JP2013523384A5 - - Google Patents
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- JP2013523384A5 JP2013523384A5 JP2013504891A JP2013504891A JP2013523384A5 JP 2013523384 A5 JP2013523384 A5 JP 2013523384A5 JP 2013504891 A JP2013504891 A JP 2013504891A JP 2013504891 A JP2013504891 A JP 2013504891A JP 2013523384 A5 JP2013523384 A5 JP 2013523384A5
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- 210000001008 Atrial Appendage Anatomy 0.000 claims description 40
- 238000000034 method Methods 0.000 claims description 10
- 210000001308 Heart Ventricles Anatomy 0.000 claims description 6
- 238000002271 resection Methods 0.000 claims description 2
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- 230000001225 therapeutic Effects 0.000 description 1
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Description
本発明は、例えば、以下を提供する:
(項目1)
左心耳を通るアクセス部位を作成するためのシステムであって、
該システムは、
第1のガイドであって、該第1のガイドは、第1の整列部材と、自身を通る第1の長手管腔を有する第1の細長い本体とを備える、第1のガイドと、
第2のガイドであって、該第2のガイドは、第2の整列部材と、自身を通る第2の長手管腔を有する第2の細長い本体とを備え、該第1の整列部材および第2の整列部材は、該第1の長手管腔と第2の長手管腔とを整列させるように構成される、第2のガイドと、
該第1および第2の長手管腔を通過するように構成される穿刺要素と、
ガイド要素と
を備える、システム。
(項目2)
前記第1および第2の整列部材は、磁性であり、前記第1のガイドと第2のガイドとを整列させるように構成される、項目1に記載のシステム。
(項目3)
前記ガイド要素は、取付け部材によって前記穿刺要素に連結される、項目2に記載のシステム。
(項目4)
アクセスデバイスをさらに備え、該アクセスデバイスは、第3のガイドと、第4のガイドとを備える、項目1に記載のシステム。
(項目5)
アクセスカテーテルをさらに備え、該アクセスカテーテルは、第1の拡張可能部材と、第2の拡張可能部材とを備える、項目4に記載のシステム。
(項目6)
閉鎖要素と、
該閉鎖要素を収容するように成形された溝を備える位置付けデバイスと
をさらに備える、項目1に記載のシステム。
(項目7)
真空デバイスをさらに備える、項目1に記載のシステム。
(項目8)
左心耳を通るアクセスポートを作成するための方法であって、
該方法は、
該左心耳の内部まで第1のガイドを前進させることであって、該第1のガイドは、自身を通る第1の長手管腔を備える、ことと、
該左心耳の外部まで第2のガイドを前進させることであって、該第2のガイドは、自身を通る第2の長手管腔を備える、ことと、
該第1の長手管腔が該第2の長手管腔と整列させられるように、該第1のガイドと第2のガイドとを整列させることと、
該左心耳を通るアクセス部位を形成するために該左心耳を穿刺することと、
ガイド要素を穿孔部位を通して前進させることと
を含む、方法。
(項目9)
前記穿刺要素は、前記左心耳を穿刺するように前記第1の長手管腔から前進させられる、項目8に記載の方法。
(項目10)
前記穿刺要素は、前記左心耳を穿刺するように前記第2の長手管腔から前進させられる、項目8に記載の方法。
(項目11)
左心耳にアクセスし、左心耳を通してデバイスを送達するためのシステムであって、
該システムは、
第1の整列部材と、自身を通る第1の長手管腔とを備える第1のアクセス要素と、
第2の整列部材と、自身を通る第2の長手管腔とを備える第2のアクセス要素であって、該第1の整列部材および第2の整列部材は、該第1の長手管腔と該第2の長手管腔とを整列させるように構成される、第2のアクセス要素と、
近位端および遠位端を備える、穿刺要素と、
閉鎖要素と、
治療デバイスと
を備える、システム。
(項目12)
閉塞部材をさらに備える、項目11に記載のシステム。
(項目13)
1つ以上の治療デバイスを心臓に送達するための方法であって、
該方法は、
左心耳の組織を通る第1のアクセス部位を形成することと、
閉鎖要素を該左心耳の周囲に配置することと、
第1の治療デバイスを該第1のアクセス部位を通して該心臓の中に前進させることと、
該第1の治療デバイスを用いて手技を行うことと、
該心臓から該第1の治療デバイスを除去することと、
該左心耳を閉鎖することと
を含む、方法。
(項目14)
前記左心耳の内部まで第1のガイドを前進させることであって、第1のアクセス要素が第1の長手管腔を備える、ことと、
該左心耳の外部まで第2のガイドを前進させることであって、第2のアクセス要素が第2の長手管腔を備える、ことと
を含む、項目13に記載の方法。
(項目15)
左心室の壁を通る第2のアクセス部位を形成することと、
該第2のアクセス部位を通して前記心臓の中に第2の治療デバイスを前進させることと
をさらに備える、項目14に記載の方法。
(項目16)
前記第2のアクセス部位を通してアクセスシースを配置することを含み、第1の拡張可能部材が前記左心室の前記壁の第1の側面上に位置付けられ、第2の拡張可能部材が該左心室の該壁の第2の側面上に位置付けられる、項目15に記載の方法。
(項目17)
前記手技は、弁修復または弁置換術である、項目13に記載の方法。
(項目18)
前記手技は、切除術である、項目13に記載の方法。
(項目19)
前記手技は、1つ以上の電極の配置を含む、項目13に記載の方法。
(項目20)
前記手技は、腱索術を含む、項目13に記載の方法。
心臓にアクセスし、デバイスを送達するためのデバイス、方法、およびシステムを本明細書で説明する。いくつかの変化例では、左心耳が、心臓の内部構造への心膜アクセスを可能にするためにポートとして使用されてもよい。左心耳を介した心臓へのアクセスを提供するために使用されるシステムは、第1の整列部材を有する第1のアクセス要素と、第2の整列部材を有する第2のアクセス要素と、穿刺要素と、ガイド/交換要素とを備えてもよい。左心耳を介して心臓にアクセスし、デバイスを送達する方法は、血管内経路によって左心耳の中に第1のアクセス要素を前進させるステップと、心膜腔を通して左心耳に向かって第2のアクセス要素を前進させるステップとを含んでもよい。第1および第2の整列部材は、第1および第2のアクセス要素が整列させられるように、相互を引き付けるか、または別様に左心耳の壁を通る取付けを形成してもよい。第1および第2のアクセス要素は、非直線構成で(例えば、第1および第2のアクセス要素は、相互に対して角度を成して、または垂直に位置付けられてもよい)、または直線構成で(例えば、概してそれらの端において、またはそれらの端に沿って)位置付けられ、整列させられてもよい。穿刺要素は、左心耳の壁を穿刺するように、いずれか一方のアクセス要素から前進させられてもよく、交換要素は、左心耳の内側と外側との間で進路を開始するように前進させられてもよい。種々のデバイスが、交換要素を使用して、心膜面から左心耳に送達されてもよい。左心耳を閉鎖および/または除外するための種々の方法およびデバイスも本明細書で説明する。
(項目1)
左心耳を通るアクセス部位を作成するためのシステムであって、
該システムは、
第1のガイドであって、該第1のガイドは、第1の整列部材と、自身を通る第1の長手管腔を有する第1の細長い本体とを備える、第1のガイドと、
第2のガイドであって、該第2のガイドは、第2の整列部材と、自身を通る第2の長手管腔を有する第2の細長い本体とを備え、該第1の整列部材および第2の整列部材は、該第1の長手管腔と第2の長手管腔とを整列させるように構成される、第2のガイドと、
該第1および第2の長手管腔を通過するように構成される穿刺要素と、
ガイド要素と
を備える、システム。
(項目2)
前記第1および第2の整列部材は、磁性であり、前記第1のガイドと第2のガイドとを整列させるように構成される、項目1に記載のシステム。
(項目3)
前記ガイド要素は、取付け部材によって前記穿刺要素に連結される、項目2に記載のシステム。
(項目4)
アクセスデバイスをさらに備え、該アクセスデバイスは、第3のガイドと、第4のガイドとを備える、項目1に記載のシステム。
(項目5)
アクセスカテーテルをさらに備え、該アクセスカテーテルは、第1の拡張可能部材と、第2の拡張可能部材とを備える、項目4に記載のシステム。
(項目6)
閉鎖要素と、
該閉鎖要素を収容するように成形された溝を備える位置付けデバイスと
をさらに備える、項目1に記載のシステム。
(項目7)
真空デバイスをさらに備える、項目1に記載のシステム。
(項目8)
左心耳を通るアクセスポートを作成するための方法であって、
該方法は、
該左心耳の内部まで第1のガイドを前進させることであって、該第1のガイドは、自身を通る第1の長手管腔を備える、ことと、
該左心耳の外部まで第2のガイドを前進させることであって、該第2のガイドは、自身を通る第2の長手管腔を備える、ことと、
該第1の長手管腔が該第2の長手管腔と整列させられるように、該第1のガイドと第2のガイドとを整列させることと、
該左心耳を通るアクセス部位を形成するために該左心耳を穿刺することと、
ガイド要素を穿孔部位を通して前進させることと
を含む、方法。
(項目9)
前記穿刺要素は、前記左心耳を穿刺するように前記第1の長手管腔から前進させられる、項目8に記載の方法。
(項目10)
前記穿刺要素は、前記左心耳を穿刺するように前記第2の長手管腔から前進させられる、項目8に記載の方法。
(項目11)
左心耳にアクセスし、左心耳を通してデバイスを送達するためのシステムであって、
該システムは、
第1の整列部材と、自身を通る第1の長手管腔とを備える第1のアクセス要素と、
第2の整列部材と、自身を通る第2の長手管腔とを備える第2のアクセス要素であって、該第1の整列部材および第2の整列部材は、該第1の長手管腔と該第2の長手管腔とを整列させるように構成される、第2のアクセス要素と、
近位端および遠位端を備える、穿刺要素と、
閉鎖要素と、
治療デバイスと
を備える、システム。
(項目12)
閉塞部材をさらに備える、項目11に記載のシステム。
(項目13)
1つ以上の治療デバイスを心臓に送達するための方法であって、
該方法は、
左心耳の組織を通る第1のアクセス部位を形成することと、
閉鎖要素を該左心耳の周囲に配置することと、
第1の治療デバイスを該第1のアクセス部位を通して該心臓の中に前進させることと、
該第1の治療デバイスを用いて手技を行うことと、
該心臓から該第1の治療デバイスを除去することと、
該左心耳を閉鎖することと
を含む、方法。
(項目14)
前記左心耳の内部まで第1のガイドを前進させることであって、第1のアクセス要素が第1の長手管腔を備える、ことと、
該左心耳の外部まで第2のガイドを前進させることであって、第2のアクセス要素が第2の長手管腔を備える、ことと
を含む、項目13に記載の方法。
(項目15)
左心室の壁を通る第2のアクセス部位を形成することと、
該第2のアクセス部位を通して前記心臓の中に第2の治療デバイスを前進させることと
をさらに備える、項目14に記載の方法。
(項目16)
前記第2のアクセス部位を通してアクセスシースを配置することを含み、第1の拡張可能部材が前記左心室の前記壁の第1の側面上に位置付けられ、第2の拡張可能部材が該左心室の該壁の第2の側面上に位置付けられる、項目15に記載の方法。
(項目17)
前記手技は、弁修復または弁置換術である、項目13に記載の方法。
(項目18)
前記手技は、切除術である、項目13に記載の方法。
(項目19)
前記手技は、1つ以上の電極の配置を含む、項目13に記載の方法。
(項目20)
前記手技は、腱索術を含む、項目13に記載の方法。
心臓にアクセスし、デバイスを送達するためのデバイス、方法、およびシステムを本明細書で説明する。いくつかの変化例では、左心耳が、心臓の内部構造への心膜アクセスを可能にするためにポートとして使用されてもよい。左心耳を介した心臓へのアクセスを提供するために使用されるシステムは、第1の整列部材を有する第1のアクセス要素と、第2の整列部材を有する第2のアクセス要素と、穿刺要素と、ガイド/交換要素とを備えてもよい。左心耳を介して心臓にアクセスし、デバイスを送達する方法は、血管内経路によって左心耳の中に第1のアクセス要素を前進させるステップと、心膜腔を通して左心耳に向かって第2のアクセス要素を前進させるステップとを含んでもよい。第1および第2の整列部材は、第1および第2のアクセス要素が整列させられるように、相互を引き付けるか、または別様に左心耳の壁を通る取付けを形成してもよい。第1および第2のアクセス要素は、非直線構成で(例えば、第1および第2のアクセス要素は、相互に対して角度を成して、または垂直に位置付けられてもよい)、または直線構成で(例えば、概してそれらの端において、またはそれらの端に沿って)位置付けられ、整列させられてもよい。穿刺要素は、左心耳の壁を穿刺するように、いずれか一方のアクセス要素から前進させられてもよく、交換要素は、左心耳の内側と外側との間で進路を開始するように前進させられてもよい。種々のデバイスが、交換要素を使用して、心膜面から左心耳に送達されてもよい。左心耳を閉鎖および/または除外するための種々の方法およびデバイスも本明細書で説明する。
Claims (20)
- 左心耳を通るアクセス部位を作成するためのシステムであって、
該システムは、
第1のガイドであって、該第1のガイドは、第1の整列部材と、自身を通る第1の長手管腔を有する第1の細長い本体とを備える、第1のガイドと、
第2のガイドであって、該第2のガイドは、第2の整列部材と、自身を通る第2の長手管腔を有する第2の細長い本体とを備え、該第1の整列部材および第2の整列部材は、該第1の長手管腔と第2の長手管腔とを整列させるように構成される、第2のガイドと、
該第1および第2の長手管腔を通過するように構成される穿刺要素と、
ガイド要素と
を備える、システム。 - 前記第1および第2の整列部材は、磁性であり、前記第1のガイドと第2のガイドとを整列させるように構成される、請求項1に記載のシステム。
- 前記ガイド要素は、取付け部材によって前記穿刺要素に連結される、請求項2に記載のシステム。
- アクセスデバイスをさらに備え、該アクセスデバイスは、第3のガイドと、第4のガイドとを備える、請求項1に記載のシステム。
- アクセスカテーテルをさらに備え、該アクセスカテーテルは、第1の拡張可能部材と、第2の拡張可能部材とを備える、請求項4に記載のシステム。
- 閉鎖要素と、
該閉鎖要素を収容するように成形された溝を備える位置付けデバイスと
をさらに備える、請求項1に記載のシステム。 - 真空デバイスをさらに備える、請求項1に記載のシステム。
- 左心耳を通るアクセスポートを作成するためのシステムであって、
該システムは、
該左心耳の内部まで前進するように構成された第1のガイドであって、該第1のガイドは、自身を通る第1の長手管腔を備える、第1のガイドと、
該左心耳の外部まで前進するように構成された第2のガイドであって、該第2のガイドは、自身を通る第2の長手管腔を備え、該第1の長手管腔が該第2の長手管腔と整列させられるように、該第1のガイドと第2のガイドとが整列させられる、第2のガイドと、
該左心耳を通るアクセス部位を形成するために該左心耳を穿刺するための穿刺要素と、
を備え、
ガイド要素は、穿孔部位を通して前進するように構成されている、システム。 - 前記穿刺要素は、前記左心耳を穿刺するように前記第1の長手管腔から前進させられる、請求項8に記載のシステム。
- 前記穿刺要素は、前記左心耳を穿刺するように前記第2の長手管腔から前進させられる、請求項8に記載のシステム。
- 左心耳にアクセスし、左心耳を通してデバイスを送達するためのシステムであって、
該システムは、
第1の整列部材と、自身を通る第1の長手管腔とを備える第1のアクセス要素と、
第2の整列部材と、自身を通る第2の長手管腔とを備える第2のアクセス要素であって、該第1の整列部材および第2の整列部材は、該第1の長手管腔と該第2の長手管腔とを整列させるように構成される、第2のアクセス要素と、
近位端および遠位端を備える、穿刺要素と、
閉鎖要素と、
治療デバイスと
を備える、システム。 - 閉塞部材をさらに備える、請求項11に記載のシステム。
- 1つ以上の治療デバイスを心臓に送達するためのシステムであって、
該システムは、
左心耳の組織を通る第1のアクセス部位を形成するための手段と、
該左心耳の周囲に配置されるように構成された閉鎖要素と、
該第1のアクセス部位を通して該心臓の中に前進するように構成された第1の治療デバイスと、
を備え、
該第1の治療デバイスは、手技を行うように構成されており、
該第1の治療デバイスは、該心臓から除去可能であり、
該閉鎖要素は、該左心耳を閉鎖するように構成されている、
システム。 - 前記左心耳の内部まで前進するための第1のガイドであって、第1のアクセス要素が第1の長手管腔を備える、第1のガイドと、
該左心耳の外部まで前進するための第2のガイドであって、第2のアクセス要素が第2の長手管腔を備える、第2のガイドと
を備える、請求項13に記載のシステム。 - 左心室の壁を通る第2のアクセス部位を形成するための手段と、
該第2のアクセス部位を通して前記心臓の中に前進するための第2の治療デバイスと
をさらに備える、請求項14に記載のシステム。 - 前記第2のアクセス部位を通して配置されるように構成されたアクセスシースを含み、第1の拡張可能部材が前記左心室の前記壁の第1の側面上に位置付けられ、第2の拡張可能部材が該左心室の該壁の第2の側面上に位置付けられる、請求項15に記載のシステム。
- 前記手技は、弁修復または弁置換術である、請求項13に記載のシステム。
- 前記手技は、切除術である、請求項13に記載のシステム。
- 前記手技は、1つ以上の電極の配置を含む、請求項13に記載のシステム。
- 前記手技は、腱索術を含む、請求項13に記載のシステム。
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US61/323,801 | 2010-04-13 | ||
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2011
- 2011-04-13 WO PCT/US2011/000676 patent/WO2011129893A1/en active Application Filing
- 2011-04-13 AU AU2011241103A patent/AU2011241103A1/en not_active Abandoned
- 2011-04-13 US US13/086,390 patent/US8795310B2/en active Active
- 2011-04-13 EP EP11769218.6A patent/EP2558007A4/en active Pending
- 2011-04-13 WO PCT/US2011/000677 patent/WO2011129894A2/en active Application Filing
- 2011-04-13 JP JP2013504891A patent/JP6085553B2/ja active Active
- 2011-04-13 US US13/086,389 patent/US20110282250A1/en not_active Abandoned
- 2011-04-13 CA CA2796267A patent/CA2796267A1/en not_active Abandoned
- 2011-04-13 CN CN201510512759.2A patent/CN104997574B/zh active Active
- 2011-04-13 CA CA2796269A patent/CA2796269A1/en not_active Abandoned
- 2011-04-13 CN CN201180029064.9A patent/CN103108597B/zh active Active
- 2011-04-13 AU AU2011241104A patent/AU2011241104B2/en active Active
- 2011-04-13 EP EP11769217.8A patent/EP2558014A4/en not_active Withdrawn
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2013
- 2013-10-30 HK HK13112205.1A patent/HK1184983A1/zh unknown
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2014
- 2014-06-19 US US14/309,835 patent/US9486281B2/en active Active
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2015
- 2015-07-14 US US14/799,419 patent/US10405919B2/en active Active
- 2015-12-02 JP JP2015235340A patent/JP2016047325A/ja not_active Withdrawn
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