JP2009511088A - 後部の葉状部脱出症の治療のための装置、システム、および方法 - Google Patents
後部の葉状部脱出症の治療のための装置、システム、および方法 Download PDFInfo
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- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
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Abstract
Description
この出願は、2005年6月27日に出願され、本明細書に参照によりその全容がすべての目的のために援用され、共に譲渡された米国仮特許出願番号第60/694,479号への優先権を主張する。
本発明は一般的に、医療デバイスに関し、特に僧帽弁における後部の葉状部脱出症を修復することに関する。
脊椎動物においては、心臓は空洞の筋肉器官であり、4つのポンプチャンバ:左および右の心房、ならびに左および右の心室を有し、各々それ自身の一方向の弁が供給されている。本来の心臓弁は、大動脈、僧帽(または両尖)、三尖、および肺動脈として特定され、各々緻密な線維リングを含む輪に取り付けられている。僧帽弁および三尖弁は、一末端で弁に付着し、他方の末端で乳頭筋に付着している、線維組織の糸状帯を有する。
本適用は一般的に、左心房(LA)から左心室(LV)への血流を制御する僧帽弁の修復におけるその使用に関して記述される。しかしながら、本発明は、三尖弁または大動脈弁修復のような他の弁の修復にも適用され得る。
本発明の他の特徴および利点が、本発明の原理を例として図示する添付の図面と関連して、次の詳細な説明から明確となる。
図5Bにさらに明瞭に示された実施形態において、ダブルアーム縫合糸50aは、本来の索が取り付けられたフリーエッジ62において、および/または隣接して、後部の葉状部Pの耳介側60の中を通され、フリーエッジ62からから約4〜5mm離れて、耳介側60へ戻される。後部の葉状部Pの中を通るとき、縫合糸50aの2つのアーム64、66の間の距離は約3mmであることにより、接合の表面の滑らかさおよび規則性を損ない得る葉状部組織のひだ形成および/または損傷を避け得る。
図7は、索取替え縫合糸50aが、後部の葉状部Pの中に再び通され、次に後部の葉状部Pの心室側68で結ばれている様子を示す。関係する特定の適用および縫合に依存して(例えば、索取替え縫合糸が比較的すべりやすい材料、例えばe−PTFEである場合)、合計10〜12の結び目が索取替え縫合糸を結ぶために必要であり得、これによって比較的顕著な残遺物が残され得る。最後の結び目または複数の結び目を心室側68で結ぶことによって、最後の結び目からの任意の顕著な残遺物を原因とする接合の表面の過剰な不規則性を防ぎ得、さらに葉状部Pおよび/または取替え索縫合糸に対して繰り返される不必要な緊張、または他のストレスを作成し得る索取替え縫合糸に沿った葉状部Pの任意の動きを避け得る。
Claims (30)
- 心臓弁を修復する装置であって、
自身の中を通る基準平面を定義し、心臓弁輪の上または中に配置されるように構成されている、サポートボディと、
該サポートボディに固定され、該サポートボディ基準平面から3mm〜15mmの距離に配置されている、第1の基準要素と
を備えている、装置。 - 前記第1の基準要素は、第1の末端および第2の末端を有する細長いデバイスを備え、該第1の末端は、前記サポートボディ基準平面からの第1の距離において前記サポートボディに固定され、該第2の末端は、該サポートボディ基準平面からの第2の距離において該サポートボディに固定されている、請求項1に記載の装置。
- 前記第1の距離は、前記第2の距離と実質的に等しい、請求項2に記載の装置。
- 前記第1の距離は、前記第2の距離よりも大きい、請求項3に記載の装置。
- 前記サポートボディが、前記心臓弁の心臓弁輪の上または中に配置されているときに、前記第1の基準要素は、該心臓弁の隣接する弁葉状部の間に納まるように構成されている、請求項2に記載の装置。
- 前記第1の基準要素は、細長いバーを備えている、請求項2に記載の装置。
- 前記第1の末端は、前記サポートボディに解放可能に固定されている、請求項2に記載の装置。
- 前記第1の末端は、スライドする接続を介して、前記サポートボディに接続されている、請求項2に記載の装置。
- 前記スライドする接続は、ロッキングメカニズムをさらに備えている、請求項8に記載の装置。
- 前記第1の基準要素は、縫合糸のラインを含んでいる、請求項2に記載の装置。
- 前記装置は、前記第1の距離および前記第2の距離における変更を提供するように構成されている、請求項2に記載の装置。
- 前記サポートボディに固定され、前記サポートボディ基準平面から、3mm〜15mmの第2の基準距離で配置されている、第2の基準要素をさらに含み、該第2の基準距離は、前記第1の基準距離とは異なる、請求項2に記載の装置。
- 前記サポートボディに固定され、前記サポートボディ基準平面から、3mm〜15mmの第3の基準距離で配置されている、第3の基準要素をさらに含み、該第3の基準距離は、前記第2の基準距離および前記第1の基準距離とは異なる、請求項12に記載の装置。
- 心臓弁を修復する装置であって、
自身の中を通る基準平面を定義し、心臓弁輪の上または中に配置されるように構成されている、該サポートボディと、
該サポート部材基準平面から、第1の部材の方へ遠ざかる方向に少なくとも3mmの長さだけ該サポートボディから延びている、第1の細長い部材と、
該サポート部材基準平面から、第2の部材の方へ遠ざかる方向に少なくとも3mmの長さだけ該サポートボディから延びている、第2の細長い部材と
を備えている、装置。 - 前記第1の細長い部材は、該第1の細長い部材の長さに沿って、異なる位置に配置された、複数の第1の縫合糸取り付け点を備えている、請求項14に記載の装置。
- 前記第1の縫合糸取り付け点のうちの1つ以上から前記サポート部材基準平面への距離を示すインディシアをさらに備えている、請求項15に記載の装置。
- 前記第2の細長い部材は、複数の第2の縫合糸取り付け点であって、該第2の縫合糸取り付け点は、前記第2の細長い部材の長さに沿って、異なる位置に配置された、複数の第2の縫合糸取り付け点を備えている、請求項15に記載の装置。
- 前記第2の縫合糸取り付け点のうちの1つ以上から前記サポート部材基準平面への距離を示すインディシアをさらに備えている、請求項17に記載の装置。
- 前記第1の縫合糸取り付け点の各々は、前記第1の細長い部材を通過する穴を備えている、請求項15に記載の装置。
- 前記第1の縫合糸取付け点のうちの第1から、前記第2の縫合糸取付け点のうちの第1へ延びている第1の縫合糸ラインをさらに含んでいる、請求項17に記載の装置。
- 前記第1の縫合糸取付け点のうちの第2から、前記第2の縫合糸取付け点のうちの第2へ延びている第2の縫合糸ラインをさらに含んでいる、請求項20に記載の装置。
- 前記第1の縫合糸取付け点のうちの第3から、前記第2の縫合糸取付け点のうちの第3へ延びている第3の縫合糸ラインをさらに含んでいる、請求項21に記載の装置。
- 対応する輪平面を用いて心臓弁輪を有する心臓弁を修復する方法であって、
第1の縫合糸ラインを第1の取り付け点で第1の乳頭筋に固定することであって、該第1の乳頭筋は該心臓弁に隣接する心臓チャンバに配置されている、ことと、
該第1の縫合糸ラインの一部を該心臓弁の第1の心臓弁葉状部を通過させることと、
索基準要素を提供することと、
該心臓弁輪の該輪平面から少なくとも3mmの位置における、該心臓チャンバ内に該索基準要素を配置することと、
該第1の縫合糸ラインを該第1の心臓弁葉状部に固定することであって、該第1の縫合糸ラインは、該索基準要素に隣接する位置で該第1の心臓弁に固定されていることと
を包含する、方法。 - 前記第1の縫合糸ラインを前記第1の心臓弁葉状部に固定することは、該縫合糸ラインを、前記索基準要素を回って通し、該第1の縫合糸ラインにおいて結び目を結ぶことにより、該索基準要素が、該結び目と該第1の心臓弁葉状部との間に配置されることを包含する、請求項23に記載の方法。
- 前記心臓弁は僧帽弁を備え、前記心臓弁葉状部は、第1の部分、第2の部分、および該第1の部分と該第2の部分との間に配置された中央の部分を備えている、請求項23に記載の方法であって、該方法は、
第1の表面くぼみを前記葉状部の該第1の部分と該中央の部分との間において縫合することと、
第2の表面くぼみを該葉状部の該第2の部分と該中央の部分との間において縫合することと
をさらに包含する、請求項23に記載の方法。 - 前記索基準要素を提供することは、
前記心臓弁輪の上または中に配置されるように構成されたメインサポートボディを供給することであって、該メインサポートボディは、サポートボディ平面を定義している、ことと、
スライドするように装置に固定されている基準要素を供給することにより、該基準要素から該サポートボディ平面までの距離が、該基準要素を該サポートボディ平面に向かって、および/または遠ざかるようにスライドさせることによって変化させられ得る、こととを包含する、請求項23に記載の方法。 - 前記索基準要素を提供することは、
該基準要素を、前記サポートボディ平面に関して所望の位置にスライドさせることを包含する、請求項26に記載の方法。 - 前記索基準要素を提供することは、
前記心臓弁輪の上または中に配置されるように構成されたメインサポートボディを供給することであって、該メインサポートボディは、サポートボディ平面を定義している、ことと、
装置に固定された複数の基準要素を供給することであって、該複数の基準要素の各々は、該サポートボディ平面から異なる距離に配置されている、ことと
を包含する、請求項23に記載の方法。 - 前記索基準要素を提供することは、
前記複数の基準要素の中から前記索基準要素を選択することと、
該索基準要素以外の、該基準要素のすべてを除去することと
包含する、請求項28に記載の方法。 - 前記索基準要素を提供することは、
前記心臓弁輪の上または中に配置されるように構成されたメインサポートボディを供給することであって、該メインサポートボディは、サポートボディ平面を定義している、ことと、
該メインサポートボディ平面から遠ざかるように延びている第1の要素を供給することであって、該第1の要素は、複数の第1の縫合糸取り付け点を備えている、ことと、
該メインサポートボディ平面から遠ざかるように延びている第2の要素を供給することであって、該第2の要素は、複数の第2の縫合糸取り付け点を備えている、ことと、
縫合糸ラインの第1の末端を、該第1の縫合糸取り付け点のうちの1つに固定することと、
該縫合糸ラインの第2の末端を、該第2の縫合糸取り付け点のうちの1つに固定することと
を包含する、請求項23に記載の方法。
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- 2006-06-26 US US11/474,740 patent/US8685083B2/en active Active
- 2006-06-27 WO PCT/US2006/024889 patent/WO2007002627A1/en active Application Filing
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US8685083B2 (en) | 2014-04-01 |
CN101208058B (zh) | 2010-08-25 |
EP1903990B1 (en) | 2015-02-25 |
US20070123979A1 (en) | 2007-05-31 |
WO2007002627A1 (en) | 2007-01-04 |
CN101208058A (zh) | 2008-06-25 |
JP5279124B2 (ja) | 2013-09-04 |
CA2609991A1 (en) | 2007-01-04 |
CA2609991C (en) | 2013-09-17 |
EP1903990A1 (en) | 2008-04-02 |
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