JP2002527157A - 弁修復手術のための経皮濾過カテーテルとその使用方法 - Google Patents

弁修復手術のための経皮濾過カテーテルとその使用方法

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JP2002527157A
JP2002527157A JP2000575576A JP2000575576A JP2002527157A JP 2002527157 A JP2002527157 A JP 2002527157A JP 2000575576 A JP2000575576 A JP 2000575576A JP 2000575576 A JP2000575576 A JP 2000575576A JP 2002527157 A JP2002527157 A JP 2002527157A
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catheter
proximal end
filter
distal end
balloon occluder
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ユエ−テー・ジャン
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12136—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/01—Filters implantable into blood vessels
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22062—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation to be filled with liquid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22067—Blocking; Occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22069—Immobilising; Stabilising
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/01—Filters implantable into blood vessels
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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Abstract

(57)【要約】 本発明は、心臓手術中に患者の大動脈からの血栓を捕捉するのに用いられる経皮濾過カテーテルである。カテーテルは長手部材（１）、近位端（３）、及び遠方端（２）を有する。バルーンオクルダー（５）は長手部材の遠方端に取りつけられ、拡張可能フィルター（１０）はバルーンオクルダーの奥手の長手部材に取りつけられる。本装置を使用するための方法も開示されている。

Description

【発明の詳細な説明】
【０００１】 （発明の技術分野） 本発明は一般的には、血管内で血栓物質を捕獲するための配置に用いるフィル
ター装置に関し、さらに詳しくは、心臓手術の間に大動脈や心臓からの血栓物質
を捕捉するために大動脈内に経皮的に配置するための連結フィルターを有するカ
テーテルシステムに関する。
【０００２】 （発明の背景） 心拍は、冠状動脈バイパス、及び弁修復、中隔欠損修復、血管粘液腫除去、動
脈瘤修復、心筋の穿孔などを含む他の心血管手術といった病的状態の主な原因と
なる。手術後の心拍数の増加と先天的なファクターは歳をとるにつれて、左心室
の機能不全、慢性糖尿病、心肺のバイパス時間の長時間化、周辺低血圧、以前の
心拍の履歴、双方の頚動脈の疾病を起こす。手術前の血栓症のメカニズムは頭蓋
外または頭蓋内の閉塞による大脳への血流の減少、頚動脈腫瘍プラーク又は動動
脈プラークからのアテローム性動脈硬化片の塞栓、左心室壁塞栓又は大動脈塞栓
及び心臓又は大動脈から空気の十分の除去の塞栓などを増加させる。弁修復手術
において、重い石灰質の大動脈又は僧帽弁の操作はその後の塞栓とともに左冠状
動脈又は左心室内のカルシウムを取り除く。アテローム片は最も頻繁に脳を塞栓
するが、秘蔵、腎臓、すい臓、及び胃腸などの身体の部分にも影響を及ぼす。こ
れらの周辺器官の塞栓は組織の乏血又は死を引き起こす。
【０００３】 さらに、血栓症の他のファクター、例えば、胸壁外傷は、心臓手術において循
環系の支持及び中央胸骨切開のための心肺バイパスの使用から病的状態へしばし
ば誘引を引き起こす。拍動−心臓及びポート−アクセスアプローチを用いた最小
の侵入手法は大動脈閉塞、心停止薬の投与、左心室の減圧を発展し、最も危険の
少ない方式である冠状動脈の血管移植や他の心臓の処理を可能にする。
【０００４】 それゆえ、心臓手術において大動脈の血栓及び又は心停止薬の投与を容易にす
る侵入性が最も低い装置及び方法が必要とされ、それは患者への周囲の血栓症の
危険性を減少させるための動脈フィルターを備える。
【０００５】 （発明の要旨） 本発明は、アテローム性破片、脂肪、心筋組織片及び空気などを含む血栓を捕
捉することができる経皮濾過カテーテルを提供する。そのカテーテルはさらに、
心臓手術特に心臓弁修復手術において大動脈血栓及び心停止薬投与を行うことが
できる。
【０００６】 １実施形態では、カテーテルは、近位端と遠方端を有する長手部材から構成さ
れる。遠方端は、（１）長手部材により運ばれる内腔と連通したバルーンオクル
ダーと、（２）長手部材のバルーンオクルダーの奥手に設けられた拡張可能フィ
ルターとを有している。バルーンオクルダーと拡張可能フィルターは、長手部材
の近位端において、独立して操作される。拡張可能フィルターは典型的には、円
周の曲げられた近位端前記長手部材と連続する近位端と放射的に拡張する遠方端
を有する。
【０００７】 他の実施形態では、長手部材は、例えば、心停止薬液を浸出させるための第２
内腔を有する。拡張可能フィルターは１実施形態として傘フレーム（構造につい
ては、完全に参照することによってこれに編入するBarbutらの米国特許番号5,76
9,816とAmbriscoらの米国特許出願番号09/070,660を参照）を有する伸縮性のフ
レームと他の実施形態として膨張シール（構造についてはBarbutらの米国特許番
号5,769,816を参照）で構成されている。さらに、実施形態では拡張可能フィル
ターは長手部材の近位端において少なくとも引っ張り線によって操作可能である
。
【０００８】 本発明は、さらに、心臓手術において血栓物質を補足するための方法を提供し
それによって、血栓による神経の合併症から患者を保護する。方法は、近位端と
遠方端、その遠方端に取りつけられたバルーンオクルダー、及びそのバリーんオ
クルダーの奥手に取りつけられた拡張可能フィルターを有する長手部材を有する
経皮濾過カテーテルを用いる。大腿部又は上腕部の血管などの患者の経皮血管内
の内経皮的な切開を通して長手部材を挿入して進めていく。最小侵入の心臓の処
置において経皮濾過カテーテルは皮下的に周辺の血管を通って又はしばしば患者
の肋骨間に配置された最小のアクセスポートを通って大動脈へ進められる。フィ
ルターは拡張し、周辺器官へ流れる血栓物質を補足するために大動脈弁の上に位
置し拡張する。バルーンオクルダーは、膨張し心臓と冠状動脈の周辺の血管系か
ら分離を循環する。第２内腔を有する実施形態では、第２内腔は、（１）心臓の
機能を停止させるために心停止薬液を送り込むため、又は、（２）圧力モニター
を運ぶために用いられる。心臓が停止した後心肺バイパスは循環系をサポートす
るために設けられ、冠状動脈移植、心臓弁修復、中隔欠損修復、血管粘液腫除去
、動脈瘤修復、心筋の穿孔などのあらゆる心肺手術が実行される。
【０００９】 ここで開示された経皮濾過カテーテルを利用することによる多くの効果が存在
することが理解されるであろう。例えば、カテーテルは、（１）カテーテルの挿
入のための皮下的なアクセスによって、大規模な組織切開の必要を回避でき、（
２）バルーンオクルダーによる大動脈の閉塞によって大動脈壁の損傷を最小限に
し従来のクランピングに比較して血栓の除去の危険性が減少し、（３）心臓手術
中の血栓材料を捕捉するフィルターによって皮下的な患者の血栓症の危険性を減
少でき、（４）心臓機能の停止のために心停止薬液を浸出でき、（５）最小の心
臓侵入処置において肋間の切開を通して装置を進めてアクセスすることができる
。
【００１０】 （詳細な説明） ここで開示された装置と方法は、心臓手術の間に血栓のおそれがあると判断さ
れる患者に使用可能であり、これによって関連する合併症と病院での滞在期間を
短くすることができる。図１は、第１実施形態にしたがった経皮濾過カテーテル
を示している。カテーテルは長手部材１、遠方端２及び近位端３を有している。
ゴム状弾性を有するバルーンで構成されたバルーンオクルダー５が長手部材１に
取りつけられ膨張用内腔６に連通している。拡張可能なフィルター１０は長手部
材１のバルーンオクルダーの奥手側に取りつけられ、カテーテルの近位端で操作
機構１２によって操作される。
【００１１】 図２は、第２内腔を有する経皮濾過フィルターの他の実施形態を示している。
カテーテルは、バルーンオクルダーを膨張させるためにバルーンオクルダー５と
膨張部７に連通した第２内腔を内腔６に対して付加的に有している。第２内腔２
０はポート２２と連通しており心停止薬液を浸出させたり、流体又は気体を吸引
したり及び/又は圧力モニターを収納したりするために用いることができる。長
手部材１に取りつけられたフィルター１０は、伸長フレーム１５を有しカテーテ
ルの近位端において機構１２によって駆動できる。
【００１２】 経皮濾過カテーテルの長さは一般には２０から９０センチメートル程度であり
、好ましくはほぼ５０センチメートルである。カテーテルの外径はおよそ０．１
から０．４センチメートルであり、好ましくはほぼ０．２センチメートルである
。バルーンオクルダーが膨張したとき１．０から５．０センチメートルの径を有
し、さらに好ましくは２．０から４．０センチメートルである。フィルターが拡
張したとき、一般には１．０から５．０センチメートルの径を有し、さらに好ま
しくは２．０から４．０センチメートルである。前述の範囲は端に典型的な装置
の寸法を示す目的のために記述したものである。本発明の原理にしたがって構成
された実際の装置の寸法は、それらの基本的原理から離れることのない列挙され
た範囲外で変化する場合もある。
【００１３】 この装置の使用方法は図３に開示されている。患者の大腿部に小さい経皮的切
開をつけた後、経皮カテーテルの遠方端をその切開を通して大動脈まで進ませる
。拡張可能なフィルター１０がその後拡張し、空気、悪性アテローマ、組織片、
脂肪、血栓などを含む心臓や大動脈からの血栓物質を捕捉する。バルーンオクル
ダー５は連通している膨張内腔６を通して膨張され心肺をバイパスするために大
動脈を閉塞する。心停止薬液を内腔２０とポート２２を通して心臓に送り込むこ
とによって心臓停止が達成される。内腔２０とポート２２は、圧力モニターを配
置したり、心臓及び大動脈から流体、血液、空気、組織又はプラーク片の吸引に
も用いられる。外科医はその後様々な心臓手術を進めることができる。
【００１４】 図４は、経皮濾過カテーテルのための異なった経皮的侵入個所を示している。
カテーテルは一般に患者の大腿部の血管から侵入される。右の股間３０または左
の股間３２はカテーテルの長手部材１の挿入のための経皮的切開位置として共通
し、ここでは左の股間３２を通して挿入し大動脈に達した状態を示している。し
かし、大腿部の血管がアテローム性動脈硬化のためカテーテルの操作に適さない
患者もいる。変形例として、カテーテルは右の前腕前部の部分３４又は左の前腕
前部の部分３６を通して挿入することもできる。カテーテルの長手部材１は前腕
前部の部分３４を通して右上腕血管と腕頭動脈を通って進み、大動脈まで進む。
大動脈内での最終的なカテーテルの配置の後、拡張フィルター１０は膨張し血栓
を捕捉し、バルーンオクルダーは膨張して心臓と冠状動脈を周囲の脈管系から分
離する。
【００１５】 ここで開示された装置は、特に弁修復手術に好適に用いられることが理解され
るであろう。なぜならこれらの手術は大動脈封鎖の場所の血栓物質を発生させる
ものと認識されるからである。参照することによって編入するMcBrideらのGlenn
's Thoracic and Cardiovascular Surgery, 6th Ed., Vol.II(1986) によれば、
中間胸骨切除はしばしば大動脈弁または大動脈弁を含む弁の組み合わせの配置の
ために用いられる切開である。右心房、下部血管、主血管への静脈カニュレーシ
ョンの後、大動脈の動脈カニュレーションは、その内部に開示された経皮濾過カ
テーテルを用いた心肺バイパスとして用いる。カテーテルは、大腿部血管又は上
腕血管を経由して大動脈を進み配置される。バルーンオクルダーまたは他の不浸
透性のダムは分散させ周辺組織から心臓を分離する。フィルターは、大動脈弁ま
たは僧帽弁から固化したプラークを捕捉するためオクルダーの上流を分散させる
。バイパスマシンからの酸素化した血液はオクルダーの下流へカテーテルを通し
て浸透される。心停止薬液は大動脈の根上の外圧大動脈弁が手動で閉じる間、大
動脈根又は直接冠動脈の小孔へ投薬される。
【００１６】 大動脈弁の修復においては、大動脈は右冠状静脈の上約１から１．５センチメ
ートルの横方向の切開を通して開かれる。僧帽弁の修復への標準的なアプローチ
は、しばしば血管間の溝と平行な切開を通って左心房に入る。左心室の明視化の
ために重い石灰質又は繊維室の弁を十分に切除した後、脱石灰の間環からの小片
であるカルシウムを絡めとるためにスポンジがこの脈管にしばしば配置される。
左心房オリフィスに配置された培養棒はカルシウムがこの管内で血栓するのを防
止し、弁の表出のための開創器が通常右心房オリフィスを閉鎖する。病原弁が取
り除かれた後補綴弁が弁状環内に縫合される。大動脈はその後２層縫合によって
閉じられる。大動脈オクルダーと濾過は取り除かれ、患者は心肺バイパスを取り
除かれる。
【００１７】 いくつかの詳細が図面と例によって開示された上述の発明は理解の明確の目的
のために開示されたものであり、請求の範囲内に属する他の変形や修正が存在す
ることは明確である。
【図面の簡単な説明】
【図１】 第１実施形態にしたがった経皮濾過カテーテルである。
【図２】 他の実施形態にしたがった第２内腔を有するカテーテルである経
皮濾過カテーテルである。
【図３】 大動脈内に進んだ位置にある経皮濾過カテーテルを示す図である
。
【図４】 患者に使用するために経皮濾過カテーテルの侵入のための異なっ
たアクセス経路を示す図である。
【手続補正書】
【提出日】平成１３年８月１０日（２００１．８．１０）
【手続補正１】
【補正対象書類名】明細書
【補正対象項目名】特許請求の範囲
【補正方法】変更
【補正内容】
【特許請求の範囲】
───────────────────────────────────────────────────── フロントページの続き (51)Int.Cl.7 識別記号 ＦＩ テーマコート゛(参考） // Ａ６１Ｂ 17/12 Ａ６１Ｍ 25/00 ４１０Ｄ Ｆターム(参考） 4C060 DD03 DD38 DD48 MM25 4C077 AA30 BB02 CC06 DD16 DD21 EE02 FF04 HH03 HH13 JJ09 JJ22 JJ24 KK11 KK25 LL02 LL12 LL15 NN01 PP18 4C167 AA05 AA08 AA09 AA32 AA58 AA71 BB02 BB28 BB29 BB36 BB40 BB51 BB62 CC08 CC19 DD01 DD10 EE03 EE11 GG02 GG11 HH08

Claims (22)

    【特許請求の範囲】
  1. 【請求項１】 遠方端と近位端を有する長手部材と； 前記長手部材の遠方端に取りつけられたバルーンオクルダーであって、前記バ
    ルーンは前記長手部材によって運ばれた内腔と連通した区画を形成し； 前記長手部材の前記バルーンオクルダーの奥手に取りつけられ、前記バルーン
    オクルダーと独立して操作可能な拡張可能フィルターとを備えた、経皮濾過カテ
    ーテル。
  2. 【請求項２】 前記バルーンオクルダーはゴム状弾性バルーンで構成されて
    いる請求項１記載のカテーテル。
  3. 【請求項３】 流体注入のための第２の内腔をさらに備えたことを特徴とす
    る請求項１記載のカテーテル。
  4. 【請求項４】 前記第２の内腔は圧力モニターを収納するのに適しているこ
    とを特徴とする請求項３記載のカテーテル。
  5. 【請求項５】 前記拡張可能フィルターは前記長手部材の近位端から操作可
    能である請求項１記載のカテーテル。
  6. 【請求項６】 前記拡張可能フィルターはさらに拡張フレームを備えている
    請求項１記載のカテーテル。
  7. 【請求項７】 前記拡張フレームは傘フレームで構成されている請求項６記
    載のカテーテル。
  8. 【請求項８】 前記拡張フレームは、膨張シールを構成する請求項６記載の
    カテーテル。
  9. 【請求項９】 前記拡張可能フィルターは、少なくとも１つの引っ張り線に
    おける操作で動作可能である請求項１記載のカテーテル。
  10. 【請求項１０】 前記拡張可能フィルターは、円周の曲げられた近位端前記
    長手部材と連続する近位端と放射的に拡張する遠方端を有する請求項１記載のカ
    テーテル。
  11. 【請求項１１】 近位端と遠方端とその前記遠方端に取りつけられたバルー
    ンオクルダーとその前記バルーンオクルダーの奥手に取りつけられた拡張可能フ
    ィルターとを有する長手部材を提供するステップと、 前記長手部材を経皮的切開を通して挿入し、前記カテーテルの遠方端を大動脈
    まで進ませるステップと、 前記フィルターを拡張するステップと、 前記バルーンオクルダーを膨張させるステップと、 心臓において手術を実行するステップとを備えた心臓手術のための経皮濾過の
    方法。
  12. 【請求項１２】 前記経皮的切開は、患者の大腿部動脈に存在する請求項１
    １記載の方法。
  13. 【請求項１３】 前記経皮的切開は、肋間筋の空間に存在する請求項１１記
    載の方法。
  14. 【請求項１４】 前記フィルターは、前記長手部材の近位端から操作可能で
    ある請求項１１記載の方法。
  15. 【請求項１５】 前記手術は、心臓弁修復手術である請求項１１記載の方法
    。
  16. 【請求項１６】 前記手術は、中隔欠損修復手術である請求項１１記載の方
    法。
  17. 【請求項１７】 前記拡張可能フィルターは拡張フレームを備える請求項１
    １記載の方法。
  18. 【請求項１８】 前記拡張フレームは傘フレームで構成されている請求項１
    ７記載の方法。
  19. 【請求項１９】 前記拡張フレームは膨張シールを構成する請求項１７記載
    の方法。
  20. 【請求項２０】 前記拡張可能フィルターは、少なくとも１つの引っ張り線
    における操作で動作可能である請求項１１記載の方法。
  21. 【請求項２１】 前記拡張可能フィルターは、円周の曲げられた近位端前記
    長手部材と連続する近位端と放射的に拡張する遠方端を有する請求項１１記載の
    方法。
  22. 【請求項２２】 前記バルーンオクルダーを膨張するステップは、前記フィ
    ルターを拡張するステップよりも前に実行する請求項１１記載の方法。
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US09/170,359 US6051014A (en) 1998-10-13 1998-10-13 Percutaneous filtration catheter for valve repair surgery and methods of use
US09/170,359 1998-10-13
PCT/US1999/023528 WO2000021604A1 (en) 1998-10-13 1999-10-08 Percutaneous filtration catheter for valve repair surgery and methods of use

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US6287321B1 (en) 2001-09-11
CA2344715A1 (en) 2000-04-20
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WO2000021604A1 (en) 2000-04-20
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US6692512B2 (en) 2004-02-17
US6051014A (en) 2000-04-18

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