FR2688692A1 - Prosthetic ring for reconstruction surgery of the aortic valve - Google Patents

Abstract

Prosthetic ring for reconstruction surgery of the aortic valve, of the type comprising a core and a textile sheath constituting a suture means, characterised in that the core forms a complete ring including three regions describing three equal or different arcs, reproducing the form of the aortic ring and allowing implantation with contact or around the ring of the aortic valve.

Description

The invention relates to a prosthetic ring for aortic annuloplasty, intended for the surgical reconstruction of aortic valve defects.

The heart generally includes 4 valves that open and close during heart contractions to ensure the proper flow of blood. The aortic valve consists of three valves of unequal size, respectively the left coronary valve, the right coronary valve and the non-coronary valve, fitting on the aortic ring. The aortic valve is opened during the ventricular systole and closed in diastole.

In some patients with aortic valve pathology, dilation of the aortic ring, whether or not associated with damage to the aortic valves, results in abnormal regurgitation of the blood during diastole. This situation, among others, can be corrected by the implantation of a support ring of the aortic valve leading to a reconstruction of the aortic fibromuscular ring to compensate for the deformation of the valve without having to remove it and replace it with a full denture
The annular reconstruction rings currently used are essentially of three types: - rigid, open or closed rings such as for example FR-A- 2 031 699 and FR-A- 2 071 172 from Carpentier, - adjustable flexible rings like that described in US-A-4 290 151 from Massana, - partially rigid and partly flexible rings like that described in FR 9006159 from Séguin.

The three types of rings have a textile element allowing their suturing.

Carpentier's mitral ring has its possible open part located on the substantially rectilinear part of the generally bean-shaped ring, rectilinear part bearing on the fibrous trigone.

Massana's flexible rings are adjustable using the free ends of a wire folded over to allow the size of the ring to be adapted on site to the shape of the ring to be reconstructed.

The common disadvantage of these three types of rings is that they are designed to be sutured onto the ring of the mitral or tricuspid valve. These two heart valves are located in humans in the same plane.

However, the ring of the aortic valve in humans is not located in the same plane.

Indeed the aortic valve is made up of three valves of unequal size being inserted on the aortic ring. Each valve describes an arc whose lowest point is called nadir. The aortic ring on which the three aortic valves are inserted is also divided into three unequal zones.

Each zone describes an arc between two ends or commissures located in the most cranial position. This arc reaches, between the two commissures, a lowest point or nadir.

The invention overcomes this drawback by providing a prosthetic ring for aortic annuloplasty, of the type comprising a core and a textile sheath, or of any other suitable material, constituting a suturing means, characterized in that the core forms a complete ring according to the generally observed form of aortic rings in humans.

This aortic ring can be implanted inside the heart or the ascending aorta.

 I1 has three identical or different areas of shape and size.

Each zone follows the previous one. Each zone begins at the zenith of the plane of the valve descends towards the lowest point - nadir - then goes up towards the highest point. Then continues with the next area.

Each of the three zones can be identical. But they can also be different since each of the aortic valve valves are most often different from each other in humans.

The invention will now be described in more detail with reference to the accompanying drawings in which: Figure 1 is a schematic representation of the aortic valve.

FIG. 2 is a three-dimensional view of an aortic valve; FIG. 3 is a three-dimensional view of a prosthetic ring for reconstructive surgery of the aortic valve of the type for implantation in the heart or the aorta. FIGS. 4 and 5 are a three-dimensional view of a prosthetic ring for aortic valve of the type for implantation outside the heart or the aorta.

Figure 1 shows Anatomy of the aortic valve. The aortic valve is composed of three valves: the left coronary valve (1), the right coronary valve (2) and the non-coronary valve (3).

Figure 2 shows a native three-dimensional aortic ring. It includes three uneven areas. Each zone is located between two commissures (1 and 2). Each commissure is the most cranial point of the plane of the aortic ring. Between two commissures the ring describes an arc whose lowest point (3) is also called nadir.

FIG. 3 schematically represents an aortic reconstruction ring of the type for implantation inside the heart. This ring has a core of rigid material. This soul follows the general shape of the aortic vane by three times describing an arched shape. The three zones can be symmetrical or not. Each zone begins at the zenith of the plane of the valve (1) descends to the lowest point - nadir (2) - then ascends to the highest point (3). Then continues with the next area.

This ring can be implanted either directly above or close to the aortic ring inside Forte.

To be fixed close to or in contact with the aortic ring, the aortic reconstruction ring can be covered with a textile, or any other suitable material. The highest points of the ring (figure 3; 1 and 3) are covered with a textile, or any other suitable material, including the curved area and the first centimeters on each side in order to fix the ring in place and d '' avoid displacement during contractions of the heart.

This aortic ring can also be implanted outside the heart or the ascending aorta.

Figures 4 and 5 schematically represent an aortic reconstruction ring of the type for implantation outside the heart and aorta. I1 can then have a different shape such as for example that of a tubular ring (Figure 4), having two notches (1 and 2) to respect the left and right coronary arteries. Before implantation, the ring is not continuous or closed in order to be able to place it around the aortic ring and the first centimeters of the ascending aorta, above or below the coronary arteries. Once in place, it is gradually tightened (Figure 5) until the desired narrowing of the aortic ring is obtained. The notches or holes provided (Figure 4; 1 and 2) for the coronary arteries allow the ring to slide during the tightening time of the latter, without risking damaging the arteries. The advantage is then to be able to correct the aortic disease from the outside without having to open the heart and the aorta.

The ring according to the invention comprises around its core a tubular sheath of woven textile material which allows its suturing to the natural valve ring. Such a tubular sheath is known per se and has not been shown in the figures.

To take account of the morphological variations of the natural rings to be reconstructed, the rings according to the invention are provided with several sizes. During the operation, the surgeon will determine the appropriate ring. The measurement is made by introducing a template.

Claims (5)

 1 - Prosthetic ring for aortic annuloplasty, in which the ring is implanted in the aorta and the heart close to the aortic ring or else outside the aorta and the heart, near or around the aortic ring, specifically designed for aortic valve reconstruction surgery and of the type comprising a core and a textile sheath constituting a suturing means characterized in that the core forms a ring comprising at least two -: ones located in a different plane (fig 2: 1, 2, 3; fig 4: 1, 2).  2. Prosthetic ring according to claim 1 characterized in that the core comprises three zones located in a different plane each describing an arc going from the highest point (fig 2: 1), passing through the lowest point (fig 2 : 3) and going up to the highest point (fig 2: 2).  3. Prosthetic ring according to one of the preceding claims, characterized in that the ring is complete.  4. Prosthetic ring - according to one of the preceding claims, characterized in that the said zones are identical or different in shape and in size.  5. Prosthetic ring according to claim 1 characterized in that the ring in the form of an open tubular ring having two notches (fig. 4 1, 2) to respect the left and right coronary arteries.