DE10049815A1 - Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz - Google Patents
Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen HerzInfo
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- DE10049815A1 DE10049815A1 DE2000149815 DE10049815A DE10049815A1 DE 10049815 A1 DE10049815 A1 DE 10049815A1 DE 2000149815 DE2000149815 DE 2000149815 DE 10049815 A DE10049815 A DE 10049815A DE 10049815 A1 DE10049815 A1 DE 10049815A1
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- spiral element
- sleeve
- hollow catheter
- spiral
- edge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00685—Archimedes screw
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22097—Valve removal in veins
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
Abstract
Beschrieben wird eine Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz mit einem Hohlkatheter, der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt, einem Hülsenelement, das fluiddicht mit dem distalen Enden des Hohlkatheters verbunden ist und distalseitig eine als scharfe Schnittkante ausgebildete Hülsenkante aufweist, einem innerhalb des Hülsenelementes, das distalseitige Ende des Hülsenelementes überragenden Spiralelement, das im Hülsenelement drehbar gelagert ist und mit einem Antriebsmittel verbunden ist sowie einen Spiraldurchmesser aufweist, der bündig mit der Schnittkante des Hülsenelementes ist.
Description
Die Erfindung bezieht sich auf eine Vorrichtung zum lokalen Abtrag einer
Aortenklappe am menschlichen oder tierischen Herz.
Bei einer Vielzahl von Patienten kommt es vor, dass sich im Laufe der Zeit
Ablagerungen an der Herzklappe bilden, insbesondere an der Aortenklappe, häufig
in Form von Kalkablagerungen oder sonstigen Materialdepositionen. Durch derartige
Materialablagerungen an der Aortenklappe, die in einem gesunden Zustand als ein
feines flexibles Gewebesegel ausgebildet ist, kommt es zu einer irreversiblen
Versteifung der Aortenklappe, wodurch insbesondere der Blutabfluss aus dem
Herzen erheblich in Mitleidenschaft gezogen wird. Blutunterversorgung im gesamten
Körper ist die Folge, so dass in einem derart fortgeschrittenen Stadium akuter
Handlungsbedarf besteht, will man schwerwiegende Folgen für den Patienten
vermeiden. Bisher bekannte medikamentöse Behandlungsmethoden zeigen jedoch
nur begrenzten Erfolg, so dass nach heutiger Kenntnis eine Verkalkung von
Aortenklappen lediglich durch einen schwerwiegenden chirurgischen Eingriff
begegnet werden kann.
Üblicherweise wird in diesem Fall im Rahmen einer Sternotomie der Brustkorb eines
Menschen geöffnet um Zugang zum Herz und insbesondere zu der verkalkten
Aortenklappe zu erhalten, die mit bekannten Schneidewerkzeugen aus dem Körper
extrahiert werden kann. Beispielsweise eignen sich hierzu Extraktionswerkzeuge wie
sie in den amerikanischen Druckschriften US 6,033,419 sowie US 5,827,316
beschrieben sind. Nach erfolgtem operativen Eingriff und Wiederverschluss des
Brustkorbes steht dem Patienten eine langwierige Heilungsdauer bevor, die in den
meisten Fällen von einer ebenso langwierigen Rehabilitationszeit gefolgt ist.
Bislang sind keine Möglichkeiten bekannt, die Entfernung einer verkalkten
Aortenklappe unter Umgehung der vorstehend genannten Sternotomie
durchzuführen.
Der Erfindung liegt daher die Aufgabe zugrunde, eine Vorrichtung zum lokalen
Abtrag einer verkalkten Aortenklappe am menschlichen oder tierischen Herz derart
auszubilden, so dass ein chirurgischer Eingriff minimal invasiv durchgeführt werden
kann, ohne die vorstehend genannten Nachteile bei der Sternotomie in Kauf nehmen
zu müssen. Es gilt insbesondere eine Vorrichtung anzugeben, mit der es möglich ist,
eine verkalkte Aortenklappe sicher und schonend zu entfernen, ohne dabei die
Herztätigkeit während des minimal invasiven Eingriffes in Mitleidenschaft zu ziehen.
Die Lösung der der Erfindung zugrunde liegende Aufgabe ist im Anspruch 1
angegeben. Den Lösungsgedanken vorteilhaft weiterbildende Merkmale sind
Gegenstand der Unteransprüche sowie der Beschreibung unter Bezugnahme auf die
Ausführungsbeispiele zu entnehmen.
Erfindungsgemäß ist eine Vorrichtung zum lokalen Abtrag einer Aortenklappe am
menschlichen oder tierischen Herz dadurch ausgezeichnet, dass ein Hohlkatheter
vorgesehen ist, der zumindest im distalen Bereich flexibel ausgebildet ist und durch
intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des
Aortenbogens anpasst. Die Länge des Hohlkatheters ist vorzugsweise derart zu
wählen, dass ein Einführen des Hohlkatheters in den Körper in der Leistengegend
eines Patienten erfolgt und das distale Ende durch entsprechende intrakorporale
Navigation durch das Gefäßsystem im Bereich der Aortenklappe positioniert wird.
Ferner weist die Vorrichtung erfindungsgemäß ein Hülsenelement auf, das fluiddicht
mit dem distalen Ende des Hohlkatheters verbunden ist und distalseitig eine als
scharfe Schnittkante ausgebildete Hülsenkante aufweist. Innerhalb des
Hülsenelementes ist ein Spiralelement vorgesehen, das das distalseitige Ende des
Hülsenelementes überragt. Das Spiralelement ist innerhalb des Hülsenelementes
drehbar gelagert und mit einem kinematischen Antriebsmittel verbunden. Das
Spiralelement weist darüber hinaus einen Spiraldurchmesser auf, der bündig mit der
Schnittkante des Hülsenelementes abschließt.
Vorzugsweise ist das Spiralelement distalseits mit einer runden Abschlusskappe
versehen, so dass ein Einbringen des Hohlkatheters sowie ein Vorschieben der
Katheteranordnung innerhalb eines menschlichen Gefäßes, ohne dieses zu
verletzen, möglich ist.
Das der Vorrichtung aufgrund seiner konstruktiven Merkmale zugrunde liegende
Wirkprinzip ist dem eines an sich bekannten Fleischwolfes vergleichbar. Ist der
Katheterkopf, das heißt, das mit dem Spiralelement ausgestattete Hülsenelement
relativ zu einer verkalkten Aortenklappe positioniert, so ragen wenigstens
Flächenteile der Aortenklappe in die Zwischenräume der Windungen des
Spiralelementes hinein. Wird nun das Spiralelement derart in Rotation versetzt, so
dass die Spiralwindungen scheinbar in das Hülsenelement proximalwärts
hineinwandern, so werden die von dem Spiralelement erfassten Flächenabschnitte
der verkalkten Aortaklappe regelrecht in das Innere des Hülsenelementes gezogen.
Gelangen sie an die als Schnittkante ausgebildete Hülsenkante, so werden sie durch
die zwischen der Schnittkante und den Windungen des Spiralelementes
hervorgerufene Scherwirkung abgetrennt und gelangen sicher in das Innere des
Hülsenelementes und werden über ein entsprechendes Spülsysteme durch den
Hohlkatheter extrakorporal verbracht.
Um die Scherwirkung in vorteilhafter Weise zu verbessern, ist zum einen die als
Schnittkante ausgebildete Hülsenkante des Hülsenelementes mit Schneidzähnen
versehen, zum anderen weist das Spiralelement ebenso Windungen mit oberen und
unteren scharf ausgebildeten Kanten auf, die ein Durchtrennen der verkalkten
Aortenklappe erleichtern.
Die Erfindung wird nachstehend ohne Beschränkung des allgemeinen
Erfindungsgedankens anhand von Ausführungsbeispielen unter Bezugnahme auf die
Zeichnung exemplarisch beschrieben. Es zeigen:
Fig. 1 Seitendarstellung des Hülsenelementes sowie des aus dem Hülsenelement
distalseits herausragenden Spiralelementes,
Fig. 2 perspektivische Darstellung des Hohlkatheters mit dem distalseits
angebrachten Hülsenelement sowie Spiralelement sowie
Fig. 3 Draufsicht auf das distale Ende des Hohlkatheters.
Fig. 1 zeigt eine Seitensicht des distalen Endes des erfindungsgemäß
ausgebildeten Hohlkatheters 1, der in der Fig. 1 lediglich am unteren Bildrand
dargestellt ist. Distalseits ist der Hohlkatheter 1 fluiddicht mit einem Hülsenelement 2
vorzugsweise lösbar fest verbunden ist. Das Hülsenelement 2 weist an seiner
distalseits gerichteten Kante eine Schnittkante 3 auf, die im Ausführungsbeispiel
gemäß Fig. 1 über einzelne Schneidezähne 31 verfügt. Aus dem Hülsenelement 2
ragt distalseits ein Spiralelement 4 heraus, das im Inneren des Hülsenelementes 2
drehbar relativ zur Hohlkatheterlängsachse gelagert ist. Das Spiralelement 4 weist
Spiralwindungen auf deren radiale Außenwand 41 bündig mit der Innenkontur des
Hülsenelementes 2 abschließt.
Vorzugsweise weisen die Windungen des Spiralelementes 4 Ober- und Unterseiten
auf, die jeweils mit der proximalseits bzw. distalseits orientierten Schnittkante
verbunden sind. Die Ober- und Unterseiten der Windungen verlaufen radial nach
innen gerichtet derart zusammen, dass sie einen gemeinsamen spitzen Winkel
einschließen. Hierdurch wird eine weitere Schnittkante erhalten, die das verkalkte
Aortenklappenmaterial zusätzlich zu teilen vermag.
Um den Vortrieb des Hohlkatheters durch die Aorta zu Zwecken ihrer Navigation und
Positionierung zu verbessern und insbesondere traumatische Gewebeirritationen
entlang der Aorta zu vermeiden, ist distalseits am Spiralelement 4 eine
Abschlusskappe 5 vorgesehen, die sphärisch ausgebildet ist und ein leichtes
Abgleiten von Gewebe ermöglicht.
In Fig. 2 ist eine bessere Übersicht der Hohlkatheteranordnung zu entnehmen, in
der der Hohlkatheter 1 im distalen Endbereich einen gebogenen Verlauf annimmt,
der in etwa der natürlichen Biegung des Aortenbogens entspricht. Der Hohlkatheter
ist zumindest in diesem Bereich flexibel ausgebildet, vorzugsweise aus
Kunststoffmaterial gefertigt, um dem natürlichen Aortenverlauf folgen zu können. Das
Hülsenelement 2 sitzt distalseits auf dem Hohlkatheter 1 auf und ist, wie gesagt,
vorzugsweise lösbar fest mit diesem verbunden. Distalseits ragt aus dem
Hülsenelement 2, das im Übrigen eine distal gerichtete Schneidkante 3 vorsieht, das
Spiralelement 4 empor. Das Spiralelement 4 ist mit einer entsprechenden
Abschlusskappe 5 geschützt. Die Postitionierung des Spiralelementes 4 gegenüber
der abzutragenden, verkalkten Aortenklappe erfolgt vorzugsweise derart, dass die
Aortenklappe in einen Zwischenspalt des Spiralelementes 4 hineinragt. In Fig. 2 ist
dieser Zwischenspalt durch die perspektivische Darstellung gut zu erkennen. Wird
das Spiralelement 4 in entsprechende Rotation versetzt, so dass die Windungen des
Stützelementes 4 scheinbar in das Innere des Hülsenelementes 2 proximalseits
verschwinden, so gelangt das in das Innere des Spiralelementes 4 hineinragende
Aortenklappenmaterial gegen die Schnittkante 3 des Hülsenelementes und der
entsprechend scharf ausgebildeten proximalseits gerichteten Schneidkante der
entsprechenden Windung des Spiralelementes 4, wodurch sie abgetrennt und in das
Innere des Hülsenelementes 2 gezogen wird. Auf diese Weise kann insbesondere
auch sicher gestellt werden, dass abgetrennte Herzklappenbruchstücke nicht frei im
Aortenbereich gelangen, sondern sicher durch den Hohlkanal extrakorporal extrahiert
werden.
Ferner sind der Fig. 2 seitlich am distalen Bereich des Hohlkatheters 1 angebrachte
Stützelemente 6 zu entnehmen, die in Art von Klappen ausgebildet sind, siehe
insbesondere Fig. 3, um den Hohlkatheter 1 zentrisch innerhalb der Aorta zu
positionieren. Alternativ zu den seitlich wegklappbaren Klappen 6 können an der
Außenwand des Hohlkatheters 1 auch dillatierbare Ballonelemente vorgesehen
werden.
1
Hohlkatheter
2
Hülsenelement
3
Schnittkante
31
Schneidzähne
4
Spiralelement
41
Außenwand
5
Abschlusskappe
6
Stützelemente
Claims (11)
1. Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder
tierischen Herz mit
einem Hohlkatheter, der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt,
einem Hülsenelement, das fluiddicht mit dem distalen Enden des Hohlkatheters verbunden ist und distalseitig eine als scharfe Schnittkante ausgebildete Hülsenkante aufweist,
einem innerhalb des Hülsenelementes, das distalseitige Ende des Hülsenelementes überragenden Spiralelement, das im Hülsenelement drehbar gelagert ist und mit einem Antriebsmittel verbunden ist sowie einen Spiraldurchmesser aufweist, der bündig mit der Schnittkante des Hülsenelementes ist.
einem Hohlkatheter, der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt,
einem Hülsenelement, das fluiddicht mit dem distalen Enden des Hohlkatheters verbunden ist und distalseitig eine als scharfe Schnittkante ausgebildete Hülsenkante aufweist,
einem innerhalb des Hülsenelementes, das distalseitige Ende des Hülsenelementes überragenden Spiralelement, das im Hülsenelement drehbar gelagert ist und mit einem Antriebsmittel verbunden ist sowie einen Spiraldurchmesser aufweist, der bündig mit der Schnittkante des Hülsenelementes ist.
2. Vorrichtung nach Anspruch 2,
dadurch gekennzeichnet, dass das Spiralelement aus einem steifen Material
gefertigt ist und einen konstanten festen oder einen variablen Gangunterschied
aufweist.
3. Vorrichtung nach Anspruch 1 oder 2,
dadurch gekennzeichnet, dass das Spiralelement distalseits mit einer runden
Abschlußkappe versehen ist.
4. Vorrichtung nach einem der Ansprüche 1 bis 3,
dadurch gekennzeichnet, dass das Spiralelement Windungen mit Ober- und
Unterseiten aufweist, die eben ausgebildet sind und parallel zueinander verlaufen
oder radial nach innengerichtet miteinander einen spitzen Winkel einschließen.
5. Vorrichtung nach einem der Ansprüche 1 bis 4,
dadurch gekennzeichnet, dass das Spiralelement Windungen mit einer radial nach
außen gerichteten Wandseite aufweist, die sich an die Innenkontur des
Hülsenelementes bündig anschmiegt, und
dass die Wandseite von einer oberen und unteren Kante begrenzt ist die als
Schnittkante ausgebildet ist.
6. Vorrichtung nach einem der Ansprüche 1 bis 5,
dadurch gekennzeichnet, dass die als scharfe Schnittkante ausgebildete
Hülsenkante Schneidstrukturen in Art von Schneidzähnen aufweist.
7. Vorrichtung nach einem der Ansprüche 1 bis 6,
dadurch gekennzeichnet, dass das Antriebsmittel mechanisch in Art einer drehbar
gelagerten Seele ausgebildet ist, die im Inneren des Hohlkatheters verläuft und
proximalwärts antreibbar ist und distalseits mit dem Spiralelement kraftschlüssig in
Wirkverbindung steht.
8. Vorrichtung nach einem de Ansprüche 1 bis 6,
dadurch gekennzeichnet, dass das Antriebsmittel elektromotorisch erfolgt, wobei ein
miniaturisierter elektromotorischer Antrieb unmittelbar mit dem Spiralelement
kraftschlüssig in Wirkverbindung steht und eine elektrische Anschlußleitung im
Inneren des Hohlkatheters proximalwärts verläuft.
9. Vorrichtung nach einem de Ansprüche 1 bis 6,
dadurch gekennzeichnet, dass das Antriebsmittel hydraulisch oder pneumatisch
antreibbar ist, wobei eine Mikroturbine unmittelbar mit dem Spiralelement
kraftschlüssig in Wirkverbindung steht und eine die Mikroturbine antreibbare Luft-
oder Flüssigkeitsleitung im Inneren des Hohlkatheters proximalwärts verläuft.
10. Vorrichtung nach einem der Ansprüche 1 bis 9,
dadurch gekennzeichnet, dass im distalen Bereich des Hohlkatheters oder im
Bereich des Hülsenelementes Mittel zum Positionieren und Zentrieren des
Hohlkaktheters innerhalb eines Gefäßes vorgesehen sind.
11. Vorrichtung nach Anspruch 10,
dadurch gekennzeichnet, dass die Mittel dillatierbare Ballone oder vom
Hohlkatheter oder vom Hülsenelement radial wegklappbare Stützelemente sind.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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DE2000149815 DE10049815B4 (de) | 2000-10-09 | 2000-10-09 | Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz |
Applications Claiming Priority (1)
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DE2000149815 DE10049815B4 (de) | 2000-10-09 | 2000-10-09 | Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz |
Publications (2)
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DE10049815A1 true DE10049815A1 (de) | 2002-04-25 |
DE10049815B4 DE10049815B4 (de) | 2005-10-13 |
Family
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