JP3972129B2 - 経血管・超音波・血行動態評価用カテーテル装置 - Google Patents
経血管・超音波・血行動態評価用カテーテル装置 Download PDFInfo
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Description
現在、多くの介入処置は、例えばバルーン膨張カテーテルのようなカテーテルを介して行うことができる。弁形成および異常のある心臓組織の切除は、頻繁的に行われる2つの処置例である。
A.超音波周波数:ここで提案された装置は、最適には、5〜20MHz、最も好ましくは7〜10MHzの周波数の変換器を使用する。超音波画像化・血行動態評価用カテーテル(UIHC)に使用される低い方の周波数は、心臓の隔膜、弁および血管外構造などの大きな対象物を画像化する必要性を反映したものである。
1.診断的画像化: 前記カテーテル20は、診断的な心臓内および経血管部の画像化を効率的に行うことができる。この用途は、どちらかと言えば、侵入の前に行われる。その後、同一のカテーテルシステム、および、その特有の送り能力を用いて、侵入が行われる。診断的な画像化のいくつかの例には、1)心臓内の欠陥の正確な画像化および測定、2)弁オリフィスの特性づけ、3)腫瘍およびその付着部の検出、4)などが含まれる。血管外診断には、1)膵臓の塊/異常の画像化、2)腹膜後の異常の画像化、3)頭蓋骨内の画像化、4)血管周囲の異常の認識、5)などが含まれる。
2.応用画像化: これは、前記カテーテルの使用、および、以下のような別の器具を送り、次いで以下のような別の技術を応用するための画像化能力を意味する。
1)隔膜の欠陥部分を閉じる閉塞装置、
2)バイパス路を処置するための切除カテーテル、
3)刃を用いた中隔開口用カテーテル、または、レーザを用いたカテーテルシステムによるもののようなきずの創出、および、
4)弁形成の監督指示、等
切除などの応用を直接的に画像化することによって、より安全に且つ反復的に処理を行うことができる。
侵入式腹腔鏡検査法と同様に、心臓内超音波法は、1)画像化、2)治療装置の送り、及び3)非侵襲性心臓外科技術を開発するために使用可能な同時的血行動態評価、を実現することができる。心臓内または血管系内に1つまたは2つ以上の装置を同時に使用することにより、非侵襲性外科療法を開発する可能性が開かれる。このような例としては、1)目視しながら第1の装置によって腫瘍を捉らえ、目視しながら第2の装置によってその付着部を切断することによって心臓腫瘍を除去し、心臓内の塊部分を摘出すること、2)目視しながらバイパス路に電気生理学的カテーテルを配置し、次いで、直接的な超音波画像化によって、第2の装置を用いてカテーテルの下にあるバイパス路を切除すること、3)心房内の欠陥の発生、導管の擬似内膜閉塞に見られるような血栓の蒸気療法などのレーザ外科手術を目視しながら行うこと、4)目視しながら心臓または血管から異物を除去すること、および、5)血管内から経血管外科手術を案内し、または、付随する血行動態の変化をモニタすること、が含まれる。
A.無線周波数切除:現在、バイパス路は、心房室弁 をシステム的に写像する電気生理学的研究によって検出されている。切除用カテーテルの位置は、X線透視法、および、前記切除用カテーテルの基準カテーテルからの距離に関係する電気的測定によって検出される。カテーテル20により、直接的な超音波画像化の下に、オペレータは房室弁を写像することができる。このようにして、カテーテルの配置精度、および、応用される治療法の正確さが向上し、即時の結果評価が可能になる。
上述した切除技術は、 特に、(三尖弁の輪部分附近の)右側のバイパス路に適用可能である。これは、三尖弁の輪部分の上の大静脈にカテーテル20を挿通することによって行われる。
左側のバイパス路については、カテーテル20は、直接的な超音波画素化に基づいて、心房隔壁を横切る状態に挿入される。こうして、僧帽弁の輪部分が直接的に写像可能になり、場所的に限定されたバイパス路を、視覚的な超音波による及び血行動態評価に関する情報に基づいて、精確に切除可能になる。弁における孔形成のような複雑な余病、切除エネルギの正確でない適用、および、不注意による正常な伝導組織の切除は、大幅に減少することになる。
バイパス路の切除は、ここに提案された超音波介入カテーテルシステムの理想的な使用例である。
心臓について安全な生検が可能な時代においては、精確な生検が必要になる。心臓内腫瘍への生検装置の超音波による案内、傷の回避、および、疑わしき組織の選択的な生検は、カテーテル装置20によって実現可能である。心臓カテーテル療法においてより頻繁に生命の脅威となる余病の1つは、カテーテルによって心臓に孔が形成されることである。このような余病は、心臓生検、電気生理学的なカテーテル操作、および、弁形成術において一般的に発生する。超音波による心臓内画像化、血行動態評価および送りカテーテルの使用は、これら処置の安全性を大幅に向上させる。
カテーテル20は、従来のカテーテルを用いたシステムのどれとも極めて異なるものである。カテーテル20は、その他の多用な器具を心臓血管系(心臓および血管)内の特定箇所に送る能力のみならず、画像化能力および血行動態評価能力を有する。カテーテル20は、将来開発される理想的な診断具および治療具であると考えられる。ここに提案された用途は、より高い精確性、適用性および安全性を促進する。超音波は、血液で充填されたスペース内から、および、該スペースを介して、他の水または流体で充填された組織中への画像化を可能にする。カテーテル20は、究極的な介入型システムに進化するであろう。
Claims (12)
- 長軸を有し、基端部と先端部との間に円筒状の側面を有し、先端部が被検者の血管系を通り、体内の液で満たされた腔の内部に達するような寸法と柔軟性を有する長尺な本体(22)と、
先端部に近い本体(22)の湾曲した側面に取り付けられ、超音波信号(50)を送信すると同時に、その結果としての、前記長尺な本体の先端部近傍の視野内にある前記腔の画像を形成するのに適した超音波信号を受信するとともに、また同時に視野内の流量を測定する変換素子を有する、リニア・フェーズド・アレー超音波変換器(30)と、
前記本体(22)内に配設されており、前記超音波変換器(30)に接続されるとともに、該本体の全長に亘り基端部まで伸延して医療装置(34,35,37,39)に接続された電気導体(32)と、を有する侵入型のカテーテル装置(20)。 - 前記治療装置がドップラー血流測定法により前記流量を測定するために設けられている、請求項1に記載のカテーテル装置。
- 前記長尺な本体(22)の全長に亘って形成されたガイドワイヤポートを有する、請求項1に記載のカテーテル装置。
- 前記液で満たされた腔は心室である、請求項1に記載のカテーテル装置。
- 前記長尺な本体(22)の基端部(24)から先端部(26)に近い個所まで延びているアクセスポート(40)を有する、請求項1に記載のカテーテル装置。
- 前記アクセスポート(40)は、長尺な本体(22)の先端部(26)に治療器具(53)を送るための、前記超音波変換器(30)の視野内にまで伸延したポートである、請求項5に記載のカテーテル装置。
- 前記治療器具(53)は前記ポート(40)内に設けられている、請求項6に記載のカテーテル装置。
- 前記超音波変換素子は、小型で、長尺な、横方向に作用する、複面または多面フェーズド・アレー超音波変換器である、前記請求項1乃至7のいずれか一項に記載のカテーテル装置。
- 前記ドップラー血流測定は、血流量の読み出しによリ行われる、前記請求項1乃至8のいずれか一項に記載のカテーテル装置。
- 前記医療装置は、前記超音波変換器の動作を制御するための制御回路手段を有する、前記請求項1乃至9のいずれか一項に記載のカテーテル装置。
- 前記医療装置は、前記腔を画像化し、同時に流量を測定するための表示手段を有する、前記請求項1乃至10のいずれか一項に記載のカテーテル装置。
- 前記表示手段は、前記腔を画像化すると同時に、血流量の画像表示を提供するために設けられている、前記請求項11に記載のカテーテル装置。
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/790,580 US5325860A (en) | 1991-11-08 | 1991-11-08 | Ultrasonic and interventional catheter and method |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
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JP50879593A Division JP3740550B2 (ja) | 1991-11-08 | 1992-11-06 | 経血管・超音波・血行動態評価用カテーテル装置 |
Publications (2)
Publication Number | Publication Date |
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JP2005319313A JP2005319313A (ja) | 2005-11-17 |
JP3972129B2 true JP3972129B2 (ja) | 2007-09-05 |
Family
ID=25151138
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Application Number | Title | Priority Date | Filing Date |
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JP50879593A Expired - Lifetime JP3740550B2 (ja) | 1991-11-08 | 1992-11-06 | 経血管・超音波・血行動態評価用カテーテル装置 |
JP2005157344A Expired - Fee Related JP3972129B2 (ja) | 1991-11-08 | 2005-05-30 | 経血管・超音波・血行動態評価用カテーテル装置 |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
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JP50879593A Expired - Lifetime JP3740550B2 (ja) | 1991-11-08 | 1992-11-06 | 経血管・超音波・血行動態評価用カテーテル装置 |
Country Status (7)
Country | Link |
---|---|
EP (3) | EP0611292A1 (ja) |
JP (2) | JP3740550B2 (ja) |
AT (2) | ATE291373T1 (ja) |
CA (1) | CA2121353C (ja) |
DE (2) | DE69233780D1 (ja) |
ES (1) | ES2241210T3 (ja) |
SG (1) | SG50556A1 (ja) |
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US6556695B1 (en) * | 1999-02-05 | 2003-04-29 | Mayo Foundation For Medical Education And Research | Method for producing high resolution real-time images, of structure and function during medical procedures |
US20090118612A1 (en) | 2005-05-06 | 2009-05-07 | Sorin Grunwald | Apparatus and Method for Vascular Access |
ES2425388T3 (es) | 2005-05-06 | 2013-10-15 | Vasonova, Inc. | Aparato para el guiado y posicionamiento de un dispositivo endovascular |
JP5097429B2 (ja) * | 2007-04-04 | 2012-12-12 | Hoya株式会社 | セクタスキャン型超音波内視鏡の先端部 |
WO2009003138A1 (en) | 2007-06-26 | 2008-12-31 | Vasonova, Inc. | Apparatus and method for endovascular device guiding and positioning using physiological parameters |
WO2009086182A1 (en) | 2007-12-21 | 2009-07-09 | Carticept Medical, Inc. | Articular injection system |
US8545440B2 (en) | 2007-12-21 | 2013-10-01 | Carticept Medical, Inc. | Injection system for delivering multiple fluids within the anatomy |
US9044542B2 (en) | 2007-12-21 | 2015-06-02 | Carticept Medical, Inc. | Imaging-guided anesthesia injection systems and methods |
WO2010041629A1 (ja) * | 2008-10-07 | 2010-04-15 | オリンパスメディカルシステムズ株式会社 | 血流検出装置 |
JP2012000194A (ja) * | 2010-06-15 | 2012-01-05 | Hitachi Aloka Medical Ltd | 医療システム |
US9119551B2 (en) | 2010-11-08 | 2015-09-01 | Vasonova, Inc. | Endovascular navigation system and method |
EP2671513A4 (en) * | 2011-10-27 | 2015-05-20 | Olympus Medical Systems Corp | ULTRASONIC OBSERVATION DEVICE |
JP6185048B2 (ja) | 2012-05-07 | 2017-08-23 | バソノバ・インコーポレイテッドVasonova, Inc. | 上大静脈区域及び大静脈心房接合部の検出のためのシステム及び方法 |
US11890025B2 (en) * | 2013-11-18 | 2024-02-06 | Philips Image Guided Therapy Corporation | Guided thrombus dispersal catheter |
US10307135B2 (en) * | 2013-11-20 | 2019-06-04 | Advanced Access Solutions, Inc. | Intravascular ultrasound needle guide |
US10405881B2 (en) | 2014-02-06 | 2019-09-10 | Nipro Corporation | Catheter |
WO2016170446A1 (en) * | 2015-04-20 | 2016-10-27 | Koninklijke Philips N.V. | Dual lumen diagnostic catheter |
US11006854B2 (en) * | 2017-02-24 | 2021-05-18 | Teleflex Medical Incorporated | Intravascular sensing devices having flexible tip structure |
JP7383608B2 (ja) * | 2017-11-13 | 2023-11-20 | コーニンクレッカ フィリップス エヌ ヴェ | 解剖学的構造介入用の多段ロボット |
US11464485B2 (en) | 2018-12-27 | 2022-10-11 | Avent, Inc. | Transducer-mounted needle assembly with improved electrical connection to power source |
US11647980B2 (en) | 2018-12-27 | 2023-05-16 | Avent, Inc. | Methods for needle identification on an ultrasound display screen by determining a meta-frame rate of the data signals |
WO2023121755A2 (en) * | 2021-10-21 | 2023-06-29 | Massachusetts Institute Of Technology | Systems and methods for guided intervention |
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US3938502A (en) * | 1972-02-22 | 1976-02-17 | Nicolaas Bom | Apparatus with a catheter for examining hollow organs or bodies with the ultrasonic waves |
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-
1992
- 1992-11-06 EP EP92925231A patent/EP0611292A1/en not_active Ceased
- 1992-11-06 EP EP05006116A patent/EP1568324B1/en not_active Expired - Lifetime
- 1992-11-06 JP JP50879593A patent/JP3740550B2/ja not_active Expired - Lifetime
- 1992-11-06 AT AT99112058T patent/ATE291373T1/de not_active IP Right Cessation
- 1992-11-06 ES ES99112058T patent/ES2241210T3/es not_active Expired - Lifetime
- 1992-11-06 DE DE69233780T patent/DE69233780D1/de not_active Expired - Lifetime
- 1992-11-06 EP EP99112058A patent/EP0950373B1/en not_active Expired - Lifetime
- 1992-11-06 SG SG1996004907A patent/SG50556A1/en unknown
- 1992-11-06 DE DE69233494T patent/DE69233494T2/de not_active Expired - Lifetime
- 1992-11-06 AT AT05006116T patent/ATE457155T1/de not_active IP Right Cessation
- 1992-11-06 CA CA002121353A patent/CA2121353C/en not_active Expired - Lifetime
-
2005
- 2005-05-30 JP JP2005157344A patent/JP3972129B2/ja not_active Expired - Fee Related
Also Published As
Publication number | Publication date |
---|---|
JPH07505791A (ja) | 1995-06-29 |
EP0950373A2 (en) | 1999-10-20 |
EP1568324B1 (en) | 2010-02-10 |
DE69233494T2 (de) | 2006-02-16 |
DE69233780D1 (de) | 2010-03-25 |
CA2121353A1 (en) | 1993-05-13 |
ATE291373T1 (de) | 2005-04-15 |
EP0950373B1 (en) | 2005-03-23 |
JP2005319313A (ja) | 2005-11-17 |
CA2121353C (en) | 2004-03-09 |
JP3740550B2 (ja) | 2006-02-01 |
SG50556A1 (en) | 1998-07-20 |
ATE457155T1 (de) | 2010-02-15 |
EP0950373A3 (en) | 2000-05-03 |
EP1568324A3 (en) | 2005-10-26 |
DE69233494D1 (de) | 2005-04-28 |
EP1568324A2 (en) | 2005-08-31 |
ES2241210T3 (es) | 2005-10-16 |
EP0611292A1 (en) | 1994-08-24 |
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