JP2011101782A - Aid for heart valve surgery - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To evade the blocking of a blood vessel on a peripheral side after a surgery by preventing a small piece separated from tissue from being left inside a ventricle during a heart valve surgery. <P>SOLUTION: The aid 1 for the heart valve surgery includes a capturing part 10 inserted inside the ventricle, and a holding part 20 formed so as to be projected from the capturing part 10. In the state of inserting the capturing part 10 to the ventricle, a heart valve is excised, and the small piece peeled off from the heart tissue at the time is captured by the capturing part 10. When the excision of the heart valve is ended, the holding part 20 is held and the capturing part 10 is taken out from the ventricle. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a heart valve surgical aid used when operating a heart valve.

  There are four heart valves in the heart: aortic valve, pulmonary valve, tricuspid valve, and mitral valve. When these heart valves become abnormal due to lesions, so-called heart valve replacement may be required in which a mechanical valve or a biological valve made of biological tissue is sewn after the heart valve is excised.

  In many patients with heart valve lesions, the heart valve and surrounding tissues are calcified due to factors such as aging. Since the calcified tissue is fragile, a part of the calcified tissue separates and falls when the heart valve is excised. When this small piece reaches, for example, a blood vessel in the brain by blood flow, the blood vessel is blocked to cause cerebral infarction, and when the small piece reaches a blood vessel in an abdominal organ, the organ is necrotized.

  On the other hand, it is known that a filter is placed in the aorta and small pieces separated from the tissue are captured when the heart valve is excised (see, for example, Patent Documents 1 and 2). This filter is used temporarily and is removed after surgery.

JP-T-2002-527157 Special Table 2007-516039

  However, the small piece separated from the heart tissue at the time of excision of the heart valve may fall not only into the aorta side but also into the ventricle. If a small piece falls deep into the ventricle, it is difficult to remove and may not notice it. And it is thought that the small piece which fell into the ventricle flows by the blood flow after the filters of Patent Documents 1 and 2 are removed, and if the small piece reaches the blood vessels of the brain or each organ by any chance There is a risk of causing it.

  The present invention has been made in view of such points, and the object of the present invention is to prevent small pieces separated from tissue during heart valve surgery from being left in the ventricle. The purpose is to avoid obstruction of the blood vessels on the peripheral side.

  In order to achieve the above object, in the present invention, a small piece is captured in the ventricle at the time of excision of the heart valve.

  Specifically, according to the first invention, there is provided a heart valve surgery assisting tool used in heart valve surgery, a capture unit for capturing a small piece inserted into the ventricle and separated from the heart tissue, and the capture It is set as the structure provided with the holding part formed so that it might protrude from a part.

  According to this configuration, the small piece separated from the heart tissue at the time of excision of the heart valve can be captured by the capturing unit in the ventricle. And since an operator and an assistant have a holding part, it becomes possible to take out a capture part from a ventricle easily, and a small piece does not remain in the ventricle.

  In the second invention, in the first invention, the gripping part is constituted by a suction tube for sucking blood.

  According to this configuration, the surgical field is ensured by sucking and removing blood in the ventricle using the grasping portion.

  In 3rd invention, the capture | acquisition part shall be comprised with the absorber which absorbs blood in 1st or 2nd invention.

  According to this configuration, the surgical field is ensured by causing the trapped portion to absorb the blood in the ventricle.

  In the fourth invention, in any one of the first to third inventions, it is assumed that the gripping portion is made of a flexible member.

  According to this configuration, when the heart valve is excised, the grip portion can be easily bent and positioned so as not to get in the way.

  According to the first invention, the small piece separated from the heart tissue can be captured in the ventricle by the capturing part, and the capturing part can be easily taken out from the ventricle by the grasping part, so that the small piece remains in the ventricle. In addition, obstruction of the peripheral blood vessels after the operation can be avoided.

  According to the second aspect of the invention, since the grip portion is configured by the suction tube for sucking blood, the heart valve operation aid can be used for blood suction treatment.

  According to the third aspect of the invention, since the capturing part is configured by the absorbent material that absorbs blood, it is possible to easily secure the surgical field.

  According to the fourth aspect of the invention, since the grip portion is configured by a flexible member, the grip portion can be positioned so as not to get in the way, and the procedure can be performed smoothly.

FIG. 3 is a side view of the assist device for cardiac valve surgery according to the first embodiment. It is a perspective view of a capturing part. FIG. 3 is a side view of the distal end side of the grip portion 20. It is a figure of the state which isolate | separated the front end side part and proximal end side part of a holding part. It is an anatomical drawing of the heart. It is a cross-sectional view around the aortic valve of the heart. FIG. 3 is a view corresponding to FIG. 2, showing a state in which the capturing unit is inserted from the aortic valve into the left ventricle. FIG. 4 is a view corresponding to FIG. 3, showing a state in which the capturing unit is inserted from the aortic valve into the left ventricle. FIG. 6 is a view corresponding to FIG. 5 showing a state in which the aortic valve is resected. It is a side view of the auxiliary tool for heart valve surgery concerning a modification. It is a figure explaining the use condition of the auxiliary tool for heart valve surgery concerning a modification. FIG. 3 is a view corresponding to FIG. 1 according to a second embodiment.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

Embodiment 1 of the Invention
FIG. 1 shows an auxiliary tool 1 for cardiac valve surgery according to Embodiment 1 of the present invention. This heart valve operation assisting tool 1 is for capturing small pieces separated from heart tissue when an aortic valve (indicated by the symbol AV in FIGS. 5 and 6) is replaced with a mechanical valve or a biological valve. . In the description of this embodiment, the anatomy of the heart H will be described based on FIG. 5 before describing the structure of the assist device 1 for cardiac valve surgery. A pulmonary vein PVe is connected to the left atrium LA. There is a mitral valve MV between the left atrium LA and the left ventricle LV. There is an aortic valve AV in front of the mitral valve MV, and the left ventricle LV is connected to the ascending aorta AAo via the aortic valve AV. On the other hand, the right atrium RA is connected to the superior vena cava SVC and the inferior vena cava IVC, and there is a tricuspid valve TV between the right atrium RA and the right ventricle RV. A pulmonary valve PVa is located in front of the aortic valve AV, and the right ventricle RV is connected to the pulmonary artery PA via the pulmonary valve PVa. The mitral valve MV and the aortic valve AV are located on the same membrane (aoro-ventricular membrane) of the heart H.

  Next, the structure of the assisting tool 1 for cardiac valve surgery will be described based on FIG. The assisting tool for heart valve surgery 1 includes a capturing unit 10 for capturing a small piece and a gripping unit 20 for a surgeon or assistant to grip. The capturing unit 10 is formed by forming a sponge that absorbs blood into a cylindrical shape. This sponge is easily deformed by applying an external force, and is made of a known material that is restored to its original shape when the external force is removed, and has an open cell structure. The sponge absorbs moisture (blood, etc.) and deforms by absorbing the moisture. As shown in FIG. 2, a plurality of holes 11 having different sizes are opened on the surface of the capturing unit 10. A small piece at the time of excision of the heart valve enters or gets caught in these holes 11.

  The capturing unit 10 is provided with a plurality of markers 12a extending in the circumferential direction and a plurality of markers 12b extending in the axial direction. The shape and number of the markers 12a and 12b are not limited to the above, and for example, a marker extending in a spiral shape may be provided.

  The outer diameter of the capturing part 10 is set larger than the inner diameter of the aortic valve AV. Further, a through hole 10 a penetrating in the center line direction is formed at the center of the capturing part 10.

  The gripping portion 20 is formed by forming a flexible resin material into a tube shape, and is inserted into the through hole 10 a of the capturing portion 10. The grip 20 and the capture unit 10 are bonded. The dimension of the grip part 20 in the longitudinal direction is set longer than the dimension of the capture part 10 in the center line direction. The outer diameter of the grip 20 is about 5 to 6 mm.

  The distal end side of the grip portion 20 is formed so as not to protrude from the one end surface 10 c of the capture portion 10. An opening 20 a is formed on the distal end side of the grip 20. The proximal end side of the grip portion 20 protrudes from the other end surface 10 b of the capturing portion 10. The projecting dimension from the capturing part 10 on the proximal end side of the grasping part 20 is set to, for example, 50 mm or more, and projects outward from the aortic valve AV with the capturing part 10 inserted into the left ventricle LV. ing.

  As shown in FIG. 3, a plurality of side holes 20 b are formed through the peripheral wall portion of the grip portion 20, and the side holes 20 b are opened in the through hole 10 a of the capturing portion 10. These side holes 20a are spaced apart in the axial direction of the gripping part 20 and are also spaced apart in the circumferential direction. Note that the number and opening positions of the side holes 20b are not limited to the above. For example, only one side hole 20b may be formed.

  The grip 20 is configured to be separable into a proximal side 21 and a distal side 22 in the vicinity of the capture unit 10. The proximal end side portion 21 and the distal end side portion 22 are detachably connected via a connection mechanism 23. As shown in FIG. 4, the connection mechanism 23 includes a magnet 23 a provided at the end portion of the distal end side portion 22, a magnet 23 b provided at the end portion of the proximal end side portion 21, and an end of the proximal end side portion 21. And a protruding tube portion 23c provided so as to be insertable from the portion into the distal end side portion 22. The magnet 23a and the magnet 23b are attracted. Further, the protruding tube portion 23 c is formed so as to be able to seal the space between the distal end side portion 22 and the proximal end side portion 21 in a state of being inserted into the distal end side portion 22.

  A suction device 15 is connected to the proximal end side of the grip portion 20. Since the suction device 15 has a conventionally well-known structure, description thereof is omitted.

  Next, the case where the heart valve surgery auxiliary tool 1 configured as described above is used will be described. After opening the heart H and reaching the aortic valve AV, the heart valve operation assisting tool 1 is inserted into the left ventricle LV from the one end face 10c side of the capturing portion 10 as shown in FIGS. At this time, since the capturing part 10 is made of a deformable sponge, the capturing part 10 can be smoothly inserted into the left ventricle LV while being deformed. Then, the other end surface 10b of the capturing part 10 is positioned so as to cover the aortic valve AV from the left ventricle LV side. Further, the grasping portion 20 protrudes from the left ventricle LV.

  At this time, depending on the procedure, the grip 20 may be an obstacle. In this case, since the gripping portion 20 is provided with the connection mechanism 23, the proximal end side portion 21 can be separated from the distal end side portion 22 so as not to obstruct the procedure. After finishing the procedure, the proximal end side portion 21 is connected to the distal end side portion 22. At this time, when the end portion of the proximal end side portion 21 is brought closer to the end portion of the distal end side portion 22, the magnet 23 b of the proximal end side portion 21 is attracted to the magnet 23 a of the distal end side portion 22, and The protruding tube portion 23 c of the end side portion 21 is inserted into the end portion of the distal end side portion 22. That is, when connecting the proximal end side portion 21 to the distal end side portion 22, the attracting force of the magnets 23 a and 23 b is used, so that the proximal end side portion 21 is not strongly pressed against the distal end side portion 22. Can be easily connected. Thereby, it also becomes minimally invasive.

  Thereafter, as shown in FIG. 9, the aortic valve AV is picked with the tweezers A, and is cut while using the cutting tool B. At this time, since the holding part 20 has flexibility, it can be easily bent and can be positioned so as not to obstruct the excision procedure.

  In addition, a small piece peeled off from the heart tissue and dropped into the left ventricle LV at the time of excision is attached to the other end surface 10b of the capturing unit 10 and captured, and enters or is caught in the hole 11 of the capturing unit 10. Be captured. Since the sizes of the holes 11 are different from each other, pieces of various sizes can be reliably captured.

  During ablation of the aortic valve AV, blood in the left ventricle LV is absorbed by the capture unit 10. Further, when there is a lot of blood in the left ventricle LV, by operating the suction device 15, blood can be sucked and removed from the opening 20a at the tip of the grip 20 and the side hole 20b in the peripheral wall. . At this time, blood can be efficiently sucked by providing both the opening 20a and the side hole 20b.

  After excising the aortic valve AV, the capture unit 10 is removed from the left ventricle LV. At this time, since the grasping part 20 protrudes from the left ventricle LV, an operator or an assistant can easily grasp the grasping part 20, and can easily take out the capturing part 10 in a state where the small piece is captured. At this time, the take-out operation can be performed smoothly by the deformation of the capturing unit 10.

  Further, since the capturing unit 10 is provided with the markers 12a and 12b, even if the direction of the capturing unit 10 is changed unexpectedly during the procedure, the operator can easily use the markers 12a and 12b as a mark. Thus, the direction of the capture unit 10 can be confirmed when connecting the proximal side 21 to the distal side 22 when the capture unit 10 is removed from the left ventricle LV.

  Thereafter, the size of the annulus of the aortic valve AV is measured, and a mechanical valve or a biological valve is sewn.

  As described above, according to the assist device 1 for cardiac valve surgery according to the first embodiment, a small piece peeled off from the heart tissue can be captured in the left ventricle LV by the capturing unit 10, and the capturing unit 10 is gripped by the gripping unit. 20 can be easily removed from the left ventricle LV, so that a small piece does not remain in the left ventricle LV, and obstruction of the peripheral blood vessel after the operation can be avoided.

  In addition, since the grasping portion 20 is configured by a tube for sucking blood, the heart valve operation assisting tool 1 can be used for blood suction treatment.

  In addition, since the capturing unit 10 is made of an absorbing material that absorbs blood, it is possible to easily secure the surgical field.

  Moreover, since the holding part 20 has flexibility, it can be positioned so that the holding part 20 does not get in the way.

  In addition, as in the modification shown in FIG. 10, the heart valve operation assisting tool 1 may include a cylindrical member 30 for accommodating the capture unit 10 and guiding it to the ventricle. The outer diameter of the cylindrical member 30 is smaller than the outer diameter of the capturing part 10, for example, is set to 10 mm or less, and is large enough to be inserted from the heart valve opening, particularly the aortic valve opening, into the ventricle. . The cylindrical member 30 is made of a material harder than the sponge constituting the capturing unit 10 and can be bent. In the case of this modification, when performing a procedure, first, the capturing unit 10 and a part of the gripping unit 20 are accommodated in the cylindrical member 30. Since the capture part 10 can be compressed and accommodated in the cylindrical member 30, workability is good. And the cylindrical member 30 of the state which accommodated the capture part 10 is inserted in a ventricle from a valve opening. At this time, since the capturing unit 10 is compressed and reduced in size, the insertion operation into the ventricle can be easily performed. After inserting the capture unit 10 into the ventricle, only the tubular member 30 is pulled out of the ventricle so that the capture unit 10 is placed in the ventricle. As a result, the capture unit 10 exits from the distal end opening of the cylindrical member 30 into the ventricle, and the shape of the capture unit 10 is restored.

  Moreover, when pulling out the capture part 10 from the ventricle, the capture part 10 comes out while contacting the annulus. At this time, the catching part 10 comes to lightly rub the calcified pieces adhering to the annulus, and the catching part 10 can catch the small pieces.

  The suction device 15 may be omitted.

<< Embodiment 2 of the Invention >>
FIG. 12 shows an assisting device 1 for cardiac valve surgery according to Embodiment 2 of the present invention. Since this heart valve surgical assisting tool 1 is different from that of the first embodiment only in the structure of the capturing part 10 and the structure of the gripping part 20 is the same, hereinafter, the same parts as those in the first embodiment will be described. The same reference numerals are given and description thereof is omitted, and different parts will be described.

  The capturing unit 10 is configured by a net. The mesh is fine enough to capture small pieces that are peeled off when the aortic valve AV is excised. The capturing part 10 has a funnel shape that gradually increases in diameter toward the proximal end side of the gripping part 20, and the opening is set larger than the annulus of the aortic valve AV. The capturing unit 10 is configured to reduce the diameter when an external force is applied in the diameter reducing direction.

  When using the assist device 1 for cardiac valve surgery of Embodiment 2, it inserts in the left ventricle LV in the state to which the capture part 10 was diameter-reduced. The small piece peeled off from the heart tissue at the time of excision of the aortic valve AV is caught by the net of the capturing unit 10 and captured. And by having the holding part 20, the capture part 10 can be easily taken out from the left ventricle LV. Note that a suction device similar to that of the first embodiment can be connected to the grip portion 20.

  As described above, according to the assist device 1 for cardiac valve surgery according to the second embodiment, as in the first embodiment, the small piece does not remain in the left ventricle LV, but the peripheral region after the operation. Side vessel occlusion can be avoided.

  In the first and second embodiments, the case of using the heart valve surgery assisting tool 1 when excising the aortic valve AV has been described. It can also be used to excise the valve MV, the tricuspid valve TV, and the pulmonary valve PVa. When the tricuspid valve TV and the pulmonary valve PVa are excised, the capture unit 10 may be inserted into the right ventricle RV.

  As described above, the assist device for cardiac valve surgery according to the present invention can be used, for example, when excising the aortic valve.

DESCRIPTION OF SYMBOLS 1 Auxiliary tool 10 for heart valve operation Capture part 10a Through-hole 15 Suction device 20 Grasping part 20a Opening part LV Left ventricle AV Aortic valve

Claims (4)

An assisting device for heart valve surgery used in heart valve surgery,
A trap that is inserted into the ventricle and captures a small piece separated from the heart tissue;
And a grasping portion formed so as to protrude from the capturing portion. The assist device for cardiac valve surgery according to claim 1,
An assisting device for cardiac valve surgery, wherein the gripping portion is constituted by a suction tube for sucking blood. The assist device for cardiac valve surgery according to claim 1 or 2,
The assisting device for cardiac valve surgery, wherein the capturing part is made of an absorbent material that absorbs blood. The assisting device for cardiac valve surgery according to any one of claims 1 to 3,
The grasping part is comprised with the member which has a softness | flexibility, The assist tool for heart valve surgery characterized by the above-mentioned.

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