DE102009047845A1 - Ventricular Assist Device - Google Patents
Ventricular Assist Device Download PDFInfo
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- DE102009047845A1 DE102009047845A1 DE102009047845A DE102009047845A DE102009047845A1 DE 102009047845 A1 DE102009047845 A1 DE 102009047845A1 DE 102009047845 A DE102009047845 A DE 102009047845A DE 102009047845 A DE102009047845 A DE 102009047845A DE 102009047845 A1 DE102009047845 A1 DE 102009047845A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
- A61B5/02154—Measuring pressure in heart or blood vessels by means inserted into the body by optical transmission
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6851—Guide wires
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/104—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body
- A61M60/109—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body incorporated within extracorporeal blood circuits or systems
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
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- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/13—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel by means of a catheter allowing explantation, e.g. catheter pumps temporarily introduced via the vascular system
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
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- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/135—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel inside a blood vessel, e.g. using grafting
- A61M60/139—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel inside a blood vessel, e.g. using grafting inside the aorta, e.g. intra-aortic balloon pumps
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
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- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/165—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable in, on, or around the heart
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- A—HUMAN NECESSITIES
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/20—Type thereof
- A61M60/205—Non-positive displacement blood pumps
- A61M60/216—Non-positive displacement blood pumps including a rotating member acting on the blood, e.g. impeller
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- A—HUMAN NECESSITIES
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/20—Type thereof
- A61M60/247—Positive displacement blood pumps
- A61M60/253—Positive displacement blood pumps including a displacement member directly acting on the blood
- A61M60/268—Positive displacement blood pumps including a displacement member directly acting on the blood the displacement member being flexible, e.g. membranes, diaphragms or bladders
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/20—Type thereof
- A61M60/295—Balloon pumps for circulatory assistance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/50—Details relating to control
- A61M60/508—Electronic control means, e.g. for feedback regulation
- A61M60/515—Regulation using real-time patient data
- A61M60/531—Regulation using real-time patient data using blood pressure data, e.g. from blood pressure sensors
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- A—HUMAN NECESSITIES
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/80—Constructional details other than related to driving
- A61M60/855—Constructional details other than related to driving of implantable pumps or pumping devices
- A61M60/871—Energy supply devices; Converters therefor
- A61M60/878—Electrical connections within the patient's body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3331—Pressure; Flow
- A61M2205/3344—Measuring or controlling pressure at the body treatment site
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/104—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body
- A61M60/117—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body for assisting the heart, e.g. transcutaneous or external ventricular assist devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/148—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel in line with a blood vessel using resection or like techniques, e.g. permanent endovascular heart assist devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/30—Medical purposes thereof other than the enhancement of the cardiac output
- A61M60/36—Medical purposes thereof other than the enhancement of the cardiac output for specific blood treatment; for specific therapy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/50—Details relating to control
- A61M60/508—Electronic control means, e.g. for feedback regulation
- A61M60/515—Regulation using real-time patient data
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/50—Details relating to control
- A61M60/508—Electronic control means, e.g. for feedback regulation
- A61M60/562—Electronic control means, e.g. for feedback regulation for making blood flow pulsatile in blood pumps that do not intrinsically create pulsatile flow
- A61M60/569—Electronic control means, e.g. for feedback regulation for making blood flow pulsatile in blood pumps that do not intrinsically create pulsatile flow synchronous with the native heart beat
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/80—Constructional details other than related to driving
- A61M60/802—Constructional details other than related to driving of non-positive displacement blood pumps
- A61M60/81—Pump housings
- A61M60/816—Sensors arranged on or in the housing, e.g. ultrasound flow sensors
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Abstract
Das Herzunterstützungssystem weist einen Katheter (10) auf, der in das Herz oder in Herznähe einführbar ist. Der Katheter (10) enthält in einem durchgehenden separaten Lumen einen optischen Druckmesskatheter, der eine druckempfindliche Membran aus Glas und einen Lichtwellenleiter aufweist. Die Membran befindet sich in einem Sensorkopf (30) am distalen Ende des Druckmessers. Der Druckmesskatheter (26) ist in dem Katheterschlauch (20) in Längsrichtung verschiebbar. Wenn der Katheter (10) eine intraarterielle Ballonpumpe aufweist, kann diese in der absteigenden Aorta platziert werden und der Druckmesskatheter kann nachträglich eingeführt und erforderlichenfalls ausgewechselt werden. Er kann auch über das distale Ende des Katheters hinaus vorgeschoben werden.The heart support system has a catheter (10) which can be inserted into or near the heart. In a continuous separate lumen, the catheter (10) contains an optical pressure measuring catheter, which has a pressure-sensitive membrane made of glass and an optical waveguide. The membrane is located in a sensor head (30) at the distal end of the pressure meter. The pressure measuring catheter (26) can be displaced in the longitudinal direction in the catheter tube (20). If the catheter (10) has an intra-arterial balloon pump, this can be placed in the descending aorta and the pressure measuring catheter can be inserted afterwards and replaced if necessary. It can also be advanced beyond the distal end of the catheter.
Description
Die Erfindung betrifft ein Herzunterstützungssystem mit einem Katheterschlauch, der mindestens ein Lumen aufweist, und einem Drucksensor zur Messung des Druckes distal von dem Katheterschlauch.The invention relates to a cardiac assist system comprising a catheter tube having at least one lumen and a pressure sensor for measuring the pressure distal of the catheter tube.
Es gibt zahlreiche Fälle, in denen ein Katheter in das Herz eingeführt oder bis in dies Nähe des Herzens vorgeschoben wird. Ein spezieller Fall besteht in der Anwendung einer intraarteriellen Ballonpumpe (IABP), die zur Herzunterstützung eingesetzt wird. Die IABP weist einen Katheterschlauch auf, der auf einen Teil seiner Länge von einem inflatierbaren und deflatierbaren Ballon umgeben ist. Der Ballon wird synchron mit der Pulsation des Herzens inflatiert und deflatiert, um die Gesamtpumpleistung zu erhöhen. Für die Synchronisation ist neben der Triggerung über EKG ein Drucksensor zur Messung des arteriellen Druckes bzw. der Druckpulsation erforderlich. Bei den meisten IABP-Systemen befindet sich der Drucksensor in der Peripherie und wird über ein Drucklumen längs des Katheters, das mit Flüssigkeit gefüllt ist, mit Druck beaufschlagt. Hierbei ist die Druckübertragung in der Regel gedämpft und von Bewegungsartefakten des Katheters überlagert. Bei einer IABP mit verbesserter Druckmessung befindet sich der Drucksensor an dem distalen Ende des Katheterschlauchs, das über den länglichen Ballon hinaus vorsteht. Wenn sich ergibt, dass der Drucksensor nicht ordnungsgemäß arbeitet, muss der gesamte Katheter aus der Aorta entfernt und durch einen anderen Katheter ersetzt werden.There are numerous cases in which a catheter is inserted into the heart or advanced into the vicinity of the heart. A special case is the use of an intra-arterial balloon pump (IABP), which is used for cardiac support. The IABP has a catheter tube which is surrounded by an inflatable and deflatable balloon over part of its length. The balloon is inflated and deflated synchronously with the heart's pulsation to increase the overall pumping power. For synchronization, in addition to the triggering via ECG, a pressure sensor for measuring the arterial pressure or the pressure pulsation is required. In most IABP systems, the pressure sensor is in the periphery and pressurized by a pressure lumen along the catheter filled with fluid. In this case, the pressure transmission is usually damped and superimposed by movement artifacts of the catheter. In an IABP with improved pressure measurement, the pressure sensor is at the distal end of the catheter tube which projects beyond the elongated balloon. If the pressure sensor does not work properly, the entire catheter must be removed from the aorta and replaced with another catheter.
Andere Herzkatheter sind dazu bestimmt, mit dem distalen Ende in das Herz hinein vorgeschoben zu werden, beispielsweise in den linken Ventrikel.Other cardiac catheters are designed to be advanced with the distal end into the heart, for example into the left ventricle.
Der Erfindung liegt die Aufgabe zugrunde, ein Herzunterstützungssystem zu schaffen, das als modulares System mit austauschbaren Komponenten ausgebildet ist.The invention has for its object to provide a heart support system, which is designed as a modular system with interchangeable components.
Das erfindungsgemäße Herzunterstützungssystem ist durch den Patentanspruch 1 definiert. Der Drucksensor ist ein optischer Druckmesskatheter, der durch den Katheterschlauch des Herzkatheters vorgeschoben werden kann. Der Druckmesskatheter weist einen Lichtwellenleiter auf, der zu einem optischen Sensorkopf mit einer druckabhängig bewegbaren Membran führt. Der Druckmesskatheter ist relativ zu dem Katheterschlauch in dessen Längsrichtung verschiebbar.The cardiac assist system according to the invention is defined by patent claim 1. The pressure sensor is an optical pressure measuring catheter that can be advanced through the catheter tube of the cardiac catheter. The pressure measuring catheter has an optical waveguide which leads to an optical sensor head with a pressure-dependent movable diaphragm. The pressure measuring catheter is displaceable relative to the catheter tube in its longitudinal direction.
Der optische Druckmesskatheter hat den Vorteil, dass er einen kleinformatigen Messkopf mit geringem Durchmesser von maximal 600 μm ermöglicht, wobei der Lichtwellenleiter einen noch geringeren Durchmesser von 80–100 μm hat. Das Lumen des Katheterschlauchs ist durchgehend, d. h. es ist an dem distalen Schlauchende offen.The optical pressure measuring catheter has the advantage that it allows a small-sized measuring head with a small diameter of a maximum of 600 microns, wherein the optical waveguide has an even smaller diameter of 80-100 microns. The lumen of the catheter tube is continuous, d. H. it is open at the distal end of the tube.
Nachdem der Katheterschlauch beispielsweise unter Verwendung eines Führungsdrahtes, in der absteigenden Aorta platziert wurde, kann nachträglich der Druckmesskatheter in das Lumen des Katheterschlauchs eingeführt werden. Der Sensorkopf kann dabei nach Bedarf positioniert werden. Ein weiterer Vorteil besteht darin, dass der Druckmesskatheter auswechselbar ist. So kann beispielsweise ein nicht ordnungsgemäß funktionierender Druckmesskatheter ausgewechselt werden oder es können unterschiedliche Druckmesskatheter mit verschiedenen Parametern bereitgehalten werden, von denen jeweils einer ausgewählt werden kann, oder der Druckmesskatheter kann bei Bedarf ex-vivo kalibriert werden, sofern eine Sensordrift vorliegt.For example, after the catheter tube has been placed in the descending aorta using a guidewire, the pressure measuring catheter can be subsequently inserted into the lumen of the catheter tube. The sensor head can be positioned as needed. Another advantage is that the pressure measuring catheter is replaceable. Thus, for example, a malfunctioning pressure measuring catheter can be exchanged or different pressure measuring catheters with different parameters can be kept, of which one can be selected at a time, or the pressure measuring catheter can be calibrated ex-vivo if necessary, provided that there is a sensor drift.
Optische Drucksensoren, die sich für einen optischen Druckmesskatheter eignen, werden von der Firma Opsens vertrieben. Ein optischer Druckmesssensor weist im Sensorkopf (Fabri Perot) eine Kavität auf, die mit einer dünnen Glasmembran abgeschlossen ist, gegen welche der Blutdruck wirkt und die sich druckabhängig verformt. Aus dem Ende eines Lichtwellenleiters tritt Licht aus, das von der Siliziummembran moduliert und in den Lichtwellenleiter hinein reflektiert wird. Am Einspeisungsende des Lichtwellenleiters befindet sich eine CCD-Kamera, die das entstehende Interferenzmuster aufzeichnet, welches sich druckabhängig im Bild verschiebt, so dass dessen Position mit einem gemessenen Druck korreliert werden kann.Optical pressure sensors suitable for an optical pressure measuring catheter are sold by Opsens. An optical pressure measuring sensor has a cavity in the sensor head (Fabri Perot), which is closed off with a thin glass membrane against which the blood pressure acts and which deforms in a pressure-dependent manner. Light emerges from the end of an optical waveguide and is modulated by the silicon diaphragm and reflected into the optical waveguide. At the feed end of the optical waveguide is a CCD camera that records the resulting interference pattern, which shifts pressure-dependent in the image, so that its position can be correlated with a measured pressure.
Neben der Kleinformatigkeit hat ein optischer Drucksensor den wichtigen Vorteil, dass er von dem umgebenden Blut nicht angegriffen wird. Blut ist in hohem Maße korrosiv. Es zersetzt Komponenten aus Metallen. Elektrische Leitungen würden eine Isolierung benötigen. Der optische Sensor besteht vorwiegend oder ausschließlich aus Glas, das von dem Blut nicht angegriffen wird.In addition to the small format, an optical pressure sensor has the important advantage that it is not attacked by the surrounding blood. Blood is highly corrosive. It decomposes components of metals. Electrical lines would need insulation. The optical sensor consists mainly or exclusively of glass, which is not attacked by the blood.
Vorzugsweise ist ein Rohr vorgesehen, das den Druckmesskatheter einschließlich einer Strecke des Lichtleiters aufnimmt und nach Positionierung des Druckmesskatheters in proximaler Richtung entfernbar ist. Ein solches Rohr braucht nicht korrosionsbeständig gegen Blut zu sein, weil es nach dem Verlegen des Druckmesskatheters entfernt wird.Preferably, a tube is provided which receives the pressure measuring catheter including a portion of the light guide and is removable after positioning the pressure measuring catheter in the proximal direction. Such a tube does not need to be corrosion resistant to blood because it is removed after laying the pressure measuring catheter.
Der Druckmesskatheter hat vorzugsweise einschließlich des Sensorkopfes einen maximalen Durchmesser von nicht mehr als 600 μm. Demnach beträgt der Durchmesser des Lumens des Katheterschlauchs vorzugsweise 0,7–0,8 mm.The pressure measuring catheter preferably has a maximum diameter of not more than 600 μm inclusive of the sensor head. Thus, the diameter of the lumen of the catheter tube is preferably 0.7-0.8 mm.
Bei einer bevorzugten Ausführungsform der Erfindung hat der Druckmesskatheter eine größere Länge als der Katheterschlauch, derart, dass der Sensorkopf aus dem Katheterschlauch heraus um eine Länge von mindestens 10 cm, vorzugsweise von mindestens 20 cm, vorstehen kann. Dadurch ist es möglich, den Druckmesskatheter über den in der Aorta descendens liegenden Ballon hinaus durch den Aortenbogen und die Aortenklappe bis in den linken Ventrikel vorzuschieben. Die Druckmessstelle liegt dann im linken Ventrikel. Der Ventrikuläre Druck ist das signifikanteste Signal, das als Trigger-Signal für die Steuerung des Ballons sehr gut geeignet ist. Die ventrikuläre Druckmessung macht eine EKG-Ableitung entbehrlich. Für den Patienten besteht der Vorteil, dass keine extrakorporalen Elektroden an den Körper als EKG-Klebepunkte angelegt werden müssen. Der Druckmesskatheter kann zusätzlich als Führungsdraht benutzbar sein, der zuerst verlegt wird und über den anschließend der Katheterschlauch des Ballonkatheters geschoben wird. Hierbei ist der Druckmesskatheter vorzugsweise mit einer flexiblen Katheterspitze distal von dem Sensorkopf versehen.In a preferred embodiment of the invention, the pressure measuring catheter has a greater length than the catheter tube, such that the sensor head can protrude out of the catheter tube by a length of at least 10 cm, preferably at least 20 cm. This makes it possible to advance the pressure measuring catheter beyond the balloon lying in the descending aorta through the aortic arch and the aortic valve into the left ventricle. The pressure measuring point is then in the left ventricle. Ventricular pressure is the most significant signal, which is very well suited as a trigger signal for the control of the balloon. Ventricular pressure measurement eliminates the need for an ECG lead. The advantage for the patient is that no extracorporeal electrodes have to be applied to the body as ECG adhesive dots. The pressure measuring catheter can also be used as a guide wire, which is laid first and then pushed over the catheter tube of the balloon catheter. In this case, the pressure measuring catheter is preferably provided with a flexible catheter tip distal from the sensor head.
Eine andere Anwendungsmöglichkeit des erfindungsgemäßen Herzunterstützungssystems besteht in Verbindung mit einer motorbetriebenen Blutpumpe, die ein axial förderndes Flügelrad aufweist und im Herzen platzierbar ist. Der Druckmesskatheter wird hierbei durch den mit der Blutpumpe verbundenen Katheterschlauch hindurchgeschoben und er verlässt diesen Katheterschlauch proximal von der Blutpumpe. Der Druckmesskatheter wird dann unter Umgehung der Blutpumpe bis in den linken Ventrikel eingeführt, wo die Druckmessung erfolgt. An der Blutpumpe kann ein weiterer Drucksensor vorgesehen sein, so dass die Druckdifferenz zwischen linkem Ventrikel und Aorta gemessen werden kann.Another possible application of the heart support system according to the invention is in connection with a motor-driven blood pump, which has an axially conveying impeller and can be placed in the heart. The pressure measuring catheter is thereby pushed through the catheter tube connected to the blood pump and leaves this catheter tube proximally from the blood pump. The pressure measuring catheter is then inserted, bypassing the blood pump, into the left ventricle, where the pressure is measured. At the blood pump, a further pressure sensor may be provided, so that the pressure difference between the left ventricle and the aorta can be measured.
Eine andere Variante eines Herzunterstützungssystems nach der Erfindung ergibt sich bei der Kanülierung des Herzens, wobei an die Herzwand und das angrenzende Gefäßsystem zwei Kanülen angeschlossen werden, welche extrakorporal mit einer parakorporalen Blutpumpe verbunden werden. Hierbei kann jede der Kanülen einen darin verschiebbaren Druckmesskatheter in einem separaten Druckmesslumen enthalten.Another variant of a cardiac assist system according to the invention results from the cannulation of the heart, wherein two cannulas are connected to the heart wall and the adjacent vascular system which are connected extracorporeally to a paracorporeal blood pump. In this case, each of the cannulas may contain a pressure measuring catheter displaceable therein in a separate pressure measuring lumen.
Bei der Druckmessung im Herzen kann auch eine Messung der Herzerholung durch Bestimmung der Steigung der Systole erfolgen, was dem Maß der Kontraktilität entspricht. Oder es kann die Steigung der diastolischen Erschlaffung gemessen werden, was eine Aussage über die Steifigkeit des Herzmuskels erlaubt, wobei Kontraktilität sowie Steifigkeit wesentliche Daten für die Herzmuskelfunktion darstellen.Heart pressure measurement can also be used to measure cardiac recovery by determining the slope of systole, which is the measure of contractility. Or the slope of the diastolic relaxation can be measured, which allows a statement about the stiffness of the heart muscle, whereby contractility and rigidity are essential data for the heart muscle function.
Im folgenden werden unter Bezugnahme auf die Zeichnungen Ausführungsbeispiele der Erfindung näher erläutert.In the following, embodiments of the invention will be explained in more detail with reference to the drawings.
Es zeigen:Show it:
Bei dem Ausführungsbeispiel der
Am Beginn der Aorta
Durch die Pulsation des Herzens erfolgt während der Systole eine Herzkontraktion, wobei Blut in die Aorta ausgestoßen wird. Während der Diastole weitet sich das Herzvolumen wieder aus.Through the pulsation of the heart occurs during systole a heart contraction, wherein blood is expelled into the aorta. During diastole, the heart volume expands again.
Der Katheter
Der Druckmesskatheter
Der Sensorkopf
Das Metallrohr
Die Auswertung des von der Kamera gelieferten optischen Bildes bzw. optischen Musters und die Berechnung des Druckes erfolgen durch einen an die Kamera angeschlossenen Rechner. Dieser steuert auch die Pulsation der Luftzufuhr zu der IABP
Der Sensorkopf
Zusätzlich zu dem Sensor
Die
Die Kanüle
Auch die Kanüle
In der jeweiligen Kanüle kann der Sensorkopf soweit zurückgezogen werden, dass er nicht aus der Kanüle heraus vorsteht. In diesem Fall wird der Druck im Innern der Kanüle gemessen. Dadurch ist eine Kontrolle von Ansaugzuständen möglich, bei denen Gewebe der Herzwand in die Kanüle eingesaugt wird. Ein weiterer Vorteil besteht in der Möglichkeit der Synchronisation der Pumpe mit der Herzaktivität. Durch Druckmessung im Innern des Herzens ist auch eine Kontrolle der Herzerholung möglich, wobei der Anstieg des Druckes dP/dt währen der Systole gemessen wird. Je größer dieser Gradient ist, umso mehr ist das Herz wieder erstarkt.In the respective cannula, the sensor head can be withdrawn far enough so that it does not protrude out of the cannula. In this case, the pressure inside the cannula is measured. This makes it possible to control aspiration states in which tissue of the heart wall is sucked into the cannula. Another advantage is the possibility of synchronizing the pump with cardiac activity. By measuring the pressure inside the heart, it is also possible to control the cardiac recovery, whereby the increase in pressure dP / dt during systole is measured. The larger this gradient, the more the heart is strengthened again.
Durch Druckmessung an der Auslassseite der Pumpe ist eine Kontrolle der Anastomose (Einschnürung) möglich.Pressure measurement on the outlet side of the pump allows control of the anastomosis (constriction).
In
Die Pumpe
In
Durch den Katheterschlauch
Der Katheterschlauch
Auch bei diesem Ausführungsbeispiel kann die Position des Sensorkopfes
Claims (10)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
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DE102009047845A DE102009047845A1 (en) | 2009-09-30 | 2009-09-30 | Ventricular Assist Device |
PCT/EP2010/063989 WO2011039091A1 (en) | 2009-09-30 | 2010-09-22 | Heart support system |
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Application Number | Priority Date | Filing Date | Title |
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DE102009047845A DE102009047845A1 (en) | 2009-09-30 | 2009-09-30 | Ventricular Assist Device |
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DE102009047845A1 true DE102009047845A1 (en) | 2011-03-31 |
Family
ID=43033142
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DE102009047845A Pending DE102009047845A1 (en) | 2009-09-30 | 2009-09-30 | Ventricular Assist Device |
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WO (1) | WO2011039091A1 (en) |
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