 (Fig. 4).The effect of valve chordae tendineae 26,28 is as " strain component ", and the closing point that the lobule 22,24 of prevention Bicuspid valve 20 is crossed them enters left atrium 12.When during systole left ventricle 14 is shunk, valve chordae tendineae 26,28 has limited movable (towards the left atrium) upward that frontal lobe and posterior lobe 22,24 are crossed frontal lobe and posterior lobe 22,24 joints, at frontal lobe and posterior lobe 22,24 joints, frontal lobe and posterior lobe 22,24 stop left ventricle 14 to the backflow (" mitral incompetence " or " mitral incompetence ") of left atrium 12.Valve chordae tendineae 26,28 is from trabeculae carneae cordis or more particularly muscle nipple (papillary muscles) rise of trabeculae carneae cordis.In each accompanying drawing here, thereby some anatomical features are by the deleted main points of illustrating better.

The frontal lobe 22 of Bicuspid valve 20 and the normally thin flexible membrane of posterior lobe 24.When Bicuspid valve 20 is closed, frontal lobe 22 and posterior lobe 24 conventionally align and contact with each other along " closing line " of their free margins rollback numbers millimeter, thereby produce sealing, have stoped mitral incompetence.When Bicuspid valve 20 is opened, blood is through the opening down left ventricle 14 that flows into producing between frontal lobe 22 and posterior lobe 24.

Manyly relate to mitral problem and can cause and permitted eurypalynous disease.These problems include but not limited to mitral incompetence.Mitral incompetence, also claims to reveal, and is the incomplete closure due to Bicuspid valve 20, and blood is from left ventricle 14 adverse currents to left atrium 12.That is to say, reveal and usually occur in heart shrinkage period, thereby frontal lobe and posterior lobe 22,24 are failed against the gap of causing each other between frontal lobe 22 and posterior lobe 24.

In general, in multiple different reasons, considerable constringency cleft can occur between frontal lobe 22 and posterior lobe 24.For example, gap can be due to congenital malformation, due to ischemic diseases or because heart 10 is damaged and exists by previous heart attack.This gap also can produce when congestive heart failure, for example, and cardiomyopathy, or cause the disease of some other types that heart 10 expands.The expansion of heart 10 can cause mitral draw together (stretching).This expansion is confined to rear valve annulus conventionally, and relates to posterior lobe 24, and this is because front ring is the fibre structure of relative stiffness.When rear widening of the ring, it causes that posterior lobe 24 leaves frontal lobe 22 motions, produces the gap during shrinking, and this is because two lobules no longer form suitable joint.This has caused leakage or the backflow of blood through valve 20.

Blood causes that by the leakage of Bicuspid valve 20 heart 10 effects reduce conventionally, and this is because heart 10 is pumped to blood externally via aorta 16, and returns to (with the form of mitral incompetence) to left atrium 12.Leakage by Bicuspid valve 20 or conventionally mitral incompetence, be considered to the tendency of congestive heart failure (CHF) conventionally, or the reason that runs down of heart failure.Conventionally have and the decay symptom of relevant different brackets of heart.These grades are classified by New York heart association (NYHA) functional classification system.Even if this grade is not from substantially there is no grade 1 that the asymptomatic patient of muscle power restriction is relevant to the relevant class 4 of patient that can not cosily carry out any physical exertion and have cardiac dysfunction symptom when the rest.In general, the degree that rectification or minimizing Bicuspid valve are revealed can successfully reduce patient's NYHA classification grade.For example, the patient who has class 4 classification can, so that his classification is reduced to grade 3 or grade 2, therefore causes when rest or even and feel relative comfort during slight physical exertion.Eliminate blood back flow to left atrium 12, reduce mitral incompetence and reduced the workload of heart 10, and can stop or the slow down cardiac function that causes due to mitral incompetence and the degeneration of congestive heart failure.

Be used for correcting that Bicuspid valve is revealed or CHF more generally, the normally highly invasive happy surgical operation for the treatment of.In egregious cases, this operation also comprises that the patient to heart failure implants ventricular assist device, such as artificial heart.Implant ventricular assist device conventionally very expensive, and patient needs life-time service anticoagulant after implanting ventricular assist device.Anticoagulant treatment has reduced the risk for example forming at ventricular assist device inner blood grumeleuse.Although wish to reduce the risk of blood clotting in ventricular assist device implanted treatment, anticoagulant treatment can increase for example uncontrollable risk of bleeding owing to falling down of patient.

In some cases, for example heart is beaten in invalid situation in certain asynchronous mode, if do not use ventricular assist device, also can use the biventricular pacemaker that is similar to pacemaker to treat.Although biventricular pacemaker may be effectively, not all cardiac is suitable for receiving biventricular pacemaker.In addition, biventricular pacemaker and operation are relatively expensive, and conventionally can not reduce or eliminate significantly mitral incompetence.

Particularly, the happy surgical operation that rectification Bicuspid valve is revealed comprises the implantation of replacement valve.Valve from the animal of for example pig can be used for replacing the Bicuspid valve 20 in human body.Although pig valve can relatively successfully be replaced Bicuspid valve, this replacement valve can be worn and torn conventionally, also needs other open surgery in the future.The Bicuspid valve that unlikely mechanical valve prosthesis of wearing and tearing also can be revealed for displacement.Yet after implanting mechanical valve prosthesis, the risk of patient's thromboembolism increases, and conventionally need to accept for a long time the treatment of anticoagulant.

Less invasive surgical operation comprises to port and enters the bypass surgery that art is relevant.With respect to cutting apart breastbone, open the open chest surgery in the whole thoracic cavity of patient, port enters art by the otch between rib or sometimes by removing the otch of one or more rib generation, heart is carried out to operative treatment.

A kind ofly relatively be successfully used in correcting that Bicuspid valve is revealed and the happy surgical operation of other mitral incompetences is annuloplasties.When annuloplasty, medical treatment device such as valve forming ring can be implanted in by the mode of operation (that is, the link position of common Bicuspid valve substrate and heart) in mitral left atrium side.This device is reduced to relatively normal size by the annulus of mitral valve of expansion.Particularly, this operation moves to assist frontal lobe-posterior lobe to engage to frontal lobe posterior lobe, and therefore improves the quality of heart shrinkage period Bicuspid valve closure.Valve forming ring is " D " shape conventionally, with the natural shape of the annulus of mitral valve shown in the upper figure of correspondence.Conventionally, the netted coating of DACRON is made and covered to these rings for example, by bar or the pipe of biocompatible material (, plastics).

In valve forming ring implant surgery, surgeon is connected to valve forming ring in mitral atrial side.At traditional ring, install in operation, doctor opens patient's breastbone and patient is placed on cardiopulmonary bypass unit.Valve forming ring is made on mitral top.When valve forming ring is sewn on Bicuspid valve, surgeon is the fibrous tissue to the joint between AoPW and ALMV substrate by the straight flange latasuture system of " D " conventionally.Along with the bending section encircling divides the rear side of making to valve annulus, in contrast to relatively little the lunging that the fibre-coated of valve forming ring adopts, surgeon need to from relatively a large amount of tissue of annulus of mitral valve, for example, use the tissue of 1/8th inches of pin and line to lunge.Once line is loosely connected to annulus of mitral valve tissue by valve forming ring, valve forming ring slips into annulus of mitral valve.The rear side annulus of mitral valve of previously having expanded due to cardiac dilatation is organized on circumference and effectively reduces, and the pulling force being applied by valve forming ring by stitching thread or line is by forward towards ALMV tractive.Therefore, the gap between ventricular systole or heart shrinkage period frontal lobe 22 and posterior lobe 24 can be reduced even in some cases substantially closed, and then reduces significantly or even eliminate mitral incompetence.At Bicuspid valve 20 during by loop forming, frontal lobe and posterior lobe 22,24 conventionally by by by posterior lobe 24 forward tractive with the frontal lobe 22 that crosses exactly, reinvent the contact wire of Bicuspid valve 20.

Although receive the patient of valve forming ring, will accept the treatment of anticoagulant, this treats limited amount, and this is because patient only must accept the time that this treats about several weeks, to organizing, valve forming ring is covered.

Another kind of more effectively reduce the operation of prolapsing to leaflet of mitral valve Bicuspid valve relevant and revealing comprise by single edge butt joint stitching thread be placed in that Bicuspid valve 20 is interior, the middle part of frontal lobe and posterior lobe 22,24.For example, in Alfieri stitching or Bow-tie prosthesis, edge butt joint is made in the middle of sewing up the large frontal lobe 22 about Bicuspid valve 20 and the gap between posterior lobe 24.Once it is in place that this is sewn between frontal lobe and posterior lobe 22,24, it is drawn into form the stitching that frontal lobe is held against to posterior lobe 24.

The another kind of surgical operation that reduces Bicuspid valve leakage comprises to be placed stitching thread along the annulus of mitral valve around posterior lobe 24.These stitching thread can form double track by sub-thread suture material, for example two " OK ".These stitching thread are located knotting at about intermediate point (P2) of posterior lobe 24.Wiping away pad is conventionally placed in selected stitching thread bottom and wears ring 40 to stop stitching thread to tear.When stitching thread tension and knotting, the circumference of ring 40 can be reduced to desired size effectively, thereby the size in the heart contraction gap between posterior lobe 24 and frontal lobe 22 is reduced.

Although the treatment that has wound surgical operation to reveal at Bicuspid valve has shown effectiveness, yet there is wound surgical operation conventionally to there is significant deficiency.Whenever during patient experience open heart operation, all can bear infection risk.Open breastbone and use cardiopulmonary bypass machine can cause short-term and long-term function of nervous system's defect.In addition, consider the complexity of open heart operation, and longer recovery time, the patient who is not caused very big inconvenience by CHF symptom, for example, the people in grade 1 classification, can select not carry out corrective procedure.In addition, need most the patient of open heart operation, for example the people in class 4 classification, can not bear this operation because of physical weakness or fragility.Therefore, many mitral patients that benefit from surgical repair can not bear surgical operation.

In another approach, use conduit system that hooping device is placed in coronary sinus (CS), wherein the hooping device of distally, centre and nearside is anchored in the tube chamber of CS, so that ring 40 folds by CS.In force, these anchor bandings together, and the distance between them by tractive such as cable or sutural, be intended to for shortening valve annulus 40 and tractive posterior lobe 24 and more shorten near the flexible strain component of frontal lobe 22 being similar to the mode of valvoplasty.Unfortunately, CS organizes relatively fragile, and these anchors are easily torn tissue during banding program.In addition, some patient's CS does not directly align with Bicuspid valve, and this therapeutic modality just can reduce mitral effect.For other, be used for treating the Minimally Invasive Surgery that Bicuspid valve is revealed, due to the effectiveness of embodiment and/or the cause of accuracy, there is separately shortcoming separately.

Summary of the invention

In one embodiment, can handle the elongated axostylus axostyle that guiding catheter comprises that handle is connected with same handle and extend from handle towards outside.This axostylus axostyle has the far-end that is in reverse to handle.This axostylus axostyle also has at the first preform bending section of far-end and at the second preform bending section of the first preform bending section nearside location.These two preform bending sections can be in molding process in conduit axostylus axostyle effectively " baking " make.

Described guiding catheter also has controllably handles at least operating mechanism of the first preform bending section of far-end.Described operating mechanism is connected between handle and elongated axostylus axostyle, and can cause that the first preform bending section is crooked at least two planes.These two planes depart from each other, and while causing operating mechanism to drive, the first preform bending section moves in spiral-shaped mode.

In one embodiment, a kind of delivery guidewire to heart Bicuspid valve place or near position to allow the folding method of annulus of mitral valve to comprise the steps: that (1) provides the guiding catheter handled with above-mentioned feature; (2) guiding catheter is inserted in the left ventricle of heart; (3) the second bending section is placed against the aorta wall of heart; (4) drive the operating mechanism can handle guiding catheter to cause that the first preform bending section is crooked and to be positioned between the papillary muscles of heart against the left ventricular wall under the cusp of heart; And (5) delivery guidewire is through handling guiding catheter to mitral ring, thereby allow by different apparatuses folding to annulus of mitral valve.

Can handle as discussed herein guiding catheter can also be for other application, and in these application, treatment material and/or apparatus are transported to destination organization, and use perienchyma that topical therapeutic is provided.

These and other aspects, Characteristics and advantages should be apparent by accompanying drawing and the description of some embodiment of this utility model.

Accompanying drawing explanation

Fig. 1 be patient and anatomical cardiac structure with generalized section, this figure also comprises through vascular system and introduces patient's aorta and the guiding catheter handled in heart;

Fig. 2 is the profile that upper figure heart is seen from top to bottom, the figure shows the guiding catheter handled of an embodiment of this utility model;

Fig. 3 is the side view of the guiding catheter handled of an embodiment of this utility model;

Fig. 4 is the decomposition diagram of the guiding catheter handled of an embodiment of this utility model;

Fig. 5 is the driver of an embodiment of this utility model, i.e. a part for guiding catheter shown in Fig. 4, profile;

Fig. 6 is the end-view of the guiding catheter handled of an embodiment of this utility model;

Fig. 7 is the profile that the hatching line 7-7 along Fig. 6 gets;

Fig. 8 is the side view of internal part of handle body of the guiding catheter handled of an embodiment of this utility model;

Fig. 9 is the top view of the handle body of an embodiment of this utility model;

Figure 10 is the side view of the conduit axostylus axostyle of an embodiment of this utility model;

Figure 11 is amplification, the close-up side view at tip far away of the conduit axostylus axostyle of an embodiment of this utility model;

Figure 12 is the profile of tube chamber of the conduit axostylus axostyle of an embodiment of this utility model;

Figure 13 be the driving of an embodiment of this utility model can operating mechanism the side view of distal ports of conduit axostylus axostyle in normal, resting guard;

Figure 14 is the side view of mandrel of the first preform bending section that is used to form conduit (far away tip section) of an embodiment of this utility model;

Figure 15 is the side view of mandrel of the second preform bending section that is used to form conduit of an embodiment of this utility model;

Figure 16 has illustrated the arch curve template for conduit axostylus axostyle of an embodiment of this utility model;

Figure 17 has illustrated being used as of an embodiment of this utility model to toast (resting position) and has been used as hinged summit template curve;

Figure 18 is the side view of the conduit axostylus axostyle in direction of elongate, and it shows, and manipulation silk leaves a tube chamber (handling fiber tube chamber) and spiral shell is connected to main tube cavity.

The specific embodiment

Now with reference to each accompanying drawing, folded tissue in this utility model (the especially relevant annular tissue of Bicuspid valve) method, device and system are described.It should be understood that, although the detail of described methods, devices and systems will provide herein, those of ordinary skills can make various changes, replacement and add these details, and these change, replace and add and still fall within the scope of the utility model that those of ordinary skills of setting forth herein can understand after integrally reading this utility model.Should be noted that, the implication that term " nearside " is conventional with this area with " distally " implication is in the present note consistent, for representing specific device or parts relative usage person's spatial relationship.That is to say, " nearside " refers to more the position near user, and " distally " refers to more the position away from user.

Although this explanation, for come folded tissue to do comparatively detailed elaboration with these devices, should be appreciated that and will be appreciated that, these devices can be used in other application that do not relate to folded tissue.For example and as discussed below, these apparatuses can be used in to correct other deformities and can be used in and the material such as stem cell, atom material, molecule etc. is delivered to target site is used for repairing target site.

Fig. 2 and 3 has illustrated according to the guiding catheter handled 100 of an embodiment.Can handle guiding catheter 100 and have elongate body 102, its edge is vertical, central shaft extends and comprise near-end 103 and far-end 105.Main body 102 can comprise flexibility, the deflectable distal ports 104 of omnidirectional, and it ends at far away most advanced and sophisticated 106, described far away most advanced and sophisticated 106 can have bending or circular outer tip end surface 108.The distal ports 104 that it should be understood that main body 102 can be shorter, can be more flexible compared with other parts of main body 102.

Can handle guiding catheter 100 and comprise that a perforation can handle the spindle rod 120 of guiding catheter, and far away most advanced and sophisticated 106 can use traditional method to be connected on spindle rod 120.So-called traditional method connects to draw together to be used binding agent (medical grade adhesive) and uses grappling band 130 (platinoiridita grappling bands).Spindle rod 120 can be with the form of establishment bar.Spindle rod 120 also has the hollow-core construction of the central lumen therefrom extending through.

Can handle guiding catheter 100 and comprise near-end 103 places that are arranged in main body 102, and can by conventional art, be connected to (comprising use binding agent, such as epoxide resin material) hub 140 of spindle rod 120 one end.Hub 140 is at least part of hollow members, and comprises the axially aligned centre bore of central lumen with spindle rod 120.Hub 140 can comprise wings 142 (for example, two opposed wings), and hub 140 is held more easily.

Can handle guiding catheter 100 and also comprise the Touhy adapter 150 of arranging along main body 102 length.Touhy adapter 150 comprises a main body (such as PCV main body) and an inner packing ring.Inner packing ring resistance to chemical attack, stops fluid to backflow, and when closing the fixing position of seal wire or apparatus.As shown, Touhy adapter 150 is arranged between two different segments of main pipe 120, that is to say, one section of main pipe 120 between hub 140 and one end of Touhy adapter 150, and another section of main pipe 120 is between the other end of Touhy adapter 150 and most advanced and sophisticated 106.

The central lumen that can handle guiding catheter 100 provides for catheter guide wire or developing agent or such as the passage of the imaging probe of optical fibers art or ultrasonic probe etc.Below also can in conjunction with 100 and seal wire (as a described operating part below) be described.

Guiding catheter 100 can be handled and traditional operating mechanism (not shown) manipulation wherein and that connect with driver can be placed on.For example, operating mechanism can comprise another root manipulation silk, is used for changing the position at tip 106 and the shape of axostylus axostyle 120, thereby stopper tip 106 is placed in to target location.

This utility model further provides by the guiding catheter handled 200 shown in Fig. 4-12.Guiding catheter 200 is elongated implement that have first (distally) end 202 and be positioned at second (nearside) end 204 of opposite location.The handle 210 that is placed in near-end 204 can be according to the guiding catheter 200 of handling described herein.Guiding catheter 200 also comprises a slender conduit axostylus axostyle 300 that has far-end 302 and be positioned at the near-end 304 of opposite location, and described near-end 304 is with handle 210 couplings.In some cases, near-end 304 is by mating with handle 210 towards open front 305 in handle 210.In handle main body towards open front 305 places a configurable sleeve pipe 217, guiding catheter 200 can pass sleeve pipe 217.The near-end 304 of guiding catheter 300 can be arranged on other workpieces hereinafter described in handle 210 and in connecting handle 210.Hold-down screw can be used in fixed sleeving 217.

As mentioned above, the conduit axostylus axostyle 300 of guiding catheter 200 comprises an operating mechanism (such as handling seal wire 301).Described manipulation seal wire 301 places and can be handled to cause that along the length of conduit axostylus axostyle 300 axostylus axostyle 300 moves (for example, crooked with curvilinear motion).Handling seal wire 301 will below describe in further detail along the details of conduit axostylus axostyle 300 wirings.Although seal wire 301 is major parts, be completely contained in conduit axostylus axostyle 300, one end 303 of seal wire 301 extends through the opening being formed in conduit axostylus axostyle 300 and along conduit axostylus axostyle 300 length, advances on outside.Seal wire 301 one end 303 can be touched, and specifically, can or advance end 303 to control the motion of conduit axostylus axostyle 300 by tractive.

Fig. 4 has illustrated all parts of handle 210.More specifically, handle 210 comprises handle main body 220.The handle main body 220 of illustrating has cylindrical shape, and is hollow, to allow to receive other workpieces of handle 210.From the top 222 of main body 220, there is a slit 223.Driver 240 extends through and can be touched by operator/user in this slit.The driver 240 of illustrating is slidably, its linearly (front and back) motion cause and the motion of control lead axostylus axostyle 300.

Driver 240 comprises button 242, handle frame 244 and button frame 246.Button 242 has a recessed end face, its profile is convenient when receiving the thumb of user and allowing user to be in one's hands handle main body 220 removable drive 240 slidably.Button 242 has a bottom surface from button towards the post of downward-extension or protrudes 243.Handle frame 244, with the form of piece, such as rectangular block, and has the tooth 245 forming along the bottom surface 247 of handle frame 244.Handle frame 244 is positioned in the slit 223 in main body 220.Handle frame 244 comprises the slit 249 at Jia 244 centers.The slit 249 of illustrating has rectangular shape.Handle frame 244 can be used traditional means, comprise that the securing member 251 such as screw is connected to handle main body 220 at every end place of frame.Thus, handle frame 244 is fixed and is static with respect to handle main body 220.

Button frame 246 comprises basilar part 250 and the post portion 252 of extending from basilar part 250 upward.Post portion 252 is positioned at respect to basilar part 250 centers.Basilar part 250 is cut apart in post portion 252, thereby makes two frame portions 254 be positioned at post portion 252 both sides.Each frame portion 254 comprises the tooth 256 forming along the end face of basilar part 250.Tooth 256 and tooth 245 complementations, and especially, tooth 256,245 is designed to mate engagingly each other, and then movable button frame 246 is connected to fixed handle frame 244.It is in place that coupling between tooth 256,245 allows button frame 246 along handle frame 244, at ad-hoc location, to fix (locking), and still allow button frame 246 by button frame 246, from the separation of handle frame 244, along handle frame 244, to move as mentioned below.

The post portion 252 of button frame 246 is hollow units, thereby can receive the post 243 of button 242 and button 242 is connected to button frame 246.This structure can be the motion of button frame 246 by the conversion of motion of button 242.Button 242 is positioned on the outside of handle frame 244, and button frame 246 is positioned on inside handle frame 244 opposite sides of handle.The bottom surface of button frame 246 has the groove 249 forming along its length.Conduit axostylus axostyle 300 is placed in groove 249, and button frame 246 slides and advances above conduit axostylus axostyle 300.

Driver 240 also comprises a travelling carriage (shuttle) 260 that is connected to button frame 246.Travelling carriage 260 comprises end face, and it comprises groove 262, and described groove 262 is identical with groove 249 or similar.Conduit axostylus axostyle 300 can be placed in groove 262, and travelling carriage 260 can be advanced slidably above conduit axostylus axostyle 300.Button frame 246 is arranged in a side of conduit axostylus axostyle 300, and travelling carriage 260 is placed in the opposite side (opposite side) of conduit axostylus axostyle 300.Travelling carriage 260 can be used conventional art (such as mechanical connection) to be connected to button frame 246.For example, travelling carriage 260 can comprise that same button frame 246 is in conjunction with the locking plate 265 of (coincideing), and button frame 246 and locking plate 265 can link together with securing member.

Handle silk 301 and be securely connected on the slide unit of driver 240, thereby make the motion of driver 240 in handle can be converted into the motion (tractive or propelling action) of manipulation silk 301.For example, handle silk 301 and can securely be connected to travelling carriage 260 and meaning as shown, handle silk 301 through the openings 261 in travelling carriage 260.Described opening 261 fully extends through travelling carriage 260 also as shown in Figure 5, handles silk 301 through travelling carriage 260 and leaves opening 261 in one end of travelling carriage 260.Connecting elements, can be used in manipulation silk 301 is fixed on travelling carriage 260 effectively such as accessory 267.Accessory 267 can be hollow unit, and the end of handling silk 301 can insert accessory, then uses traditional means (such as crimping) that accessory is connected with this silk 301.Because the size of accessory 267 is greater than the size of opening 261, accessory 267 can not insert in opening 261 completely, and then silk 301 is fixed on travelling carriage 260.

The end face of travelling carriage 260 comprises a pair of hole or recess 269, and they are distributed in the both sides of groove 262.Shown travelling carriage 260 is normally semicircular, can be placed in the inner chamber with complementary shape in handle 210, thus the slip of permission travelling carriage 260.Similarly, the bottom surface of button frame 246 comprises a pair of hole or recess (not shown), and they axially aim at hole 269 when button frame 246 and travelling carriage 260 match each other.Biased element 270 is arranged between button frame 246 and travelling carriage 260, and biased element 270 application of forces are to button frame 246, thereby by tooth 256 and tooth 245 engagements.Therefore biased element 270 causes button frame 246 and handle frame 244 interlockings.In common resting position, button frame 246 bias voltage engagement upward handle frame 244.

Biased element 270 can be a pair of spring being securely placed in the hole of handle frame 244 bottom sides and the hole of button frame 246 end faces.Spring 270 can cause button frame 246 to contact with handle frame 244.If need to movable button frame 246 is separated with fixing handle frame 244, can press push button 242, thus cause that button frame 246 moves down, cause spring 270 compression storage power.At button frame 246, move down and during spring 270 stored energy, tooth 245,256 is separated from one another, and then allow driver 240 along handle freely-movable.The motion of driver 240 (linearity) causes handles correspondingly motion of silk 301, and then causes conduit axostylus axostyle 120 to present the configuration of curve (bending) more or more straight configuration.

In driver 240 is advanced along conduit axostylus axostyle 200, the degree of advancing of driver 240 is formed at the length restriction of the slit 223 in handle main body 220.

Handle 210 also comprises the rotor assembly 305 that is arranged in the proximal end of handle 210 and is rotatably coupled with handle.The mode that the near-end 304 of conduit axostylus axostyle 300 connects with rotor assembly 300 can allow rotor assembly 305 around 200 rotations of conduit axostylus axostyle.Rotor assembly 305 comprises rotor subject 310, and rotor subject 310 has the centre bore 313 of a both ends open.The rotor subject 310 of illustrating has a cylindrical shape with the cylindrical shape complementation of handle main body.The end 312 of rotor subject 310 can have the structure that allows rotor subject 310 to match each other with the opening of handle main body, such as end 312 can have a flange shape structure that can be placed in handle main body opening.The flange shape structure at end 312 places of rotating main body 310 and the end of handle main body match each other, and the fastening same handle main body of rotor subject 310 is connected.

The rotating main body 310 of illustrating also comprises the angled side ports extending outwardly 328 of same rotor subject 310.Side ports 328 is hollow-core constructions and comprises hole 329, and described hole 329 is communicated with centre bore 313.Therefore, side ports 328 can be brought into play function from apparatus element to centre bore 313 that introduce or shift out from centre bore 313.Side ports 328 can flush with rotor subject 310, or can be cloudy Rule type adapter, thereby can be with complementary male connector coupling.

In one embodiment, rotor subject 310 makes to allow user can observe in centre bore 313 by transparent material, thereby guarantees that guiding catheter 100 operates exactly.Because hole 313 is communicated with the central lumen in being formed at conduit axostylus axostyle 300, user can be observed the object that enters and pass guiding catheter 200.Transparent rotor subject 310 can also help user to observe harmful bubble, fluid etc.

Rotor assembly 305 comprises the device for the near-end 304 of connecting duct axostylus axostyle 300, so that conduit axostylus axostyle 120 is fixedly connected to handle main body, and the relative to each other freely rotation of rotor subject 310 and handle main body.Rotor assembly 305 can comprise nearside insert 320, and it comprises centre bore or the opening 322 being formed at wherein.Hole 322 sizes can allow conduit axostylus axostyle 300 through hole 322.Conduit axostylus axostyle 300 can be mounted to the pipeline 330 of certain length, and described pipeline 330 ends at the near-end of conduit axostylus axostyle 300 and extends in hole 320.Hollow pipeline 330 provides a tube chamber axially aligned tube chamber with conduit axostylus axostyle, thereby the object inserting through pipeline 330 is entered in the central lumen of conduit axostylus axostyle 300.Insert 320 also mates with one end of rotor subject 310, and the hole 313 of rotor subject 310 axially aligns with hole (tube chamber) and the conduit axostylus axostyle 120 of insert 320.Insert 320 interconnects with rotor subject 310, so that the two rotates together.

As shown, insert 320 is included in the outstanding of a corresponding construction coupling on the same rotor subject 310 of its one end.So-called corresponding construction can be a slit of the end of rotor subject 310.Sealing ring, such as O shape ring 325 can just put outstanding 321 and rotor subject 310 outstanding between.

Rotor assembly 300 also comprises a proximal handle cap 340 securely connecting with one end of rotor subject 310.Cap 340 is hollow-core constructions, comprises the opening 342 being formed on wherein.Opening 342 can be annular opening.Cap 340 can have female thread 344, thereby cap 340 is securely linked together with rotor subject 310, and cap 340 is rotated together with rotor subject 310.

Between rotor subject 310 and cap 340, can place a pressure ring 350.One end of rotor subject 310 can comprise recess, and pressure ring 350 can be positioned in this recess.Pressure ring 350 can be a cylinder component, this cylinder has a centre bore or opening 352, and when cap 340 and rotor subject 310 mate together by being arranged in pressure sealing ring 250 between them, pressure ring 350 centre bores and other centre bores axially align.

The opening 342 of cap 340 can be screw thread openings, can same female Luer 360 couplings.Now, this female Luer 360 can represent the near-end of recent side parts and guiding catheter 100.Nearside female Luer 360 comprises screw thread 362, female Luer 360 securely can be connected on cap 340, thereby a part for female Luer 360 is extended outwardly from one end of cap 340.Female Luer 360 is hollow-core constructions, has and therefrom passes hole or the through hole 361 forming, allow to insert in hole 361 such as the thing of silk or conduit, and the central lumen that enters conduit axostylus axostyle 300 by the luminal structure of rotor assembly 300.Transparent rotor subject 310 makes user can see the object that inserts female Luer 360.

As below more described in detail, rotor assembly 305 represents that user is held that part of the guiding catheter 100 of (grasping) when wishing rotary guide pipe axostylus axostyle 300.When user rotates guiding catheter 100, with predetermined direction rotation, rotor assembly 305 keeps static to handle main body 210.Because conduit axostylus axostyle 300 is fixedly connected to handle main body 210, the rotation of handle main body 210 is converted into the rotation of conduit axostylus axostyle 300.This makes the tip of conduit axostylus axostyle 300 can be positioned at the position of expectation at during surgery.This structure fabric is equipped with its special advantage, and this is because it is when allowing the rotation of conduit axostylus axostyle 300, assembly 305 and be arranged in the impact that any object in side ports 320 can rotatablely not moved by conduit axostylus axostyle 300.

Handle 210 and associated components thereof, such as rotor assembly 305, can make by enough any materials (comprising suitable plastics).

According to this utility model, the conduit axostylus axostyle 300 of guiding catheter 100 can be handled and various curved shapes can be made in advance as required, such as, the second preform bending section 500 that conduit axostylus axostyle 300 has the first preform bending section 400 and is interval in the first preform bending section 400.Figure 10 shows these two preform bending sections and forms previous conduit axostylus axostyle 300.Figure 13 show before handling described operating mechanism in common release position two bending sections 400,500.The first preform bending section 400 is positioned at far-end 302 places of conduit axostylus axostyle 300, and the second preform bending section 500 is at the nearside that is interval in the first preform bending section 400.The second preform bending section 500 can be considered to aorta bending, and the first preform bending section 400 can be considered to be intended to be positioned between papillary muscles and against the crooked distal tip section 410 of Bicuspid valve downside left ventricle.The radius of curvature of the first preform bending section 400 is greater than the radius of curvature of the second preform bending section 500.

As more described in detail herein, in conduit axostylus axostyle of the present utility model, the existence of two curves provides a plurality of advantages, such as, the anatomical structure of the heart that the typical surgical intra-operative that these two curves (curved section 400,500) allow conduit 100 to follow better mitral annular tissue is carried out runs into.More specifically, an illustrative surgical operation described herein comprises that conduit passes aortic valve, passes the retrograde passage of papillary muscles, thereby the far-end of conduit is positioned to mitral rear side below.

The second preform bending section 500 (aorta bending section) in conduit 100 reduces the wound of conduit to aortic arch tissue.Secondary bending (the second preform bending section 500) has increased the navigability of conduit and has increased the transmission of conduit internal torque.This is because this bending has reduced conduit 100 and aortal Exposure.This bending is borrowed by aortic arch change direction, the best located that reaches conduit and layout conduit.Do not adopt the whole length of conduit to stop and follow aortal bending, by secondary bending (bending section 500), form the catheter length that conduit 100 of the present utility model reduces the contact of Liao Yugai regional organization.Therefore,, due to less-restrictive, torsion conduit 100 becomes and has been more prone to.

Far-end crooked (the first preform bending section 400) design rests against on left ventricular wall conduit 100, and other medical treatment devices can be performed the operation and/or puncture annulus of mitral valve at annulus of mitral valve place through the central lumen of conduit axostylus axostyle.Distally crooked (the first preform bending section 400) makes conduit 100 for example rest against conduct, to (, conduit is borrowed and leaned against on wall) on the wall of this conduit support.Although conduit 100 leans against on wall, anchor/seal wire described ring that can puncture.

Below describe in further detail an embodiment, the first preform bending section 400 is can the section of manipulation, and wherein its curvature can change according to the driver 240 in user control crank main body 210.Comparatively speaking, the curvature of the second preform bending section 500 is substantially constant during using guiding catheter 100.The second preform bending section 500 can be considered to fixed bend pars convoluta.Below bending section 400,500 is done to describe in further detail.

The first and second bending sections 400,500 can be used conventional art (including but not limited to molded operation) preform.Figure 14 shows a mandrel 600 that can be used to form the first preform bending section 400.Described mandrel 600 is designed to make it can give the curved shape of tip section 410 expectations far away.

Sheathed catheter is through on mandrel 600 so that mandrel is arranged in the central lumen of conduit.Wear conduit until the predetermined portions of distal end of catheter is arranged on the bending section 601 of axle 600.

Then to heating conduit until the material of conduit (for example, PEBAX) reach fritting condition and material and start deliquescing.Then make conduit cooling, this bending that mandrel 600 is given is fixed.After cooling, remove mandrel 600.The first curve 400 is by " bake into " thus.

The shape of mandrel 600 can have shaft-like, and has a hook at far-end, and described hook has determined to handle the structure of tip section 410 far away.Once should be noted that mandrel 600 is removed, most advanced and sophisticated 410 elasticity due to material far away can slightly be opened.For this reason, the shape of mandrel 600 and the shape of the distal tip shown in Figure 13 410 in common resting position have slight difference.It should be understood that Figure 13 is only the representative of two curves, the variation of this Figure 13 and 14 curve relative size is only for signal.

Similarly, mandrel 610 can be used for forming the curved shape of the second preform bending section 500.As mentioned above, the second preform bending section 500 deflection curve distal tip regions (the first preform bending section 500) at its nearside.It is less obvious that the curve of the second preform bending section 500 (radius of curvature) is compared the curve of the first preform bending section 400, the second preform bending section 500 slight bending just in the whole shape of conduit axostylus axostyle.As described below, in use, the second 500 of preform bending sections are against aortal tube wall for guiding catheter 100.

Axle 600 first can be for the first bending section 400 of " baking " (formation) conduit axostylus axostyle 300 far-ends effectively, (after forming the material cooled of conduit axostylus axostyle 300) subsequently, mandrel 610 can insert " baking " (formation) the second bending section 500 in conduit axostylus axostyle 300.This second process forms the aorta crooked (second segment 500) of tip section nearside far away effectively.In bake process, sections 611 is fixed conduit according to the shape of aorta bending.Sections 612 is identical with the sections 601 of mandrel 600 in shape.Sections 612 keeps its curved shape 400 in the second bake process that forms bending section 500.Between sections 611 and 612, can there is a straight sections 613.Therefore, two of conduit bendings 400,500 can be placed along conduit.The curvature of distal tip section 400 is unaffected in the process that forms aorta curvature section 500.

From Figure 13, can find out, be benchmark along a certain side of conduit axostylus axostyle 300, if the second bending section 500 is recessed, the first bending section 400 just has a protruding shape.Similarly, along the second contrary side of conduit axostylus axostyle 300, if the first bending section 400 has concave shape, the second bending section 500 just has convex shape so.In other words, the curvature direction of the second bending section 500 is in reverse to the curvature direction of the first bending section 400 conventionally.

In fact guiding catheter axostylus axostyle 300 is formed by a plurality of luminal structures that prolonging the length of axostylus axostyle 300.Such as shown in figure 12, conduit axostylus axostyle 300 has a main tube cavity of axially aligning with the central lumen in handle body 123.This luminal structure can be used for receiving an object and is passed to guiding catheter 100 far-ends.Main tube cavity 123 is at far-end 302 place's openings of conduit axostylus axostyle 300, and the far-end 302 of conduit axostylus axostyle 300 is also the far-end of guiding catheter 100.In addition, the second tube chamber 125 be positioned at main tube cavity 123 side, along main tube cavity 123 extend, the length of the second tube chamber 125 is little with the length difference of main tube cavity 123.In addition, the second tube chamber 125 is slightly shorter than main tube cavity 123, and ends at certain position of far-end nearside.The second tube chamber 125 has represented to handle silk (traction fiber) tube chamber, thereby handles the far-end that silk 301 can be routed to main tube cavity 123.As shown in the figure, the diameter of the second tube chamber 125 is less than the diameter of main tube cavity 123.In illustrated embodiment, main tube cavity 123 and the second tube chamber 125 are all circular, and are formed by the suitable material such as PTFE.

As shown in figure 18, handling silk 301 leaves the second tube chamber 125 and advances along the outer surface that forms the structure of main tube cavity 123.According to this utility model, handle silk 301 and from the end of the second tube chamber 125, do not march to linearly the far-end of main tube cavity 123, but advance with certain angle rotation along the length of main tube cavity 123.For example, in an illustrative embodiment, handle silk (traction fiber) 301 along with advancing in can handling point 410 far away (Figure 18) at main tube cavity 123 forward, and rotate approximately 70 degree.The far-end of handling silk 301 is used and comprises that the conventional art of bonding grade is fixed to the far-end of main tube cavity 123.At the termination of handling silk 301, can arrange the labelling 309 such as PT-IR indicia band.

According to this utility model, handle departing from and rotating and can cause conduit axostylus axostyle crooked in a spiral manner when driving operating mechanism of silk 301.More specifically, point 410 far away is with crooked in out-of-plane mode, crooked in plane when driving operating mechanism unlike conventional catheters axostylus axostyle.Owing to handling silk 301 and leave from silk 301 point of tube chamber 125, to handling silk 301 anchor points that are anchored into main tube cavity 123, around main tube cavity, rotate, far away most advanced and sophisticated 410 can be crooked in two planes.A plane (the first plane) is the plane that comprises tip section 410 far away, and another plane (the second plane) is the first out-of-plane plane.In other words, the driving of operating mechanism causes tip section 410 far away not only at the first plane inner bending, but also at the second plane inner bending, thereby make the bending of tip section 410 far away, is activities of a helical buckling.

Because any fastening structure of handling in silk 301 different the second bending sections 500 must connect, the second bending section 500 representatives can not the section of manipulation.But, it in standard static position in overall solid shape; Yet it is flexible and easily bending.

Screw traction silk has increased the navigability of distal end of catheter.Plane extrinsic deflection is realized by traction fiber, and designs according to the anatomical structure of the heart running into when for the aortic valve of passage between papillary muscles along with conduit.It should be understood, however, that conduit 100 is not limited to dispose medical apparatus and instruments between papillary muscles.Due to above-mentioned structure, this conduit can be handled around papillary muscles.Therefore, this conduit can be handled to a plurality of impact points on Bicuspid valve front side and rear side.In addition, conduit of the present utility model is not limited to conveying object to mitral flesh ring.Conduit 100 of the present utility model can be used in guiding/conveying object to left ventricular wall on any point between Bicuspid valve flesh ring and papillary muscles.

It should be understood that sleeve or sheath 129 cover the structure that forms main tube cavity 123 and the second tube chamber 125.Sleeve 129 can be formed by traditional catheter shaft bar material.Than the remainder of sleeve 129, can handle far away most advanced and sophisticated 410 and can there is different structures and/or be made from a variety of materials.For example, can handle tip section 410 far away can be with spiral, to strengthen the reinforcement shaft section of version, and sheath can be made from a variety of materials.Sheath 129 can also extend and exceed a little spiral strengthens structure, thereby tip section 411 is only formed by sheath material, and there is no main tube cavity 123.

Labelling 417 can be used for marker sleeve 129 sleeve 129 is made a distinction with strengthening tip section 410 far away.Labelling 417 can be an endless belt forming on sleeve 129 outer surfaces.

Figure 13 shows the tip far away of handling in resting position (driving before driver), and wherein curvature and the shape of tip section far away are exactly preform curved shape (described " baking " curvature).In order to change, can to handle the curvature of tip section 410 far away and give this section crooked (hinged) greatly, driver 240 is in the interior slip of slit 223.The slip of driver 240 (button 242) causes handling silk 301 and is pulled in the direction towards handle main body 220.As shown in Figure 16-17, the traction of handling silk 301 causes the bending (increase curvature) of tip section 410 far away, wherein tip section 410 decurvations far away crooked towards other parts of conduit axostylus axostyle 300.Figure 17 shows range of activity and in the at utmost movable position of handling most advanced and sophisticated 410 places far away.

As mentioned above, owing to handling silk 301, in tip section 410 far away, have spiral-shapedly, the traction of handling silk 301 not only causes the bending of handling silk 301, in its crooked or curling process, handles silk 301 and also does rotation slightly.From Figure 16, can find out, the second bending section 500 also can slight curvature during handling traction fiber 310.

In order to make to handle tip section 410 far away, return to its resting position, driver 240 move in the opposite direction (slip).

When the second bending section 500 rests against on target (such as aorta wall) surface, the rotational of conduit axostylus axostyle 300 causes that by some the simple rotations at handle main body 220 places conduit axostylus axostyle 300 rotates to handle tip section 410 far away and is positioned at desirable target location.

In the method for folding Bicuspid valve 20 flesh rings 40, guiding catheter 100 can be used as guiding sheath or pipe, thereby all further conduit devices guiding are entered in left ventricle 14.The guidance method that it should be understood that other can be used for substituting or supplementary the whole bag of tricks disclosed herein.Can handle guiding sheath and be positioned at the ideal position place in annulus of mitral valve ventricular side, seal wire or other apparatuses just can be arranged by means of handling guiding sheath.For example, seal wire can enter nearside female Luer 360 and enter in central lumen, and self (main tube cavity 123) forms through conduit axostylus axostyle 300.Described central lumen consists of rotor assembly 300 and handle main body 220.

Seal wire also can comprise for auxiliary puncture organizes 40 RF or radio-frequency (RF) energy delivery tip by ring.It should be understood that in this article, " ring tissue " refers to the common tissue along ring 40, and can be in fact the suprabasil tissue of posterior lobe 24 self.RF seal wire is inserted through ring tissue 40, so that its extremity extends into left atrium 12 to be similar to the mode of RF seal wire.

About other details of wire catheter and seal wire and said procedure in total U.S. Patent Application Serial Number 11/685, in 240 (open as U.S. Patent Publication No. 2008/0228265), illustrate, the full content of this patent application is contained in this by introducing.In addition, miscellaneous part is used together with seal wire, for tissue anchor (wiping away pad) being connected to (such as ring tissue 40) tissue.For example, comprise that anchor (the wiping away pad) delivery conduit of flexible conduit main body and handle can be used in the anchor that receives and arrange prestrain, described anchor is described in commonly assigned U.S. Patent Application Serial 61/407,341, and its integral body is contained in this by introducing.

As previously mentioned, apparatus disclosed herein application-specific is folded tissue; Yet apparatus disclosed herein also has other application.For example, guiding catheter can be used in the detection of guiding to specific part (destination organization etc.).Guiding catheter disclosed herein can be used in electric physiology (EP) application, comprises and is used to observe and identifies bad tissue, and take corrective measure.More specifically, in confirming the situation of bad tissue, can handle guiding catheter and can be handled and be positioned at target location, then the rectification material such as stem cell or other molecules is injected in destination organization through guiding catheter.Injection process can for example, be adjusted and be operated by the apparatus (, syringe) of the tube chamber through guiding catheter.It should be understood that stem cell can be transported to impaired destination organization, promotes the regrowth of damaged tissue.When destination organization quilt presses down, by producing road molecule again, but circuit can be walked around to time to organize again, recover.In addition, in heart tissue recirculation and when percussion, can accurately be positioned at target site by conduit as herein described, carry out topical therapeutic.By using the tissue around damaged tissue, can provide topical therapeutic.

As previously mentioned, guiding catheter can be as the conduit of carrying material to target site.Described material can be stem cell, atom material, other molecules or any other material that rectification effect can be provided conventionally.For example, described material is delivered to destination organization place by guiding catheter, and described material arrangements is arrived to destination organization place.

In addition, guiding catheter can be used in little gauge needle the studying interested tissue of carrying without sheath.It should be understood that comprising material referred to above can carry through described entry needle.In an application, artificial valve, around can reveal, guiding catheter of the present utility model can be used for filling the leakage around of artificial thin film, thereby corrects or repair this problem.In this application, due to the favourable structure of guiding catheter as herein described, once guiding catheter is in place, one or more apparatuses and material can arrive target through guiding catheter.

In another embodiment, can handle guiding catheter can be used in apex of the heart application.One type through apex of the heart application, be to implant (TA-AVI) through apex of the heart aortic valve, this therapeutic strategy is more novel comparatively speaking, be applicable to aortic stenosis and operation early stage, during and the larger patient of later stage risk.The clinical experience of the operation entering through the apex of the heart based on many decades, its tip (top) of passing through to pass left ventricle at conventional cardiac during surgery is to heart degasification.With relative plain mode, by this top, insert conduit and be possible with rear enclosed.Can also be for repairing valve etc. through apex of the heart application, the above-mentioned guiding catheter of handling of the present utility model just can be used in this application.Therefore, the summary step of above-mentioned tissue fold is only illustrative in essence, and this utility model can be by comprising that the other technologies through apex of the heart technology reach same effect.Specifically, the guiding catheter of handling of the present utility model can be used in apex of the heart application, for comprising valve repair, displacement, and also carries out other operations that comprise the bad tissue of reparation.

Therefore, should be noted that, described guiding catheter can be used in its hetero-organization, and provides not only for delivery of the means of seal wire (as detailed in this article) and for delivery of the means of above-mentioned other materials and apparatus.

Therefore, device as herein described is not limited only to tissue anchor application, can also be for multiple other application.

Should be noted that in addition, the structure of conduit axostylus axostyle is specially adapted to carry out operation as herein described, more particularly, is applicable to carry by delivery guidewire the apparatus that is suitable for folding Bicuspid valve flesh ring, is used for folding flesh ring.

Although this explanation has been described this utility model in conjunction with some embodiment, other materials and structure can be implemented with other forms, be used to this utility model.Therefore, this utility model is with each clause of appended claims and further extend to standard under doctrine of equivalents.

Claims (13)

1. can handle a guiding catheter, it comprises:

Hands handle;

The elongated axostylus axostyle that connects and extend from handle towards outside with handle, this axostylus axostyle has the far-end that is in reverse to handle, this axostylus axostyle has at the first preform bending section of far-end and at the second preform bending section of the first preform bending section nearside location, wherein said the second preform bending section comprises can not the section of manipulation, the radius of curvature of wherein said the second preform bending section is less than the radius of described the first preform bending section, described the second preform bending section is bent upwards in the first party along the second preform bending section length, and described the first preform bending section is crooked in the second direction contrary with first direction, from first direction, observe, described the second preform bending section has the concave shape along its length, and

Only, for the operating mechanism of the first preform bending section at steer distal end place controllably, described operating mechanism is connected between handle and elongated axostylus axostyle, and can cause that the first preform bending section is crooked at least two planes.

2. the guiding catheter of handling claimed in claim 1, wherein said two planes depart from each other, cause when driving described operating mechanism, and described the first preform bending section moves in spiral-shaped mode.

3. the guiding catheter of handling claimed in claim 2, the second tube chamber that wherein said elongated axostylus axostyle comprises the first main tube cavity and is parallel to described the first main tube cavity, the manipulation silk that is anchored into main tube cavity in the first preform bending section in described the second tube chamber load.

4. the guiding catheter of handling claimed in claim 3, it comprises the sleeve being arranged on the first main tube cavity and the second tube chamber, and described sleeve at least has two different sections, and wherein one section is positioned in the first preform bending section.

5. the guiding catheter of handling claimed in claim 4, its middle sleeve described wherein one section comprise spiral strengthening segment.

6. the guiding catheter of handling claimed in claim 3, also comprise and handle silk, its be connected to handle operating mechanism, pass and pass the second tube chamber and be anchored in the first main tube cavity a bit, the displacement of wherein handling silk causes the motion of elongated axostylus axostyle in the first preform bending section.

7. the guiding catheter of handling claimed in claim 6, wherein said operating mechanism comprises slide drive, it comprises the parts that connect manipulation silk, wherein the linear movement in driver proximal direction causes manipulation silk to be pulled, and the first preform bending section is bent to cause larger degree of crook.

8. the guiding catheter of handling claimed in claim 7, wherein said elongated axostylus axostyle is securely connected to the first paragraph of described handle, and described handle is formed by first paragraph and second segment, and wherein first paragraph is rotatable with respect to second segment.

9. the guiding catheter of handling claimed in claim 8, wherein said second segment comprises rotor subject, this rotor subject has the side ports from its extension, described rotor subject is rotationally attached to first paragraph, described rotor subject comprises a tube chamber, it is communicated with and axially aligns with described main tube cavity, thereby allows object to insert and go forward side by side into main tube cavity through rotor subject.

10. the guiding catheter of handling claimed in claim 9, wherein said rotor subject is transparent.

11. guiding catheters of handling claimed in claim 1, wherein said the second preform bending section is designed to seat by aorta wall.

12. guiding catheters of handling claimed in claim 6, the distal ports of wherein said manipulation silk is rotated to handling a predetermined angular for the point measurement that is anchored into main pipe with the end from the second tube chamber.

13. guiding catheters of handling claimed in claim 1, wherein said the first preform bending section has for being arranged between the papillary muscles of heart against the shape of the left ventricular wall under heart Bicuspid valve.