JP2003503101A - 僧帽弁不全の治療装置と方法 - Google Patents
僧帽弁不全の治療装置と方法Info
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- JP2003503101A JP2003503101A JP2001505828A JP2001505828A JP2003503101A JP 2003503101 A JP2003503101 A JP 2003503101A JP 2001505828 A JP2001505828 A JP 2001505828A JP 2001505828 A JP2001505828 A JP 2001505828A JP 2003503101 A JP2003503101 A JP 2003503101A
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- extension
- mitral valve
- coronary sinus
- state
- valve annulus
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- 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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2451—Inserts in the coronary sinus for correcting the valve shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
-
- 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
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2002/826—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents more than one stent being applied sequentially
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S623/00—Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
- Y10S623/902—Method of implanting
- Y10S623/903—Blood vessel
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Transplantation (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Vascular Medicine (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
Description
関するものである。
性心臓疾患、心臓胸筋疾患(cardiomyopathy)のような幾つかの原因で生じる。
僧帽弁の4つの主な構造要素は輪、2つの葉状器官、索、および乳頭筋である。
さまざまな組合せにおいてそれらのいずれか1つまたは全ては損傷したり、不全
を生じ得る。輪拡張は、その原因に係わらずに僧帽弁不全の病理の主要因である
。さらに、多くの患者は後輪の拡張を主因または唯一の原因とする僧帽弁不全を
有する。何故なら、前葉状器官の輪は心臓基底の繊維性骨組に固定されているた
めに拡張しないからである。
性患者は通常は5年以内に厳しい廃病に進むことを見い出した。現在、その処置
は僧帽弁の交換または修復から成り、そのいずれの方法も心臓を切開しての外科
術を必要とする。交換は機械弁または生体弁のいずれを使用しても実施できる。
在的な危険を伴うのに対し、生体補綴は耐用性が限られるという影響を受ける。
交換による他の危険は、心内膜炎の危険性である。これらの危険性、およびその
他の弁に関連する合併症は、弁を修復することによって著しく減少される。
可能である。修復の基本的な4つの技術は、輪形成外科リングの使用、疾患のあ
る後葉状器官の四角形部分の切除、細長い索の短縮、および後葉状器官索の前葉
状器官への移動を含む。
一般的なリングの全ては左心房の僧帽弁輪に隣接した僧帽弁の後葉状器官に沿っ
て縫合される。デュラン・リングは弁を完全に取り囲むのに対して、他のものは
前葉状器官に向かって開放されている。このリングは、本来のカーペンティア・
リングのように剛性が大きくてもよく、また、デュラン・リングまたはコスグロ
ーブ・エドワード・リングのように可撓性なるも非弾性であってよい。
プ、および心臓麻痺阻止(cargdioplegic arrest)の全てを使用して心臓を切開
する外科術を必要とする。
た患者、腎臓疾病の患者、大動脈が厳しく石灰化した患者、既に心臓外科術を受
けた患者、または他の合併症のある患者は特に、たとえ修復が完全でなくとも、
組織を冒すことのない手法が最も好適のようである。現在の趨勢は、心肺バイパ
スをせずに、組織をさほど冒さない冠状動脈外科術に向かっており、同様にPT
CAもしばしば付随する僧帽弁不全の修復のために組織をさほど冒さない方法を
要求する。
要とせずに、僧帽弁不全を処置する装置および方法を提供することである。
させることである。
7で定義される方法によって達成される。
るとともに2つの状態を有する伸長体を含み、第1の状態において伸長体は冠状
洞の形状に適合できる形状を有し、また伸長体は前記第1の状態から第2の状態
に移行して小さな曲率半径となることができ、これによって伸長体が冠状洞内に
配置された時に冠状洞の曲率半径および僧帽弁輪の周囲長が縮小される。
第2の状態へ移行させるための手段が提供される。
は短縮する手段を含むことができる。
おいて、本発明装置は幾つかのステント部分を含み、前記曲げおよび/または短
縮手段はステント部分の間隔距離を短縮するワイヤーを含むことができる。
の近くで冠状洞に伸長体を挿入する段階、およびその後に冠状洞の曲率を小さく
して僧帽弁輪の円周を縮小させるように、冠状洞内に位置された本体を曲げおよ
び/または短縮する段階を含む。
現在のカテーテル−ガイド技法を使用して修復を可能にする。
血液を排出し、より大きい静脈は大動脈と関連して、実質的に僧帽弁開口および
輪を取り囲む冠状洞内へ延在する。これは、心房隔壁とオイスタヒイ後洞との間
の右心房内へ排出するまえに、左心房壁と心室心筋層との間の脂肪層内に位置す
る後房室系の溝内を延在する。
以内に近づく。正常体重の成人の解剖において実施した予備測定は、内側付着箇
所で5.3±0.6mmの距離、後葉状器官の横方向において約10mmという
同様な結果を示している。冠状洞の円周は、心門で18.3±2.9mm(5.
8±0.9mmの後葉状器官直径を与える)であり、また後葉状器官の横方向に
沿って9.7±0.6mm(3.1±0.2mmの直径に等しい)であった。
であろう。
図は、僧帽弁の後葉状器官2、および房心筋および室心筋の隣接部分3,4を示
す。冠状洞5は、僧帽弁輪6に隣接し、後葉状器官2の付着箇所7の後方に示さ
れている。冠状洞5は実質的に僧帽弁輪6を取り囲むので、曲がった冠状洞5の
曲率半径の縮小も僧帽弁輪6の直径および円周の縮小をもたらす。
たは他の同様な本来形状の記憶を有する材料で形成されて一時的に図2に示され
た他の形状となるように強制されることのできる、図3に示された伸長体8を含
む。この伸長体8は、以下に説明するように互いに取り付けられ、また移動を可
能にすることのできる1つ、2つまたはそれ以上の記憶金属製の螺旋またはその
他の形状のばね9を含む。伸長体8に沿って幾つかのフック10が半径方向外方
へ突出するように取り付けられている。これらのフック10は図2のカバー・シ
ート11で覆われている。
ように強制される。この安定具12は、2本のアーム13をロッド15の先端1
4に有し、また1つの固定手段16をロッド15の基端に有する。ロッド15の
両端の間隔距離は、冠状洞5内に挿入されたときの伸長体8の望ましい長さに一
致する。
との間を自由に移動できる。固定手段16は2つの固定ノブ17を有しており、
これらの固定ノブ17は2つのばねブレード18でロッド15から半径方向外方
へ向けて押圧されている。したがって、伸長体8は安定具12のロッド15上で
押された後、アーム13と固定ノブ17との間で伸長されて、図5に示されるよ
うに最終的にその伸長状態にてアーム13と固定ノブ17との間に固定される。
に追従するように曲がることはできる。固定手段16の近くの安定具11の金属
ワイヤーは、静脈の曲がり具合に容易に追従できるようにもっと曲がり易い。
用できる。静脈系へのアクセスを得たならば、導入用シートを通し、静脈系を経
て金属製の長い案内ワイヤー(図示せず)が冠状洞5へ進められる。この案内ワ
イヤーはX線マーカーを備えており、冠状洞5内での案内ワイヤーの位置が監視
できる。
いカバー・シート11内に導入される。その後、この集合体は導入シートおよび
静脈系を通して冠状洞5へ向けて押されて案内ワイヤー上に乗る。僧帽弁19が
中央間隙20を有して示されている図8に示すように、冠状洞5内で伸長体8を
正確に位置決めした後、カバー・シート11は引き戻されて冠状洞5内で伸長体
8を露出させる。この操作は、伸長体8上のフック10を冠状洞5の壁および心
臓に突き立てできるようにする。伸長体8は安定具12上に依然として固定され
ているので、フック10は冠状洞5の壁と伸長体8を伸長すなわち延長させた状
態で係合する。
により伸長体8を固定手段16から解放させるためにカテーテル21が案内ワイ
ヤーおよびロッド15の上を押し進められる。この動きは固定ノブ17並びにア
ーム13を伸長体8との係合から解放し、伸長体8は図9に示されるように短縮
し、また僧帽弁輪6へ向けて曲がる結果としてその後部分を前方(図9に矢印で
示すように)へ移動させる。この移動は僧帽弁輪6の円周を縮小させ、これによ
り中央間隙20を閉じる。
示し、これによりフック10の少なくとも幾つかの相互連結部分が元の形状とな
るように短縮されたときに、伸長体8は非対称に短縮して曲がりを生じる。
されたときに僧帽弁輪6に最も隣接した冠状洞5の壁に係合する開放U形リング
形状の中実ワイヤーである。伸長体8’は記憶金属材料で構成され、元の形状に
復帰した時には図11に示されるような曲がりを生じる。開放リング8’の元の
形状への復帰は、当業者に明らかなような幾つかの方法で開始されることができ
る。
部分23〜25を含み、それらの部分は伸長体8''の一端、その中央、および伸
長体8''の他端にそれぞれ位置される。これらのステント部分23〜25は位置
が固定されるように従来手段によって図示されるように冠状洞5内に位置するこ
とができる。それらはワイヤー26,27で連結され、それらのワイヤーは静脈
系の外側から操作されて隣接するステント部分23,24そして24,25の間
隔距離が縮小される。さらに詳しくは、それらの距離は非対称的に縮小される、
すなわち、冠状洞5の側で大きく、僧帽弁輪6の後部分に隣接して最も大きく縮
小される。これにより伸長体8''は、図13に示すように曲がり、冠状洞5を僧
帽弁輪6に対して押圧して間隙20を閉じる。
れる装置を提供するものとである。この装置は、後葉状器官の付着箇所から、現
在の輪形成外科リングが配置される距離を大きく超えない或る距離に配置され、
冠状洞はそのような装置を保持するために十分に長い行程に亘る。装置はカテー
テル技術または他のいずれかの適当な技術によって位置決めされ、現在の切開外
科方法にかわる安全性を与える。装置は冠状洞における血栓症を防止するように
設計されるか、ヘパリン被覆を施され、したがってアスピリン、チクロペディン
または抗凝固治療の必要性を減少させる。
業者によってなされ得ることを理解すべきである。
6と共に示す模式図。
6と共に示す模式図。
5と共に示す模式図。
。
。
。
。
Claims (10)
- 【請求項1】 冠状洞(5)に挿入可能な寸法を有するとともに2つの状態
を有する伸長体(8;8’;8'')を含み、第1の状態において前記伸長体(8
;8’;8'')は冠状洞(5)の形状に適合できる形状を有し、また前記伸長体
(8;8’;8'')は前記第1の状態から第2の状態に移行して小さな曲率半径
となることができ、もって前記伸長体(8;8’;8'')が冠状洞(5)内に配
置された時に冠状洞(5)の曲率半径が縮小し、僧帽弁輪(6)の周囲長が縮小
するようになっている僧帽弁輪拡張治療装置。 - 【請求項2】 前記伸長体(8;8'')を大きな曲率半径から小さな曲率半
径となるように曲げおよび短縮して第2の状態へ移行させるための手段(9;2
2;26,27)を更に含む請求項1に記載された僧帽弁輪拡張治療装置。 - 【請求項3】 短縮によって前記伸長体(8)を曲げおよび短縮する手段を
前記移行手段(9;22;26,27)が含む請求項2に記載された僧帽弁輪拡
張治療装置。 - 【請求項4】 第2の状態へ移行させる記憶材料を前記伸長体(8;8’)
が含む請求項1に記載された僧帽弁輪拡張治療装置。 - 【請求項5】 前記伸長体(8)がステントを含む請求項1または請求項2
に記載された僧帽弁輪拡張治療装置。 - 【請求項6】 前記伸長体(8'')が幾つかのステント部分(23〜25)
を含み、前記曲げ手段(9;22;26,27)が前記ステント部分の間隔距離
を短縮させるワイヤー(26,27)を含む請求項2に記載された僧帽弁輪拡張
治療装置。 - 【請求項7】 僧帽弁の後葉状器官(2)の近くで冠状洞(5)内に伸長体
(8;8’;8'')を挿入する段階、および冠状洞(5)の曲率を小さくして僧
帽弁輪(6)の周囲長を縮小させるように、冠状洞(5)内に配置された前記伸
長体(8;8’;8'')を曲げおよび短縮させる段階を含む僧帽弁輪の周囲長縮
小方法。 - 【請求項8】 前記伸長体(8;8'')を曲げおよび短縮する前記段階が前
記伸長体の短縮によって行われる請求項7に記載された僧帽弁輪の周囲長縮小方
法。 - 【請求項9】 記憶材料を前記伸長体(8’)に用いて第2の状態に移行さ
せる請求項7または請求項8に記載された僧帽弁輪の周囲長縮小方法。 - 【請求項10】 前記伸長体(8'')が幾つかのステント部分(23〜25
)で形成され、前記伸長体(8'')を曲げるために前記ステント部分(23〜2
5)の間隔距離を短縮させるのにワイヤー(26,27)を用いる請求項7また
は請求項8に記載された僧帽弁輪の周囲長縮小方法。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
SE9902455A SE514718C2 (sv) | 1999-06-29 | 1999-06-29 | Anordning för behandling av bristande tillslutningsförmåga hos mitralisklaffapparaten |
SE9902455-6 | 1999-06-29 | ||
US09/345,475 US6210432B1 (en) | 1999-06-29 | 1999-06-30 | Device and method for treatment of mitral insufficiency |
PCT/SE2000/001369 WO2001000111A1 (en) | 1999-06-29 | 2000-06-28 | Device and method for treatment of mitral insufficiency |
Related Child Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2008157297A Division JP2008272502A (ja) | 1999-06-29 | 2008-06-16 | 僧帽弁不全の治療装置と方法 |
JP2009150377A Division JP2009207929A (ja) | 1999-06-29 | 2009-06-24 | 僧帽弁不全の治療装置と方法 |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2003503101A true JP2003503101A (ja) | 2003-01-28 |
JP4381640B2 JP4381640B2 (ja) | 2009-12-09 |
Family
ID=26663608
Family Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2001505828A Expired - Lifetime JP4381640B2 (ja) | 1999-06-29 | 2000-06-28 | 僧帽弁不全の治療装置 |
JP2008157297A Pending JP2008272502A (ja) | 1999-06-29 | 2008-06-16 | 僧帽弁不全の治療装置と方法 |
JP2009150377A Withdrawn JP2009207929A (ja) | 1999-06-29 | 2009-06-24 | 僧帽弁不全の治療装置と方法 |
Family Applications After (2)
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2000
- 2000-06-28 EP EP09007360.2A patent/EP2135559B2/en not_active Expired - Lifetime
- 2000-06-28 BR BR0012314-5A patent/BR0012314A/pt not_active Application Discontinuation
- 2000-06-28 CN CN00809730A patent/CN1359279A/zh active Pending
- 2000-06-28 US US10/019,563 patent/US7044967B1/en not_active Expired - Lifetime
- 2000-06-28 AU AU60386/00A patent/AU6038600A/en not_active Abandoned
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2004
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Also Published As
Publication number | Publication date |
---|---|
SE9902455L (sv) | 2000-12-30 |
CA2369129A1 (en) | 2001-01-04 |
JP2009207929A (ja) | 2009-09-17 |
US20070100442A1 (en) | 2007-05-03 |
WO2001000111A1 (en) | 2001-01-04 |
JP4381640B2 (ja) | 2009-12-09 |
US20070288090A1 (en) | 2007-12-13 |
AU6038600A (en) | 2001-01-31 |
JP2008272502A (ja) | 2008-11-13 |
US7637945B2 (en) | 2009-12-29 |
SE514718C2 (sv) | 2001-04-09 |
SE9902455D0 (sv) | 1999-06-29 |
US6210432B1 (en) | 2001-04-03 |
EP1196113A1 (en) | 2002-04-17 |
US7717954B2 (en) | 2010-05-18 |
CA2369129C (en) | 2008-11-18 |
EP2135559A1 (en) | 2009-12-23 |
CN1359279A (zh) | 2002-07-17 |
US7044967B1 (en) | 2006-05-16 |
EP2135559B2 (en) | 2017-02-08 |
US20050043792A1 (en) | 2005-02-24 |
BR0012314A (pt) | 2002-03-19 |
US20100185273A1 (en) | 2010-07-22 |
EP2135559B1 (en) | 2013-06-19 |
US7311728B2 (en) | 2007-12-25 |
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