JP4270871B2 - 輪形成バンド及び方法 - Google Patents
輪形成バンド及び方法 Download PDFInfo
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- JP4270871B2 JP4270871B2 JP2002572911A JP2002572911A JP4270871B2 JP 4270871 B2 JP4270871 B2 JP 4270871B2 JP 2002572911 A JP2002572911 A JP 2002572911A JP 2002572911 A JP2002572911 A JP 2002572911A JP 4270871 B2 JP4270871 B2 JP 4270871B2
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- band
- annuloplasty
- annuloplasty band
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2445—Annuloplasty rings in direct contact with the valve annulus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2445—Annuloplasty rings in direct contact with the valve annulus
- A61F2/2448—D-shaped rings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2466—Delivery devices therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2496—Devices for determining the dimensions of the prosthetic valve to be implanted, e.g. templates, sizers
Description
上述したように、輪形成リング及び輪形成バンドの双方は、房室弁の修復のために利用できる。輪形成リングの例は、米国特許第5,306,296号;米国特許第5,669,919号;米国特許第5,716,397号、米国特許第6,159,240号に示されており、その教示内容は参考として引用し本明細書に含めてある。また、デュラン(Duran)CMGらによる、房室弁の再形態形成用の完全に可撓性の補綴用リングの臨床的及び血行動態的性能(Clinical and Hemodynamic Performance of a Totally Flexible Prosthetic Ring for Atrioventricular Valve Reconstruction)(胸部外科手術年鑑)(Annals of Thoracic Surgery)1976;22(5):458-63);及びテ゛ュランCMGによる、前僧帽弁索の引伸び裂傷の修復(Repair of Anterior Mital Leaflet Chordal Rupture of Elongation)(フリップ−オーバ技術(The Filip-Over Teghnique))胸部外科手術ジャーナル(Journal of Cardiac Surgery)1986;1(2):161-66)も参照するとよい。可撓性の輪形成リングは、米国、ミネソタ州、フリッドレイのメドトロニク(Medtronic)インコーポレーテッドによって「デュアラン(DURAN)(登録商標名)」という商品名で市販されている。一般的な用語において、輪形成リングは、弁の輪の前部分及び後部分の双方を完全に取り囲む。後部分は、疾患状態となりすなわち拡張し且つ心臓の組織によって十分に支持されないことが多い。これに反して、前部分は、周囲の心臓組織によって十分に支持されている。このように、輪形成リングは、健全な前部分を過度に支持して組織の破断に至る可能性がある。
(a)シースと、該シース内に配置された、全体として円弧状の補強要素であって、第一の端部から第二の端部まで伸び、補強要素が輪形成バンド弁の輪に固着すべく縫合糸を受け入れ得るようにされたアイレットをその第一の端部及び第二の端部に有する該補強要素とを備える輪形成バンドを提供するステップと、
(b)弁の輪の弁膜尖を取り囲み得るように輪形成バンドを弁の輪に沿って配置し、補強要素の第一及び第二の端部が弁の輪の所望の部分に隣接する位置に配置されるようにするステップと、
(c)アイレットを弁の輪に固着するステップとを備えている。
Claims (30)
- 弁の輪を形成する房室弁を修復するための輪形成バンドにおいて、
シースと、
該シース内に配置された全体として円弧状の補強要素であって、第一の端部から第二の端部まで伸びており、第一の端部及び第二の端部の各々が、輪形成バンドを弁の輪に縫合する縫合糸を受け入れ得るようにされたアイレットを有する補強要素と、を含む輪形成バンド。 - 請求項1の輪形成バンドにおいて、弁が、前−側方三角と、後弁膜尖と、後−中間三角とを有する僧帽弁であり、更に、アイレットが、輪形成バンドを縫合糸を介して前−側方三角及び後−中間三角にそれぞれ縫合し得るようにされた、輪形成バンド。
- 請求項1の輪形成バンドにおいて、弁が、前弁膜尖と、後弁膜尖と、中隔の弁膜尖とを有し、該弁膜尖の各々が弁の輪に対して基部により画成される三尖弁であり、更に、アイレットが、輪形成バンドを縫合糸を介して中隔の弁膜尖の基部及び前弁膜尖の基部にそれぞれ固着し得るようにされた、輪形成バンド。
- 前記補強要素は両端がアイレットと形成し得るようにそれ自体に折り重ねられたワイヤーを有する請求項1の輪形成バンド。
- 前記ワイヤーはエラストマー的材料にてオーバモールドされる請求項4の輪形成バンド。
- 前記エラストマー的材料は生体適合性の熱可塑性材料及びシリコーンから成る群から選ばれた材料を含む請求項5の輪形成バンド。
- 請求項4の輪形成バンドにおいて、ワイヤーが、第一の曲率半径を有する中間部分と、各々が第二の曲率半径を有する両端部分とを有し、第一の曲率半径が第二の曲率半径よりも大きい複合曲線を画成し得るような形態とされる、輪形成バンド。
- 請求項7の輪形成バンドにおいて、一端部分の各々が、
中間部分から外方に伸びて、第二の曲率半径を有する遷移部分と、
該遷移部分から伸びて、第三の曲率半径を有する一端部分とを有し、
第二の曲率半径が第三の曲率半径よりも大きいようにした、輪形成バンド。 - 前記補強要素は成形した重合系要素を有する請求項1の輪形成バンド。
- 前記シースはアイレットの位置を表示し得るように標識付けされる請求項1の輪形成バンド。
- 前記シースはシースの色と異なる色を有する縫合糸によりアイレットの配置を表示し得るように標識付けされる請求項10の輪形成バンド。
- 前記補強要素は放射線不透過性である請求項1の輪形成バンド。
- 前記シースは織地材料で作られている請求項1の輪形成バンド。
- 前記シースは生物学的組織で作られている請求項1の輪形成バンド。
- 約3mm以下の厚さを有する請求項3の輪形成バンド。
- 前記補強要素はX−Y平面内で全体として円弧状でありZ平面内で全体として鞍状形状である請求項1の輪形成バンド。
- 弁の輪を画成する患者の心臓弁にて行われる輪形成外科手術において外科医が使用する輪形成バンド及びホルダの組み合せ体において、
シース、及びシース内に配置された全体として円弧状の補強要素であって第一の端部から第二の端部まで伸びており第一の端部及び第二の端部の各々が輪形成バンドを弁の輪に固着するため縫合糸を受け入れ得るようにされたアイレットを形成する補強要素を含む輪形成バンドと、
輪形成バンドを選択的に維持するホルダと、を含み、
前記ホルダは、全体として輪形成バンドの曲率に相応する曲率を画成する円周を形成するバンド保持板であって、該円周が、輪形成バンドをバンド保持板に取り付けたとき、アイレットの周りに隙間を提供し得るようにされた切欠きを形成するバンド保持板を含む前記組み合せ体。 - 前記補強要素は両端がアイレットを形成するようにそれ自体に折り重ねられたワイヤーを備え、該ワイヤーはエラストマー材料にてオーバモールドされる請求項17の組み合せ体。
- 前記シースはアイレットの配置を表示し得るように標識付けされる請求項17の組み合せ体。
- 前記シースはシースの色とコントラストのある色を有する縫合糸によりアイレットの配置を表示し得るように標識付けされる請求項19の組み合せ体。
- 請求項17の組み合せ体において、輪形成バンド及びバンド保持板が僧帽弁を修復し得るようにされる、組み合せ体。
- 請求項17の組み合せ体において、輪形成バンド及びバンド保持板が、三尖弁を修復し得るようにされる、組み合せ体。
- 請求項1の輪形成バンドにおいて、輪形成バンドは約3mm以下の厚さを有する、前記輪形成バンド。
- 約2.7mm以下の厚さを有する請求項23の輪形成バンド。
- 約2.5mm以下の厚さを有する請求項23の輪形成バンド。
- 前記補強要素がその端部にてアイレットを形成する請求項23の輪形成バンド。
- 弁の輪を画成する患者の心臓にて行われる輪形成外科手術において外科医が使用する輪形成バンド及びホルダの組み合せ体において、
シース、及びシース内に配置された全体として円弧状の補強要素であって第一の端部から第二の端部まで伸びており第一及び第二の端部の各々が輪形成バンドを弁の輪に固着するため縫合糸を受け入れ得るようにされたアイレットを形成する補強要素を含む輪形成バンドと、
輪形成バンドの曲率と全体的に相応する曲率を画成する円周を形成するバンド保持板を有するホルダと、
輪形成バンドの第一の端部の周りにループ状に巻かれ且つ輪形成バンドの第一の端部をバンド保持板に対して保持する第一の縫合糸と、
輪形成バンドの第二の端部の周りでループ状に巻かれ且つ輪形成バンドの第二の端部をバンド保持板に対して保持する第二の縫合糸とを備える、組み合せ体。 - 請求項27の組み合せ体において、輪形成バンドの中央部分をバンド保持板に対して保持する、保持板における指状体を更に備える、組み合せ体。
- 請求項27の組み合せ体において、第一の縫合糸を輪形成バンドの第一の端部から解放する第一の切断点と、第二の縫合糸を輪形成バンドの第二の端部から解放する第二の切断点とを更に備える、組み合せ体。
- 請求項27の組み合せ体において、第一の縫合糸及び第二の縫合糸が輪形成バンドに貫入しないようにした、組み合せ体。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US27617401P | 2001-03-15 | 2001-03-15 | |
PCT/US2002/007948 WO2002074197A2 (en) | 2001-03-15 | 2002-03-13 | Annuloplasty band and method |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2004528885A JP2004528885A (ja) | 2004-09-24 |
JP4270871B2 true JP4270871B2 (ja) | 2009-06-03 |
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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JP2002572911A Expired - Fee Related JP4270871B2 (ja) | 2001-03-15 | 2002-03-13 | 輪形成バンド及び方法 |
Country Status (5)
Country | Link |
---|---|
US (3) | US6955689B2 (ja) |
EP (1) | EP1370202B1 (ja) |
JP (1) | JP4270871B2 (ja) |
DE (1) | DE60234912D1 (ja) |
WO (1) | WO2002074197A2 (ja) |
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2001
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2002
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US8585614B2 (en) | 2013-11-19 |
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WO2002074197A3 (en) | 2003-07-17 |
EP1370202A2 (en) | 2003-12-17 |
US6955689B2 (en) | 2005-10-18 |
DE60234912D1 (de) | 2010-02-11 |
JP2004528885A (ja) | 2004-09-24 |
WO2002074197A2 (en) | 2002-09-26 |
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