JP2687846B2 - catheter - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a catheter, for example, a catheter suitable as an ablation catheter for cauterizing an affected area.

[0002]

2. Description of the Related Art For the treatment of tachyarrhythmia, a surgical operation (thoracotomy) of opening the chest to remove the tissue causing the arrhythmia, or a method of treating the arrhythmia by administering a drug is adopted. Has been done. Treatment of the heart by thoracotomy is painful to the patient and has a long period of postoperative recovery.

In recent years, instead of thoracotomy, catheter ablation is performed in which DC or high-frequency current is applied from the tip of an electrode catheter that is percutaneously inserted into the heart chamber to ablate the tissue causing the arrhythmia. , Is developing mainly in Europe and America.

[0004] Cauterization by direct current energization is performed under general anesthesia and has a strong tissue destructive power, but the shock is large and the occurrence of acute complications and sudden death have been reported. Therefore, recently, a method of performing cauterization by passing a high frequency current of about 300 to 750 KHz and an output of about 5 to 50 W has attracted attention. The method by applying high-frequency current is convenient because there is no need for general anesthesia during the procedure and because it can be monitored by an electrocardiogram.

The Kent bundle is an example of an accessory conduction path that contributes to tachyarrhythmia. The Kent bundle is a muscle bundle, 70% of which is located in the septal or left ventricular free wall. Generally, the Kent bundle does not work, but there are people who work this.

FIG. 15 is a schematic sectional view of the heart. The pulsation of the heart is made by stimulation by nerves (right leg) 89 and (left leg) 90 that pass through the wall of the heart 81 from the sinoatrial node 87 through the atrioventricular node 88. Then, as shown in FIG. 17, the pulsation timing is deviated depending on the part of the heart.

When the Kent bundle is functioning, excitement is transmitted directly from the sinoatrial node 87 to the Kent bundle 92 and the left ventricle 85 beats.
Left ventricle, if the Kent bundle is not functioning (usually)
85 pulsates in response to excitement via sinus 87, atrioventricular 88, and nerve 90 passing through the wall of the left ventricle. If the Kent bundle is working, the left ventricle beats faster than it should.

This situation is schematically shown in FIG. During sinus rhythm, when excitement is normally transmitted to the conduction pathway and the accessory conduction pathway (Kent bundle), the excitement is transmitted to the QRS complex early, and Δ shown in FIG.
Waves appear. Since the propagation direction of the depolarization process of the ventricle is abnormal, it takes longer than normal, resulting in QR
The S group becomes very wide.

In addition, since the Kent bundle is likely to cause reverse transmission of excitement, it can be normally connected to the conduction path to form one closed circuit. When the excitatory rotation movement occurs therein, a seizure of paroxysmal tachycardia is induced, and the patient's distress increases. Fig. 15
Inside, 82 is the right atrium, 83 is the right ventricle, and 86 is the mitral valve.

The state of Kent bundle ablation by the ablation catheter is also shown in FIG. The position of the affected area is specified in advance by sufficient mapping by electrocardiographic measurement. Then, the ablation catheter 94 is inserted from the femoral artery 93 into the left ventricle 85, the ablation electrode 95 at the tip is brought close to the Kent bundle 92, and the electrode 95 and the counter electrode plate 96 located on the back of the patient are placed.
A high-frequency current is passed between and. Thus, the area containing the Kent bundle that is causing the arrhythmia (depth 5 mm, width 10 mm
Within) to cauterize and necroticize and stop its function.
In the figure, 97 is a high frequency generator.

In the ablation catheter, since the electrode at the tip is located at a predetermined position, it is desired that the tip side can be bent into a desired shape.

As such an ablation catheter, there has been proposed one provided with an operating portion having a structure shown in FIG. 18 as a schematic view for explaining the principle (US Pat. No. 4960134).

The operating portion includes a cylinder 101, a cylinder
It comprises a piston 102 reciprocable in 101 and a wire 104 connected to the piston 102. The wire 104 is inserted into a catheter body (not shown), and its tip is fixed to the tip portion of the catheter body and the cylinder 101. Finger hanging
When the thumb is hung on 103 and the piston 102 is pushed out, the distal end side of the catheter body is pulled by the wire 104 and bent. This operation unit can meet the above-mentioned request.

However, since the size of pulling the wire is the same as the moving size of the piston, it is difficult to finely control the catheter bending. In addition, the movement of the wire in the operation unit
Since it is in the opposite direction to the movement of the piston, it is hard to say that the operation is easy.

In addition to the above, there is an operation section to which the mechanism shown in FIG. 19 is applied. In this operating portion, the rear ends of two wires 114 and 124 are fixed to a rotary shaft 111 to which a lever 112 is attached. The wires 114 and 124 are inserted into a catheter body (not shown), and their tips are fixed to the tip portion of the catheter body. When the lever 112 is operated to rotate the rotary shaft 111, one of the wires 114 and 124 is pulled as shown by the arrow and the other is paid out.

Although this operation causes the distal end side of the catheter body to bend, this operation part can be said to be easier to operate as compared with the above-described example of piston operation by converting rotational motion into reciprocating motion. . However, it is similar to the above example in that it is difficult to finely control the bending.

Further, in both cases, it is difficult to fix the piston or the lever in order to maintain the bent state of the catheter body, and it is not easy to accurately hold the bent state of the catheter body.

[0018]

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and facilitates bending of the distal end side of the catheter body, and adjustment of this bending and maintenance of the bent state are easy. It is an object of the present invention to provide a catheter that is easy to return from its bent state to its original shape.

[0019]

The present invention has a catheter body and an operating portion for bending the distal end side of the catheter body. The operating portion includes a rotating member and the rotating member. A moving member that engages with the moving member and moves in conjunction with the rotation of the housing, and an adjusting means for adjusting the movement of the moving member is provided between the rotating member and the moving member. A tubular body is provided in the housing, and a moving member holder for fixing an end of a supporting rod slidably supporting the moving member is inserted inside the tubular body, and the adjusting means is present. Side wall of the housing is always urged by the urging means, and the releasing means for releasing the engagement between the rotating member and the moving member is the urging direction of the moving member holder. While being connected to the end of the A connecting means attached to the formed through hole and connecting the distal end of the catheter body and the moving member to the distal end of the catheter body when the moving member is moved by the rotation of the rotating member. Is caused to cause the bending, and from this bent state, the releasing means is actuated against the biasing means so that the moving member holder moves together with the supporting rod in the cylindrical body, and the rotating member. On the other hand, the present invention relates to a catheter configured such that the moving member is disengaged and returns to the original position, and the catheter body returns to the original shape.

In the present invention, the movement of the moving member which is interlocked with the rotation of the rotating member is carried out by the concave and convex fitting of these two members, and the movement of the moving member is in the direction along the rotation center line of the rotating member. Moreover, it is desirable that the bending of the distal end side of the catheter body is maintained.

Further, in the present invention, it is desirable that the rotating member and the moving member are fitted in the concave and convex via a feed screw mechanism.

Further, in the present invention, it is desirable to provide fitting holding means (for example, slider holders 11 and 12 which will be described later) for holding concave and convex fitting between the rotating member and the moving member.

Further, in the present invention, it is desirable to provide a mechanism (for example, a push button 19 described later) for releasing the fitting between the rotating member and the moving member.

Further, in the present invention, in the mating released state,
It is desirable to provide a means (for example, a compression coil spring 29 described later) for moving the moving member to return the catheter body to the original shape.

Further, in the present invention, an ablation catheter (for example, a large tip 53 described later) is provided at the tip of the catheter body, and an ablation catheter is constructed by connecting a current-carrying lead wire to the ablation electrode. You can

Further, in the present invention, it is preferable that the outer peripheral portion of the rotating member is larger than the outer diameter of the housing of the operating portion and is exposed on the outer surface of the housing.

[0027]

Embodiments of the present invention will be described below.

Embodiment 1 FIGS. 1 and 2 show an operating portion, FIG. 1 is a sectional view taken along the line II of FIG. 2, and FIG. 2 is a sectional view taken along the line II-II of FIG.

The operating section 41 has housings 3 and 5.
The housings 3 and 5 have an adhesive 8 on the end faces of the step portions 3a and 5a.
Are fixed to each other to form a space 7 for accommodating each portion other than the rotating member of the operation portion. Through holes 4 and blind holes 6 passing through the space 7 are provided in the housings 3 and 5, respectively, and the bottomed cylindrical bodies 9 and 10 are fitted into the holes 4 and 6, respectively.

Slider holders 11 and 12 are inserted into the cylinders 9 and 10, respectively, and through holes 13 formed in the slider holders 11 and 12,
Both ends of the pipes 20 and 21 are fitted into 14, 15 and 16, respectively. In order to enable the fitting of the pipe and the lowering of the pipe, which will be described later, the cylinders 9, 10
Side holes 9a and 10a are provided in each.

Compression coil springs 17 and 18 are located between the slider holders 11 and 12 and the bottom walls of the cylinders 9 and 10, respectively, and the slider holders 11 and 12 are urged upward in the drawing. . A stepped push button 19 is located on the slider holder 11 in the cylindrical body 9, and the push button 19 is locked to the step of the through hole 4 and the upper end portion projects from the outer surface of the housing 3.

A slider 22 is movably engaged with the tubes 20 and 21. This engagement is made through the through hole 2 provided in the slider.
This is done by inserting tubes 20 and 21 into 3 and 24, respectively. Thus, the slider 22 is held at a predetermined position by the slider holders 11 and 12 via the guide tubes 20 and 21.

At the tip of the housing 3, the catheter body is attached.
The wire 30 having the rear end fixed to the slider 22 is fixed to the catheter body attaching portion 1 for attaching 42.
It is inserted into the catheter body 42 via the space 7, the through hole 36 at the tip of the housing, and the space 2 of the catheter body mounting portion 1. The tip of the wire 30 is fixed to the tip of the catheter body 42, which will be described in detail later. The slider 22 is biased toward the catheter body by a compression coil spring 29.

An arcuate surface is formed on the slider 22 in an area of about 90 degrees on the outer circumference, and a male screw 25 is threaded on the arcuate surface. An annular handle 26 having a female screw 27 threaded thereon is located between the housings 3 and 5, and a male screw 25 of the slider 22 and a female screw 27 of the annular handle 26 are screwed together. Slider 22
The location opposite to the location where the male screw 25 is provided is located inside the step portions 3a, 5a of the housings 3, 5 and is separated from the step portions 3a, 5a of the housing.

When the annular handle 26 is rotated, the slider 22 threadedly engaged with the annular handle 26 is guided by the tubes 20 and 21 to move in the direction of the central axis of the housing. Then, the slider 22 moves forward to the right in the drawing against the biasing force of the compression coil spring 29,
Move from the solid line position to the virtual line position. Along with this, the wire 30 whose one end is fixed to the slider 22 moves to the right. As a result, the distal end side of the catheter body 42 is pulled and bent, which will be described later in FIG.
This will be described with reference to FIGS. 8 and 10. The annular handle 26
The rotation angle and the moving size of the slider 22 can have an appropriate relationship. That is, the slider moving speed can be freely selected.

A tube 31 is provided on the rear side of the cylindrical body 10 in the space 7 in the housing, and wirings 32, 33, 34, 35 for connecting to the respective electrodes of the catheter body are provided on the tube 31 and the slider 22. The wire insertion hole 28 (see FIG. 2), the through hole 36, and the space 2 are inserted into the catheter body 42.

FIG. 3 shows the cylinders 9 and 10, the slider holder 11,
FIG. 7 is an exploded cross-sectional view showing a procedure for assembling the compression coil springs 17, 18, the push button 19, the tubes 20, 21, the slider 22 and the annular handle 26. FIG. 4 is a perspective view showing the relationship between the slider 22 and the annular handle 26 extracted from each other.

First, as shown by the one-dot chain line arrow, the compression coil springs 17 and 18 and the slider holders 11 and 12 are attached to the cylindrical bodies 9 and 10.
Insert The push button 19 is inserted into the tubular body 9 on the slider holder 11. Next, the pipe 20 is inserted into the through holes 14, 23, 13 as shown by the double-dotted chain line arrow. Similarly, the pipe 21 through the through hole 16,
Insert through 24 and 15. The slider 22 has an annular handle.
Set 26 beforehand.

Next, as shown by the three-dot chain line arrow, the slider holders 11 and 12 are brought close to the compression coil springs 17 and 18, the cylinders 9 and 10, and these and the slider 22 are assembled. At this time, the left and right housings (3 and 5 in FIG. 1) are brought into contact with each other so as to sandwich the annular handle 26 and fixed with the adhesive 8 to assemble the operation portion 41 in FIG.

The wire 30 is fixed to the tip end surface of the slider 22 by caulking, for example. However, as shown by the phantom line in FIG. 3, the wire 30 may be inserted through the slider 22 and caulked to the rear end surface thereof.

The threaded engagement between the slider 22 and the annular handle 26 is
Threading with a multi-thread screw is convenient because the lead can be made larger and the slider can move faster. However, the pitch for each line is increased within a range in which the annular handle is not rotated by the movement of the slider, but this is preferable for speeding up the operation.

As described above, the rotation of the annular handle 26 is converted into the movement of the slider 22 by screwing the screw to move the slider 22.
Since the wire 30 to be connected to is pulled to bend the distal end side of the catheter body as described later,
A small force is required to rotate the annular handle 26. Further, it is easy to finely adjust the degree of bending. In addition, even if the slider 22 tries to return to the original position, the annular handle 26 does not reverse in such a mechanism, and it is unnecessary to maintain the bent state.

FIG. 5 is a sectional view of the distal end side of the catheter body, and FIG. 6 is a sectional view taken along line VI-VI of FIG.

On the distal end side 50 of the catheter body 42, a cauterizing electrode (called a large tip) 53 is fixed to the distal end of a flexible tube 51. The large tip 53 has, for example, a diameter
The terminal plate 54 has a length of 2.3 mm and a length of 4 mm and is fitted in the tube 51. The large tip 53 is made of, for example, a platinum-iridium alloy or stainless steel.

A long metal plate 52 is inserted into the tube 51, and a coating tube 37 that covers the wire 30 is fixed to the metal plate 52. The tip of the wire 30 is exposed from the coating tube 37 and the terminal plate 54 It is fixed to, for example, by soldering. The wiring 32 is guided on the metal plate 52, and the tip of the wiring 32 is fixed to the terminal plate 54 by soldering, welding, or the like, and is electrically connected to the large chip 51.

The flexible tube 51 has annular electrodes 55, 56 and 57.
Are exposed and fitted, and the wirings 33, 34 and 35 connected to these annular electrodes are guided onto the metal plate 52.

Next, the operation of bending the distal end side of the catheter body will be described.

The state in which the slider 22 has moved is shown by an imaginary line in FIG. When the wire 30 moves as shown by the imaginary line arrow by the movement of the slider 22, the terminal plate 54 to which the tip of the wire 30 is fixed is pulled, as shown in FIG.
The metal plate 52 shifts from a straight state shown by an imaginary line to a curved state shown by a solid line. As a result, as shown in FIG.
The distal end side 50 of the catheter body bends.

In this manner, the distal end side 50 of the catheter body 42 shifts from the straight line state shown in FIG. 9 to the bent state shown in FIG. In order to bend the distal end side of the catheter body, the annular handle 26 is manually turned. To facilitate this operation, the annular handle 26 is cylindrical and has a diameter slightly larger than the housings 3 and 5. And is slightly projected from the outer peripheral surface of the housing (see FIG. 1). With such a structure, the operation of bending the catheter is significantly facilitated. During use, the operating part rests on the patient's body.

The catheter body is composed of a rear end portion attached to the catheter body attachment portion (1 in FIG. 1) of the operating portion and a front end portion thereof, and both end portions are connected to each other to form the catheter body. doing. FIG. 11 is a cross-sectional view showing this connection.

The rear end side 43 of the catheter body 42 has a mesh tube 44 in which fibers are woven to improve torque conductivity, and a reinforcing tube 45 is inserted inside the net tube 44.
A stopper tube 46 is fitted on the tip side of the mesh tube 44. The end face of the flexible tube 51 on the distal end side 50 of the catheter body 42 and the net-filled tube 44 on the rear end side 43 thereof.
And the end surface of is joined by, for example, adhesion or fusion. Then, the rear end surface of the flexible tube 51 and the rear end surface of the metal plate 52 contact the front end surface of the stopper tube 46.

As a result of the pulling by the wire 30, the metal plate 52
Although it tries to move to the right in the figure, the rear end surface of the stopper tube 46 contacts the tip surface of the reinforcing tube 45, and even if the metal plate 52 further moves, this movement is hindered. That is, the stopper tube 46 includes the metal plate 52.
Function as a stopper for stopping the unwanted movement of the. As a result, the metal plate 52 is pulled by the wire 30.
Bends as shown in FIG. 7, and the distal end side 50 of the catheter body bends as shown in FIGS. 8 and 10.

To release the bending on the distal end side of the catheter body,
Made with one touch. 12 (a) and 12 (b) are sectional views showing the mechanism.

At the time of releasing the bending, the push button 19 is pushed in the direction of the arrow as shown in FIG. Then, the slider holder 11 moves down against the biasing force of the compression coil spring.
Then, the slider 22 held by the slider holder 11 via the pipes 20 and 21 is inclined and slightly descended,
The threaded engagement between 22 and the annular handle 26 is released.

At that moment, as shown in FIG. 12 (b), the slider 22 moves to the left in the figure as indicated by the arrow by the urging force of the compression coil spring 29 with the tubes 20, 21 as guides.
By this movement, the pulling by the wire 30 is released,
The metal plate 52 of FIG. 7 returns from the curved state of the solid line to the linear state of the virtual line. As a result, the distal end 50 of the catheter body is
The bending state of 0 and FIG. 12 is immediately returned to the linear state of FIGS.

Next, when the push button 19 is released, the slider holder 11, the tubes 20, 21 and the slider 22 are lifted by the urging force of the compression coil spring 17, and the state of the solid line in FIG. 1 is restored.

As described above, according to this embodiment, the bending of the catheter main body is instantly released by the extremely simple operation of pressing the push button 19, and the bending of the catheter main body, the fine adjustment of the bending and the bending holding are performed. The operation of the catheter is simple and easy in addition to the fact that it is extremely easy to operate.

In this example, the tension of the slider can be adjusted by a tension coil spring instead of the compression coil spring. That is, the slider 22 of FIG. 1 and the slider holder 11 are connected via a tension coil spring (not shown), and the slider 22 is biased to the left while the slider 22 is moving to the right in the figure. To do so.

Further, no spring for urging the slider is provided, and the elasticity of the metal plate 52 and / or the elasticity of the flexible tube 51 on the distal end side of the catheter main body causes the distal end of the catheter main body to be in a straight state from a bent state. It can be restored to its original shape. In addition, it is possible to introduce compressed air into the catheter body in conjunction with the operation of pressing the push button 19 and to release the bending by this pressure.

Example 2 This example is an example in which the pair of housings of the operating portion are more securely fixed to each other and the assembly is facilitated. 13 is a front view of the operating portion 61 according to this example, and FIG. 14 is a sectional view taken along line XIV-XIV of FIG.

At the ends of the housings 63 and 65 according to this example, a plurality of (three or more, the smaller the number, three in this example) locking portions 64, 64, 64, 66, 66 radially protruding are provided. , 66
Are provided at equal intervals in the circumferential direction. Through-holes 64a and 66a are provided in the locking portions 64 and 66, respectively.
Insert the bolt 67 into “a” and tighten with the nut 68.
Fix 63 and 65 to each other.

Since the annular handle 26 is located between the housings 63 and 65, the bolts are arranged so that the housings can be securely fixed and the annular handle can be smoothly rotated.
The 66 is adapted to be inserted into a tubular spacer 69 sandwiched between the locking portions 64, 66. Others are the same as in the first embodiment.

Although the embodiments of the present invention have been described above, various modifications can be made to the above embodiments based on the technical idea of the present invention.

For example, interlocking and adjusting the position of the slider with respect to the annular handle can be performed by a feed screw mechanism, a combination of gears, or another appropriate mechanism.

Further, for connecting the distal end of the catheter body and the slider, for example, band steel or the like can be used instead of the wire.

Furthermore, the catheter according to the present invention can be used for cauterization of a Kent bundle, cauterization of other organs to be removed, or medical procedures other than cauterization.

[0067]

The catheter according to the present invention includes the moving member that interlocks with the turning of the turning member, and has the connecting means for connecting the moving member and the distal end of the catheter body. The moving member can be moved by a simple operation of rotating to bend the distal end side of the catheter body, and this bending work is easy. Further, it is possible to avoid particularly requiring an operation for maintaining this bent state.

Further, since the adjusting means for adjusting the movement of the moving member is provided between the rotating member and the moving member,
The bending of the distal end side of the catheter body can be made to a desired degree.

Moreover, the bending of the catheter main body is instantly released by the extremely simple operation of disengaging the moving member from the rotating member by the movement of the holder and the supporting rod by the operation of the releasing means. In addition to the operability that the bending, the fine adjustment of the bending and the bending holding are extremely accurate and easy, the operation of the catheter is simple and easy. As a result, medical treatment is performed easily and accurately.

[Brief description of the drawings]

FIG. 1 is a sectional view of an operating portion according to a first embodiment (I in FIG. 2).
-I line sectional view).

FIG. 2 is a sectional view taken along line II-II of FIG.

FIG. 3 is an exploded cross-sectional view showing a procedure for assembling the constituent parts of the operation section.

FIG. 4 is a perspective view showing the slider and an annular handle in an extracted manner.

FIG. 5 is a cross-sectional view of the distal end side of the catheter body.

6 is a sectional view taken along line VI-VI of FIG.

FIG. 7 is a perspective view showing a curved state of the metal plate.

FIG. 8 is a cross-sectional view of the bent catheter body distal end side.

FIG. 9 is a perspective view of the catheter in the same linear state.

FIG. 10 is a perspective view of the catheter with the tip side of the catheter body bent.

FIG. 11 is a partial cross-sectional view showing a connection structure between the front end side and the rear end side of the catheter body.

FIG. 12 is a cross-sectional view of an operation unit showing a backward movement operation of the slider.

FIG. 13 is a front view of an operation unit according to a second embodiment.

14 is a sectional view taken along line XIV-XIV in FIG. 13.

FIG. 15 is a partial cross-sectional view of the heart showing the structure of the heart and the procedure of the Kent bundle cautery treatment.

FIG. 16 is a graph schematically showing the pulsation of the left ventricle.

FIG. 17 is a graph schematically showing the pulsation of each part of the heart.

FIG. 18 is a schematic sectional view of an operation unit according to a conventional example.

FIG. 19 is a schematic front view of an operation unit according to another conventional example.

[Explanation of symbols]

 3, 5, 63, 65 ... Housing 9, 10 ... Cylindrical body 11, 12 ... Slider holder 17, 18, 29 ... Compression coil spring 19 ... Push button 20, 21 ... Pipe 22 ・ ・ ・ Slider 25 ・ ・ ・ Male screw 26 ・ ・ ・ Annular handle 27 ・ ・ ・ Female screw 30, 30A, 30B ・ ・ ・ Wire 32, 33, 34, 35 ・ ・ ・ Wiring 41, 61 ・ ・ ・ Operating part 42 ... Catheter body 43 ... Catheter body rear end side 50 ... Catheter body tip end side 51 ... Flexible tube 52 ... Metal plate 53 ... Large tip (cauterization electrode) 54 ・ ・ ・ Large chip terminal board 55,56,57 ・ ・ ・ Ring electrode 81 ・ ・ ・ Heart 92 ・ ・ ・ Kent bundle

Claims (1)

(57) [Claims] 1. A catheter main body and an operating portion for bending the distal end side of the catheter main body, the operating portion including a rotating member and a rotating member that engages with the rotating member. A moving member that moves in conjunction with the moving member, the housing includes a moving member, and adjusting means for adjusting the movement of the moving member is provided between the rotating member and the moving member. A moving member holder for fixing the end of a support rod slidably supporting the moving member is provided inside the cylindrical body, and the wall portion side of the housing on the side where the adjusting means is present. A state in which a biasing means is constantly biased by the biasing means, and a releasing means for releasing the engagement between the rotating member and the moving member is continuously provided at an end portion in the biasing direction of the moving member holder. Attach to the through hole formed in the wall of the housing. The connecting means for connecting the distal end of the catheter body and the moving member applies a bending force to the distal end of the catheter body when the moving member is moved by the rotation of the rotating member, From this bent state, the releasing means is actuated against the urging means to move the moving member holder together with the support rod in the cylindrical body, and the moving member moves with respect to the rotating member. A catheter configured to be disengaged and return to its original position so that the catheter body returns to its original shape.