JP2002536079A - 血管内心臓弁手術用デバイス - Google Patents
血管内心臓弁手術用デバイスInfo
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- JP2002536079A JP2002536079A JP2000596993A JP2000596993A JP2002536079A JP 2002536079 A JP2002536079 A JP 2002536079A JP 2000596993 A JP2000596993 A JP 2000596993A JP 2000596993 A JP2000596993 A JP 2000596993A JP 2002536079 A JP2002536079 A JP 2002536079A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M29/00—Dilators with or without means for introducing media, e.g. remedies
- A61M29/02—Dilators made of swellable material
-
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
-
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/243—Deployment by mechanical expansion
- A61F2/2433—Deployment by mechanical expansion using balloon catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/13—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel by means of a catheter allowing explantation, e.g. catheter pumps temporarily introduced via the vascular system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/20—Type thereof
- A61M60/205—Non-positive displacement blood pumps
- A61M60/216—Non-positive displacement blood pumps including a rotating member acting on the blood, e.g. impeller
- A61M60/237—Non-positive displacement blood pumps including a rotating member acting on the blood, e.g. impeller the blood flow through the rotating member having mainly axial components, e.g. axial flow pumps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/80—Constructional details other than related to driving
- A61M60/855—Constructional details other than related to driving of implantable pumps or pumping devices
- A61M60/865—Devices for guiding or inserting pumps or pumping devices into the patient's body
-
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/148—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel in line with a blood vessel using resection or like techniques, e.g. permanent endovascular heart assist devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/80—Constructional details other than related to driving
- A61M60/855—Constructional details other than related to driving of implantable pumps or pumping devices
- A61M60/89—Valves
- A61M60/894—Passive valves, i.e. valves actuated by the blood
- A61M60/896—Passive valves, i.e. valves actuated by the blood having flexible or resilient parts, e.g. flap valves
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Heart & Thoracic Surgery (AREA)
- Cardiology (AREA)
- Public Health (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Mechanical Engineering (AREA)
- Anesthesiology (AREA)
- Hematology (AREA)
- Vascular Medicine (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Prostheses (AREA)
- External Artificial Organs (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Vehicle Body Suspensions (AREA)
- Fittings On The Vehicle Exterior For Carrying Loads, And Devices For Holding Or Mounting Articles (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
Abstract
Description
バイスに関する。
心臓に導入されることができる心臓内血液ポンプが記載されている。こうした血
液ポンプは、たとえば、血液を左心室から大動脈へ押し出すために、大動脈を通
して大動脈弁に配置されることができる。こうした血液ポンプは、心臓の押出し
作用を保持または置きかえるようになっている。これらは、心臓を開ける必要な
く、心臓に配置されることができる。
する血管内血液ポンプが公知である。血液ポンプは、患者の脈管系統を通して押
し出される。それは、せいぜい約7mmの直径を有する微小軸ポンプである。ポ
ンプ部は、ポンプ・ハウジングの外側の流路をふさぐ拡張可能な阻止デバイスで
囲まれる。それによって、確実に、引き入れられるすべての血液が、モータ部を
通って流れ方向に運ばれ、ポンプ部のまわりの流れによって生ずる回路短絡が避
けられる。阻止デバイスは、ポンプ・ハウジングに固定された環状バルーンまた
はポンプ・ハウジングに接続された取入れホースであってもよい。この血液ポン
プは、血管内での使用を目的とし、阻止デバイスは、ポンプ部のまわりの血管内
腔をふさぐだけであって、血管壁を変形はしないという目的に役立つ。そのため
、阻止デバイスのバルーンは、血管壁に対して外傷を与えることなくシールする
ための、低圧で膨張させられた低圧バルーンである。
張カテーテルが公知である。こうした膨張カテーテルは、狭窄に対して永久に広
げる支持部を形成するために、拡張可能な金属構造から成り、支持デバイスを形
成する環状ステントを挿入するために使用することができる。こうした膨張カテ
ーテルは、膨張したバルーンを通して血液を運ぶポンプ部を有する灌流カテーテ
ルとして設計されている。心臓弁手術に関して、この膨張カテーテルは、せいぜ
い2mmの小さな直径に対してのみ適用されるのであれば、適切ではない。
、弁は十分に閉じることができない。このため、逆流が生ずる。通常、こうした
弁は、人工弁で置き換えられなければならない。狭窄を有する弁は、端部でいっ
しょに成長した弁小葉を有し、それによって、弁は、完全には開かず、全血流が
そこを通ることができない。
弁が取り除かれ、生体人工器官または機械的心臓弁で外科的に置き換えられる。
この形態の外科手術に対しては、手術領域から血液がない状態に保つ、すなわち
、自然の血流を転流させる必要がある。生来の心臓弁を修復する場合、弁に挿入
されたバルーンを用いて、侵入を最小にする介入を行うことができる。たとえば
、大動脈弁でのこうした手術では、心臓外科医または心臓病学者は相当な技量を
必要とする。とりわけ、破壊操作中に大動脈を通る血流が止められなければなら
ないために、脈管系統への供給が回復されるために、手術が非常に短時間で行わ
れねばならないということがこの理由である。さらに、大動脈流を止める時に、
心臓内部の圧力が極端に上昇し、冠状血管を介した血液供給が停止される。
せきたてられずに行える血管内心臓弁手術用デバイスを提供することである。
を通して押し進められ、8mmを超えない、対応する小さな外直径を有するポン
プが備わっている。微小軸ポンプのポンプ部は、心臓弁内に配置された時に、心
臓弁の狭窄を破壊するようになっている膨張デバイスを保持する。この膨張デバ
イスは、拡張した直径が少なくとも15mmで、少なくとも1.0barで膨張
可能な高圧バルーンを備えることが好ましい。高圧バルーンは、心臓弁の狭窄を
破壊するか、または、膨らませて広げるように、心臓弁に配置され、液体を用い
て拡張させられる。膨張デバイスは、こうして、心臓弁の狭窄、特に、大動脈弁
または二尖弁の狭窄を破壊する活性要素を形成する。
の大きな生理学的体積の流れでの強すぎる局所血流を避けるために、少なくとも
8mmである。さらに、膨張デバイスの担体は、膨張デバイスに対する十分に大
きな支持が形成され、直径の増加の程度が過度にならないように、少なくとも8
mmの外直径を有するべきである。
するデバイスに関する。このデバイスは、また、膨張デバイスを保持する微小軸
ポンプを備える。さらに、内側面上に可撓性心臓弁人工器官を担持するステント
を備える。心臓弁人工器官を含むステントは、病原となる心臓弁内に導入され、
生来の心臓弁の弁小葉を押し離すように、膨張デバイスにより拡張される。この
心臓弁人工器官は、自動的に機能を引き受け、生来の心臓弁に代わる単一または
複数翼心臓弁を含む。
とができる。これは、自然の組織の生体人工器官である。
、左心室LVを図示する。大動脈弁は、大動脈AOに突き出て、流通の意味で、
通路を大動脈へのみ許可するチェック弁を形成する、3つの弁小葉を有する。
動脈を通して心臓に導入される。このデバイスは、微小軸ポンプ40と接続され
たカテーテル10を備える。ポンプは、電気モータを含み、円筒駆動部11の遠
端から突き出るシャフト12を駆動する駆動部11を備える。保持ウェブ13は
、駆動部11から管状ポンプ部14へ軸方向に延びる。ポンプ部14は、駆動シ
ャフト12によって駆動される羽車を含むポンプ・リング15およびポンプ・リ
ング15を軸方向に延長させるカニューレ16を備える。ポンプ・デバイス全体
、すなわち、駆動部11とポンプ部14は、8mmの最大直径を有する。カテー
テル10は、微小軸ポンプ40の供給および制御用電気ワイヤと圧力液が供給さ
れる圧力内腔を備える。
示されている。カテーテル10の圧力内腔を通して、バルーン17は、液体で膨
張させることができる。バルーンは、膨張した直径が少なくとも15mm、好ま
しくは、15〜40mmの間の高圧バルーンで、8barまでの圧力に耐えられ
る。バルーン17は、カニューレ16の長さの一部の上に延びる。その全長は、
カニューレ16の圧縮を防ぐ剛性リングによって支持されてもよい。
左心室に配置することにより、大動脈に導入される。その後、デバイスが、ガイ
ド・ワイヤに沿って進められ、取込み部16が左心室LV内にあって、出口部1
9が大動脈内になるように、大動脈弁AKに配置される。こうして、ポンプ部1
5は、大動脈弁AKにより囲まれる。ポンプ・デバイスは、血液を後ろに運ぶ、
すなわち、軸方向に引き、出口部19において横方向に吐き出す。
プが左心室LVから大動脈AOに血液を運ぶように駆動される。それによって、
心臓が容積および圧力の点で軽減され、落ち着く。そして、膨張デバイス18を
形成するバルーン17が大動脈弁AKの中央で膨張させられる。高圧で膨張させ
られたバルーン17により、大動脈弁AKの弁小葉は、押し広げられ、可能性の
ある交連への癒着が破壊される。こうして、狭窄を有する弁が、完全に開いた状
態を再びとるのに十分に遠くまで押し広げられる。ポンプ・デバイスにより、こ
の形態の弁手術は、手術が終るまで心拍出量(リットル/分)が膨張デバイスを
通してポンプ・デバイスにより運ばれるため、落ち着いた環境で、急ぐことなく
行うことができる。同様に、前述の膨張デバイスは、狭窄を有する生来の二尖弁
を破って開くのに使用することができる。
この目的のために、通常、図1および図2を参照して記載されているのと同じデ
バイスが使用される。このデバイスは、図6に示される。収縮させられ、折りた
たまれた膨張デバイス18の上にあるのは、圧縮された螺旋形状ステント21が
配置された可撓性の心臓弁人工器官20である。
配置するのに役立つガイド・ワイヤ22を例示している。ガイド・ワイヤ22は
、カニューレ16の遠端から突き出ている。ガイド・ワイヤ22は、カニューレ
の横穴23を通過し、カテ−テル10に沿って、ポンプ部14と駆動部11の外
側を延びる。
子牛から採取された生体人工器官である。この目的のために、導管弁25を含む
血管の部分24が除去される。この弁24は、単一翼または三翼の弁であっても
よい。図4によれば、この弁人工器官20は、ステント21内に配置される。ス
テント21は、本発明の例においては、曲折進路のように曲げられ、軸方向圧縮
または放射方向拡張を可能にする、金属棒の管状要素である。たとえば、伸張材
料のセル構造のような、他のステント構造が使用されることもできる。ステント
が、確実に、圧縮された管状形状および拡張された管状形状をとることが重要で
ある。導管人工器官20のホース形状の壁24は、ステント21の棒に縫いこま
れる。こうして、導管人工器官20は、導管人工器官の移植後に、ステントが、
自然な心臓弁と生体人工器官の間にあり、血液と接触しないように、ステント2
1の内側面に固定される。こうして、ステントにより、血栓に対する抗凝固剤の
適用は必要としない。
ス18のバルーンおよび弁人工器官20は、ポンプ・リング15のまわりで複数
の輪に折りたたまれており、弁人工器官は、ステント21の棒に固定されている
。この状態で、バルーン、弁人工器官20およびステント21は、ポンプ部14
を囲む平坦パッケージを形成する。このパッケージは、生来の心臓弁AKに配置
される。その後、ポンプが駆動され、膨張デバイス17がポンプ動作とともに膨
張する。図7に示されるように、ステント21は膨張させられ、心臓弁人工器官
24を広げ、生来の大動脈弁AKの小葉を、開いた位置(収縮時の弁位置)に、
外側に押す。それによって、大動脈弁AKが不動態化される。ステント21は、
心臓弁開口に残る。ステントには、元の状態に大きくされ、弁小葉25を含む心
臓弁人工器官24がある。今や、この心臓弁が、生来の大動脈弁AKの機能を引
き受ける。
0を、生来の心臓弁を囲む環26に固定することができる。これは、心臓弁人工
器官の保持部として使用するのに適した軟骨組織の強いリングである。
りを囲むバルーンを有するポンプ部の断面図である。
Claims (7)
- 【請求項1】 カテーテル(10)に固定され、管状ポンプ部(14)を有
する微小軸ポンプ(40)と、心臓弁(AK)に配置された時に前記心臓弁の狭
窄を広げるのに適した、ポンプ部(14)を囲む膨張デバイス(18)とを備え
る血管内心臓弁手術用デバイス。 - 【請求項2】 膨張デバイス(18)が、少なくとも1.0barで膨張可
能な環状高圧バルーンから成ることを特徴とする、請求項1に記載のデバイス。 - 【請求項3】 ポンプ部(14)が、ポンプ・リング(15)とそれに接続
された管状カニューレ(16)を備えることを特徴とする、請求項1または2に
記載のデバイス。 - 【請求項4】 高圧バルーンが、剛性環状支持部上に位置する、請求項1か
ら3のいずれか一項に記載のデバイス。 - 【請求項5】 カテーテル(10)に固定され、管状ポンプ部(14)を有
する微小軸ポンプ(40)と、ステント(21)を拡張する膨張デバイス(18
)と、折りたたまれた可撓性の心臓弁人工器官(20)を担持し、膨張デバイス
(17)により拡張可能にされたステント(21)とを備える血管内心臓弁手術
用デバイス。 - 【請求項6】 心臓弁人工器官(20)が、ステント(21)に縫いこまれ
た、請求項5に記載のデバイス。 - 【請求項7】 心臓弁人工器官(20)は、膨張デバイス(17)のバルー
ン壁とともに折りたたまれたホース形状の壁(24)を有する、請求項5または
6に記載のデバイス。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19904975A DE19904975A1 (de) | 1999-02-06 | 1999-02-06 | Vorrichtung zur intravasalen Herzklappenoperation |
DE19904975.0 | 1999-02-06 | ||
PCT/EP2000/000863 WO2000045874A1 (de) | 1999-02-06 | 2000-02-03 | Vorrichtung zur intravasalen herzklappenoperation |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2002536079A true JP2002536079A (ja) | 2002-10-29 |
JP4148646B2 JP4148646B2 (ja) | 2008-09-10 |
Family
ID=7896726
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2000596993A Expired - Lifetime JP4148646B2 (ja) | 1999-02-06 | 2000-02-03 | 血管内心臓弁手術用デバイス |
Country Status (16)
Country | Link |
---|---|
US (2) | US20050049696A1 (ja) |
EP (1) | EP1152780B1 (ja) |
JP (1) | JP4148646B2 (ja) |
KR (1) | KR20010101782A (ja) |
CN (1) | CN1338951A (ja) |
AT (1) | ATE310544T1 (ja) |
AU (1) | AU769794B2 (ja) |
BR (1) | BR0008027A (ja) |
CA (1) | CA2361972A1 (ja) |
CZ (1) | CZ20012784A3 (ja) |
DE (2) | DE19904975A1 (ja) |
IL (1) | IL144386A0 (ja) |
NO (1) | NO20013686L (ja) |
PL (1) | PL349765A1 (ja) |
RU (1) | RU2001124662A (ja) |
WO (1) | WO2000045874A1 (ja) |
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- 2000-02-03 KR KR1020017009894A patent/KR20010101782A/ko not_active Application Discontinuation
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EP1152780A1 (de) | 2001-11-14 |
CA2361972A1 (en) | 2000-08-10 |
US20050049696A1 (en) | 2005-03-03 |
ATE310544T1 (de) | 2005-12-15 |
DE19904975A1 (de) | 2000-09-14 |
PL349765A1 (en) | 2002-09-09 |
RU2001124662A (ru) | 2004-03-10 |
DE50011686D1 (de) | 2005-12-29 |
NO20013686L (no) | 2001-09-28 |
AU769794B2 (en) | 2004-02-05 |
BR0008027A (pt) | 2001-11-06 |
CN1338951A (zh) | 2002-03-06 |
JP4148646B2 (ja) | 2008-09-10 |
KR20010101782A (ko) | 2001-11-14 |
EP1152780B1 (de) | 2005-11-23 |
US8613777B2 (en) | 2013-12-24 |
AU2801300A (en) | 2000-08-25 |
WO2000045874A1 (de) | 2000-08-10 |
CZ20012784A3 (cs) | 2001-10-17 |
NO20013686D0 (no) | 2001-07-27 |
IL144386A0 (en) | 2002-05-23 |
US20090024212A1 (en) | 2009-01-22 |
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