FR2501939A1 - METHOD AND APPARATUS FOR MONITORING BY TELEPHONE TRANSMISSION - Google Patents

Abstract

THE INVENTION CONCERNS MONITORING TECHNIQUES. AN APPARATUS INTENDED FOR THE REMOTE MONITORING OF A PHYSIOLOGICAL PARAMETER INCLUDES IN PARTICULAR A SENSOR 20 WHICH CONVERTS THIS PARAMETER INTO AN INPUT SIGNAL, A TRANSMITTER 30 WHICH CONVERTS THE INPUT SIGNAL INTO A DIGITAL FORM AND TRANSMITS IT ON A TELEPHONE LINK 40 A MODEM 50 WHICH RECEIVES THE DIGITAL SIGNAL AND A COMPUTER 70 WHICH PROCESSES THE SIGNAL RECEIVED IN A MANNER TO EXTRACT SIGNIFICANT INFORMATION THEREOF AND PRESENTS THIS INFORMATION. APPLICATION TO MEDICAL EQUIPMENT.

Description

250 1 93 9

  The present invention relates generally

  the monitoring equipment and it is more particularly

  equipment for the monitoring of physiological parameters. Monitoring of various physiological parameters is a very common technique. A typical example of a monitoring system can be found in US Pat. No. 3,799,147. This patent discloses a system for diagnosing myocardial infarction which is based on the frequency response of electrocardiogram signals and acoustic signals. . It is interesting to note that the techniques and apparatus used in the patent

  mentioned above are characteristic of what is commonly used

  because the main processing circuits are

  in the field of time, so

  analog. An essential disadvantage of such a technique

  that monitoring consists in the fact that the signals to be

  care must be treated and monitored in real time, that is, they must maintain their relationship in the time domain. This has the effect of increasing the bandwidth required for the equipment used and for

  any transmission link used.

  U.S. Patent 4,214,589 discloses an example of a

  apparatus which measures physiological parameters in use

  reading digital data. This patent describes the

  blood pressure using measures

  the sound of Korotkov and other signals of

  Tree. However, upon examination of U.S. Patent 4,214,589, it is determined that the information which is converted into digital form from the pressure sensor is always transmitted to the processing apparatus in relation to the time domain. Here again, as in the previous case, this requires that the bandwidth of the device be

  sufficient to allow real-time operation.

  Other examples of monitoring devices that employ time-converted digital information can be found in relation to time

  in U.S. Patents 4,006,737 and 4,073,011.

250,193 9

  in these patents, the electrocardiographic computer

  That describes the real time accelerates so that the electrocardiogram signals can be reviewed in a much shorter time than the time required to collect the data. In fact, a 24-hour information tape can be processed in a time not exceeding 12 minutes. It should be noted, however, that the processing involved is always tied to real time, which requires relatively large bandwidths to allow the processing of the information with an exact relation to the

time domain.

  Speech recognition is probably the area in which physiological monitoring has reached

  its highest degree of sophistication in the field of

  do not digital. Although the word to be treated does not constitute medical data in the strict sense of the word, we can nevertheless include speech if we adopt a definition.

  very wide physiological parameters. We can find

  an example of a speech processing technique in U.S. Patent 4,227,177. Note that speech is introduced as an amplitude signal in

  function of time, and that a corresponding signal is produced

  really digital, whose nature is that of a text. However, the essential difference between this type of speech recognition and true monitoring for the purpose of medical diagnosis is as follows: although speech is transformed into digital signals, these only correspond to what is said and not to the way it was said. Thus, the effects of

  time domain are totally excluded during the processing

transformation.

  U.S. Patent 4,093,821 discloses a method of

  interesting to try to recognize the emotional state of a person from speech. In this patent, attempts are made to analyze the signals in the time domain to determine the emotional state of the person applying the input signal. This technique is suitable for achieving the purposes set out in the aforementioned patent, but

250,193 9

  probably not accurate enough or accurate enough

for a medical purpose.

  U.S. Patent 4,123,785 describes an example of an apparatus which records information, in this case in an analog format, and which affects this information.

  time marking to allow for the reconstruction of

  the domain of time. This patent describes the use

  a portable recorder to record an informa-

  electrocardiogram, also recording separate time markers to enable the monitoring and analysis apparatus to reconstruct this

  time, to complete his analysis and provide information

  output. Note, however, that the information

  which is recorded by the monitoring device

  table is actually saved in the form of a

analog signal.

  The actual parameter that the inventors have chosen

  if to monitor by the device described here is the slap

  sound that is produced by the operation of a

  heart valve prosthesis. It has been shown in the art of

  that such devices emit signals that

  have specific frequency components. An accu-

  embolic-type mating occurring later on these prosthetic heart valves tends to change the

  characteristic frequency components of clicks.

  A first publication concerning this effect is entitled "Sound Spectro Analytical Diagnosis of Malfunctioning Prosthetic Heart Valve" by Kagawa, et al. and it was originally presented at the Sixtieth Anniversary of the First Department of Surgery, Tohoku University School of Medicine, and was subsequently published in the journal Experimental Medicine, Vol. 123, pages 77-89, 1977. It should be noted that

  Kagawa et al. provide a theoretical basis for moni-

  described here, but they do not describe any devices

  practice for a technique designed to accomplish this

  torage. There is a second reference providing a theoretical basis for this type of monitoring in an article

250 1939

  entitled "Real Time Sound Spectro Analysis for Diagnosis of Malfunctioning Prosthetic Heart Valves," by Kagawa, et al. published in the Journal of Thoracic Cardiovascular Surgery, Vol. 79, pages 671-679, 1980. In this last article, Figure i shows an apparatus for

  deal with this click information. Note, however,

  that the treatment is essentially

  real time, and essentially takes the form of ana-

  logical in the field of time. Here again, this article

  key provides a theoretical basis for the type of monitoring described here, but it does not show any

  the practical implementation of these monitoring objectives.

  The invention provides an apparatus and a technique for monitoring physiological parameters. We

  performs this monitoring by converting the signals of

  in digital form and by assigning them a mark of

  time. Although conversion to digital form is important for effectively processing information in the future, it is very important to note that time stamping provides a way to overcome the time domain during processing and processing. the transmission of data. After conversion into digital form, the information is stored in a digital memory and is then transmitted by

  transmission lines to a central monitoring computer

  ized. Because the data is in true digital format at this time, there is great flexibility for

  the selection of the various bandwidths for the trans-

  mission of the data. For example, the data may

  be transmitted by the faster transmission link

  that the actual time in which they were collected

  more slowly, depending on the width of the bank.

available transmission.

  The data collected in the apparatus described here is constituted by the acoustic slam which is characteristic of the operation of a prosthetic heart valve. These acoustic data are immediately converted to digital information and recorded in a

250 1939

  5. temporary memory. During the collection of the information, a window is applied to the real time, so that only the interesting period, that is to say the time during

  which the click occurs, is actually recorded

  and no corresponding information is recorded

  the period between clicks, except for recording

  record this time interval as a numerical quantity.

  The central monitoring computer receives the information

  training and presents it to the attending physician. The infor-

  tion is presented in four different ways. Linen-

  training corresponding to patient identification, valve identification and various time intervals is presented directly in the form of numerical quantities. The time intervals between

  clicks are also represented in graphical form

  than. The acoustic snapping information is presented

  in the time domain, by reconstructing the analog signal as received. The fourth

  presentation technique consists in carrying out a trans-

  Fast Fourier training on data, to pre-

  the slamming signal in the area of

  quences. Using these four techniques of presentation

  the physician at the central monitoring site can easily determine the presence of an embolic accumulation on the prosthetic heart valve of a given patient, and begin

  immediately a clean treatment to remedy it. We notice-

  ra that this monitoring takes place in a very convenient way,

  for the patient as for the attending physician.

  The invention will be better understood when reading

  the following description of an embodiment and

  with reference to the accompanying drawings in which: Figure 1 is a general block diagram

  showing the main elements of the apparatus described.

  Figure 2 shows the data presentations

  which are made for the attending physician at the monito-

central core.

6 '

  Figure 3 is a block diagram of the transmitter

30.

  Figures 4a and 4b arranged in the manner

  indicated in Figure 4, are a developed diagram of the

analog set 200.

  Figures 5a-5d, arranged in the indi-

  Figure 5, are a developed diagram of the sub-

digital set 400. -

  Figures 6a and 6b are a flowchart of the

  firmware relating to the main program of the

tor.

  Figure 7 is a flowchart of the sub-program

INT_75.

Figure GADJ. The figure

INT_55.

The figure

INVALIDATION.

The figure

SMASQUE.

The BIP figure. The figure

VALIDATION.

The figure

LIFE BATT.

  15 is i is i) is is is is a is a one a a a flowchart c flowchart i flowchart i flowchart i flowchart flowchart flowchart flowchart

sub-program

sub-program

sub-program

sub-program

sub-program

sub-program

sub-program

sub-program

  FIGURES 16a and 16b are a flowchart of the

sub-program BAUDSORTIE.

  Figure 17 is a flowchart of the sub-program

me STAT_8251

  Figure 18 is a flowchart of the software

  sky-which is in the central monitoring computer that performs the functions of central monitoring and presentation. The invention is described by considering a product me me me me me me me especially for the monitoring by telephone transmission of the snaps characteristic of cardiac valves of prosthesis. Those skilled in the art can easily

  apply the invention described here to other types of

  monitors, used in different configurations.

  to measure different physiological parameters.

CONFIGURATION OF SET

  Figure 2 represents a general synoptic

  of the heart valve monitor

  prosthesis. Patient 10 has been previously implanted

  one or two prosthetic heart valves.

  The sensor 20 is an acoustic sensor which is intended

  to produce electrical signals under the effect of

  Acoustic signals received. The sensor 20 is probably a device of the type microphone of high quality. The electrical output signal of the sensor 20 is transmitted

  to the transmitter 30 by the cable 80. The transmitter 30 converts

  information in digital form and record it

  be in a form in which it is ready to be transmitted to the centralized monitoring site. The

  transmission of data is carried out by the tele-

  This link probably includes both terrestrial link segments and RF transmission segments. At the centralized monitoring site, the modem 50 demodulates the signal and transfers it by the cable

  input / output 60 to the central monitoring computer.

70.

  The computer 70 is a device for calculating the

  trade. In the preferred embodiment, the computer

  70 is a Hewlett-Packard computer system

  HP-85. The equipment needed for this device is

  with the tape cartridge and the printer.

  mantis incorporated. The available options that are required

  For this application, the following are: a 16K byte RAM module, the ROM

  input / output, the HP-82239A serial interface, and the

  standard software of the HP-85. The software necessary for the computer 70 will be described later.

250,193 9

  considers that it is not necessary to further describe the hardware of computer 70, because

  a commercial device that is readily available.

  The modem 50 is also a hardware of the com-

  commerce. In the apparatus under consideration, it is manufactured by the

  Novation Corporation and this is a CAT model.

  As will be seen later, the mode of transmission

  preferred transmission corresponds to a 300 baud transmission on the telephone line 40. The interface between the modem

  50 and the computer 70 is of the RS-232 type.

  Figure 2 is a representation of the data

  which are presented at computer level 70, at the

  attention of the attending physician. Collectively, the output data is what is called the information of

  output 100. The output information 100 includes

  some tabular data, and graphs 112, 114, and 118. The tabular data contains a patient identification number 102

  and a valve identification number 104. These numbers are

  ros are introduced by the doctor through

  transmitters, before the detection and transmission of the information. Precise generation

  signals will emerge from the subsequent description of the

  Transmitter operation 30. The time intervals T1, bearing the reference 106, and T2, bearing the reference 108, are respectively the time intervals of the clicks and the time intervals between the clicks. For patients who are equipped with two prosthetic heart valves, it is important

  note the time interval between the snap

  a first prosthetic heart valve and the click produced by the second, to verify that the transmitter has selected the desired snap. Rhythm

  cardiac is also presented in 110.

  Graph 112 shows the actual

  times Tl and T2 for a patient equipped with a single valve. These intervals are represented on a

reconstructed time axis.

  The graph 114 shows the click signal as it is received, and shows this click on a reconstructed time axis. Note that the signal trace

  116 is normalized with respect to a slap amplitude

  0. This standardization is desirable to correct the various amplitude variations between patients and

between monitoring sequences.

  The third graph is chart 118.

  It is a graph of the amplitude according to the frequency

  quence, and it presents the snap information after

  the accomplishment of a fast Fourier transformation.

  On the basis of the theoretical articles

  cited, that chart 118 may in fact be the most significant for a diagnosis, given that

  that accumulation of an embolic nature produces

  of the various frequency components that can easily be

  observe by comparing chart 118 with a sequence

this from monitoring to another.

MATERIAL OF THE TRANSMITTER 30

  Figure 3 is a block diagram of the transmitter

  30. It should be noted that it contains two main elements:

  pal. The analog subset 200 contains the analog circuits of the transmitter 30 and the digital subset

  400 contains the digital circuits. The acoustic signal

  that analogue is received from the sensor 20 by the cable

  80 (see also Figure 1). Acoustic information

  tick is processed by the input processing circuit

  202 and it is applied to the analog converter-

  402 in which it is converted into a format

  digital. A second output of the processing circuit of

  202 applies an analog signal to the detector circuit.

  peak value 204. The detection circuit of

  peak value 204 applies an interruption to the process

  and in memory, 404, by line 304, under the effect

  detection of analog peak values. The cir-

  cooked 204 peak value detection also attacks

  the lamp 210 via line 212 for furnishing

  give the patient a visual indication of the detection of

250 1939

  clapping. Line 306 is used to allow processor / memory 404 to control the analog gain of the

  input processing circuit 202.

  The processor / memory 404 controls the operation

  The processor / memory 404 is restored by the restore button 410 which is connected by the line 406. The restoration button 410 allows the

  patient to restore the processor / memory 404 and reden

  to initiate the monitoring process. The patient dis-

  poses a second push button which is the button

  412. This button applies a positive voltage to the

  caterer / memory 404, via line 408, and indicates when data transmission

  must take place by means of the telephonic transmission

  Picnic. The doctor fixes the identification number

of the patient, through the identifica-

  patient 418, as well as his identification number.

  of the particular valve, by the val-

  420 before supplying the transmitter to the patient. The identical

  patient tester 418 and valve identifier 420 are switches that introduce

8 bits for each function.

  The processor / memory 404 controls the conversion

  Analog-digital weaver 402 by line 414. In fact, line 414 is shown so that we can better represent the technique of comriande. In practice, as will emerge from the detailed diagrams that will be described in relation to FIGS. 5a-5d, this line 414 is in fact the normal memory bus that the processor / memory 404 uses for the internal communication in the digital circuit 400. The output signal of the processor / memory 404 transits through the lines 300 and 302 that drive the output signal generation circuit 206. The output signal generation circuit 206 is actually a

  modem, which applies the modulated signal to the transmission line

  telephone mission 40, generally by an acoustic coupler

  tick connected to a normal telephone. Lines 300 and 302 enable processor / memory 404 to provide the data signals and squelch signals respectively. Figures 4a and 4b show a diagram

  analogue sub-assembly 200. For the commu-

  of the reader, the three main parts of the analog subassembly 200 are represented. It can be seen that

  input processing circuit 200, the driver circuit

  peak value 204 and the general circuit

  output signal 206 are relative circuits--

  independently. The internal power supply is represented as an element of the output signal generation circuit 202. It comprises a filter capacitor

  350, a converter 348 and a regulator 354.

  These elements are considered classic and will not be described at length. It is only necessary that the

  input capacitor 350 is an electronic capacitor

  lytic value, to produce sufficient filtering

  that converter 348 is a converter

  DC-DC providing an output voltage.

  negative 9 volts, from the positive voltage

  of 5 volts 352 denoted by + V, and that the

  The driver 354 applies on line 356 a regulated voltage of + 9V. From a 9-volt battery, the zener diode 347 provides a regulated voltage of -5 volts which is the

  reference voltage for the analog converter-

  402. In all the drawings, the voltage +5 volts is represented by + V, in each case, and the voltage

+9 volts is represented by +9.

  As indicated above, the sensor 20 is

  probably a high quality microphone. It is connected

  ground to one side and is connected to the other to the operational amplifier 218 via line 80 and to the input coupling capacitor 214. The load resistor 216 has a value of 10 kL and the input coupling capacitor 214 has a value of 0.012 μF. The feedback network for operational amplifier 218 is

  consisting of the resistor 222, a value of 15 k.Ci -

  and by the capacitor 220, a value of 0.01 jyF.

250 1939

  The output of the operational amplifier 218 is connected via line 224 to the 50 or 60 Hz filter, 226, depending on the country of use. The filter at 50 or 60 Hz,

  226, is a crevice filter whose sole purpose is to

  re disappear the sector frequency at 50 or 60 Hz which

  is present in most electrical environments

  active. The output of the 50 or 60 Hz filter 226 is connected to the operational amplifier 234 by the

  resistance 228 of a value of 200 kSL. Positive entry

  of the operational amplifier 234 is connected

  to ground by resistance 236 of a value of 200 k4Ω.

  The present reaction network consists of the resistance

  232, worth 1.6 MFIs. and by the capacitor

  230 with a value of 10 pF. The output signal of the

  operational folder 234 is applied to an amplifier

  gain controller 244 as well as the

  peak value detection 204. Coupling to the amplifier

  The indicator 244 is effected by a capacitor 242 of 0.1 VF. The coupling to the peak value detection circuit 204 is performed by the resistor 238 of 100 kXL and

  line 208. The diode 240 is of the type lN4148 and is used

  to set the basic level of the input signal

  to the peak value detecting circuit 204.

  The amplifier 244 is a conventional digital control analog amplifier circuit. The component bearing the reference 7523 is characteristic

  of the circuit used. The digital input signal from

  gain is applied by line 306 (see also

  Figure 3). The analog input signal is good

  heard received by pin 15 and it goes out through pin 8.

  The zener diode 246 sets the base level of the output signal.

  which is received by the operational amplifier 350. The reaction is provided by the resistor 248 of a value of k L.

  The output signal of the operation amplifier

  No. 250 is applied to the operational amplifier 262 by the resistor 252, a value of 15 kΩ. The network of

  reaction for the operational amplifier 262 is

250,193 9

  13 - killed by the resistor 260, a value of 68 kl .., and the capacitor 258, a value of 220 pF. Potentiometer 254 applies an offset voltage and is a 50k potentiometer which is connected between the + V and -V terminals of the power supply. The positive input of the operational amplifier 262 is connected to ground by the

  264 resistance of 12 kIL. The output signal of the

  operational plifier 262 is applied by line 308 to the analog-to-digital converter 402 which is part of the digital subset 400 (see also FIG.

Figure 3).

  The peak value detecting circuit 204 is intended to generate an interrupt for the processor /

  404, by line 304, as a result of the detection of

  a peak value during a click. A visual reaction is also transmitted to the patient by the lamp 210. The analog input signal applied to the peak value detecting circuit 204 transits through the line 218, as indicated above. This signal is

  applied to the input of the operational amplifier 266.

  The negative input of the operational amplifier 266 is biased by the resistor 265, 9.10 kn, and the resistor 267, 100-Q. The output of the operational amplifier 266 is placed in capacitive coupling with the monostable multivibrator 274, by the capacitor 268. The diode 270 sets the base level of the output signal. The

  monostable multivibrator 274 and the single multivibrator

  Table 280 are respective parts of a 4098 dual monostable multivibrator. The delay time of the monostable multivibrators is defined in each

  case by the value of a circuitRC. In the case of the monostable multi-vibrator 274, the capacitor 278, having a value of 0.022

  pF, and the resistor 276, having a value of 2 MU, produce a pulse width of about

  5 ms. This signal of 5 ms is applied to the multivibrator mo-

  nostable 280, whose pulse width, output is established by the resistor 284 of 15 M-- and the capacitor

  282, 0.047 ViF. This gives a pulse width of

250 1 9 3 9

about 70 ms.

  An output of the multivibrator is also used.

  Monostable transmitter 274 for transmitting a reaction to the patient by lamp 210. This is done by means of coupling diode 294, type 1N4148. Capacitor 296 has a value of 0.1 pF and resistor 298 has a

  value of 10 MCL. The lamp 210 is a diode device

  electroluminescent that is attacked by the amplifier

operational 311.

  The 70 ms output pulse of the multivibrator

  monostable transmitter 280 is used to generate an interrup-

  for the processor / memory 404. The actual interruption

  is generated by the operational amplifier 292 which

  that line 304. The resistor 286 has a value of 2.7 k-L and the resistor 290 has a value of 2.2 kXL. The output signal of 70 ms of the monostable multivibrator 280 is not critical but must be long enough

  to produce the interrupt 6.5 that the micro-

  INTEL 8085 processor, as will be discussed below from

more detailed way.

  As mentioned above, the gener-

  The output signal circuit 206 consists essentially of a modem for modulating the RS 232 receiver, received in digital form, on a carrier suitable for transmission over the telephone link. The heart of the device is constituted by the integrated circuit MODI, 330, which is the FSK modulator at 1170/2125 Hz. This circuit

  integrated receives the RS232 input signal via pin 6.

  The preferred type of integrated circuit for the MOD1 330 is the CH1224 model, from Cermetek, Inc., which is a standard integrated circuit. Resistors 336, 338, 340, 342 and 344 have respective values of 66.5 kJ-L, 2 kfL, 66.5 k-L, 19.6 kL and 19.6 kIL. The resistances

  326 and 328 have respective values of 2 kL and 4.7 ML.

  The coarse silencer circuit is constituted by the

  resistance 332 of 10 kΩ and adjustable resistor 334,

20 k IL.

  The operational amplifier 346 provides the signal

250 1939

  input that is applied to the MODI 330 circuit.

  pal input signal applied to the amplifier operation-

  346 transits through line 302 which is attacked direc-

  by processor / memory 404, as is envisaged

  will be described in more detail below. The output signal of the MODi circuit 330 is applied to pin 15 of the

  MOD2 circuit 322. The MOD2 circuit 322 is an internal circuit

  the standard CH1262 type chip, from Cermetek, Inc., and it is a two-channel FSK / Hybrid Line / Silent Emission Filter circuit for frequencies of 1170 and 2125 Hz. Resistor 324 has a value of 68 kL. The output volume is adjusted by the resistance

  316 which has a value of 10 k-a. The output is coupled

  capacitive geometry with the cable 40 via the

  320 densifier of 0.022 pF. In practice, we use a

  loudspeaker, as shown, in acoustic coupling

  tick with the transmitting part of a conventional telephone handset. This allows the patient to easily emit

  information by his conventional telephone.

  The muffler control is also provided by the operational amplifier 318, to enable the

  processor / memory 404 to control all transmitters

  sions. This allows processor / memory 404 to generate

  the protocol information needed for synchronization

  transmission. The input signal of the amplifier

  Operational flag 318 is applied by diode 314.

  The operational amplifier 312 is connected to the process

  memory 404 by line 300 and is attacked from

the way described above.

  Figures 5a-5d show a detail diagram

  400. This scheme is presented in a slightly different form than the one used.

  for the block diagram of Figure 3, which was

  in order to facilitate understanding. The converts

  analog-digital system which is used has the reference

  402. It is a product of the firm Analog Devices,

  of the type AD7574. This is an analog converter-

  8-bit digital clock in CMOS technology, having a time of

  minimum conversion of 15 Ps.

  digital 402 receives its analog input signal through pin 4 and compares it with the reference received on pin 3. The amplitude of the input analog signal is adjustable by means of variable resistor 538, 2 k-. ., which corresponds to an adjustment to be made at the factory or maintenance, and is not intended to be adjusted by the patient. Similarly, the reference voltage is established by means of variable resistor 540 which also has a value of 2 k-n. The internal clock oscillator for the analog-to-digital converter 402

  is controlled by resistance 542, which is a resistance

  that of 120 k-xL, and by the capacitor 544-which has a

  - 100 pF. The data output of digital analog converter 402 is through line 416 as shown. As can be seen in the drawing,

  this is the normal 8-bit data bus that is

  folded into the digital subset 400. The signal

  START CONVERSION and READING is present on pin 15.

  This signal is produced by the OR gate 446. This signal authorizes the triggering of the converter and the reading, by simultaneous low logic levels coming from the output (pin 11) of the decoder 422 and the output of the

  OR gate 444. As can be seen, the exit of the door

  OR 444 is simply the reading line that is common to the memory devices in the subset

  400. As will be seen in the discussion of the micro-

  program for the transmitter 30, the normal way of

  turn on the 402-analog-digital converter

  read the output data is to process this conver-

  weaver as if it were a special location in the available memory. In this way, because pin 15 of the analog-to-digital converter 402

  requires a negative input signal to start playback

  In fact, the OR gate 446 actually operates as if it were an AND function and therefore requires a specific address from the decoder 422, as well as the presence of a READ signal on the memory address bus.

2 5 0 1 9 3 9

  internal. Connections between the analog subset

  and the digital subset 400 can be made

  killed in various ways. In the preferred embodiment, the circuits of the analog subassembly 200 are on a printed circuit board and the circuits

  of the digital subset 400 are on another.

  The connection between the two cards can be facilitated by the use of connectors providing the connection between the printed circuit boards. As shown in FIGS. 5a-5d, these connectors are referred to as connector A, 426, and connector B, 428. The various signals that go to these connectors are appropriately labeled, and will be described so that the reader can establish

  the relationship with the corresponding circuits of the sub-

  analog set which is represented in the figures

4a, 4b.

  The microprocessor 424 is of the INTEL brand, model 8085. The quartz 464 is connected to the pins 1 and 2, as shown in the diagram and described in the manufacturer's documentation for the microprocessor 424. The pin 3 of the microprocessor 424 is a Release

  restoration. This provides an output signal corresponding to

  laying down a condition of restoration which makes it possible

  taurate other associated circuits requiring some sort of reset or initialization signal. Pin 4 of the microprocessor 424 is the pin of the serial output data. Serial output data consists of a programmable data bit that is used as output data to drive the generation circuit

  206. As shown in the figures

  d, thus Figures 4a, 4b, pin 4 is connected to the operational amplifier 312 via the

  connector A 426 and line 300. As indicated above,

  above, these data then become the command signal

  silencer which controls the moment at which the mo-

  are applied to the telephone transmission network.

  than. Returning to FIGS. 5a-5d, it will be noted that pin 5

250 1939

  18 'of the microprocessor 424 is the input corresponding to the serial input data. This data consists of an input bit which can be read programmatically and which, in the

  considered, is used for transmitting

  be the EMISSION signal that comes from a push button actuated by the patient. Referring to Figure 3, it can be seen that this button is referenced 412 and that it applies the positive voltage to the line 408. Returning to Figures 5a-5d, we see that the line 408 is connected to the pin 5 of the microprocessor 424. The resistance of

  ground connection 468 has a value of 9.1 kXL. The model

  preferred embodiment does not use the trap trap present on pin 6 of the microprocessor

  424, nor the interrupt line connected to pin 10.

  As a result, these two lines are connected to ground.

  Markable Interrupt 7.5 is connected to

  Markable interruption 5.5. These interruptions are

  respectively present on the pins 7 and 9. They are generated under the effect of a countdown timer operation of the timer / RAM 430. As can be seen, the line is connected to

  pin 6 of the timer / RAM 430. The description

  The following indicates how this interruption is gener-

used and used.

  Pin 8 of the microprocessor 424 corresponds to the maskable interrupt at level 6.5. A load resistor 466 is connected in parallel to this pin. The

  connection between pin 8 and the operating amplifier

  292 of the peak value detection circuit 204 (see also FIGS. 4a, 4b) is carried out by the connector

At 426, pin 3 and line 304.

  Pins 12 to 19 of the microprocessor 424 correspond to

  address lines O to 7. Note that they are connected by an address bus to the memory devices present in the digital subset 400. The upper 8 address bits (i.e. address bits 8 to

  ) are present on pins 21 to 28 of the microproces-

  424. These address bits are essentially used in

* 19

  as selection lines, for selection between memory devices and others. Pins 21 and 22 (i.e., address bits 8 and 9) select RAMs 432 and 434. Address bits 11 to 13 (i.e. 26) are applied to

  decoder 422, for translation in the manner described above.

  above. The remaining address bits are used as shown. The signal ADDRESS / VALIDATION is present on the pin 30 and is distributed by the memory bus as shown. WRITING and READING signals are present on the pins 31 and 32. It will be noted that these signals are distributed by the address bus by using the gates 442 and 440, respectively. It will be noted that resistors are also used.

Charging 470 and 472.

  The microprocessor 424 restore input is connected to the restore button 410. Again,

  as the previous drawings show, there is a

  The input signal generated by the patient, and pressing the button causes microprocessor 424 to initialize these programs at address 00, as explained in the INTEL technical documentation. Pin 37 is the output pin of the CLOCK signal of the microprocessor 424. Note that this signal is distributed as shown to timer / RAM 430 and transmit device 403. This allows these devices to operate in synchronism with the clock.

microprocessor 424.

  The decoder 422 is a decoder of the type three bits-eight outputs. It is used to decode the address bits 11, 12 and 13 to produce VALIDATION signals for the various devices, using the address bus. The inputs of the decoder 422 can be

  connected by means of input jumpers 452, 454 and 456.

  This makes it easy to change the configuration of

  wise, in manufacturing or maintenance. These jumpers are not intended for use by the patient. The enable inputs of the decoder 422 (i.e.

250 1939

  pins 4 and 5) are attacked by the address bits 14

  and 15 (i.e., pins 27 and 28) of the microproces-

  424. Note that these inputs can also be connected using jumpers 448 and 450. The decoder 422 is preferably a decoder of the firm INTEL, model

the 8205.

  The decoder output signals are used

  422 as validation signals for the various

  positive, as explained below. For example, the

  output signal O is present on pin 15. It is used

  read to enable the read-only memory 438. Similarly, the output signal 1, which is present on the pin 14, is used to enable the RAM 432 and the RAM 434. The output signal 3 is present on the pin

  12 and it is used to validate the transmission device

  mission 403. As explained above, the conversion

  analog-to-digital weaver 402 is validated by the signal

  output 4, present on pin 11.

  The timer / RAM 430 is a device

  of the INTEL firm, type 8155. It fulfills three

  fundamental functions. It has a capacity of 256 multi-

  Plets of RAM. It has three entry ports /

  exit; it also contains a function timer

  by counting in decreasing direction. Pins 21-28 are called Input / Output Access A. This is an 8-bit access that can be programmed for the input or output function. As we see in

  the description of the firmware, access A is used

  as input access and it ensures the introduction of patient identification information. The switch

  418 is the paging identification input switch

  holds, at 8 bits, maneuvered manually. It will be noted that it contains separate switches 502, 504, 506, 508,

  510, 512, 514 and 516. These switches allow the physician to

  cin fix the patient identification number that

  is assigned to the patient. If all interrup-

  are open except for switch 516, the test mode is switched on, which causes the generation and

250,193 9

  the transmission of test data. Note that we use

  load resistors 490, 492, 494, 496, 498, 500

and 501 which are connected to + V.

  The timers / RAM pins 29 to 36 constitute the input / output port B. Like the input / output port A, the input / output port B is

  programmed by the firmware of the pre-programmed embodiment

  to fulfill the input function. The switch 420 contains eight individual switches which have the references 518, 520, 522, 524, 526, 528, 530 and 532. These eight individual switches allow the doctor to

  set the patient's valve identification number.

  Note that, as in the case of access A, we use

  load resistors connected to + V. These resistances

* these bear the references 474, 476, 478, 480, 482, 484,

486 and 488.

  C input / output access is a six-bit access that uses pin 37 for bit 0, pin 38 for bit 1, pin 39 for bit 2, pin 1 for bit 3, pin 2 for bit 4 and pin 5

  for bit 5. Pins 37, 38 and 39, which correspond to

  To bits 0.1 and 2 of the input / output port C, are used to control the gain of the amplifier circuit 244 via the line 306 (see also Figs. 4a, 4b). Pin 37, that is bit 0,

  is connected by the pin 14 of the connector A 426 to the cir-

  cooked amplifier 244, pin 6, via

  line 306A. Similarly, pin 38 of the

  The riser / random access memory 430 is connected by the pin 2 of the A connector 426 to the line 306B, and therefore to the pin of the amplifier circuit 244. Similarly, the pin 39 of the timer / random access memory 430 is connected.

  through pin 15 of connector A 426 to pin 7 of the circuit

  cooked amplifier 244, via the line

306 C.

  Bit 3 of access C, which corresponds to the bro-

  1 of the timer / RAM 430, is connected to the pin 13 of the connector A 426. Similarly, the bit

  4 of access C, which corresponds to pin 2 of the temporisa-

  memory 430, is connected to pin 4 of the

  A bit 426. Bit 5 of access C is connected to the

  The restoration of the transmission device 403, which corresponds to the pin 21, will be seen by examining the firmware that can be used to restore this device. Pin 6 of the timer / RAM 430 corresponds to the output of the timer. As can be seen in the manufacturer's technical documentation, the timer / RAM 430 has a register which can be decremented, accessed using the appropriate commands, and produces an output signal on pin 6 when decremented. . As shown in the drawing, this pin is connected to the level 7.5 and level 5.5 interrupts of the microprocessor 424. It will be seen during the microprogram examination that this makes it possible to interrupt the microprocessor various precise times. Pins 8, 9, 10 and 11 are respectively the enable, read, write and address temporary memory enable entries. As can be seen, these pins are simply connected to the bus

  of address, as for any other element of

  memory. Pins 12 to 19 correspond to the eight posi-

  address bit patterns that are also connected to the

address bus.

  Each of the RAMs 432 and 434 is a

  positive memory with a capacity of 1024 times 8 bits. These RAMs are connected in a similar way to the address and data buses. They are addressed in the same way. The only connection difference between the RAM 432 and the RAM 434 is that

  the address bit 10, connected to the microprocessor 424,

  che 23, is connected with opposite polarities, which

  that one or the other RAM is validated.

  It can be seen that the address bit 10 is connected to the

  input pin CE 13 of the RAM 432 and is connected

  to the input pin CE2, 12, of the RAM 434.

  Table A below shows the address space that is defined in the preferred embodiment. We

  note that all addresses are given in hexadecimal.

  The address space from the address 0800 to the address OBFF is in the RAM 432 and the space

  from OCOO to OFFF is in RAM 434.

  Note also that all of the above address space above the address 1000 is assigned to the timer / RAM 430. The address space from address 0000 to address 07FF

  found in ROM 438. Returning to FIGS

  5a-5d, it can be seen that the random access memory 438 is addressed to

  address register 436. This device is a

  address register of the firm INTEL, type 8212. We note-

  ra that the address register 436 is connected to the address bus, such as the RAMs, and that it has an address output which is simply connected to the

  eight address input lines of the RAM 438.

  The eight data output pins of the RAM 438 are the pins 9 to 17 and, as can be seen,

  they are simply connected to the data bus / address.

  There are additional address pins, which are pins 23, 22, 19 and 21, respectively providing the address bits 8, 9, 10 and 11. The address bits 8,

  9 and 10 (i.e., pins 23, 22 and 19) are sim-

  connected to the address bus. Pin 21, which is

  responds to the address bit 11, can also be connected to the address bus, by means of a jumper 546, as shown. This allows further expansion of the ROM space, if necessary. Naturally, the read only memory 438 is validated only during the correct addressing time, by the decoder 422, output 0, as explained above. The corresponding enable signal is present on the pin 18. The pin 20 is an output enable pin which is connected to the read line of the address bus, attacked by the gate 440.

  note that this signal is necessary to validate the trans-

  mission data from the ROM 438 to

  the common bus of data and address.

  The main remaining logic element shown in FIGS. 5a-5d is the transmission device

  403. It is preferably an integrated communications

  Sion of the firm INTEL, type 8251. It is a universal serial asynchronous transmitter / receiver, commonly called USART, which converts the RS-232 serial format

  snapping data that are recorded in the memo

  re, for their transmission to the telephone transmission channel 40 by the signal generation circuit of

  output 206. The output signal of the transmission device

  403 appears on pin 19. Note that it is.

  transmitted to the pin 10 of the B connector 428, and then to the operational amplifier 346 by the line 302 (see also Figures 4a, 4b). Returning to FIGS. A-5d, it can be seen that the CTS output of the device

  transmission 403 corresponds to pin 17 which is connected

  to the mass by the rider 536. It should be noted that

  seen the means necessary for the transmission of this signal to the modem, in case one would wish a synchronous transmission. Similarly, pin 3 which corresponds to the data of the receiver is connected to ground by jumper 534, since it is not used at this time. The circuit selection input is pin 11

  which is connected to the output 1 of the decoder 422. This allows

  causes the microprocessor 424 to load the state registers into the transmission device 403, using specialized addresses. Table B shows the addresses

specials that are used.

TABLE A -

ADDRESS (HEXADECIMAL) DEVICE

0000 - 07FF DEAD MEMORY 438

0800 - OBFF LIVING MEMORY 432

OCOO - OFFF LIVING MEMORY 434

  1000 - 17FF TIMER / LIVE MEMORY 430

TABLE B

ADDRESS

1000 - 13 FF

1402

2000

USE

LIVER MEMORY OF TIMER /

  MEMORY LIVED 430 (repeats every 256

ORDER / STATE OF THE TIMER /

LIVING MEMORY 430

ACCESS TO TIMER / MEMORY

VIVE 430

ACCESS B TIMER / MEMORY

VIVE 430

TIMER / MEMORY ACCESS C

VIVE 430

LOW WEIGHT BODY OF THE ACCOUNT OF

TIMER

STRONG BIT WEIGHT OF THE ACCOUNT OF

TIMER

DATA REGISTER OF THE DEVICE

TIF OF TRANSMISSION 403

ANALOG-DIGITAL CONVERTER

THAT 402

  Returning to FIGS. 5a-5d, it can be seen that the pins 27, 28, 1, 2, 5, 6, 7 and 8 correspond to

  data bits (ie bits 0-7) of the

  transmission system 403. It should be noted that these pins are

  simply connected to the 8-bit address / data bus.

  Similarly, pins 10 and 13, which correspond to

  to the writing and reading inputs, must also be

  be connected to the data bus to enable reading and writing from the data register and the command register. It will be noted that pin 12 determines whether access must be made to the order register

  or the data register, and that this pin is simple-

  connected to address O which comes from the address register.

se 436, pin 4.

  As shown in Figures 5a-5d, as well as Tables A and B, the microprocessor 424 is capable of addressing the various devices that are in the

  digital subset 400 and communicate with them.

  Special attention should be paid to Table B which shows the specialized addresses that are important

  for the transmitter firmware 30. These addresses

  will leave the reader in. review of program listings

  which are appended to the description.

MICROPROGRAMM.E FOR THE TRANSMITTER 30

  Figures 6a and 6b show a detailed flowchart of the specialized microprogram used for

  transmitter 30. The firmware is entered through the

  restoration 1000, under the effect of pressing the restoration button 410 by the patient (see also

  Figure 3), or when powering on. The fact of

  yer on the button directs the microprocessor 424 to

  address 0 which causes the execution of the main program

  pal. At element 1002, the command is transferred to

  INVALIDATION program, in order to invalidate all interrupts. At element 1004, the command is then

  transferred to the OFF_BIP element, to stop the frequency

  this carrier of the 'modem. Element 1006 causes the charge

  In the control clock of the timer / RAM 430 of an integer which produces a maskable interrupt level 7.5 or level 5.5, 10000-times per second. By consulting the table B, we can see that this loading is done by designating the addresses 1400,

1404 and 1405, in hexadecimal.

  Referring back to FIGS. 6a, 6b, it can be seen that at item 1008, the program determines whether the patient's identification number is or nonexactly equal to -1. As explained previously, the fixed doctor

  in advance the particular identification number of the

  holds with the 8-bit switch 418 (see also

  Figure 3). Maintenance staff know that the introduction

  duction of -1 or FF in hexadecimal (that is, all

  open switches, as shown in Figure 5a),

  void the transition to the test program. As shown in Figures 5a5d, the patient identification number

  is transmitted to timer / RAM 430 via

  the input / output access A. In Table B, we can see that this is done using

address 1401, in hexadecimal.

  Returning to FIGS. 6a and 6b, it can be seen that if the test mode is selected, the connection is made and the program proceeds to perform the test at element 1010. If it is assumed that the patient has entered a number valid patient identification and did not select the test mode, the program passes

  to element 1012 which initializes a number of values

  the program. Element 1014, combined with the element

  1016 causes zero of all six bytes of the variable buffer BUFFER TIME. It is in this table that time marks are recorded

  for calculating intervals between clicks. cer-

  Additional variables are initialized at the time of

  1018. Note that the variable GAIN AN is set to 0, which minimizes the gain of the amplifier circuit 244

  (see also Figures 4a, 4b).

  Returning to FIGS. 6a, 6b, it can be seen that the element 1020 determines whether one or more valves have been implanted on a given patient. Note that the physician is instructed to enter a positive patient identification number if a single valve

  implanted on a given patient, and an identification number

  Negative patient if several valves have been implanted on this patient. Element 1022 initializes

  the time and count for the single-valve patient.

  Similarly, the element 1024 initializes these same

  values for patients with multiple valves.

  A mask is prepared for element 1026 to

  that an SMASQUE procedure passes to item 1028 at

  maskable rashes at level 7.5, but not level 5.5 or 6.5. The command is then transferred to item 1030 which proceeds to procedure INT_55 for operation

  of data relating to data derived from the

  analogue-digital service 402. It should be noted that this

  The main purpose of entry is essentially to establish the

  calf to be used for amplifier circuit 244.

  A new mask is established at element 1036 and

250 1939

  28 'the command returns to the SMASQUE procedure, to the element

  1038, to hide all interrupts, except the

  veal 6.5. Recall that the level 6.5 interruption is-

  the peak value interruption generated by the peak value detecting circuit 204 (see also FIG.

re 4).

  Item 1040 transfers the command to the procedure

  validates VALIDATION to validate interruptions in

  generation of an interrupt 6.5. The control is then transferred to the GADJ procedure at the W42 element, in order to set the input gain for the analog-to-digital converter 402. As explained above, this setting is made in

  applying a three-bit value to the amplification circuit

  244 through the input / output port

  C of the timer / RAM 430. The element 1044 de-

  ends again if the present patient is a patient to

  a single or multiple valve. This is important

  the fact that multiple valve patients have more than one click to monitor per cardiac cycle, and the fact that data must be collected for the same interval between each snap, in the same

heart cycle.

  For a patient with a single valve, the element 1064 sets the interrupt mask to 19 in hexadecimal and

  element 1066 returns the command to the SMASQUE procedure.

  This validates both level 6.5 interrupts and

  level 7.5. The order is then returned to the

  to the element 1068, to fill the random memory

  pon with data from the analog converter-

  The element 1070 prepares a new mask equal to OF in hexadecimal, following the introduction of

  all data. The order is transferred to the

  SMASQUE, at element 1072, to hide all

  maskable terruptions. The order is transferred to the

  BIP procedure to 1074, to trigger a port.

  intended for the transmission of data. Element 1076 transfers the command to the VIEBATT procedure that transfers

2 5 0 1 9 3 9

  data to the central monitoring site.

  Lisa. Element 1078 goes back to the VIEBATT procedure for

  allow repetition of data transmissions.

  Assuming that the element 1044 determines that the patient is a multi-valve patient, the element 1046 subtracts the byte 1 from the time buffer of the byte 3 of the time buffer. This is to determine if the interval between clicks of the same cardiac cycle is greater than the interval

  between clicks of different cardiac cycles. This cal-

  continue to item 1048. The item 1050 deter-

  mine if the interval is larger and, if the result is YES, element 1060 determines whether the number

  Valve identification number is greater than 0. If the

  response is NO, the patient can not be tested and the

  program goes out by element 1062. If the identification number

  Validation is a positive number, element 1060 transfers control to element 1056 which determines

  whether the maximum value indicator is set or not.

  If the maximum value indicator is not set,

  This indicates that the unit was unable to hear the

  vules, and the program goes back to element 1058 again.

  If element 1050 determines that the second difference

  is not greater than the first, the identification number

  Valve is checked again and if it is superior

  0, the patient can not be tested again

  and the program goes out to element 1054.

  If the element 1008 determines that the test mode has been selected, the program is directed to the element

  1010 to complete the test. Basically, the function

  testing allows standard data to be introduced

  in the device, to transmit them to the monito-

  centralized rage, to control the operation of the equipment throughout the device. The elements 1080, 1082 and 1084 combine to assemble all 2048 bytes of the data buffer with the selected background values for the test. Element 1086 then assembles some special multiplets with the test information. The element 1088 then introduces the values of selected time intervals into the time buffer and the element 1090 generates a delay.

  programmed which corresponds to the normal processing time.

  Element 1092 and the following then work together to output the test data to control the rest of the apparatus. For example, element 1094 transfers the command to the BIP procedure,

  to mimic the click signal of the detected patient.

  Elements 1096 and 1098 correspond to the return of the

  command to the LIFE BATT procedure, to transmit the

  test, and the output from the main program.

  pal is done at element 1100 which corresponds to the completion

test.

  Figure 7 is a detailed flowchart of the

  firmware that corresponds to procedure INT_75, 1102.

  As shown in Figures 6a, 6b, this procedure is used to replenish the input buffer with the data of the analog-to-digital converter. The normal monitoring cycle requires 2048 multiplets of information, in decimal. Entry into the procedure

  INT 75 is at element 1102. Element 1104 resists

  the interruption of level 7,5 which is required by

  the INTEL microprocessor, type 8085. The 1106 element validates

  of all interrupts and the 1108 element continues

  to generate a delay, waiting for an interruption.

  As explained above, the level interruption

  7.5 corresponds to a delay signal which is gen-

  by the timer / RAM 430. This interrup-

  is generated 10000 times per second, as programmed in program element 1006

  principal (see also Figures 6a, 6b). In return-

  Figure 7 shows that the order is transferred

  to element 1110 upon receipt of the interruption.

  In fact, what actually happens is that the

  reception of the interruption causes the meter counter to

  truction at the position corresponding to the interruption received. Element 1110 determines what type of

  the interruption received and, as indicated above, the

  7.5 ruption corresponds to an indication of the time

  porisateur. The level 6.5 interrupt corresponds to the detection of a peak value by the peak value detecting circuit 204 (see also FIGS. 4a, 4b). The receipt of the level 6.5 interrupt means the receipt of a snap and the element 1112

  invalid the timer interrupt. Other inter-

  ruptions are committed to element 1114 and element 1116 outputs to the main program. If it is assumed that the interrupt is a level 7.5 interrupt (ie a timer interrupt),

  element 1118 triggers analog-to-digital conversion

  than. As previously discussed in relation to

  Table B, the triggering of the analog converter

  that digital 402 corresponds to a reading at the memory address 2000, in hexadecimal. Due to delays in the converter, the first order

  sent to the analog-to-digital converter 402

* the converter and the following command produces a read

  data. Consequently, the order corresponding to the element 1118 generally leads to the reading of a

  information that is invalid and must be rejected.

  Element 1120 establishes the loop for reading data from the analog-to-digital converter

  402, and this reading takes place 2048 times, in decimal. The the-

  1122 determines whether the pointer has been incremented this

  number of times. If it has been, element 1124 puts the point

  zero. The pointer is kept at element 1126 and element 1128 picks up the new data in the

  analog-to-digital converter 402. As has been explained

  This corresponds to the reading of the address 2000, in hexadecimal.

  Element 1130 saves in the buffer memory

  pon of 2048 bytes the multiplet of information that

  has just been taken from the analogue converter-

  402. This record is made at one location

  which is specified by the pointer, and the value indicator

  their peak is controlled at element 1132.-If the indica-

  If the peak value indicator is not set, the command is continued to element 1134. If the peak value indicator is not set, the command is simply

  returned to element 1104, for another pass.

  If the peak value indicator is

  born, the element 1134 increments the counter and the element 1136 determines whether or not the counter has already reached 1536,

  in decimal. If it has not reached this value, then again

  the counter value is stored at element 1138 and the command returns to element 1104. Once the counter has reached the maximum value, the output of the routine proceeds to element 1139. The output returns of course the command to the main program calling.

  Figure 8 shows the flowchart of the procedure

  lasts GADJ, 1140. It is recalled that, as indicated

  in the description of the main program, this

  This procedure is referred to element 1042 (see also FIGS. 6a, 6b) in order to adjust the gain of the analog signal which is applied to the input of the converter.

  analogue-digital 402. This adjustment is obviously effec-

  killed by transferring a value to three bits of access

  C timer / RAM 430 to the circuit am-

244.

  We will now return to FIG. 8 on which we can see that the element 1142 determines whether the

  value of DONNEESTEMP is greater than 90, in hexadecimal

  wrong. The DATA TEMP variable consists of a single multi-

  plet which corresponds to the largest value read in the analog-to-digital converter 402. If the value is

  sufficiently large, the order is transferred to the

  1158. Otherwise, the element 1144

  mine if AO, in hexadecimal, is less than the variable.

  -If the answer is YES, the gain is changed by the element

  1146 which fixes the variable GAINAN equal to two, and the output

  The variable GAINAN is in fact the address 1403, as can be seen in Table B. This corresponds to the value to be loaded in the access C, for transmission to the amplifier circuit. 244. Element 1158 determines whether or not 40, in hexadecimal, is less than the last input value. If the

  answer is NO, the output is at element 1160.

  If the answer is YES, element 1162 determines whether 60, in hexadecimal, is less than DONNEESTEMP. If the answer is NO, element 1164 sets the variable GAIN-AN equal to

  1, and the output is to element 1166. If the response is

  YES, element 1168 determines whether 70, in hexadecimal

  badly, is less than DONNEESTEMP. If the answer is NO, the element 1170 sets the variable GAINAN equal to 2, and the output is done by the element 1178. If the answer is YES, the element 1174 sets the variable GAINAN equal to 6, and the output is to element 1176. Note that,

  In this way, the GADJ procedure sets an optimum level

  wrong for the amplitude of the converter input signal

analog-digital 402.

  Fig. 9 is a flowchart of the procedure INT_55,1178. In accordance with item 1030 of Fig. 6a, the main program calls this procedure for

  the introduction of data from the converted

  analog-digital source 402. Returning to FIG.

  we can see that element 1180 validates interrupts.

  Element 1182 makes the command does not move forward

  until an interruption has been received. At the reception

  interrupt, element 1184 determines the type of interruption. In this case, because of the mask that has been generated at the element 1026 and introduced to the element 1028 (see also FIG. 6a), the only interruptions

  expected are interruptions at level 5.5 or inter-

  ruptures of level 6.5. As explained above,

  level 6.5 terressions come from the timer

  which belongs to the timer / RAM 430.

  In the event of such an interruption, the element 1186 invalidates the interrupt of the timer. Element 1188 validates other interrupts and element 1190 outputs

to the main program.

  If it is assumed that the interrupt received is an interruption of the level 5.5, control passes to the element 1192 which triggers the analog-to-digital converter 402. As explained above, the operation relating to the element 1184 is in fact the referral process

  material which corresponds to the types of interruptions

  ble. Here again, as also explained above

  above, the data received at element 1192 is rejected

  because they correspond to the previous conversion.

  Element 1194 and element 1196 set the initial state of the counter loop. If the value of

  counter is less than the value of CTEMPS, the

  This is transferred by element 1198 to the BIP procedure. This naturally causes the carrier to appear. The return of element 1198 is done by a tight loop

  which is obviously opened by the interruption received.

  The element 1196 transfers the command to the element 1200 at the moment of determining that the content of the counter is no longer less than the variable C TIME. The

  value of C TIME is FO, in hexadecimal, for the pa-

  single-valve and 50 hexadecimal for multi-valve patients, in accordance with the 1022 and 1024

also Figures 6a, 6b).

  Element 1200 replaces the value of the counter in memory and element 1202 determines whether the indicator of

  peak value is set. If not, the

  mande goes to element 1218. If the value indicator

  crest is set, the element 1204 memorizes the

  their counter in BUFFER TIME. Note that this affects a time mark at the point at which the peak value was received. Element 1206 increments the REGTEMPS variable and stores it. This item keeps track

  evolution of time during the process of entry. The the-

  1208 sets the peak value indicator to zero and

  element 1210 increments the number of peak values.

250 1939

  Element 1212 determines whether or not the number of peak values has reached the value of the ACCOUNT variable P that has been set at element 1022 for single-patient patients.

  valve (ie 2) or element 1024 for the

  with multiple valves (ie 3). If the

  answer is YES, the subroutine exits to element 1216.

  If the answer is NO, element 1214 stores the new

  the value of NOMB CRETE, and the information of the convert-

  analogue-digital service 402 is again

1218.

  The element 1220 determines whether the last value read in the analog-to-digital converter 402 is

  less than DONNEESTEMP. If the answer is NO, the new

  the value of the analog-to-digital converter is saved as a DATA TIME variable. However, in one case as in the other, the command returns to the element 1180 for further processing. This continues until an interruption of level 6.5 is received or until the desired number of values

  peak (ie 2 or 3) was counted.

  Figure 10 is a flowchart of the sub-program

  INVALIDATION, 1224. Note that it simply invalidates all interrupts at element 1226. The output

is done by element 1228.

  Figure 11 is a flowchart of the sub-program

  me SMASQUE. After entering the element 1230, the element 1232 takes the desired interrupt mask. Element 1234 positions the mask in the state register. The exit

is done by element 1236.

  Figure 12 shows the flowchart of the sub-

  BIP program. The entry is made by element 1238.

  An interrupt mask value equal to CO, in hexadecimal

  is chosen for element 1240. The element 1242 calls

  the procedure SMASQUE to make appear the carrier

  for the output generation circuit 206. This is done

  kills by setting the serial output data (SOD) bit. As explained above, this signal is transmitted by line 300 to the operational amplifier 312 (see FIG.

250 1939

  also Figure 4). Element 1244 produces a delay

  by repeating the sequence 2001 times.

  Element 1246 selects a mask equal to 40, in hexadecimal. The SMASQUE procedure is again called at element 1248. This mask (that is, 40) resets

  the serial output data bit, which blocks the

  output signal of the output signal generating circuit

  The element 1250 sets a delay by repeating the sequence 2001 times. The subprogram then goes out to

the element 1252.

  FIG. 13 represents the flowchart relating to the procedure VALIDATION 1254. The element 1256 validates the

  interruptions. It should be noted that this adds to the position-

  mask in the status register. If necessary, consult the manufacturer's technical documentation for additional details on the microprocessor.

  424. The exit is effected by element 1258.

  The data that is collected and saved

  in the RAM are presented as output by the

  VIEBATT procedure whose flowchart is shown in Figure 14. After input to the element 1260, the element 1262 resets the main index I. The element 1264 ensures that, for the first 75 iterations, the BIP procedure is not called. For these first iterations, the element 1270 resets the index J, and the EMISSION procedure is called by the element 1272 to transmit the data. Element 1274 increments J and element 1276 determines when the smallest loop has been executed 32000 times. Element 1278 Increments Index I

  and element 1280 determines when the largest

  loop has been executed 32000 times. After 32,000 execu-

  the largest loop, element 1282 provides the

  exit to the calling procedure.

  For the iterations that follow the first 75

  res, element 1264 causes element 1266 to

  calls the BIP procedure to transmit the carrier frequency.

  The command is then transferred to the EMISSION procedure by the element 1268, to transmit the data. Elements 1278 and 1280 make the largest loop

  iterated 32000 times and that the output is carried out

  1282, as explained above.

  Figure 15 is a flowchart for the procedure

  Hard EMISSION, 1366. As can be seen, item 1368 reads the EMISSION button to determine if it has been depressed by the patient. Here again, it is the transmission button 412, as shown in FIG. 3. As indicated above, this information is read in the form of

  serial entry data and it is in the regis-

  mask. Element 1370 then calls the procedure

  BAUDSORTIE which presents the output data, and the

  gram leaves the EMISSION procedure with 1372.

  Figures 16a, 16b show a flowchart

  detailed description of the procedure BAUDSORTIE, 1284. This procedure

  hard is called by the SEND procedure, to set the format of the actual output information. Element 1286 initializes a number of values. Element 1288 calls the SMASQUE procedure to reveal the carrier frequency. As previously indicated, this is accomplished by inputting into the mask register data which produces the serial output data signal. Element 1290 determines whether or not it is the first iteration. If the answer is YES, the element

  1292 initializes a number of variables. These variations

  are required to initialize the output transmission. We use the variable CONT_8155 to order

  the input / output port C, for the purpose of controlling the

  positive of transmission 403. It will be noted that the variable

  GAINAN is fixed to the maximum, and then to O which

  kills a hardware restoration of the transmission device

  mission 403, via bit 5 of the input / output port C. The TEMP variable is set at the address

  start of the buffer, to be emitted. Variations

  MODE_8251 and COMM_8251 are set to values according to the desired transmission mode. In that case,

  it is desirable to have a clock rate which

  respects to a multiple of 64. The transmission takes place

  with 8 bits, no parity bit. We do not use parity

  and use a "stop" bit. The output signal as well

  obtained corresponds to a standard protocol at 300 bauds.

  Element 1295 imposes a delay and item 1296 calls STAT procedure 8251 to acknowledge receipt that the transmitting device 433 is ready to accept a data transfer. As soon as it is ready, element 1298 places an initial data configuration in the DON variable: .EES_8251, for which Table B shows that this is the 1800 address that is in the data register of the transmission device 403. The DATA variable 8251 must be considered as basically the output value. Element 1300 makes a 7F configuration, in hexadecimal,

  (ie 0111 1111), is transmitted 150 times. The the-

  1302 calls the STAT_8251 procedure again for

  acknowledge receipt of the last transmission and the

  1304 transmits the configuration shown, in the form of a second part of the preamble. Element 1306 causes this configuration to be transmitted 10 times. Element 1308 again calls the procedure

  STAT_8251 to acknowledge receipt of the ready status of the

  transmission system 403 for additional data

  res. Element 1310 then transmits the identification variable

  cation of the patient. Element 1312 calls the procedure

  STAT 8251 and acknowledges the transmission of the identity

  tification of the patient. Element 1314 then transfers the valve identification number. The element 1316

  transfers the order to STAT procedure 8251 for

  receive the transmission of the identification number

Valve.

  Element 1318 then transfers the variable contained in the time buffer 1. Element 1320

  acknowledges receipt of the transmission. The 1322 element

  then fills the contents of the time buffer 3.

  Element 1324 again acknowledges the transmission of

  if we. Element 1326 transfers the contents of the memory

  time stamp 5 and item 1328 again acknowledges receipt-250 193 9

  5. These variables are the time stamps for the digital data. Element 1332 zeroes the index to ensure the transfer of all data in the data buffer. Element 1334 increments the pointer; and element 1336 determines if the pointer has been incremented to 2047. If the answer is YES,

  element 1338 resets the pointer

  tor. In one case as in the other, the 1340 element

  transfers the command to the STAT_8251 procedure for

  Ser reception of the successful completion of the last transmission. Element 1342 transfers a byte of data from the incremented buffer by the

  15. Pointer and 1344 increments the pointer. The the-

  1346 causes the loop to be iterated 2048 times, after which element 1348 resets index I.

  Element 1350 ensures that there is an accused of

  ception for the last transmission and the element 1352 emits the number 80 in hexadecimal. The elements 1354 and 1356 cause the hexadecimal number 80 to be transmitted times. Then, the element 1358 sets the MASK variable equal to 40; and the element 1360 transfers the command to the

  SMASQUE procedure to invalidate the data bit of output.

  series, and therefore the output signal generation circuit 206. The element 1362 resets the variable I and sets the variable T to 1. The element 1364 ensures the return to

the appellant procedure.

  Figure 17 is a flowchart of the procedure

  STAT 8251, 1374. This procedure ensures that the

  the previous case was successfully transmitted by the

  positive transmission 403 before a new character is loaded into the output register. This is necessary because the transmission protocol transmits, at a serial rate of 300 baud, characters which are received from the microprocessor 424 in the form of bytes. Of

  this fact, it takes significantly less time for microproces-

  424 to transfer the data to the

250 1939

  transmission 403 to the transmission device 403 for converting the data in serial form and for

  transfer to the output signal generation circuit

tie 206.

  Element 1376 takes the variable CONTROLE_8251.

  This causes a reading of the order register of the

  transmission rate 403. The absolute address of this va-

  is 1801, as can be seen in Table B. Returning to Figure 16, we can see that the element

  1376 reads this variable looking for a signal of completion.

  data that is combined by an AND function with

  1, item 1378. Element 1380 determines whether the result of

  tat is O and, if the answer is YES, the command returns to element 1376. This is the case when the data has not yet been transferred. Element 1380 transmits the

  command to the element 1382, for the output to the sub-

  calling program, when the transmission completion bit

  data mission is positioned. It should be noted that

  STAT_8251 is called for each multiplet that

  is transferred via the transmission device

mission 403.

  The complete program list for the micro-

  transmitter program 30 is given in Appendix A.

SOFTWARE FOR THE COMPUTER 70

  Figure 18 is a flow diagram of the

  software that is used in the computer 70 of the site of

  centralized monitoring. As indicated above, the

  70 is a Hewlett-Packard HP-85 computer,

  equipped with its standard operating system. The diversions

  minor equipment options that must be controlled

  with the computer have been indicated previously.

  The program receives the order from the program

  1400. Element 1402 initializes a number of variables. Item 1404 asks if

  the input signal is a new patient or not.

  This interrogation is presented on the device of

  presentation, with the conventions of the operating system

  normal situation. The input signal is received at 1406.

2 5 0 1 9 39

  In element 1408, the program determines whether the

  patient is a new or an old patient. For a new

  Patient Calf, Item 1410 is needed to create a new patient record. The patient record is created in a standard format that allows the use of the normal file management utilities of the HP-85, for subsequent presentation and updating of the periodic monitoring information. The data

  are introduced to element 1412 and element 1414 de-

  ends if an error has been created. If an error is

  appeared, element 1416 signals a transmission error.

  the operator and asks him to retest. Item 1418 is a pause that causes a return to supervisor mode, waiting for a new

supervisor level order.

  Assuming no transmission error

  has been found, item 1420 presents the identification number

  the patient's identification number,

  valve and the various time intervals measured. The the-

  1422 signals to the operator that the data is

  produced and converted, and that appreciable time is

  necessary because of the fulfillment of a transformation

  fast Fourier formation. In element 1426, the operator noted that the data transfer was completed, and the

  order is transferred to item 1436.

* Assuming the patient is a patient

  old, it is not necessary to create the new

  patient record. As a result, the control moves to item 1428 and the patient identification number

  is asked. The input information is received by the

  1430, and the operator is notified at item 1432

  a patient record is playing.

  Element 1434 calls the subprogram in 1060 to look for

expensive registration.

  That the patient present is a new patient

  or a former patient, element 1436 calls the sub-pro-

  gram 1260, for the plot of time intervals. The graph of time intervals can be observed again

2 5 0 1 9 3 9

  with reference to Figure 2. Note that the graph

  of time intervals is graph 112.

  Returning now to FIG. 18, it will be noted that the command is transferred by the element 1436 to the subroutine 1140, to accomplish a transformation of

  Fourier fast on the data. We know that the transformation

  Fast Fourier takes the data that is numerically

  in the amplitudes domain and converts them into the frequency domain. This has the effect of determining which frequency components make up the

  complex signal. After the completion of the transformation

  Fast Fourier mation, element 1440 created both

  plotted by transferring the command to subroutine 2370.

  The two plots are seen in FIG. 2. Chart 114 is a graph of amplitudes in the time domain that shows the snapping signal 116. It should be noted that the graph 114 is normalized so that the signal 116 varies around the time. an arbitrary amplitude O. The second graph that is drawn is the graph 118. We will note

  that it presents information in the amplitude-

  frequency, which is normalized to -36 dD. As we have

  plicated above, this graph is probably the most useful for the purpose, because

  The above theoretical arguments indicate that one can easily

  undermine the existence of an embolic accumulation

  by frequency offsets of certain frequency bands

accordingly.

  Returning to Figure 18, we can see that -

  Element 1442 queries the operator to determine whether to treat another patient. The information introduced

  is received at element 1444. Element 1446 evaluates the

  response. If no additional patient treatment is

  request. 1452 indicates that the treatment is

  mined and item 1454 returns the command to the program

  supervisor. If element 1446 determines that another

  patient must be processed, item 1448 indicates that a new sequence of operation will begin and the command returns to the supervisor program in 1450. The

  interested in a more detailed examination of the

  Computer 70 may refer to the list in Annex B.

  The foregoing description as well as the figures

  describe in detail the structure and use of a

  cardiac valve monitoring apparatus by means of

  phone call. Those skilled in the art may apply the

  different configurations, in accordance with the

  description that has just been made.

  Case g -4 o 'Ca ta - ta Cao. <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< ## STR1 ## z> 2> $ Xw <as Ca -c; C = = o> 7 5 = u5Rv> x <r Cai> S m a st S '-, n- C.1C0? 10> O. ## EQU1 ## C ## STR1 ##

  m - - ---- ----- - C -

  o CN trn L Co w Cl w Ca: Ca -i - - el COC-., t. -W BDBDB C- Zi i W C Iii I - t, - - o t, <O - Lii O C <O t C r BD sn W BDZ1t <j i "<-: O B o .. o-,

BD. S

  - - o- C = t, = C = CC. t, o- J - r X C Z- C.o

  O B-CC, - B-O # C, O .. E% xEz- - 2

  d t 2. Retci 5 - - iiOCO OBD.J BD-- 5- -f Zi, -: F

C) C) BDH

  BD ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ C..g-B-g; z t8 e.e e, * =: L r> WCC xB t, r> tt, t,

O O _

= z -t, - - = = -

  r ') elX el r4 - m4 r: el 45 C. Cu éN é2r

BD 4 tge rBD - =} - - O - - -

  B OQD _ O O _ O - O _O O _ - - = _, -_ -

oL o \ Lrb (\ to -r n v0

M C B

LiiC

<0 E C.

a - "C -

In Ll-nr :: he BD O C> where o_

M. _ = =

O _: o e Me:

.I :: =

  o 'A., the CIC w tu _P mcI K M5Q0â; x, C, pi -e. &: Mi P: he 0 m eq om r Qi C- e on M m Y e t p CFZ tJ

Not a word-

  f. <_ c. ## EQU1 ## Ln Oc, lZ. c .: c. f3 S 2: n .. r: AL ^ eftc 8 f Oaf c. f2 C> <. ## EQU1 ## where: fw = ib -: D b-

---- o - 0 ----------. r.oe, .--

  8 Sooo oeoee t. ' o o - - "- o 0r- -0o't, oe c .. basJo <brao

  O-La = o-O-O. O r- o, r, 0. e <J--

  f CDI Ln c r .. w The w a 4- x I, w o 'you co 3-Z. at. ## EQU1 ## where: ## STR2 ## . 'ha' f r <'.0 s s' .o_ 8,5 + u s >>> 3.5.3 "'.; SS nr; ; A ? <.3;: m n. C8 <tSS oL o LflL r- -o LU

a.r .-- - --- -.-.-

eep! p 9Ze.- "- e eel

-s ss * - 8 W 8 S;> W-imN. E.-Ns- -

- af 8r- _u ,, d ___ 0gXB @

- --- s_A N-- 7 N--

  - raaNta..ta * D l; aSta; m> "5 e SZO -N jr> o ', o CU tat tn CD Enz; 2 e _ I 11, 1 _ ::. #, - M t Y: Z , ,,:; not,.,

> M 02ci O 't 1 1 t' .- Q Di.

  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

  = one in: 8th ---%, _. m.go 0 = 0 - =! = I-- ME ...

  --- - ----- o_ o -O --- -, _ _ me _ X N001f ft 35- 7I 7) leg "> w Mt qvvt <tt çt; m_5 and o- LU _ -0 B ..> R oq 0 ,, 0% o N) LN c, me = 1-

_ le- o; _ -

lX) i - * cn- -

  Ln n! I 2.Cl. M t, -, C e <ne Lfl .. - O <. - -l Ao, o, o -. o To ...... .... _t

  _ _ _ _ e e e p e. p e - e e -

_ _ _ _ _

cn

  ## EQU1 ##

  r-N lee> N 0 m sf _ lD o N $ * o Or D .-- a 4 <>. x O O O _ _ _ _ _ _ - - - - - - * * * * * * * * * * * * * , Ln o cqJ C 4 LO eWS.5e --e

- - - - - - -

  ## EQU1 ## ## STR1 ## ## STR1 ##

  --- ---- - - - - - - - - - - - - -4- '-

  - - - - --- - - ---- --- qt-o * .-. c5 :: n o -

r0.El c'Moe MO) CK'to: e- <o.1-o

  -___ ok> _a-u o. a, = Eo. Pb <J-, 1 <:> -_raw o. Lao.

  zO _._ == _ = _- u o a, m .. == 2 = n _ OOe-.o OOefOO eNOO't nA 2 "-> $ OcOs Ln" t e! '. the m 2 IO <C7 I-_ 1

F F Q7

2:

O: L 2: 6

  ## EQU1 ## ac A-e 2: e2 _ t- m - = eln

Dt. -

_._

CD 2: 2:

  t-l tt--, It 11 11 It It - <r t-l <r t-. <rg t <r t- <r C I2: 22: C> 2 :: Q: e "2 a - I

J, I.

c- i = i

r .. t-

J M.

  NN N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N T N N aeW I- -0 2 e; uii "i t4 - e_e_e_e_e_e H th o = _ oo - _ _ - ___ _ _ o _ _ - _ _ -o - - -We _ _ _ _ _ _ eS.; e gcne * - = oe- Ceo,

  mmmmmmmm mmW UP X7 Q 2- ----

%. we co-

: -., -

not %!

- j-

V VJ

  ## STR1 ##, ## STR1 ##, ## STR2 ## K m - C - = "_ w t b- oZ I C D e e * 2 CD

  ## EQU1 ##. ## STR2 ## ## STR2 ##

  = r.t: - _e __._, - - _ O2 = _ *. o * - _ o n o _, _D _, _ e o

  VJ - VI V n t t - o S X o _ "* r O 0 _> tg _ -

  - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - 2 - - -

  ! C o 'w, (' r - j F- -s tn Ln = rF]!

  ; '.L0.,. t. *, Jf.j.9 t..f.% ,. ## EQU1 ## where ## EQU1 ##, where ## EQU1 ##

  ## EQU1 ## where ## EQU1 ##, ## EQU1 ##, ## EQU1 ## LM1 e (l% b) e dD "lj In Ojb 4W t) 1- O; WD (O ^ | ri ro ib tv) FA O''OQ O'5'Qc 00000 0000ci O 00 oaiboa0 ocQ000 0 'Fitn sfFrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr - 'cir ... m o'

  v, 4 to 0..4., 4, 4, 4, 4, 4, 4, 4

  > '>'> - t '> m rn'> mi ''> '> W'> mo "> rns-l - l <q: D XCr cm c-fa rcr (m rd-4rf \> Wr -mrrm '11Xim r "rn _: e In -4c) .. OS; pC" Xi N% 0J.r Ocf r. M: m mrb. ** I s .... IIm: - It i 'lI: lQ r> 1IIA. r.3 + 'I.ooC) Q to 3 o "nm cr n W; *> .-: D -I *'>: OF P'O r * M-ri * Z'rN% oF - '^ tMM M -4 -gs "* rm O -ro ,; X) b b 8 8 8 F "" ""% 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 44 3. 3. 3. 3. 3. 3. 3. 3. ## EQU1 ## ## STR1 ## ## STR1 ## ## STR1 ## 4'-f * 4 I "., R. ## EQU1 ##, ## STR2 ##, ## STR1 ## -ja'cim G oofie- o No a

  ll1; C rx ilZ = Com * '., J Lir-l.-n e.-

  : -I: C: 401 ó, - | 4IO 11Il i4N - l.

WC-W '' MI, V) Om (r 'the -ImI Gzm I

? .â: t "tJ -4 (PJ1111 Z N --ie- <tv-

  ## EQU1 ## where ## EQU1 ## where ## EQU2 ##

a to Z4 - W W 4 Zw IX m m Z Z m.

-.2''C: c m -. mmm-n-I-m m ..

  ## STR1 ## O: ci Z O * oJ, c o r c. \ R

b * 'A' .J. r .. -

Ooc 'c .:

- Where - * -.

"-.4"

Jr 'mt- <of

, ....,

= _.M

M. - '.

  M r. -1. * Tln r'tl 4-cd f-n Ln c 'o (A "O

  r. - -, ..- 'D0 0' D. ## EQU1 ## ## STR2 ## ## STR0000 ## ## STR0000 ##, ## STR2 ## .q Lq 1.

  ## EQU1 ## O, - -f -. .-I. O, O, O, W, O, O, O, R, R, R, G, + ## STR2 ## wherein 'I r'

  ## STR5 ## ## STR2 ##

  ^ TIn ri mm- n. -No.

  -D 11.O; XZ / * 'Z CC! I -4 * Q 11D1M r + nmo-Ir 4- 4 -4 -

  X 4 He / she - V - 40, I - 11Il -1 10-rn, M -I1 rI1 I1 11.ilIlil 11 r11j 111 -:

  ## EQU1 ## where ## EQU1 ##

  ## EQU1 ## ## EQU1 ##, ## EQU1 ## .- .. 4 .. fila,.: .- -o

To - I - L -

  ## EQU1 ## * -v -I -1-4 +. -) -t nC

C & COOC: CI - M

  cO,> - c | n sSO v v - "o 'II", (ie,

  ## EQU1 ## where ## EQU1 ## where ## EQU2 ## where ## EQU1 ## dIl a C. W I - ,,,,,. J 'q'ó, j. * u _ C _ U'. t_t-, 4 ,. : O>, I-, t., 0F a -> F O.Z _. * t ',:. ## EQU1 ## where ## EQU1 ## J.-, J.-, I.-, e. ## EQU1 ## where: ## EQU1 ##, ## STR2 ## ## STR3 ## wherein R 1, R 2, R 4, R 4, R 4, R 4, R 4, R 4 ## EQU1 ##, ## EQU1 ##, ## STR2 ## - - I 1-_t13 4.-4 0.0 Ij .-. 40. LtW (OiJU 1, - t-cq-t> JOI- \ 4-f W% 4 vi -I Yl C 14- F - \. 04 FIG. 4 is an example of a method which can be used in the context of the present invention. ## EQU1 ## where: ## EQU1 ## where: ## EQU1 ## ## STR2 ## ## STR2 ## ## STR2 ## ## STR2 ## z1 * M t-X J f. >: - * X fI Lm 'D * 4F' -00 0.0. tC. 0.? W,: W <t ...'.-. J * .. J * .J C..Z .- .. J ttIJ Fo S "5U. *. JUJ" I: LL CtL't QtfWC CtH-W ############################################################################################################################### 000s * C XP at CJFL 2 (O -r *: U 19 t0-aNry M Ir) t <'m, l Nr-teIle'. GS iyP tu e)

  1-4,44-4,44,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4,4 -

  ## EQU1 ## where ## EQU1 ##, ## STR2 ## 3, Nr-

: .to.4- NZW

* sr_ _ __ -% r. b F * ^ s youZW 11

  * * .- ',,. 0') 4rI - * r. N IIfxIr.l: 0 '% * ..

  -Mr.

0, -N, 4, ZJM M

-I ') - MM Min -.JWZWZW + I') Min-

  ## STR1 ## where ## STR1 ##

  C '' C h *; cnO'4. ## STR5 ## wherein Y is N 2 -NH 2 O.

  k-o; *: -PI * "# lo 'N.4U, ... + + +> ++ C * eCD' Fi) - NY02lC = 'ro 0 ze- +> t + M, - m () ..

  J q - -.N-.a3 nra _-. 0 s t t,,, t't't't't't't't't't't't't't't't't't't't't't',,,,,,, ## EQU1 ## where: - WKWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW -...- 3. Wu: J '.JL, 03 i. X EJ -. ## EQU1 ## ## STR2 ## ## STR2 ## ## EQU1 ##, ## EQU1 ## ## EQU1 ## ## EQU1 ##, ## EQU1 ## ., aeXqD, ani-i-oe'iO.4cDD@Jr o.0corC'oo.- rr -jw rwr-tr X tr '.N .-. J. 0JMlUshec) 8 | tX; aOsON <k i.if ,. of h.NNNNr..r.NrNNNoeoeC.0oe co

  tN wr i,% e rorr3ra% r,) r o ro. ura3N r'Nffler WN lur @ reNr 9m4N Nrtç4NNN NNNNrstNh> rer.

  "[t * oi '1 t the rl" ") o' r '1' 11 ', 3 m4 4b A- 4b" 4 "" 4 "4, .. r" lW rlio N4 ## STR2 ## ## STR2 ## wherein ## STR2 ## wherein ## STR2 ## wherein ## STR2 ## ## EQU1 ## where ## EQU1 ## where ## EQU1 ## ## EQU1 ## where: ## EQU1 ## where: ## EQU1 ##, ## STR2 ##, ## STR2 ##, ## STR2 ##, ###, ####################################################################################################

  c-Z; gxx;: Dcrm I :: n 1 n; z i mr c '-. -W: n nl; ornan-ru.-qpu> a 't'S <: 3C :; ew'ocwc't.oe -

  mm.sub.rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr 4.-4 .. v I VI. ## EQU1 ## ## EQU1 ## ##. ## EQU2 ## CID at OI (A rl: I 2: 4JI: -jr CD cn cv c1% r ,. tr if ws - ro = E r- o; nQ -1 -4 CD3, + WD bl 3 h4 G tI ## EQU1 ## ## EQU1 ## where: ## STR2 ## ## STR2 ## ## STR2 ## s- * rtX. r- '-4. N b tq

m "a o '-' '

  ## EQU1 ## ## EQU1 ## ## STR1 ## ## STR1 ## ## STR1 ## ## STR2 ## rD, = t.fl- II $ D ntD.O _. ## EQU1 ## where: ## EQU1 ## ## EQU1 ## where: ## EQU1 ##, mm, mm-mm-mm-I + M * qeXrr ## STR2 ## wherein: ## STR1 ## ## STR2 ## wherein: ## STR2 ## ,, "IDO D <D OQ r"

  Z:, - * r '> OL \ t X r = 0 * LIIo> czD3 nen or r'> o'- '- n r3 r r r r r -

  At>:,. = 1 ', $ 4. _' = C: 4A1, '.d,',. C -. (D --- I.

  0 = 3 c O Drano r l 'or _n-o U%% n 11 m * D, D0, DOE, S0r, A, r, r, r, r, r, rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrn - "rowNe ai707r9f; $ 1":; '<. Ir-CD * II ± - v, -, O "' ->. -. r'jO

-. -O O: C - '- A C'-

  w 0. * LP.CD 3I'l- '* irDOCi'! rNlOa 4+ o $ WJ I-, r CD * <'<< Do * XOI * J n 4N O 4' M * A * I -1 + '- D, -t \ r - -'

-J% :. ' ci O -

  r - <n1 --I'n. 1 O "r 4-4 * _ _ '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' * ' ## STR1 ## where ## STR1 ##

62 2501939

Claims (29)

REVENDIOATIONS   1. Apparatus for monitoring a physiological parameter   siological by telephone transmission, characterized   in that it comprises: a sensor (20) for converting   shooting the physiological parameter in mu input signal; means (42) connected to the sensor for converting the input signal to a nlumeric signal;   means (404) which are connected to the converting means   to record this digital signal; of the   means (206) connected to the recording means   in order to transmit the mnumeric signal by a telephone link; and means (50, 70) which are connected to the transmission means so as to receive the digital signal by a telephone link   2. A device according to claim 1, characterized   in that the recording means consist of a digital memory (404).   3. Apparatus according to claim 2, characterized   in that the digital memory is a random access memory.   4. Apparatus according to claim 3, characterized   in that the sensor (20) converts a representation   acoustic of the physiological parameter to give the entry level.   5.Apparatus according to claim 4, characterized   the reception means comprise modalities   processing yens (70) and presentation means (70).   Apparatus according to claim 5, characterized   in that the processing means (70) comprise in   in addition to means to transform the digital signal   than to move it from the domain of time to the domain frequencies.   Apparatus according to claim 6, characterized   in that the presentation means (70) further comprises means which are connected to the transformation means so as to present the digital signal both in the time domain and in the frequency domain.   8. Method for monitoring a physiological parameter   logic by telephone transmission, characterized in that   that: (a) the physiological parameter is converted into a   entrance certificate; (b) converting the input signal to a digital signal; (c) the digital signal is recorded; (d) transmitting the digital signal via a telephone link; and (e) the digital signal is received by the telephone link.   9. Apparatus for monitoring a slap   prosthesis heart valve characterized in that it comprises: a sensor (20) for generating an input signal under the effect of snapping; means (404) connected to the sensor for recording the input signal; and means (70) which is connected to the recording means so as to display the signal input.   Apparatus according to claim 9, characterized   in that it further comprises a transmission link   telephone mission (40) which connects the means of   recording (404) and display means (70)   11o. Apparatus according to any of the claims   9 or 10, characterized in that it further comprises a converter (402) which is connected to the sensor (20) and the recording means (404) for converting the   input signal into a digital signal.   Apparatus according to claim 11, characterized   in that the presentation means (70) comprises   in addition, means for transforming the digital signal   slamming it out of the realm of time at the frequency domain.   13. A method of monitoring a slam of a prosthetic heart valve, characterized in that:   converts the snap into an electrical signal; we trans-   puts this electrical signal through a telephone link; this electrical signal is received by the telephone link;   and display the electrical signal.   14. Process according to claim 13, characterized   in that the electrical signal is recorded after the   conversion and before transmission via the tele- phoni that.   15. A method according to any of the claims   13 or 14, characterized in that the conversion   In addition, it carries a conversion in digital form, whereby the electrical signal is converted into a digital signal.   16. Apparatus for monitoring a keyboard   as a prosthetic heart valve, characterized in that it comprises: a sensor (20) for converting the slam into an electrical signal; means (50) connected to the sensor for transmitting the electrical signal over a telephone link; and means (50) that are   connected to the transmission means by a tele-   in order to receive the electrical signal by the telephone link.   17.Control apparatus for a physiological parameter   siological telephone transmission, characterized in that it comprises: a sensor (20) for converting the physiological parameter into an input signal; means (42) connected to the sensor for converting the input signal into a digital signal Lum; means (404) which are connected to the converting means so as to record this digital signal; means (206) connected to the recording means for transmitting the digital signal over a telephone link; means (50, 70) which are connected to   transmission means so as to receive the digital signal.   by a telephone link; and means (204)   which are connected to the sensor and to the recording means   to mark the time   input signal, thanks to which the means of transmission   can transmit the digital signal in a timely   bitrate compared to the time required for the sensor to convert the physiological signal to give the input signal.   18. Apparatus according to claim 17, characterized   in that the recording means consist of a digital memory (404)   19.Apparatus according to claim 18, characterized   in that the digital memory is a RAM.   20.The apparatus of claim 19, characterized   in that the sensor (20) converts a representation   acoustic of the physiological parameter to give the entry level.   21.Apparatus according to claim 20, characterized   in that the reception means comprise means   processing device (70) and display means (70).   22.Apparatus according to claim 21, characterized   in that the processing means (70) comprise   in addition, means for transforming the digital signal   to move it from the realm of time to the maine frequencies   23. Apparatus according to claim 22, characterized   in that the display means (70) further comprises means which are connected to the transformation means so as to present the digital signal both in the time domain and in the frequency domain.   24. Method for monitoring a physiological parameter   telephone transmission logic, characterized in that: (a) the physiological parameter is converted to an input signal; (b) the input signal is converted to a digital signal; (c) the digital signal is recorded;   (d) the digital signal is transmitted by a tele-   sound; (e) the digital signal is received by the link   his telephone; and (f) time stamping   on the digital signal before the recording operation.   25. Apparatus for monitoring a slap   prosthesis heart valve characterized in that it comprises: a sensor (20) for generating an input signal under the effect of clai.cuement; means (404) which are connected to the sensor to record the input signal; means (70) which are connected to the recording means so as to present the signal   input; and means (204) that is connected to the cap-   to mark time on the screen. intercom   26. Appearing according to Reverendication 25, character-   in that it further comprises a transmission link   telephone connection (40) which connects the recording means.   trement (404) and the display means (70)   27. Apparatus according to any one of the   25 or 26, characterized in that it further comprises a converter (402) which is connected to the sensor (20) and the recording means (404) to convert the   input signal into a digital signal.   28. Apparatus according to claim 27, characterized   rised by the fact that the means of display (70) include   in addition, means for transforming the digital signal   slamming it out of the realm of time at the frequency domain.   29. A method of monitoring the slamming of a prosthetic heart valve, characterized in that:   cc-nvertit slam into an electrical signal; we trans-   puts this electrified signal through a telephone link; this electrical signal is received by the telephone link; time marking is carried out on the electrical signal, which makes it possible to reconstruct a time base at the time of the display of the electrical signal; and we post the electrical signal.   30. The method of claim 29, characterized   rised by recording the electrical signal after the   conversion and before transmission by   Picnic. 31. A method according to any one of   cations 29 or 30, characterized in that the conversion   In addition, it carries a conversion in digital form, whereby the electrical signal is converted into a digital signal.