JP2008536592A - 血流制御装置 - Google Patents
血流制御装置 Download PDFInfo
- Publication number
- JP2008536592A JP2008536592A JP2008507007A JP2008507007A JP2008536592A JP 2008536592 A JP2008536592 A JP 2008536592A JP 2008507007 A JP2008507007 A JP 2008507007A JP 2008507007 A JP2008507007 A JP 2008507007A JP 2008536592 A JP2008536592 A JP 2008536592A
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- JP
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- Prior art keywords
- valve
- prosthesis
- heart
- blood flow
- valve means
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Abstract
Description
本出願は、2005年4月21日に出願されたスウェーデン国特許出願第0500891−7への優先権を主張し、その開示は、本明細書に参照によりその全体が援用されている。
本発明は、患者の血液循環システムの中に移植されるように構成された血流制御装置、および漏れのある心臓弁の治療方法に関する。
心臓弁疾患は、まさに共通の問題である。毎年、世界で50万人の人々が、心臓弁疾患を患う。20万人が重症すぎて治療できないが、残りは治療される。現在、心臓弁疾患の治療は、心臓弁修復または弁の取替え、いずれかから成る。両方法は、全心肺バイパス、大動脈クロスクランピング(cross−clamping)および心臓の停止の使用による、心臓切開手術を必要とする。特定の群の患者にとっては、心臓切開手術は、特に危険である。しかしながら、心臓弁修復のための侵襲性の少ない方法が、一般的に有利である。
漏れのある心臓弁の治療のためのデバイスおよび方法を提供することが本発明の目的であり、治療はいかなる心臓弁に対しても実行され得る。心臓切開手術または心臓停止の必要なく、使用され得るデバイスおよび方法を提供することが、本発明のさらなる目的である。
ここで本発明は、添付の図を参照して、例によってさらに詳細に記述される。
生物学的な組織は、例えば動物の心膜または心臓弁からの組織であり得る。
図11aに示されるように、装置42の固着手段54は、肺動脈22に配置され得ることにより、装置42の位置を固定する。固定手段54はステント55を含み、ステント55は肺動脈22と接触して膨張することにより、装置42の位置を固定する。固着手段54は、弁手段52の「流出」側に配置されることにより、弁手段52は、肺動脈弁の位置の近くに配置され得る。弁手段52は、右心室15から肺への血流を効果的に制御するために配置される。弁手段52は、接合エリア94における肺動脈22の壁と接触するように配置されることにより血液が弁手段52を過ぎて流れることを妨げる。弁手段52は、右心室15からの血流に晒されるとき、接触を解除して開く。図11bにおいて、固着手段54の別の配置が示されている。固着手段54は、肺動脈22の主たる左分枝24に配置される。接続手段46は、この実施形態において、あらかじめプログラムされた形状を有し得、弁手段52の位置と固着手段54との間の動脈の湾曲に適合する。図11cに示されるように、固着手段54は代替的に弁手段52の「流入」側に配置され得る。固着手段54は、右心室15に近い肺動脈22内の位置に装置42の位置を固定する。弁手段52は、肺動脈22が左右の肺動脈に分岐する位置の上流で、肺動脈22内の位置に配置され得る。従って、さらに弁手段52は、右心室から肺へ流れる血流を効果的に制御するために配置される。図11dに示されるように、さらなるステント43が、肺動脈弁20の位置で、肺動脈22に配置され得る。このステント43は、機能不全の肺動脈弁およびその任意の石灰化を肺動脈22の壁に押し当て得ることにより、装置42の弁手段52の血流制御は、生来の肺脈弁20よって乱されない。ステント41についてのように、ステント43も覆われたステントか、または少なくとも部分的に覆われたステント43であり得る。
図12において、上大静脈2に配置された血流制御装置42、および下大静脈4に配置された別の血流制御装置42が示されている。弁手段52は、上大静脈2および下大静脈4それぞれの壁と接触しかつ接触を解除するように配置されることによって、血管を通る血流を開閉する。上大静脈2または下大静脈4における弁手段52は、肺動脈22に弁手段52を配置することが不可能であるような先天的な欠陥の場合に有用であり得る。このとき、弁手段52が代わって、例えば図12に示されるように血液循環システムの上流に配置され得る。
図13aにおいて、装置42は、弁手段52が三尖弁8に配置されるように配置される。装置42の位置が、血管の壁と係合するために上大静脈2に配置された固定手段54によって体内に固定される。図3bに示されるような固着手段54の実施形態が使用される。接続手段146が、上大静脈2と三尖弁8との間で右心房6を通って伸びることにより、弁手段52を固着手段54に接続する。図13bにおいて、装置42は、弁手段52が僧帽弁8に配置されるように配置される。ここで、図3cに示されるような固着手段54が、上大静脈2の壁と係合するために使用される。接続手段246は、上大静脈2から、右心房6を通り、心房間隔壁14を貫通し、かつ左心房26を通り、僧帽弁30に配置された弁手段52へ伸びる。接続手段46は、上大静脈2と僧帽弁30との間のその延長に適合された、予めプログラムされた形状を有し得る。あるいは、接続手段46は、柔軟性があることにより、適正な形状にされ、その後適正な形状にロックされる。
図13cにおいて、図3dに示されるような装置42が、僧帽弁30を治療するために使用される。固着手段154は、膨張されて左心房26の内壁に接触することにより、装置42の位置を固定し、一方弁手段52は、僧帽弁30に配置される。図13dにおいて、図3bに示された装置42を使用する別の方法が示されている。固着手段54はここで、肺動脈弁28の血管壁と接触するように配置され、接続手段46は、左心房26を通って、僧帽弁30に配置されている弁手段52に伸びるように配置されている。
図13e〜図13iは、弁手段52が、僧帽弁30に配置されているとき使用されるための固着手段54の異なる実施形態を示す。これらの実施形態が、弁手段52を三尖弁8に配置するために使用され得ることは、当業者によって理解される。図13eにおいて、図4bに示されるような装置が使用される。固着手段354が、腱索11と係合するように配置され、それによって腱索11は、固着手段354のフック355内で捕らえられることにより装置42の位置を固定する。図13fにおいて、図4dに示されるような装置が使用される。固着手段554が、僧帽弁輪と係合するように配置される。固着手段554が、弁輪の相対する側と係合する円盤状の要素555を有し弁輪を貫通することにより装置42の位置を固定する様子が示されている。さらに、別の円盤状の要素555が、弁輪の心室側と接触して配置されることにより、左心室17内で装置42を安定させる。図13gにおいて、図4cに示されるような装置42が使用される。固着手段454は、乳頭筋13と係合して配置されているクリップ455を有することにより装置42の位置を固定する。図13hおよび図13iにおいて、図4aに概略示されたような装置42が使用される。固着手段254は、組織壁と接触して配置された円盤状の要素255を有する。弁手段52および固着手段254は、組織壁の相対する側で配置され、接続手段46は、組織壁を貫通する。従って、組織壁と接触する固着手段254は、装置42の位置を固定する。しかしながら、図13hおよび図13iにおいて、固着手段254は、別の円盤状の要素255を含み、それによって、円盤状の要素255は組織壁の相対する側と係合することにより、確実に装置42の位置を固定する。図13hにおいて、固着手段254は、心室間隔壁16と係合するように配置され、図13iにおいては、固着手段254は、左心室筋壁18と係合するように配置されている。
図13jおよび図13kは、僧帽弁30および三尖弁8を同時に治療するために使用される装置42を示す。装置42は、それぞれの生来の弁に配置されている2つの弁手段52を含む。装置42は、2つの弁手段52を接続する接続手段46を含む。接続手段46は、心室間の隔壁16(図13jに示されるように)または心房間の隔壁14(図13kに示されるように)それぞれを通って弁の間を伸びて配置されている。さらに、装置42は、心室間の隔壁16または心房間の隔壁14それぞれの相対する側に配置された円盤状の要素255を有する固着手段254を含むことにより、組織と係合し、かつ装置42の位置を固定する。
ここで図14a〜図14hを参照して、装置42を患者の中に挿入するための配送システム500が示されている。図14aに示されているように、配送システム500は、誘導ワイヤ508を含み、誘導ワイヤ508は、最初に患者の中に導入され、装置42が配置されるべき位置へ伸びる。その後、誘導ワイヤ508は、患者内の所望の位置への誘導経路を提供する。配送システム500はさらに、配送カテーテル502を含み、配送カテーテル502は、患者の脈管システム内の配送システム500の最も外側の部分である。明確さのために、配送カテーテル502は、配送システム500の以下の図では示されていない。装置42は、配送カテーテル502内の位置に誘導される。配送システム500はさらに、抑制カテーテル504を含む。このカテーテル504は、配送の間、装置42を圧縮された状態に保つ。配送システム500は、内部チューブ506をさらに含み、内部チューブ506は、誘導ワイヤ上を所望の位置までスライドし、その前にある装置42を押すように配置されている。
Claims (20)
- 心臓内の生来の心臓弁を通る血流を改善する補綴物であって、
該心臓と関連する組織と係合し、それによって該補綴物を固着するように構成された固着フレームワークと、
該固着フレームワークに結合され、該固着フレームワークから伸びることにより、該固着フレームワークが該組織と係合した場合、該生来の心臓弁の葉状部間に配置される弁部材とを備え、
該弁部材は、血液が第1の方向に流れる間、該生来の心臓弁の少なくとも1つの葉状部と接触するための膨張した構成を有し、該弁部材は、血液が第2の方向に流れる間、該生来の心臓弁の該少なくとも1つの葉状部との接触を解除するための収縮した構成を有する、補綴物。 - 前記固着フレームワークは、前記心臓における心室組織と係合するように構成された、組織係合構造を備えている、請求項1に記載の補綴物。
- 前記固着フレームワークは、前記弁部材を前記組織係合構造に結合するための接続部材をさらに備えている、請求項2に記載の補綴物。
- 前記固着フレームワークは、身体管腔における配置のために構成されたステントである、請求項1に記載の補綴物。
- 前記弁部材は、血液の流れに対して横切る方向に膨張可能であることにより、前記生来の心臓弁を通る逆流を防ぐ、請求項1に記載の補綴物。
- 前記弁部材は、こうもり傘状の柔軟性のあるフラップを備えている、請求項1に記載の補綴物。
- 前記固着フレームワークは、前記こうもり傘状のフラップの中心領域を通って伸びる細長いロッドを含む、請求項6に記載の補綴物。
- 前記こうもり傘状のフラップの周辺エッジおよび前記固着フレームワークから伸びる複数の柔軟性のある接続部材をさらに備えている、請求項7に記載の補綴物。
- ヒトの心臓における僧帽弁の機能を回復するための装置であって、
流れ制御部材と、
第1の端末および第2の端末を有するアンカーであって、該アンカーの該第1の端末は、該流れ制御部材に接続され、該アンカーの該第2の端末は組織係合構造を有し、該アンカーはある長さを有することにより、該組織係合構造が組織と係合するとき、該流れ制御部材は該僧帽弁内に少なくとも部分的に配置される、アンカーとを備え、
該流れ制御部材は、該僧帽弁の少なくとも1つの葉状部と接触し、それによって該僧帽弁を過ぎる血流を実質的に妨げる膨張状態と、縮小状態により、該僧帽弁を過ぎる血流を可能にする縮小状態との間で移動可能である、装置。 - 前記アンカーは、前記第1の端末と前記第2の端末との間に伸びている、請求項9に記載の装置。
- 前記流れ制御部材は、柔軟性のあるこうもり傘状のフラップである、請求項10に記載の装置。
- 前記こうもり傘状のフラップの円周から前記アンカーへ伸びる複数の接続糸をさらに備えている、請求項11に記載の装置。
- 前記組織係合構造は、前記心臓の内面と係合可能な支材のフレームワークを含む、請求項9に記載の装置。
- 前記組織係合構造は、複数のフックを備えている、請求項13に記載の装置。
- ヒトの心臓における心臓弁の機能を回復する方法であって、
該心臓の内部に補綴物を導入することと、
該補綴物の1つの端末を該心臓内の組織に固定することと、
該補綴物の反対側の端末を、該心臓弁の相対する葉状部間に配置することと、
該補綴物を膨張させることにより、該補綴物を該心臓弁の少なくとも1つの葉状部と接触させ、それによって、該心臓弁を通って第1の方向に血液が流れることを実質的に妨げることと、
該補綴物を収縮させることにより、該心臓弁を通って第2の方向に血液が流れることを実質的に可能にすることと
を包含する、方法。 - 該心臓内における該補綴物の1つの端末を固定することは、該補綴物の1つの端末を少なくとも部分的に左心室における心臓組織を通して伸ばすことを含む、請求項15に記載の方法。
- 該補綴物を膨張させて該心臓弁の少なくとも1つの葉状部と接触させることは、該心臓弁の少なくとも1つの葉状部を該補綴物と接合させることを含む、請求項15に記載の方法。
- 該補綴物を膨張させて該心臓弁の少なくとも1つの葉状部と接触させることは、該補綴物の1つの端末に配置されたこうもり傘状の柔軟性のあるフラップを膨張させることを含む、請求項15に記載の方法。
- 前記柔軟性のあるフラップの周辺と前記補綴物との間で伸びる複数の柔軟性のある接続部材で、該柔軟性のあるフラップの周辺を該補綴物に固定することをさらに包含する、請求項18に記載の方法。
- 前記補綴物を収縮させて、実質的に血流を可能にすることは、前記こうもり傘状の柔軟性のあるフラップがしぼむことを可能にすることを含む、請求項18に記載の方法。
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