EP1001708A1 - Systeme et methode de revascularisation peroperatoire du myocarde au moyen d'energie sonique pulsee - Google Patents
Systeme et methode de revascularisation peroperatoire du myocarde au moyen d'energie sonique pulseeInfo
- Publication number
- EP1001708A1 EP1001708A1 EP98940826A EP98940826A EP1001708A1 EP 1001708 A1 EP1001708 A1 EP 1001708A1 EP 98940826 A EP98940826 A EP 98940826A EP 98940826 A EP98940826 A EP 98940826A EP 1001708 A1 EP1001708 A1 EP 1001708A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- heart
- sonic energy
- patient
- probe member
- pulsed sonic
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- 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
- A61B17/22004—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 using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
- A61B17/2202—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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement the ultrasound transducer being inside patient's body at the distal end of the catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
Definitions
- This invention generally relates to the field of heart tissue removal, and more particularly to the use of pulsed sonic energy for myocardial revascularization to improve the flow of blood to the heart muscle and cure angina.
- Myocardial revascularization typically involves formation of one or more channels in a patient's heart wall defining the heart chamber to treat a patient's ischemic myocardial tissue therein.
- the first trials of the revascularization process was made by Mirhoseini et al. See for example the discussions in Lasers in General Surgery (Williams & Wil ins; 1989), pp 216-223. Another early disclosure of this procedure is found in U.S. Patent 4,658,817 (Hardy). Both of these references describe laser myocardial revascularization (LMR) procedures in which a laser is used to form the revascularization channels through the epicardium, myocardium and endocardium.
- LMR laser myocardial revascularization
- LMR low cost yet reliable myocardial revascularization system
- the present invention generally involves use of a pulsed sonic energy apparatus for the removal of heart tissue, including both the ablation of the tissue and the formation of channels in the tissue.
- a pulsed sonic energy apparatus for the removal of heart tissue, including both the ablation of the tissue and the formation of channels in the tissue.
- One aspect of the invention provides a method for ablating tissue of a patient's heart comprising, providing a pulsed sonic energy apparatus with an elongated probe member. The probe member contacts the patient's heart tissue, and transmits bursts of pulsed sonic energy to the heart tissue.
- a system for forming a channel in a patient's heart wall comprising an elongated probe member connected to a source of bursts of pulsed sonic energy.
- the transverse dimension, or diameter, of the probe member is essentially the same as the size of the channel to be formed.
- the energy bursts are delivered in a timed sequence, which may be either dependent or independent of the patient's heart cycle. By providing the sonic energy bursts at a specific frequency and pulse duration, the removal of the heart tissue can be optimally controlled.
- Fig. 1 is a schematic section of a human heart showing revascularization of the myocardium according to the invention.
- Fig. 2 is a schematic block diagram of a pulsed sonic energy system synchronized to a heart beat according to the invention.
- a pulsed sonic energy generator 10 of the invention generally comprises a source of pulsed sonic energy 11 and a transmitting device 12 including an elongated probe member 13.
- the elongated probe member 13 is inserted into the chest cavity.
- Elongated probe member 13 is then placed in contact with an area of the heart 16, such as a ventricle 17, having an area 18 in need of increased blood circulation due to cardiovascular disease. Portions of the heart other than ventricles 17 might also be revascularized by this method. Pulsed sonic energy is transmitted in a plurality of bursts through the elongated probe member 13 of the transmitting device 12 to the patient's heart tissue in contact therewith. A number of channels 20 can then be formed by the elongated probe member 13 from the outer wall, or epicardium 21 , and extend through the myocardium 22. The channel can optionally perforate the interior of the heart wall, or endocardium 23.
- the elongated probe member 13 is shaped to facilitate contact with a region of the patient's heart, e.g. with a bend, into a desired configuration (not shown).
- One aspect of the invention provides a system for forming a channel of desired transverse dimensions in a wall of a patient's heart.
- the system comprises an elongated probe member 13, a source of a plurality of bursts of pulsed sonic energy 11 , and means to connect the source 11 to the proximal extremity of the probe member 13.
- the elongated probe member 13 having a proximal end 14 and a distal end 15, when in contact with tissue, cuts a channel essentially equal to the transverse dimension of the probe member distal end 15.
- the means to connect the pulsed sonic energy source 11 has a handle means (not shown) to enable an operator to press the distal extremity of the probe member 13 into contact with the patient's heart wall to form a channel.
- the handle means facilitates pressing the probe member distal extremity perpendicularly against the patient's heart wall.
- the heart beat is preferably monitored, and the sonic energy source 11 is preferably gated to generate one or more pulses during contractions (systole) of the heart, and to generate no pulses during the rest of the heart cycle.
- the presently preferred pulse duration is no more than 100 milliseconds.
- a plurality of bursts of pulsed sonic energy may be required to complete the channel 20 in the heart wall.
- the presently preferred frequency of the pulsed sonic energy emitted from the pulsed sonic energy source is at least 15,000 Hz.
- the sonic energy includes, for example, ultrasound, and the presently preferred source of pulsed sonic energy is an ultrasonic generator.
- the ultrasound generator drives a transducer operating at resonance coupled to the elongated probe member 13.
- pulsed sonic energy is delivered to the heart tissue in a sequence dependent on the patient's heart beat cycle.
- the R wave is one of four distinct waveforms that exist in each heart beat cycle.
- Fig. 2 illustrates a schematic block diagram of a pulsed sonic energy system in which a +5 volt pulse is produced from an ECG monitor 31 for each R wave of a beating heart.
- the ECG +5 volt pulse is sent to a one shot trigger generator 32, where it triggers a variable width pulse.
- the variable width pulse is typically no greater than 100 msec, and is sent from the one shot 32 to a NAND gate 33. When the system is turned on, the NAND gate 33 switch will close, in response to the variable width pulse from the one shot.
- the closed NAND gate sends a signal to a NPN transistor 34, which in turn energizes a reed relay 36, which triggers an ultrasonic generator 38 for a time that approximates the pulse width of the one shot.
- a foot switch connector may be provided so that the physician may selectively energize the elongated probe member 13 with ultrasonic energy for the formation of channels 20.
- the ECG monitor 31 may be a standard model, such as is available from Hewlett-Packard Company.
- the one shot trigger generator 32 and NAND gate 33 may be readily obtainable models, such as National Semiconductor models CD4047 BM, and CD 4011 BM respectively.
- the ultrasound generator 38 may be, for example, the MISSONIX generator, or another readily obtainable generator.
- the distal end of the elongated probe member 13 may be maintained in position on the outer heart wall by a gentle pressure that advances the elongated probe member, to insure that the member 13 is not dislodged in the formation of the channel 20 between pulses of the sonic energy.
- a gentle pressure that advances the elongated probe member, to insure that the member 13 is not dislodged in the formation of the channel 20 between pulses of the sonic energy.
- as few as one pulse of sonic energy per heartbeat is transmitted to the heart tissue.
- an energized probe member 13 contacting the heart surface at a non-perpendicular angle has an increased risk of producing a heart arrhythmia.
- the elongated probe member 13 is held by the operator at an angle of approximately 90° to the heart surface.
- the elongated probe member is maintained in the perpendicular orientation relative to the surface of the beating heart by an orientation means (not shown).
- the orientation means comprises for example, a track in which the elongated probe member 13 proximal end 14 slides, wherein the probe member distal end 15 extends beyond the distal end of the tract and into the patient.
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Vascular Medicine (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Mechanical Engineering (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
Abstract
L'invention concerne une méthode permettant de pratiquer l'ablation de tissus au niveau du coeur d'un patient, méthode qui consiste à utiliser un appareil à énergie sonique pulsée pourvu d'une sonde allongée. La sonde allongée vient au contact des tissus du coeur du patient et on pratique l'ablation de ces tissus au moyen de salves d'énergie sonique pulsée transmises via la sonde. L'invention concerne également un système permettant de pratiquer un canal dans la paroi du coeur d'un patient, lequel système comprend une sonde allongée connectée à une source de décharges d'énergie sonique pulsée. Lors de l'ablation ou de la formation de canaux, les salves d'énergie sont appliquées en séquences temporisées, indépendantes ou non du cycle cardiaque du patient.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US90824697A | 1997-08-07 | 1997-08-07 | |
US908246 | 1997-08-07 | ||
PCT/US1998/016528 WO1999007296A1 (fr) | 1997-08-07 | 1998-08-07 | Systeme et methode de revascularisation peroperatoire du myocarde au moyen d'energie sonique pulsee |
Publications (1)
Publication Number | Publication Date |
---|---|
EP1001708A1 true EP1001708A1 (fr) | 2000-05-24 |
Family
ID=25425439
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP98940826A Withdrawn EP1001708A1 (fr) | 1997-08-07 | 1998-08-07 | Systeme et methode de revascularisation peroperatoire du myocarde au moyen d'energie sonique pulsee |
Country Status (3)
Country | Link |
---|---|
EP (1) | EP1001708A1 (fr) |
AU (1) | AU8901598A (fr) |
WO (1) | WO1999007296A1 (fr) |
Families Citing this family (15)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6254564B1 (en) | 1998-09-10 | 2001-07-03 | Percardia, Inc. | Left ventricular conduit with blood vessel graft |
US6217575B1 (en) | 1999-02-24 | 2001-04-17 | Scimed Life Systems, Inc. | PMR catheter |
US6468271B1 (en) | 1999-02-24 | 2002-10-22 | Scimed Life Systems, Inc. | Device and method for percutaneous myocardial revascularization |
US6669691B1 (en) | 2000-07-18 | 2003-12-30 | Scimed Life Systems, Inc. | Epicardial myocardial revascularization and denervation methods and apparatus |
US6533779B2 (en) | 2001-01-16 | 2003-03-18 | Scimed Life Systems, Inc. | PMR catheter and associated methods |
US6544220B2 (en) | 2001-02-14 | 2003-04-08 | Scimed Life Systems, Inc. | Fluid jet PMR |
US6508783B2 (en) | 2001-03-14 | 2003-01-21 | Scimed Life Systems, Inc. | Ultrasound method for revascularization and drug delivery |
DE102005003632A1 (de) | 2005-01-20 | 2006-08-17 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Katheter für die transvaskuläre Implantation von Herzklappenprothesen |
US7896915B2 (en) | 2007-04-13 | 2011-03-01 | Jenavalve Technology, Inc. | Medical device for treating a heart valve insufficiency |
WO2011104269A1 (fr) | 2008-02-26 | 2011-09-01 | Jenavalve Technology Inc. | Stent pour le positionnement et l'ancrage d'une prothèse valvulaire dans un site d'implantation dans le cœur d'un patient |
US9044318B2 (en) | 2008-02-26 | 2015-06-02 | Jenavalve Technology Gmbh | Stent for the positioning and anchoring of a valvular prosthesis |
AU2011257298B2 (en) | 2010-05-25 | 2014-07-31 | Jenavalve Technology Inc. | Prosthetic heart valve and transcatheter delivered endoprosthesis comprising a prosthetic heart valve and a stent |
CN105491978A (zh) | 2013-08-30 | 2016-04-13 | 耶拿阀门科技股份有限公司 | 用于假体瓣膜的径向可折叠框架及其制造方法 |
EP3288495B1 (fr) | 2015-05-01 | 2019-09-25 | JenaValve Technology, Inc. | Dispositif à débit réduit de stimulateur cardiaque lors d'un remplacement de valvules cardiaques |
US11065138B2 (en) | 2016-05-13 | 2021-07-20 | Jenavalve Technology, Inc. | Heart valve prosthesis delivery system and method for delivery of heart valve prosthesis with introducer sheath and loading system |
Family Cites Families (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4658817A (en) | 1985-04-01 | 1987-04-21 | Children's Hospital Medical Center | Method and apparatus for transmyocardial revascularization using a laser |
US4827911A (en) * | 1986-04-02 | 1989-05-09 | Cooper Lasersonics, Inc. | Method and apparatus for ultrasonic surgical fragmentation and removal of tissue |
US4931047A (en) * | 1987-09-30 | 1990-06-05 | Cavitron, Inc. | Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis |
US4936281A (en) * | 1989-04-13 | 1990-06-26 | Everest Medical Corporation | Ultrasonically enhanced RF ablation catheter |
US5304115A (en) * | 1991-01-11 | 1994-04-19 | Baxter International Inc. | Ultrasonic angioplasty device incorporating improved transmission member and ablation probe |
US5362309A (en) * | 1992-09-14 | 1994-11-08 | Coraje, Inc. | Apparatus and method for enhanced intravascular phonophoresis including dissolution of intravascular blockage and concomitant inhibition of restenosis |
US5630837A (en) * | 1993-07-01 | 1997-05-20 | Boston Scientific Corporation | Acoustic ablation |
US5827203A (en) * | 1997-04-21 | 1998-10-27 | Nita; Henry | Ultrasound system and method for myocardial revascularization |
-
1998
- 1998-08-07 EP EP98940826A patent/EP1001708A1/fr not_active Withdrawn
- 1998-08-07 WO PCT/US1998/016528 patent/WO1999007296A1/fr not_active Application Discontinuation
- 1998-08-07 AU AU89015/98A patent/AU8901598A/en not_active Abandoned
Non-Patent Citations (1)
Title |
---|
See references of WO9907296A1 * |
Also Published As
Publication number | Publication date |
---|---|
AU8901598A (en) | 1999-03-01 |
WO1999007296A1 (fr) | 1999-02-18 |
WO1999007296A9 (fr) | 1999-04-29 |
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Legal Events
Date | Code | Title | Description |
---|---|---|---|
PUAI | Public reference made under article 153(3) epc to a published international application that has entered the european phase |
Free format text: ORIGINAL CODE: 0009012 |
|
17P | Request for examination filed |
Effective date: 20000216 |
|
AK | Designated contracting states |
Kind code of ref document: A1 Designated state(s): AT BE CH DE FR GB IT LI NL |
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RAP1 | Party data changed (applicant data changed or rights of an application transferred) |
Owner name: ECLIPSE SURGICAL TECHNOLOGIES, INC. |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: THE APPLICATION IS DEEMED TO BE WITHDRAWN |
|
18D | Application deemed to be withdrawn |
Effective date: 20040303 |