JP6439510B2 - Biometric instrument and auxiliary equipment set - Google Patents

Description

  The present invention relates to a biometric instrument and an auxiliary instrument set that measure the distance between physically separated locations in a living body.

  Advances in medical technology have made it possible to perform surgical treatment at various locations in the living body. For example, the symptom of mitral insufficiency, in which the opening and closing of the heart leaflets is hindered due to rheumatic diseases, is known, and mitral valvuloplasty (MVP) is a surgical treatment for treating such symptoms. : Mittal Valve Plastic) is known.

The heart structure and MVP will be specifically described below.
The heart has left and right atria and ventricles, which are circulated in a predetermined direction by mitral, tricuspid, aortic and pulmonary valves to prevent backflow.
FIG. 1 is a schematic diagram of a human heart 300. For example, a mitral valve 310 is formed between the left atrium 302 and the left ventricle 304, and two leaflets 210 protrude from the left atrium 302 toward the left ventricle 304. When the left atrium 302 contracts, the valve leaflet 210 opens and the blood flow is sent to the left ventricle 304. When the left ventricle 304 contracts, the valve leaflet 210 closes and the blood flow flows back to the left atrium 302. prevent. Thereby, blood flow is unilaterally sent from the left ventricle 304 to the aorta 320. The tricuspid valve 312, the aortic valve 314, and the pulmonary valve 316 are each composed of three valve cusps 210, from the right atrium 306 to the right ventricle 308, from the left ventricle 304 to the aorta 320, and from the right ventricle 308 to the pulmonary vein 322. Each unilaterally sends out blood flow.

  The normal leaflet 210 is connected to the papillary muscle 212 located downstream of the valve leaflet 210 in the normal blood flow direction by the chordae 214. In FIG. 1, only the mitral valve 310 and the tricuspid valve 312 illustrate the papillary muscle 212 and the chordae 214, and the aortic valve 314 and the pulmonary valve 316 are not shown. The leaflet 210 is connected to the papillary muscle 212 by the chord 214 to maintain the state of protruding toward the downstream side in the blood flow direction. When the valve leaflets 210 are closed, the valve leaflets 210 are in close contact with each other and close together to close the heart valve. Further, when the heart valve is closed, the protruding state of the leaflet 210 is maintained against the pressure of the blood flow that flows backward, and the leaflet 210 does not reverse in the reverse direction.

  However, in the case of the mitral valve 310, for example, there is a symptom of mitral regurgitation in which the opening and closing of the valve leaflet 210 is hindered due to rheumatic diseases or ruptured chordae. In such a case, the chords 214 that connect the leaflets 210 of the mitral valve 310 and the papillary muscles 212 extend or break. As a result, even when the papillary muscle 212 contracts, the leaflet 210 is not sufficiently closed, or the leaflet 210 is inverted toward the left atrium 302. Similarly, regarding aortic valve 314, tricuspid valve 312, and pulmonary valve 316, an insufficiency that impedes opening and closing of valve leaflet 210 has been reported. MVP is a surgical treatment aimed at normalizing the operation of the leaflet 210 by connecting the leaflet 210 and the papillary muscle 212 with an artificial chord to cope with such symptoms.

  Patent Document 1 discloses an instrument used for mitral valve plasty, which is sewed on a papillary muscle contact portion that makes contact with a sewn portion of an artificial chord in the papillary muscle, and a leaflet of the artificial chord. An auxiliary device is described having a hook for hooking the side to be touched. The hook portion is formed on the distal end side of the rod-shaped gripping portion, and the most advanced papillary muscle contact portion of the auxiliary device and the hook portion are provided apart from each other by a predetermined dimension. While holding the artificial chords sewn on the papillary muscles at the papillary muscle contact part, the artificial chords can be made the length of the above-mentioned predetermined size by tying both ends of the artificial chords together on the hook part it can. Thereby, according to the said auxiliary device, it is supposed that a papillary muscle and a leaflet can be connected with the artificial chord of desired length. In addition, in order to connect a desired length with an artificial chord, it is described that an auxiliary device corresponding to the length of the artificial chord to be reconstructed is selected, and an attempt to deal with the desired length is made. ing.

JP 2009-268632 A

  By the way, in using the auxiliary device described in Patent Document 1, there are the following problems. That is, Patent Document 1 describes that careful determination is made with reference to a preoperative echocardiogram or the like when determining the length of an artificial chord. However, pre-operative echocardiograms and the like have limitations in measuring the distance between the leaflets 210 and the papillary muscles 212 and appropriately determining the length of the artificial chords of the order of several tens to several tens of millimeters. It was. For this reason, even if an auxiliary device that matches the length of the artificial chord determined by an echocardiogram before surgery is selected, it does not actually correspond to the distance between the leaflet 210 and the papillary muscle 212, Inadequate length of chords could occur.

  The problem of mismatching of the length of the artificial chord in the implementation of MVP described above is a problem that arises because it is difficult to directly measure the distance between the leaflet and the papillary muscle. MVP is an example of a surgical operation in a living body, but the distance between a first part in the living body and a second part physically separated from the first part is accurately determined in other various surgical operations. There was a need for a measurable instrument.

  The present invention has been made in view of the above-described problems, and is a biological measurement capable of accurately measuring the distance between a first part in a living body and a second part physically separated from the first part. A tool and an auxiliary tool set are provided.

  The biometric instrument of the present invention is a biometric instrument that measures the distance between a first part in a living body and a second part that is physically separated from the first part, and is in contact with the first part. A first insertion port provided with a possible end contact portion at one end in the longitudinal direction of the biometric instrument, and through which an artificial thread that is provided at the end contact portion and is sewn to the first portion is inserted; The artificial end inserted in the first insertion port provided at the other end in the longitudinal direction opposite to the end abutting portion or an intermediate portion that is an intermediate region between the end abutting portion and the other end It has a drawing part by which a thread is drawn out to the outside of the biometric instrument, and a measuring part that is provided in the intermediate part and measures the distance between the first part and the second part.

  The auxiliary instrument set of the present invention connects the biometric instrument of the present invention to the leaflets of the heart valve and the papillary muscle located downstream of the valve leaflets in the normal blood flow direction with artificial chordae. And an artificial chordae forming aid used for the purpose.

According to the assist device for forming an artificial chordae of the present invention, the leaflet of the heart valve (ie, the first portion) and the papillary muscle (ie, the second portion) physically separated from the leaflet are easily obtained. It is possible to accurately measure the distance of a predetermined part in the living body such as a distance.
Further, according to the assisting device set of the present invention, the biometric device of the present invention measures the distance between the leaflets of the heart valve and the papillary muscle, and the artificial chordae forming assisting device having a length corresponding to the distance is provided. It can be used to finish the artificial chord to a desired length.

It is a schematic diagram of a human heart. (A) is a side view of the biometric instrument of the first embodiment of the present invention, (b) is a back view of the above-mentioned biometric side view, and (c) is a cross-sectional view taken along line II of (a). And (d) is a sectional view taken along line II-II in (a). (A) is a schematic diagram showing a state in which an abnormality has occurred in the chord to connect the leaflet and the papillary muscle, (b) is a schematic diagram showing a state in which an artificial thread is sewn on the papillary muscle, (c) is a schematic diagram showing a state in which the biometric instrument of the first embodiment is attached to an artificial thread sewn on the papillary muscle, and (d) is a diagram of the papillary muscle and valve leaflet according to the biometric diagram of the first embodiment. It is a schematic diagram which shows the state which measured the distance. (A) And (b) is a side view which shows the modification of the biometric instrument of 1st embodiment. It is explanatory drawing of the auxiliary tool set of this invention. (A) is a perspective view of an example of an artificial chordae forming auxiliary tool used in the auxiliary tool set of the present invention, and (b) is a front view of the artificial chordae forming auxiliary tool. (A) is a schematic diagram showing a state in which each of a pair of artificial chordae forming auxiliary devices is attached to the artificial chordae, and (b) is a pair of artificial tendons to which the artificial chordae forming auxiliary device is attached. It is a schematic diagram which shows the state which tied the cord mutually, (c) is a schematic diagram which shows the state which removes the auxiliary tool for artificial chordae formation from an artificial chord.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In each drawing, corresponding constituent elements are denoted by common reference numerals, and redundant description is omitted as appropriate.

  2A is a side view of the biometric device 100 according to the first embodiment of the present invention, FIG. 2B is a back view of the biometric device 100, and FIG. 2C is FIG. ) Is a cross-sectional view taken along the line II of FIG. 2, and FIG. 2D is a cross-sectional view taken along the line II-II of FIG. FIG. 3A is a schematic diagram showing a state in which an abnormality has occurred in the chords 214 that connect the leaflets 210 and the papillary muscles 212. FIG. 3B shows an artificial thread (artificial chords 200 on the papillary muscles 212). 3) is a schematic diagram showing a state in which the biometric instrument 100 of the first embodiment is attached to an artificial thread (artificial chord 200) sewn on the papillary muscle 212. FIG. 3D is a schematic diagram showing a state in which the distance between the papillary muscle 212 and the leaflet 210 is measured by the biometric instrument 100 of the first embodiment. FIG. 4A and FIG. 4B are side views showing a modification of the biometric instrument 100 of the first embodiment.

  First, an outline of the biometric instrument 100 of the present embodiment will be described.

  The biometric instrument 100 is a biometric instrument that measures the distance between a first part in a living body and a second part that is physically separated from the first part. The biometric instrument 100 is provided with an end abutting portion 10 that can abut on a first part at one end 110 in the longitudinal direction of the biometric instrument 100. The biometric instrument 100 includes a first insertion port 20 through which an artificial thread that is provided in the end contact portion 10 and is sewn to the first portion is inserted, and the other in the longitudinal direction facing the end contact portion 10. An extraction portion provided in the end portion 112 or an intermediate portion that is an intermediate region between the end portion contact portion 10 and the other end 112 and through which the artificial thread inserted through the first insertion port 20 is pulled out outward of the biometric device. (Second insertion port 30) and a measurement unit 40 that is provided in the intermediate part and measures the distance between the first part and the second part.

As shown in FIG. 3C, the biometric instrument 100 has an end contact portion in a state where an artificial thread (artificial chord 200) is inserted through the first insertion port 20 and the second insertion port 30. 10 can be brought into contact with the first part (papillary muscle 212). In this state, the artificial thread (artificial chord 200) inserted through the first insertion port 20 and the second insertion port 30 is operated, or the grasping portion 50 is grasped, and the biometric instrument 100 is pointed in an appropriate direction. Then, the end contact portion 10 is temporarily fixed to the first portion (papillary muscle 212). In the temporarily fixed state, the biometric instrument 100 is arranged so that the longitudinal direction of the biometric instrument 100 is substantially parallel to the linear direction connecting the first part (papillary muscle 212) and the second part (valve leaflet 210). Adjust the directivity direction. Then, by measuring the position of the second part (leaflet 210) in the measurement unit 40, the distance between the first part (papillary muscle 212) and the second part (valve leaflet 210) can be accurately measured.
In the following description, the end contact portion 10 is brought into contact with the first part (papillary muscle 212), and the biometric instrument 100 is oriented in an appropriate direction to temporarily fix the position of the end contact portion 10. In some cases, this is simply called temporary fixing. Here, the direction of the biometric instrument 100 in an appropriate direction means that a linear direction connecting the first part (arbitrary part of the papillary muscle 212) and the second part (arbitrary part of the leaflet 210) and the longitudinal direction. This means that the biometric instrument 100 is oriented in a direction that is substantially parallel to the direction. Note that the above-mentioned linear direction does not mean a specific limited direction, but means a general direction connecting two points where distance measurement is scheduled.

In the present embodiment, the measurement includes a wide range of modes in which the distance between the first part and the second part can be grasped directly or indirectly. More specifically, the measurement includes an aspect in which the distance between the first part and the second part is directly measured in vivo, and the position of the second part is recorded in the measurement unit in the temporarily fixed state described above. The aspect of measuring the distance of the recorded location and the edge part contact part 10 afterwards is included.
In the present invention, the longitudinal direction means the longitudinal direction of the biometric instrument 100 unless otherwise specified. Further, regarding the biometric instrument 100, one end and the other end mean end portions in the longitudinal direction, an end portion region means a predetermined region including the end portions and extending in the longitudinal direction, and an intermediate portion is It means the area between the end areas in the longitudinal direction.

  Next, this embodiment will be described in detail. In the following description, a case where the distance between the leaflet 210 and the papillary muscle 212 to be treated is measured in advance in order to appropriately determine the length of the assist device for forming artificial chordae used in the MVP. The present invention will be described by taking as an example. In addition, the artificial thread referred to in the present invention is a thread-like material capable of suturing a living body, and examples thereof include, but are not limited to, a suture thread or an artificial chord.

In the following description of the present embodiment, the second part is the leaflet 210 of the heart valve, and the first part is the papillary muscle 212 located downstream of the valve leaflet 210 in the normal blood flow direction. The artificial thread is an artificial chord 200.
As described above, according to the present embodiment, it is possible to accurately measure the distance between two physically separated places in a portion having a narrow visual field in the living body such as the inside of the heart. However, the following description does not limit the 1st site | part in this embodiment, the 2nd site | part, and the artificial thread at all.

  The biometric instrument 100 can be made of a soft resin material such as a soft vinyl chloride resin, a polyurethane resin, or a silicone resin. Thereby, when using it in the living body, the biological tissue which contacts the biometric instrument 100 is not damaged. It should be noted that only a predetermined portion of the biometric measuring instrument 100 such as a gripping portion 50 described later can be formed with a separate member. In the present embodiment, the entire biometric instrument 100 including the grip portion 50 is integrally formed as one material. Thereby, it is possible to reduce the manufacturing process and the number of parts without unexpectedly separating a specific part such as the grip portion 50 from the biometric instrument 100. For example, the biometric instrument 100 can be produced by injection molding of a thermoplastic soft resin material.

The biometric instrument 100 includes a first insertion port 20 and a drawing portion (second insertion port 30). The artificial chords 200 to which the biometric instrument 100 is attached are inserted into the first insertion port 20 having an opening shape and are drawn outward from the extraction portion (second insertion port 30). In the present embodiment, the lead-out portion is the second insertion port 30 having an opening shape provided at the other end 112.
The drawing portion is a portion that pulls out the artificial thread in the outward direction of the biometric instrument in a state where the biometric instrument is attached to the artificial thread. In the present embodiment, the lead-out portion is provided at the other end 112 and is a second insertion port that draws out the artificial thread in the outward direction of the biometric instrument 100 by inserting the artificial thread (artificial chord 200).

As shown in FIG. 2A, the biometric instrument 100 has a gripping part 50 for gripping the biometric instrument 100 at a position biased to the other end 112 in the longitudinal direction.
The gripping unit 50 is a part that grips the biometric instrument 100 with the fingers, tweezers, etc. (hereinafter, also simply referred to as fingers) of the operator. By providing the grip 50, the biometric instrument 100 can be easily supported in a limited space in the living body, and the operability of the biometric instrument 100 is improved.
The grip 50 in the present embodiment is formed in a single plate shape that protrudes outward from the outer periphery of the biometric instrument 100. However, the shape of the grip portion 50 is not limited to this, and is, for example, a groove formed in a circumferential direction at a predetermined position on the outer periphery of the biometric measuring instrument 100, and a recess (not shown) into which the tip of the tweezers can be fitted. There may be.

  By providing the grip 50 at a position biased toward the other end 112, the end contact portion 10 is brought into contact with the papillary muscle 212 to confirm the position of the leaflet 210 and the distance between the papillary muscle 212 and the leaflet 210. When measuring, it is suppressed that the gripping part 50 interferes with the measurement work (see FIG. 3D). From this point of view, it is more preferable that the grip 50 is provided in the end region of the biometric instrument 100 as shown in FIG.

  The end contact portion 10 in the present embodiment is formed in a planar shape, and consideration is given to preventing the papillary muscle 212 from being damaged when the end contact portion 10 is in contact with the papillary muscle 212. . The end contact portion 10 may be planar or curved.

As shown in FIG. 2, the biometric instrument 100 of the present embodiment is provided with an artificial thread guide portion 70 that extends in the longitudinal direction across the first insertion port 20 and the drawing portion (second insertion port 30). ing. Thereby, the insertion state of the artificial chord 200 (see FIG. 3C) inserted through the first insertion port 20 and the second insertion port 30 can be stabilized. FIG. 3C shows a state in which the artificial thread guide unit 70 is inserted into the first insertion port 20 and the second insertion port 30 and is guided to the artificial thread guide unit 70 (not shown).
Here, the guide means that the artificial chord chord 200 is restricted from moving in at least a part of the direction orthogonal to the longitudinal direction of the biometric instrument 100.
An example of the biometric instrument 100 including the artificial thread guide portion 70 is a hollow cylinder, and one end opening is the first insertion port 20 and the other end opening is the second insertion port 30. A mode (illustration omitted) provided with a central lumen which continues between part openings can be mentioned. The whole biometric instrument 100 is not limited to a hollow cylindrical shape, and a part of the biometric instrument 100 is a hollow cylindrical shape having a central lumen communicating in the longitudinal direction, and the central lumen is used as an artificial thread. It can also function as the guide unit 70.

  The 2nd insertion port 30 in this embodiment is provided in the other end 112 as shown in FIG.2 (b). That is, the biometric instrument 100 of the present embodiment is long, and the first insertion port 20 and the second insertion port 30 are provided at one end 110 and the other end 112, respectively. Thereby, by operating the artificial chord 200 inserted through the first insertion port 20 and the second insertion port 30, it is easy to direct the entire longitudinal direction of the biometric instrument 100 in a desired direction. However, this is an example of the present invention and does not exclude that the second insertion port 30 is provided at a place other than the other end 112. For example, the second insertion port 30 can also be provided at an arbitrary position in the intermediate portion of the biometric instrument 100 (not shown).

  By the way, as shown in FIG. 3B, an artificial thread such as the artificial chord 200 used for the biometric instrument 100 may be provided with curved puncture needles 202 at both ends. In such a case, it may be physically difficult to pass the puncture needle 202 through the first insertion port 20, the second insertion port 30, and the artificial thread guide portion 70.

In such a case, the artificial thread guide section 70 is continuously provided with an opening section 60 (see FIG. 2B) that opens with an opening width that can receive the artificial thread (artificial chord 200). It is good to have been. Accordingly, the opening 60 can be attached to the artificial thread guide 70 along the opening 60 and can be detached from the artificial thread guide 70 along the opening 60.
Specifically, as shown in FIG. 3B, the artificial thread (artificial chord 200) sewn on the papillary muscle 212, which is the first part in the living body, faces the opening 60 to face the artificial thread. The guide part 70 can be attached.
Even if it is an artificial thread (artificial chord 200) that does not have the curved puncture needle 202, the threading operation of passing the thread through the small-diameter cavity takes time. On the other hand, the threading operation can be omitted by providing the opening 60. As shown in FIG. 2B, the opening 60 in the present embodiment extends between the first insertion port 20 and the second insertion port 30 in a substantially linear shape. As a modified example not shown, at least a part of the opening 60 may extend in the direction intersecting the longitudinal direction. This makes it difficult for the artificial chords 200 inserted in the first insertion port 20 and the second insertion port 30 and disposed in the artificial thread guide portion 70 to pass through the opening 60 and to be detached from the biometric device 100. Can do. More specifically, for example, the opening 60 can be formed in a spiral shape across the first insertion port 20 and the second insertion port 30. Moreover, the opening part 60 may have the linear part with respect to a longitudinal direction between the 1st insertion port 20 and the 2nd insertion port 30, and a spiral part or a curved part.

As shown in FIG. 2B, the biometric instrument 100 of the present embodiment is provided with a drawing portion (second insertion port 30) at the other end 112. As shown in FIG. 2 (c), the minimum opening width of the opening 60 observed on the cut surface cut in the direction orthogonal to the longitudinal direction is smaller than that of the both end regions in the longitudinal direction. It is configured to be larger. The minimum opening width here means the minimum width dimension of the opening 60 observed on the cut surface.
More specifically, as shown in FIG. 2 (c), the minimum opening width of the opening 60 in the end region of the biometric instrument 100 is W1, and as shown in FIG. The minimum opening width of the opening 60 in the intermediate portion is W2. Here, the biometric instrument 100 in the present embodiment has a relationship of minimum opening width W1 <minimum opening width W2, the end region has a narrow width region 60a having the minimum opening width W1, and the intermediate portion has a relatively width. A thick region 60b having a large minimum opening width W2 is formed. The narrow region 60a and the wide region 60b are easily observed by the cross section as shown in FIGS. For example, the minimum opening width W2 is sufficiently larger than the diameter (wire diameter) of the artificial chord 200. Further, for example, the minimum opening width W <b> 1 is approximately the same as the diameter (wire diameter) of the artificial chords 200, or the dimension of the artificial chords 200 or less.

As described above, the opening 60 has the narrow region 60a, so that the state in which the artificial chord 200 is attached to the biometric instrument 100 can be satisfactorily maintained, and the biometric measurement is inadvertently performed during the procedure. The artificial chord 200 is prevented from detaching from the device 100.
Further, since the artificial chord 200 is smoothly detached from the wide area 60b by passing through the narrow area 60a radially outward, it is easy to remove the artificial chord 200 from the biometric instrument 100. The load on the artificial chord 200 when removing is small.

In this embodiment, an example in which the opening width of the opening 60 observed in the cross section is not uniform is shown. However, this does not exclude an embodiment in which the opening width of the opening 60 is uniform. . In the biometric instrument 100, when the opening width of the opening 60 is uniform in any cross section in the longitudinal direction, or the opening width in either the end region or the intermediate portion in the longitudinal direction is equal. Including cases. When the opening width of the opening 60 observed in the cross section is equal, the opening width having the same width (that is, the uniform opening width observed in the cross section) is set as the minimum opening width in the cross section. Recognize and determine the magnitude relationship between the minimum opening width W1 and the minimum opening width W2.
FIG. 2D shows an example in which the opening width continuously increases from the minimum opening width W2 toward the outer peripheral opening width W6. For example, the discontinuity increases from the minimum opening width W2 toward the outer peripheral opening width W6. Alternatively, the opening width may be increased (not shown). More specifically, the concave portion 70b is a concave portion that opens at 180 degrees, and has a discontinuous step from the opening end of the concave portion in the left-right direction on the paper surface (that is, the direction perpendicular to the opening direction on the paper surface). In addition, the gap may be opened from the step to the outer periphery at an equal width (not shown). In this case, the opening width at the opening of the concave portion is the minimum opening width W2, and the opening width of the equal width opening from the step toward the outer periphery is the outer peripheral opening width W6.

  As described above, the biometric instrument 100 is provided with the drawer portion (second insertion port 30) at the other end, and is observed from the outer peripheral side of the biometric instrument 100 as shown in FIGS. The outer peripheral opening width (outer peripheral opening width W5, outer peripheral opening width W6) of the opening 60 is configured such that the intermediate portion is larger than both end regions in the longitudinal direction. That is, the outer peripheral opening width W6 in the middle portion is larger than the outer peripheral opening width W5 in the end region. Therefore, the artificial chord 200 can easily pass through the outer peripheral opening width W6 by passing through the outer peripheral opening width W5, and the biometric instrument 100 can be smoothly attached to the artificial chord 200.

  As a modification not shown, the artificial thread guide portion 70 may have a half-cylindrical cylindrical shape that is continuous in the longitudinal direction at the intermediate portion.

The artificial thread guide portion 70 in the present embodiment penetrates the biometric instrument 100 longer than the diameter (outer diameter) of the one end 110 or the other end 112 in the longitudinal direction in the longitudinal end region. It is the through-hole 70a opened by the opening part 60 which allows artificial yarn (artificial chord 200) to pass through to the side so that attachment or detachment is possible. The through hole 70a in the present embodiment is formed in a substantially circular shape, for example, when viewed from the front.
Further, the artificial yarn guide portion 70 forms an arc-shaped concave portion 70b that is continuous in the longitudinal direction at the intermediate portion and in the cross section. The recess 70 b is opened laterally by the opening 60.
The through-hole 70a regulates the movement of the artificial chord 200 in substantially four directions excluding the opening 60. The recess 70b also allows the artificial chord 200 to move in the direction of the opening 60 and restricts the movement of the artificial chord 200 in other directions.
In addition, as a modification of the artificial yarn guide portion 70 not shown, the artificial yarn guide portion 70 that has a predetermined width dimension and extends in the longitudinal direction, or a half cylindrical shape continuous in the longitudinal direction. A certain artificial thread guide 70 may be mentioned. By disposing the artificial chords 200 along the plate-shaped artificial thread guide part 70, the movement of the artificial chords 200 to the plate-shaped member side can be restricted. Moreover, the movement of the artificial chords 200 can be similarly controlled by arranging the artificial chords 200 along the inner circumferential surface of the halved cylindrical shape.

As can be understood from FIGS. 2B and 2C, the outer peripheral surface 120 in the narrow region 60 a of the biometric instrument 100 is a substantially cylindrical surface except for the grip portion 50. A slit-like opening 60 is cut along the central axis (longitudinal axis) in the radial direction of the biometric instrument 100 at a depth from the outer peripheral surface 120 to the through hole 70a.
The wide area 60b of the biometric instrument 100 has a recess 70b that opens larger than the narrow area 60a (see FIG. 2D). The through hole 70 a in the narrow width region 60 a and the recess 70 b in the wide width region 60 b are connected in the longitudinal direction, and constitute the artificial yarn guide portion 70. As shown in FIGS. 2C and 2D, the biometric device 100 of the present embodiment specifically has the minimum opening width W1 <the minimum opening width W2, and the outer peripheral opening width W5 and the outer peripheral opening width W6. . The dimensions of the minimum opening width W1 and the minimum opening width W2, and the outer peripheral opening width W5 and the outer peripheral opening width W6 are intermittently changed in the longitudinal direction.
In the modification of the present embodiment (not shown), a width change region in which the width dimension changes may be provided between the narrow region 60a and the thick region 60b. For example, the width change region increases in width from the narrow region 60a to the thick region 60b.

  The opening 60 that opens the through hole 70a to the side is in the form of a slit that is cut from the outer periphery of the biometric device 100 toward the through hole 70a. The dimensions of the narrow region 60a and the through hole 70a in the longitudinal direction are substantially equal.

  For example, the opening 60 can be formed as follows. First, a narrow slit is formed over the longitudinal direction of the cylindrical body. Next, with the narrow slit remaining in the end region, a thick slit having a relatively large width dimension is formed continuously in the longitudinal direction in the intermediate portion. Thereby, the opening part 60 which has the narrow area | region 60a and the wide area | region 60b can be formed easily.

Next, the measurement unit 40 of the biometric instrument 100 will be described.
The measurement unit 40 in this embodiment is the outer peripheral surface of the biometric instrument 100. That is, the measurement unit 40 is configured by an arbitrary region on the outer peripheral surface of the biometric instrument 100.
As shown in FIG. 2A, the biometric instrument 100 of the present embodiment is a long body that extends linearly from one end 110 to the other end 112, and the measurement unit 40 is provided on the outer circumferential surface of the long body. It has been.

Here, the outer peripheral surface is a peripheral surface observed when the biometric instrument 100 is viewed from the outside. For example, as shown in FIG. 3 (d), the measurement unit 40, which is the outer peripheral surface, has the leaflet 210 (here, the teat of the leaflet 210) in a state where the end contact portion 10 is temporarily fixed. A location corresponding to the position of an arbitrary edge near the muscle 212 is recorded by the marker 220 or the like. Thereafter, the distance between the papillary muscle 212 and the leaflet 210 can be measured by measuring the distance from the end contact portion 10 to the recorded location with a dimension measuring tool such as a ruler. By using the outer peripheral surface as the measurement unit 40, the configuration of the biometric instrument 100 can be simplified, which is advantageous in terms of manufacturing and is preferable because there is no risk of damaging the living body.
The marker 220 is, for example, a rod-shaped body provided with an ink absorbing portion 221 at the end, and a marker in which a sterilized pigment that can be used in the living body (for example, picotanine) is absorbed by the ink absorbing portion 221 is exemplified. However, the present invention is not limited to this. The recording may be performed by means other than the recording using the marker 220 or the like. For example, the position of the leaflet 210 may be recorded on the outer peripheral surface by scratching the outer peripheral surface.

  For example, as shown in FIG. 2A, the measurement unit 40 may be provided with a measurement scale 12 that can measure a predetermined distance in the longitudinal direction from the end contact portion 10. Thus, the distance between the papillary muscle 212 and the leaflet 210 can be measured by confirming the position of the leaflet 210 with the measurement scale 12 while the end contact portion 10 is temporarily fixed. As an example of a specific measurement method, in a state where the end contact portion 10 is temporarily fixed, the position of the leaflet 210 with respect to the measurement scale 12 is confirmed with the naked eye or an endoscope, and the leaflet 210 is directly The distance from the papillary muscle 212 can be measured. As another example, the position of the leaflet 210 is recorded as described above, and thereafter, the recorded position with respect to the measurement scale 12 is confirmed, so that it is quickly recorded without using a separate dimension measuring tool. Can also be measured.

  A number indicating the distance from the end contact portion 10 may be attached to the measurement scale 12 as appropriate. Further, the measurement scale 12 may be a colored portion whose hue is changed at a predetermined interval, and may be configured such that the distance from the end contact portion 10 can be confirmed by confirming the color. Lines, numbers, letters or arbitrary symbols representing the measurement scale 12 may be printed on the outer peripheral surface of the biometric measuring instrument 100, or may be formed by raising or lowering the outer peripheral surface into a predetermined shape. It may be formed by a combination of these.

  As a modified example of the measurement unit 40, as shown in FIG. 4A, a mode in which a protrusion 42 that protrudes outward from the outer peripheral surface of the biometric instrument 100 and extends in the longitudinal direction is included. The protruding portion 42 is a portion having a relatively small thickness, such as a pleat shape or a plate shape, and a sufficiently large size in the longitudinal direction. For example, the protruding portion 42 continuously extends from the other end 112 toward the end contact portion 10 over a half of the longitudinal direction. It is preferable that the protrusion 42 has a size that can be picked up with a finger or the like in a direction orthogonal to the longitudinal direction. In FIG. 4A, the region near the other end 112 of the projecting portion 42 also serves as the gripping portion 50. However, the projecting portion 42 and the gripping portion 50 are independent from each other so that they are discontinuous in the longitudinal direction. Also good.

  For example, the position of the valve leaflet 210 is recorded by pinching the location of the protruding portion 42 corresponding to the position of the valve leaflet 210 (not shown) with the end contact portion 10 temporarily fixed. Thereafter, the distance between the leaflet 210 and the papillary muscle 212 can be measured by measuring the distance between the position picked by the tweezers 402 and the end contact portion 10. The position picked by the tweezers 402 may be confirmed at the tip position of the tweezers 402 in the state where the protrusion 42 is picked, or the protrusion 42 is picked by the tweezers 402 and a part of the protrusion 42 is damaged. May be confirmed at the position of the scratch. Further, the measurement scale 12 may be provided on the protrusion 42.

As another modified example of the measurement unit 40, as shown in FIG. 4B, there is an aspect having a movable unit 44 that can move the measurement unit 40 in the longitudinal direction.
The movable portion 44 shown in FIG. 4B is ring-shaped or C-shaped, and has an inner diameter that is substantially the same as the outer diameter of the intermediate portion that is configured in the cylindrical shape of the biometric instrument 100. The inner peripheral surface of the ring-shaped movable part 44 does not move in the longitudinal direction under its own weight, but to some extent it can be moved in the longitudinal direction by artificially applying a force with a finger or the like not shown. The living body measuring tool 100 is in close contact with the outer peripheral surface. With the end contact portion 10 temporarily fixed, the movable portion 44 is moved to the position of the leaflet 210, and the distance between the end contact portion 10 and the movable portion 44 is measured to thereby determine the papillary muscle 212 and the leaflet 210. Can be measured. The biometric instrument 100 may be provided with the measurement scale 12 in a region where the movable portion 44 is movable.

  In the two modes shown in FIGS. 4A and 4B, the operation of recording the position of the valve leaflet 210 with the marker 220 in the measurement unit 40 can be omitted. It is possible to check the position of and operate. Therefore, it is possible to measure the distance between the first part and the second part even in a place where the operation space is narrower. However, the above description does not exclude recording the position of the leaflet 210 with the marker 220 on the protrusion 42.

  4 (a) and 4 (b) show an embodiment in which an artificial thread 201 having an end portion formed with a ball retaining portion 203 is used. 4 (a) and 4 (b), the biometric instrument 100 is attached to the artificial thread 201 that is sewn to the papillary muscle 212 via the pad 204 and from which the thread retaining portion 203 prevents the thread from coming off. An embodiment was shown. The ball retaining portion 203 has a diameter larger than the outer diameter of the artificial yarn 201 (not shown) provided at the end of the artificial yarn 201. The ball retaining portion 203 may be formed by gathering ends of the artificial yarn 201 itself, or may be formed by providing another member such as a rod-like body at the end of the artificial yarn 201.

As described above, the biometric instrument 100 can measure the distance between the papillary muscle 212 and the leaflet 210 more accurately than in the past.
Therefore, the biometric instrument 100 is an artificial chordae forming auxiliary tool 400 used to connect the leaflets 210 and the papillary muscles 212 with the artificial chords 200 (hereinafter also simply referred to as the auxiliary tool 400, see FIG. 6). Can be used to select the size.
That is, the measuring unit 40 provided in the biometric measuring instrument 100 is in a state in which the artificial chord 200 sewn on the papillary muscle 212 is guided by the artificial thread guide unit 70 and the end contact portion 10 contacts the papillary muscle 212. The distance between the papillary muscle 212 and the leaflet 210 can be measured. The distance measured in this way can be used as an index for selecting the size of the auxiliary tool 400.

  By measuring the distance between the leaflet 210 and the papillary muscle 212 accurately with the biometric device 100, the auxiliary device 400 of an appropriate size can be selected. By using the auxiliary tool 400 selected in this way for the MVP, the papillary muscle 212 and the leaflet 210 can be connected by the artificial chord 200 having a desired length.

  The assisting device 400 selected by using the biometric device 100 is an assisting device used for connecting the papillary muscle 212 and the leaflet 210 with an appropriate length for the artificial chord 200 used in MVP. Any one may be used. For example, it can be used to select the size of the auxiliary device described in Patent Document 1 described above. Examples of the auxiliary tool 400 recommended in this embodiment include the following modes.

  That is, as shown in FIG. 6, the auxiliary tool 400 recommended in the present embodiment is provided with a pair of end support portions 420 and 421 that respectively support the leaflets and papillary muscles at both ends in the longitudinal direction. . The first and second chordal insertion ports 422 and 423, which are formed in the pair of end support portions 420 and 421 respectively to have a diameter larger than the diameter of the artificial chords and through which the artificial chords are inserted, and the first and second chords A chordae guide part 430 formed extending in the longitudinal direction across the two chordae insertion openings 422, 423, an instrument gripping part 440 formed in the middle part of the chordae guide part 430 in the longitudinal direction; Is provided.

By the way, as described above, the auxiliary device described in Patent Document 1 is a hook portion formed by sticking both ends of the artificial chord to a stick-shaped gripping portion while holding the artificial chord sewn to the papillary muscle with the papillary muscle contact portion. Need to be tied together. However, such work is not easy, and there is a problem that a high skill is required for the operator.
In other words, the rod-shaped gripping part extends closer to the operator than the hooking part, so when the ends of the artificial chords are tied together with the leaflets placed on the hooking part, It is inevitable that the part interferes with the leaflets. When performing MVP using the auxiliary device of Patent Document 1, it is necessary to tie an artificial chord with the valve leaflet turned up along the rod-shaped gripping portion. The technique of forming a knot is difficult. Also, when the auxiliary device is removed after the artificial chord is fixed, the gripping portion interferes with the leaflets and knots, and the removal work is hindered.

On the other hand, according to the assisting tool 400 recommended in the present embodiment, the operator who holds the instrument gripping portion 440 is attached to at least one of the papillary muscle 212 or the leaflet 210 as shown in FIG. The sewn artificial chords 200 can be inserted into the first and second chords insertion holes 422 and 423 (see FIGS. 6A and 6B) to attach the chordae guide 430 to the artificial chords 200. As a result, the artificial chordae in a state where the distance between the leaflet 210 and the papillary muscle 212 supported by the pair of end support portions 420 and 421 is maintained at a predetermined length, that is, the length in the longitudinal direction of the assisting device 400. 200 can be secured to leaflet 210 or papillary muscle 212. And since the instrument holding | grip part 440 is formed in the intermediate part of the longitudinal direction of the auxiliary tool 400, when fixing the artificial chord 200, the instrument holding part 440 does not interfere with the valve leaflet 210, and patent document 1 The valve leaflets do not turn up like the auxiliary equipment.
Therefore, by selecting the auxiliary tool 400 having an appropriate size using the biometric measuring instrument 100 and performing MVP using the selected auxiliary tool 400, the valve leaflet 210 and the papillary muscle 212 can be artificially formed regardless of the skill of the operator. The operation of the leaflet 210 can be made normal by connecting with a chord.

The biometric instrument 100 of the present embodiment may be provided as a single item or as a set of a plurality. Moreover, the biometric instrument 100 of this embodiment is good also as a set with the auxiliary tool for artificial chordae formation used for MVP.
That is, the present invention is used to connect the biometric instrument 100 and the leaflet 210 of the heart valve and the papillary muscle 212 located downstream of the valve leaflet 210 in the normal blood flow direction with the artificial chordae 200. Provided with an artificial chordae forming auxiliary tool (for example, the auxiliary tool 400). As a result, before using the artificial chordae formation assisting device in MVP, the distance between the papillary muscle 212 and the leaflet 210 is measured using the biometric measuring device 100, and these distances are grasped. An assistive device for artificial chordae formation can be selected.
In the following description, as an auxiliary tool set of the present invention, an aspect of an auxiliary tool set 500 including an auxiliary tool 400 recommended in the present embodiment as shown in FIG. 5 will be described. The assist device for artificial chordae formation included in the assist device set is not limited. The assist device for artificial chordae formation included in the assist device set of the present invention is disposed between the leaflet 210 and the papillary muscle 212, and is used to connect the leaflet 210 and the papillary muscle 212 with the artificial chord 200. Can be selected as appropriate from the auxiliary tools to be used.

The auxiliary tool set 500 of this embodiment is demonstrated using FIG. FIG. 5 is an explanatory diagram of the auxiliary tool set 500.
The auxiliary instrument set 500 includes the biometric instrument 100 and the auxiliary instrument 400 as described above. The number of the biometric device 100 and the auxiliary device 400 included in the auxiliary device set 500 is not particularly limited. In view of selecting an auxiliary tool 400 having an appropriate length from the distance measured by the biometric instrument 100, the auxiliary instrument set 500 includes one or more biometric instruments 100 and a plurality of auxiliary instruments having different lengths. Preferably, the tool 400 is provided.

For example, as shown in FIG. 5, the assisting device set 500 includes a plurality of biometric measuring devices 100 and artificial chordae forming assisting devices. The plurality of auxiliary tools 400 include those in which the longitudinal dimensions of the auxiliary tools 400 are different from each other, and the longitudinal dimensions of the multiple auxiliary tools 400 are all the same as the longitudinal dimensions of the biometric instrument 100. Below.
The assisting device set 500 including such a combination includes a plurality of assisting devices included in the assisting device set 500 including an assisting device 400 having a length corresponding to the distance between the valve leaflet 210 and the papillary muscle 212 measured by the biometric device 100. It is possible to select from 400 as appropriate.

  In FIG. 5, two biometric measuring devices 100 and four auxiliary tools 400 having different lengths are illustrated, but the number of biometric measuring devices 100, the number of auxiliary tools 400, and the lengths thereof are shown here. It is not limited. The assisting device 400 included in the illustrated assisting device set 500 includes one each of four types of lengths L1 to L4. However, variations in length and the number of assisting devices 400 of each length are included. Can be appropriately changed.

FIG. 5 is an explanatory diagram of a plurality of auxiliary tools 400 included in the auxiliary tool set 500 of the present embodiment. For example, the assisting device set 500 includes a plurality of biometric measuring devices 100 and a plurality of assisting devices 400 that are combined into packs 150 and 152 that are contained in containers. Although illustration is omitted, one or a plurality of biometric instruments 100 and a plurality of auxiliary instruments 400 may be combined in one container. The container is preferably a sterilized container that holds a sterilized body of contents. This is because the contents of the auxiliary tool set 500 can be opened and used immediately before use without the need for sterilization.
The pack 150 includes a plurality of biometric measuring devices 100 having the same length and is sealed.
The pack 152 encloses and seals a plurality of auxiliary tools 400 having different longitudinal dimensions of the chord guide part 430.

As illustrated in FIG. 5, the auxiliary tool 400 includes a recording unit 444 in which the longitudinal dimensions (L1 to L4) of the auxiliary tool 400 are recorded so as to be visible from the outside.
By visually recognizing the recording unit 444, an auxiliary tool that can correspond to the distance between the valve leaflet 210 and the papillary muscle 212 measured by the biometric instrument 100 included in the auxiliary tool set 500 from the plurality of auxiliary tools 400. 400 can be selected quickly. In the present embodiment, the recording unit 444 is provided in the instrument gripping part 440, and the instrument gripping part 440 in the four auxiliary tools 400 has a longitudinal length of the chord guide part 430 of L1, L2, L3, and L4, respectively. Directional dimensions are recorded.

  The difference from the longitudinal dimensions L1 to L4 of the chord guide portions 430 in the plurality of auxiliary tools 400 is N (where N is an integer of 1 or more) millimeters. The plurality of 400 dimensions L1 to L4 are different in increments of 1 millimeter. The dimensions L1 to L4 can be, for example, 13 mm or more and 16 mm or less. In this way, by preparing a plurality of auxiliary tools 400 having different longitudinal dimensions L1 to L4 of the chordae guide 430, an appropriate auxiliary tool 400 corresponding to the distance measured by the biometric measuring device 100 is prepared. Can be selected. The dimensions L1 to L4 are preferably numerical values that are continuous in increments of 1 millimeter.

FIG. 5 illustrates an example in which the pack 152 includes four auxiliary tools 400, but the number of the auxiliary tools 400 is not particularly limited. The pack 152 may include a plurality of auxiliary tools 400 having different lengths L1 to L4 in the longitudinal direction of the chord guide part 430 for each length. That is, the pack 152 may include a plurality of auxiliary tools 400 having the same longitudinal dimension of the chord guide part 430 for each of the dimensions L1 to L4.
For example, the auxiliary tool 400 may be provided in the same number as the number of biometric measuring instruments 100 included in the auxiliary tool set 500 for each dimension. Thereby, when reconstructing a plurality of artificial chords 200, the biometric instrument 100 measures the distance between the leaflets 210 and the papillary muscles 212 at each location where the artificial chords 200 are scheduled to be reconstructed. The assisting device 400 can be selected from the assisting device set 500 without any shortage.

  The biometric instrument 100 or the auxiliary instrument 400 may be entirely colorless, or may be entirely or partially colored. The biometric instrument 100 of the present embodiment is colored by kneading pigments in the respective soft resin materials constituting the biometric instrument 100 and the auxiliary instrument 400, and has good visibility. In the auxiliary instrument set 500, the biometric instrument 100 and the auxiliary instrument 400 may be colored in different colors. Thereby, the biometric instrument 100 and the auxiliary tool 400 can be distinguished smoothly during the procedure.

  Further, a radiopaque contrast agent such as barium sulfate may be kneaded in the soft resin material constituting the biometric instrument 100 or the auxiliary tool 400. Thereby, after the procedure is completed, it can be confirmed by X-ray imaging that the biometric instrument 100 is not left in the body cavity of the subject.

Details of the auxiliary tool 400 will be described below with reference to FIGS. 6 and 7.
FIG. 6A is a perspective view of an example auxiliary tool 400 used in the auxiliary tool set 500 of this embodiment, and FIG. 6B is a front view of the auxiliary tool 400. FIG. 7A is a schematic diagram showing a state in which each of the pair of auxiliary tools 400 is attached to the artificial chord 200, and FIG. 7B is a diagram of connecting the pair of artificial chords 200 to which the auxiliary tool 400 is attached to each other. FIG. 7C is a schematic diagram illustrating a state in which the auxiliary tool 400 is removed from the artificial chord 200. FIG.

  The auxiliary tool 400 according to the present embodiment is roughly divided into a chordae guide portion 430 constituting a main body portion, a first chordal insertion port 422 formed at both ends in the longitudinal direction of the chordae guide portion 430, and a second chordae insertion port 422. , And a pair of instrument gripping portions 440 with which an operator grips the chordae guide portion 430 with a finger or the like.

  As shown in FIG. 7 (b), the chordae guide 430 is inserted between the leaflet 210 and the papillary muscle 212 so that the artificial chordal cord 200 is substantially interposed between the leaflet 210 and the papillary muscle 212. It is the site | part guided in the state extended | stretched straightly. The chord guide part 430 of the present embodiment has a hollow cylindrical shape including the central lumen 414, but the present invention is not limited to this.

  As shown in FIG. 6B, the chordae guide portion 430 includes a slit portion 412 that opens with an opening width W3 (see FIG. 6) that can receive the artificial chord cord 200 (see FIG. 7A), and a longitudinal length. A hollow tube having a central lumen 414 penetrating in the direction. The slit portion 412 is formed on the side of the chord guide portion 430 over the entire length in the longitudinal direction and communicates laterally with respect to the central lumen 414.

  The peripheral surface 410 of the chordae guide part 430 is a substantially cylindrical surface, and the slit part 412 has a depth from the peripheral surface 410 to the central lumen 414 along the central axis (longitudinal axis) of the chordae guide part 430. Cut in the radial direction. As shown in FIG. 6B, the slit portion 412 includes a narrow width portion 412b and a wide width portion 412a. The narrow width portion 412b is a portion connected to the central lumen 414 with a smaller diameter than the diameter of the central lumen 414. The widened portion 412a is smoothly connected to the outer side in the radial direction than the narrow-width portion 412b, and the width dimension gradually increases toward the peripheral surface 410. The maximum width dimension of the widened portion 412a is the opening width W3, and the minimum width dimension of the widened portion 412a is substantially equal to the width dimension of the narrow width portion 412b. The opening width W3 of the slit portion 412 is sufficiently larger than the diameter (wire diameter) of the artificial chord 200. However, the slit portion 412 is not limited to the above, and various forms can be adopted.

  The central lumen 414 is a through-hole formed at the approximate center of the chord guide part 430. The central lumen 414 of the present embodiment is formed in a substantially circular shape when viewed from the front shown in FIG.

  The instrument gripping part 440 is a part for the operator to grip the auxiliary tool 400 with a finger or the like. The instrument gripping portion 440 of the present embodiment is formed in a pair of plate shapes that protrude outward in the radial direction from the peripheral surface 410 of the chordae guide portion 430. As a result, as shown in FIG. 7A, the operator can hold the auxiliary tool 400 so that the pair of instrument holding portions 440 are sandwiched between the thumb and the index finger, for example. The formation region of the instrument gripping portion 440 is on the inner side of both ends in the longitudinal direction of the chord guide portion 430. Thereby, as shown in FIG. 7B, when the assisting tool 400 is inserted between the leaflet 210 and the papillary muscle 212, the instrument gripping portion 440 interferes with both the leaflet 210 and the papillary muscle 212. There is nothing. Thereby, when performing the operation | work which connects the both ends of the artificial chord 200 mutually, the instrument holding part 440 does not become trouble.

  The instrument gripping part 440 is formed at a position that is biased toward one end support part (the end support part 420 in the present embodiment) in the intermediate part of the chord guide part 430. Thereby, as shown in FIG. 7A, the artificial chord 200 is inserted through the chord chord guide 430 through the slit 412. In other words, the chord chord guide 430 is attached to the artificial chord 200. Excellent in properties.

  The end support portions 420 and 421 are portions that support the leaflet 210 and the papillary muscle 212, respectively, and are provided at both ends in the longitudinal direction of the chord chord guide portion 430 of the assisting tool 400. The end support portions 420 and 421 are formed in a planar shape. The end support portions 420 and 421 may be planar or curved. By forming the end support part 420 and the end support part 421 in a planar shape, as shown in FIG. 7B, when the artificial chord 200 is tied with a predetermined tension, the end support part 420, The part support part 421 does not bite into the leaflet 210 or the papillary muscle 212 excessively. Thereby, the chord chord guide part 430 of the auxiliary tool 400 serves as a spacer, and the longitudinal dimension thereof is the separation distance between the leaflet 210 and the papillary muscle 212. By fixing the artificial chords 200 to the leaflets 210 in such a state, the leaflets 210 and the papillary muscles 212 are connected by the artificial chords 200 having a desired length after the mitral valvuloplasty. Become.

  The chordae guide 430 can be made of the same material as that of the biometric instrument 100 described above. Thus, even when the leaflet 210 and the papillary muscle 212 are pressed against the chordae guide 430 with a predetermined force when the artificial chord 200 is combined using the chordae guide 430 as a spacer, the leaflet 210 and the nipple The muscle 212 is not damaged by the chord guide 430.

  The instrument gripping part 440 may be integrally formed with the chordae guide part 430, or may be integrally formed by joining the peripheral surface 410 of the chordae guide part 430 after forming the instrument gripping part 440 as a separate member. Also good. In this embodiment, the instrument gripping part 440 and the chordae guide part 430 are integrally molded as one material.

  The end support portion 420 is formed with a first chordal insertion port 422, and the end support portion 421 is formed with a second chordal insertion port 423. The first chordal insertion port 422 of the present embodiment is one open end of the central lumen 414, and the second chordal insertion port 423 is the other open end of the central lumen 414.

  As shown in FIGS. 6A and 6B, a slit portion 412 is continuously provided in the radial direction of the chord guide portion 430 at the first chord cord insertion port 422 and the second chord cord insertion port 423. The slit portion 412 is formed over the entire length of the chord guide portion 430 in the longitudinal direction. For this reason, as shown in FIG. 7A, the chordae guide part 430 can be mounted from the side with the slit part 412 facing the artificial chordae 200.

As shown in FIGS. 6A and 6B, a rough surface portion 442 is provided on at least a part of the surface of the instrument gripping portion 440. The rough surface portion 442 of the present embodiment is composed of a plurality of concave grooves parallel to each other. The rough surface portion 442 can be formed by transferring a protrusion formed on the inner surface of a mold (not shown) used for injection molding of the instrument gripping portion 440. In addition, the rough surface portion 442 may be a plurality of concave grooves intersecting each other, or may be a large number of dot-shaped uneven portions or protrusions formed randomly or in an array. Alternatively, the rough surface portion 442 may be formed by roughening the surface of the instrument gripping portion 440 after injection molding.
The surface on one side of the instrument gripping portion 440 in this embodiment is a rough surface portion 442, and the other surface is a recording portion 444. For example, in the two opposing instrument gripping portions 440, the rough surface portion 442 may be provided on the surface on the opposite side, and the recording portion 444 may be provided on the surface opposite to the opposite side.

  The instrument gripping part 440 of the auxiliary tool 400 shown in FIG. 6 is provided with a recording part 444 recorded as “23”. This means that the dimension of the chord guide part 430 in the longitudinal direction is “23 mm”. When the distance measured by the biometric instrument 100 is 23 mm or a value close thereto, the assisting instrument 400 shown in FIG. 6 can be selected smoothly.

On the peripheral surface 410 of the chordae guide part 430, an easy tear part 416 for tearing the chordae guide part 430 is formed along the longitudinal direction.
By forming the easy tearing part 416 in the chordae guide part 430, after connecting the leaflet 210 and the papillary muscle 212 with the artificial chordae 200, the chordae guide part 430 is broken along the longitudinal direction. The auxiliary tool 400 can be easily detached from the artificial chord 200 by dividing it into pieces. As shown in FIGS. 7A and 7B, the auxiliary tool 400 may be attached to the artificial chord 200 so that the instrument gripping portion 440 is closer to the leaflet 210 than the papillary muscle 212. As a result, when the pair of instrument grasping portions 440 are grasped with fingers or the like and the chordae guide portion 430 is broken, the instrument grasping portion 440 is applied to the instrument grasping portion 440 from the left atrium 302 (see FIG. 1) And can be easily accessed.

  The easy tear portion 416 of the present embodiment is formed along the slit portion 412 on the opposite side of the slit portion 412 in the peripheral surface 410 of the chord guide portion 430. The easy tear portion 416 is formed continuously or intermittently along the slit portion 412 over the entire length in the longitudinal direction.

  The pair of instrument gripping portions 440 are formed on both sides with the easy tearing portion 416 interposed therebetween. Accordingly, by pulling the pair of instrument gripping portions 440 outwardly with a predetermined force or more, the chordae guide portion 430 is torn over the entire length, and the auxiliary tool 400 as shown in FIG. It is completely separated into two parts. The easy tearing portion 416 does not intersect the slit portion 412 and is formed over the entire length of the chordae guide portion 430 in the longitudinal direction, so that an unexpected small piece may be generated when the chordae guide portion 430 is torn. Absent.

  The easy tearing portion 416 is a bottomed groove that is cut non-penetrating from the peripheral surface 410 of the chord guide portion 430 toward the central lumen 414, and the opening width W4 of the easy tearing portion 416 has a slit portion 412. Is smaller than the opening width W3. By making the opening width W4 of the easy tear portion 416 smaller than the opening width W3 of the slit portion 412, the operator is prevented from being confused with the easy tear portion 416 and the slit portion 412.

  Instead of this embodiment, the auxiliary tool 400 may be removed from the artificial chord 200 without forming the easy tear portion 416 and dividing the auxiliary tool 400 into a plurality of pieces. That is, by pulling the pair of instrument gripping portions 440 outwardly strongly from the state shown in FIG. 7B, the chordae guide portion 430 can be plastically deformed so that the slit portion 412 opens greatly. As a result, the artificial chords 200 accommodated in the central lumen 414 can easily pass through the narrow portion 412b, and the auxiliary tool 400 can be detached from the artificial chords 200.

  Below, the usage example of the biomedical instrument 100 and the auxiliary tool 400 is demonstrated using FIG.3, FIG.5 and FIG.7. In this use example, in order to select an auxiliary tool 400 having an appropriate length for use in MVP, first, the papillary muscle 212 and the leaflet 210 at a location where the artificial chord 200 is scheduled to be reconstructed using FIG. A method for measuring the distance with the biometric instrument 100 (hereinafter also referred to as the present measurement method) will be described. Then, a method for selecting an auxiliary tool 400 having an appropriate length from the distance measured in the present measurement method and reconstructing the artificial chord 200 (hereinafter also referred to as the present reconstruction method) will be described with reference to FIG. . FIG. 5 shows an auxiliary tool set 500 used in this use example. However, in this usage example, the biometric device 100 and the auxiliary device 400 that are handled individually (that is, not set) can be used as appropriate.

  Examples of the heart valve in which the leaflet 210 and the papillary muscle 212 are connected by the artificial chord 200 with the assisting device 400 include the tricuspid valve 312, the aortic valve 314, or the pulmonary valve 316 in addition to the mitral valve 310. (See FIG. 1). Among these, this use example demonstrates the mitral valvuloplasty which reconstructs the chordae 214 in one or both of the two leaflets 210 of the mitral valve 310 by the artificial chordae 200. In the normal mitral valve 310, each leaflet 210 is connected to the papillary muscle 212 via a plurality of chordae 214. 3 and 7 used in this usage example, the illustration of the normal chord 214 is omitted as appropriate. FIG. 3A illustrates the broken chord 214, and FIGS. 3B to 3D omit the determined chord 214.

As shown in FIG. 3A, this usage example is applied when a part of a chord chord 214 connecting the papillary muscle 212 and the leaflet 210 is broken or the like.
First, as shown in FIG. 3B, the artificial chord 200 is sewn to the papillary muscle 212 as an artificial thread in accordance with a position where the artificial chord 200 is scheduled to be reconstructed. The artificial chords 200 sew the artificial chords 200 at two adjacent positions with respect to the papillary muscles 212 to make the artificial chords 200 U-turn. Since the papillary muscle 212 is located deeper in the left ventricle than the leaflet 210, the artificial chord 200 may be sewn first to the papillary muscle 212, but the artificial chord 200 is sewn to the leaflet 210. Then, the distance between the papillary muscle 212 and the leaflet 210 can be measured, and the artificial chord 200 can be reconstructed using the auxiliary tool 400. Although not shown in FIGS. 3 (b) to 3 (d), the sewn portion 205 of the artificial chord 200 provided on the papillary muscle 212 (the folded portion of the artificial chord 200 in the papillary muscle 212) is appropriately illustrated. 7 A pad 204 as shown in each figure may be applied to protect the papillary muscle 212.

  The artificial chords 200 used in this use example are provided with puncture needles 202 at both ends. The puncture needle 202 is a curved needle, and even when the papillary muscle 212 is accessed from the left ventricle through the mitral valve 310 (see FIG. 1), the puncture needle 202 can be easily punctured from the papillary muscle 212 toward the leaflet 210. And minimally invasive procedures are possible. The artificial chord 200 can be made of, for example, a synthetic resin material. Specifically, for example, Gore-Tex (registered trademark) in which polytetrafluoroethylene is stretched and combined with a polyurethane resin can be used for the artificial chord 200. A felt or a fluororesin film can be used for the pad 204 and the pad 206. The same material may be used for the pad 204 and the pad 206, or different materials may be used.

  As shown in FIG. 3 (c), the biometric instrument 100 is attached to the artificial chord 200. Two biometric measuring devices 100 are individually attached to two straight portions of the artificial chord 200 that are folded back at the papillary muscles 212 into a V shape. The biometric instrument 100 has an opening 60 formed along the longitudinal direction from the first insertion port 20 to the second insertion port 30. Therefore, the biometric instrument 100 can be attached to the artificial chord 200 from the side. As a result, the artificial chord 200 is guided to the artificial thread guide 70 that communicates with the opening 60. By having the opening 60 in this way, the threading operation of inserting the artificial chord 200 into the first insertion port 20 and the second insertion port 30 can be omitted. The biometric instrument 100 can be easily attached to the artificial chordal cord 200 provided with a puncture needle 202 that is a curved needle at the end.

  The mounting direction of the biometric instrument 100 is adjusted so that the end contact portion 10 contacts the papillary muscle 212. The end contact portion 10 is provided with a first insertion port 20, and the end contact portion 10 is brought into contact with the papillary muscle 212 with the artificial chord 200 being inserted through the first insertion port 20. The end contact portion 10 can be temporarily fixed to the papillary muscle 212 which is the first part. Thereby, the base end on one side of the artificial chord chord 200 to be reconstructed and the measurement end where the distance is measured by the biometric instrument 100 can be matched. Therefore, according to the biometric instrument 100, it is possible to accurately measure the distance of the place where the artificial chord 200 is scheduled to be reconstructed as compared with the conventional measurement method using echo or the like.

  The biometric instrument 100 attached to the artificial chord 200 is operated by operating the artificial chord 200 or the biometric instrument 100 itself, as shown in FIG. On the other hand, the artificial chord 200 is oriented substantially parallel to the direction in which the artificial chord 200 is reconstructed (hereinafter also referred to as the reconstruction direction). The longitudinal dimension of the biometric device 100 used in this use example is sufficiently larger than the normal distance between the papillary muscle 212 and the leaflet 210 in a general adult (that is, the length of the normal chord 214). Designed to be long. Therefore, when the biometric instrument 100 is oriented in the reconstruction direction, the other end 112 reaches the middle part of the leaflet 210 that is the second part or the front side (the operator side) of the leaflet 210. In this state, when the biometric device 100 is viewed from the side, the attachment position of the artificial chord 200 of the valve leaflet 210 is confirmed at the intermediate portion of the biometric device 100. In the usage example shown in FIG. 3C, the other end 112 of the artificial chord 200 is located on the front side of the leaflet 210 in the drawing and in the middle of the leaflet 210 in the thickness direction. Therefore, the outer edge of the leaflet 210 (position where the artificial chord is attached) facing the papillary muscle 212 is confirmed in the measurement unit 40 of the biometric instrument 100. In the case where a distance in the living body other than the distance between the papillary muscle 212 and the leaflet 210 is measured, the biometric instrument 100 is more than the approximate distance between the first part and the second part that are scheduled to be measured. It is preferable that the dimension in the longitudinal direction is sufficiently large.

  When the outer edge of the leaflet 210 (position where the artificial chord is attached) with respect to the measurement unit 40 is confirmed as described above, it is recorded in the measurement unit 40 with the marker 220 as shown in FIG. Note that the position of the outer edge of the leaflet 210 may be confirmed by the naked eye or an endoscope, and may be confirmed by touch such as the contact state of the fingertip or the marker 220.

  When the plurality of chords 214 are not normal due to breakage or the like, the papillary muscle 212 may be loose compared to the normal shape as shown as the papillary muscle 212a. When the papillary muscle 212a in such a relaxed state is observed by echo or visual observation, it may be difficult to appropriately grasp the distance between the papillary muscle 212 and the leaflet 210. On the other hand, as shown in FIG. 3 (b), the artificial chords 200 are sewn to the papillary muscles 212, and the artificial chords 200 are moderately tensioned, so that the papillary muscles in a normal state (or a state close thereto) are obtained. 212b can be reproduced. Therefore, by using the biometric instrument 100, as shown in FIG. 3B, the artificial chord 200 is moderately tensioned, and the distance between the papillary muscle 212b and the leaflet 210 where the normal distance is reproduced is obtained. Can be measured. As a result, the distance between the papillary muscle 212 and the leaflet 210 can be accurately measured. Further, the auxiliary tool 400 having an appropriate length can be selected from the accurately measured distance.

  The biometric instrument 100 recorded in the measuring unit 40 as described above is detached from the artificial chord 200 (not shown). The method of detachment is not particularly limited. For example, the position of the biometric instrument 100 is moved to the opposite side of the artificial chord 200 from the sewn portion 205, and the artificial measuring device 100 is inserted through the opening 60 before the puncture needle 202. The chords 200 may be detached from the biometric instrument 100.

  From the distance between the papillary muscle 212 and the leaflet 210 measured as described above, an auxiliary tool 400 having an appropriate size used in the present reconstruction method described below can be selected. For example, as shown in FIG. 3 (d), when the distance between the papillary muscle 212 and the leaflet 210 is measured at two different locations, the distance on the right side of the paper is larger than the distance measured by the biometric instrument 100a on the left side of the paper. The distance measured by the biometric instrument 100b may be large. In such a case, as shown in FIG. 5, an artificial chordae formation assisting tool 400 having the same length or the closest distance to each of the measured distances from a plurality of artificial chordogenesis assisting tools 400 of different lengths. Can be selected.

This reconstruction method for reconstructing the artificial chord 200 using the auxiliary tool 400 selected as described above will be described below.
In addition, the artificial chord 200 in the present measurement method described above and the present reconstruction method described later is also used. Since it is not necessary to sew artificial yarn separately for measurement, a series of operations of the measurement method and the reconstruction method can be performed smoothly and in a short time. In order to use the artificial chords 200 as described above, for example, the following modes are preferably employed.

That is, as described above, the artificial chordae formation assisting device 400 is provided with a pair of end support portions 420 and 421 that respectively support the leaflets 210 and the papillary muscles 212 at both ends in the longitudinal direction. The portions 420 and 421 are provided with first and second chordal insertion openings 422 and 423, which are formed larger than the diameter of the artificial chords 200 and through which the artificial chords 200 are inserted, respectively. Here, it is preferable that the diameters of the first and second chordal insertion openings 422 and 423 of the artificial chordae forming auxiliary tool 400 and the diameter of the first insertion opening 20 of the biometric measuring instrument 100 are substantially the same. . Thereby, the artificial chord 200 used in the artificial chord forming auxiliary tool 400 can also be used as the artificial thread used in the biometric tool 100. In addition, it is possible to stabilize the feeling of wearing when attached to the artificial chord 200 to the same extent in both the biometric instrument 100 and the auxiliary tool 400. In the present embodiment, it is more preferable that the diameter of the second insertion port 30 that is the lead-out portion is substantially the same as the diameters of the first and second chordal insertion ports 422 and 423.
In the present invention, the plurality of apertures being substantially the same means that the other aperture is not less than 1 and not more than 2 times, and may be, for example, not less than 1 and not more than 1.5 times. .

Preferably, the minimum opening width W1 (see FIG. 2 (c)) of the biometric device 100 and the width dimension of the narrow portion 412b (see FIG. 6 (b)) of the auxiliary tool 400 are substantially the same. Is preferred. Since the force applied when the artificial chord 200 is detached by passing through the minimum opening width W1 or the narrow width portion 412b from the biometric measuring instrument 100 or the auxiliary tool 400 can be made similar, the feeling of use is good. It is.
Also preferably, the opening width (outer opening width W5) of the outer peripheral surface in the narrow area 60a (see FIG. 2C) of the biometric instrument 100 and the opening width W3 of the auxiliary tool 400 (see FIG. 6B). Are preferably substantially the same. Since the degree of force applied when the biometric instrument 100 or the auxiliary tool 400 is attached to the artificial chord 200 can be made similar, the usability is good.
In the present invention, the phrase that the plurality of width dimensions are substantially the same means that the other diameter is 1 to 1.2 times the diameter of either one.

  Regarding implementation of this reconstruction example, first, as shown in FIG. 7A, the auxiliary tool 400 is attached to the artificial chord 200 sewn to the papillary muscle 212. In this usage example, two auxiliary tools 400 are individually attached to two straight portions of the artificial chord 200 that are folded back at the papillary muscles 212 into a V shape. The auxiliary tool 400 has a slit portion 412 formed along the length of the chordae guide portion 430 in the longitudinal direction, and the chordae guide portion 430 can be attached to the artificial chordae 200 from the side. For this reason, it is not necessary to insert the curved puncture needle 202 into the central lumen 414 of the chordae guide 430. In other words, since it is not necessary to insert the puncture needle 202 into the central lumen 414 of the chordae guide 430, a curved needle can be used as the puncture needle 202.

More specifically, in the state where the puncture needle 202 is punctured into the papillary muscle 212 and the leaflet 210 and the artificial chord 200 is passed between the papillary muscle 212 and the leaflet 210 with substantially no tension, The chord guide part 430 of the auxiliary tool 400 is attached to the chord chord 200. For example, as shown in FIG. 7A, the instrument gripping part 440 is gripped with a finger or the like, and the artificial chords 200 are introduced into the chordae guide part 430 from the side through the slit part 412. As a result, the artificial chord 200 is guided to the central lumen 414.
Subsequently, the artificial chord 200 fitted with the auxiliary tool 400 is sewn to the valve leaflet 210, so that the artificial chord 200 matches the length of the central lumen 414 (longitudinal dimension of the chord guide 430). The leaflet 210 and the papillary muscle 212 are connected.

  In this state, both ends of the artificial chord 200 are joined together to form a knot 208 on the pad 206 (see FIG. 7B). As a result, the artificial chord 200 is looped. The process of connecting the artificial chords 200 is performed in a state where the leaflets 210 and the papillary muscles 212 are pressed against both ends of the chordae guide part 430 of the auxiliary tool 400. Thereby, as shown in FIG. 7B, the length of the artificial chord 200 is determined in a state where the chord guide portion 430 of the auxiliary tool 400 is inserted between the leaflet 210 and the papillary muscle 212. Since the artificial chord 200 formed in a loop shape is folded over the pad 204 and the pad 206, the artificial chord 200 is suppressed from biting into the papillary muscle 212 or the chord 214.

  Next, as shown in FIG.7 (c), the instrument grip part 440 of the auxiliary tool 400 is pulled outward, and the chord guide part 430 is torn. Since the auxiliary tool 400 is performed with the valve leaflet 210 and the papillary muscle 212 interposed, it is preferable to grip the instrument gripping part 440 using an instrument such as tweezers from the viewpoint of accessibility to the instrument gripping part 440. . By pulling the instrument gripping portion 440 of the assisting device 400, the assisting device 400 is torn into two parts, and is separated from the artificial chord 200 laterally, so that the assisting device 400 is separated from the leaflet 210 and the papillary muscle 212. Removed from.

  As described above, in the present usage example, the biometric measuring instrument 100 accurately measures the distance between the papillary muscle 212 and the leaflet 210 in advance, and uses the auxiliary tool 400 selected based on the distance, the artificial chord 200 is determined. Rebuilt. As a result, the papillary muscle 212 and the leaflet 210 are sewn by the artificial chord 200 having a desired length that substantially matches the normal chord 214 (see FIG. 1).

  In the measurement method described above, an example is shown in which the biometric instrument 100 is attached to the artificial chord 200 sewn to the papillary muscle 212. However, the aspect of using the biometric instrument 100 is not limited to this, and the biometric instrument 100 may be attached to the artificial chord 200 first, and then the artificial chord 200 may be sewn to the papillary muscle 212. For example, in the aspect in which the opening 60 in the biometric instrument 100 is not provided, the biomedical instrument 100 is attached to the artificial chord 200 in advance as described above, and then the artificial chord 200 is attached to the papillary muscle 212. It is preferable to sew.

  In the present measurement method described above, the artificial chord 200 used in the present reconstruction method is also used as the artificial thread. However, the present measuring method is not limited to this, and an artificial thread other than the artificial chord 200 is used, and after the present measuring method is finished, the artificial thread is removed from the living body, and a place substantially equal to the place where the artificial thread is sewn. Alternatively, the artificial chord 200 may be sewn and this reconstruction method may be performed.

  In this measurement method and this reconstruction method, the artificial chord 200 is sewn in a V shape with respect to the papillary muscle 212, and two biometric measuring devices 100 or two auxiliary devices are formed in two straight lines constituting the V shape. A mode in which the tool 400 is mounted has been described. As a modified example, an artificial chordal cord 200 having a ball retaining portion 203 shown in FIG. 4 formed on one end is used, and the artificial chordal cord 200 is sewn in an I shape in one direction with respect to the nipple. One biometric instrument 100 or auxiliary tool 400 may be mounted directly on the book. In this case, a single artificial chord is reconstructed.

  The embodiment of the present invention has been described above. The present invention is not limited to the above-described embodiment, and includes various modifications and improvements as long as the object of the present invention is achieved.

The above embodiment includes the following technical idea.
(1) A biometric instrument for measuring a distance between a first part in a living body and a second part physically separated from the first part,
An end contact portion capable of contacting the first part is provided at one end in the longitudinal direction of the biometric instrument,
A first insertion port through which an artificial thread that is provided in the end contact portion and is sewn to the first part is inserted;
The artificial yarn that is provided in the other end in the longitudinal direction opposite to the end contact portion, or in an intermediate portion that is an intermediate region between the end contact portion and the other end, and is inserted into the first insertion port. A withdrawing portion that is drawn outward of the biometric instrument;
A biometric instrument that includes a measuring unit that is provided in the intermediate part and measures the distance between the first part and the second part.
(2) The biometric instrument according to (1), further including a grip portion for gripping the biometric instrument at a position biased toward the other end in the longitudinal direction.
(3) The biometric instrument according to (1) or (2), further including an artificial thread guide portion extending in the longitudinal direction across the first insertion port and the drawing portion.
(4) The biometric instrument according to (3), wherein the artificial thread guide section has an opening that continuously opens in the longitudinal direction with an opening width that can receive the artificial thread.
(5) The drawer portion is provided at the other end,
In the above (4), the minimum opening width of the opening observed on the cut surface cut in a direction orthogonal to the longitudinal direction is larger in the intermediate portion than in the both end regions in the longitudinal direction. The biometric instrument described.
(6) The drawer portion is provided at the other end,
The biometric instrument according to claim 4 or 5, wherein an outer peripheral opening width of the opening observed from an outer peripheral side of the biometric instrument is larger in the intermediate portion than in both end regions in the longitudinal direction.
(7) The biometric instrument according to any one of (1) to (6), wherein the measurement unit is an outer peripheral surface of the biometric instrument.
(8) The measurement unit according to any one of (1) to (7), wherein the measurement unit includes a protrusion that protrudes outward from an outer peripheral surface of the biometric instrument and extends in the longitudinal direction. Biometric instrument.
(9) The biometric instrument according to any one of (1) to (8), wherein the measurement unit includes a measurement scale capable of measuring a predetermined distance in the longitudinal direction from the end contact portion. .
(10) The biometric instrument according to any one of (1) to (9), further including a movable part capable of moving the measurement part in the longitudinal direction.
(11) The second part is a leaflet of a heart valve,
The biometric instrument according to any one of (1) to (10), wherein the first portion is a papillary muscle located downstream of the valve leaflet in a normal blood flow direction.
(12) The biometric device is used to select a size of an artificial chordae forming auxiliary tool used for connecting the leaflet and the papillary muscle with an artificial chordae,
Having an artificial thread guide portion extending in the longitudinal direction across the first insertion port and the drawing portion;
In the state where the artificial tendon sewn to the papillary muscle is guided by the artificial thread guide and the end abutting portion is in contact with the papillary muscle, the measuring unit is configured to connect the papillary muscle and the valve. The biometric instrument according to (11) above, which measures the distance from the apex.
(13) In the artificial chordae forming auxiliary tool, a pair of end support portions that respectively support the valve leaflets and the papillary muscles are provided at both ends in the longitudinal direction, and the artificial tendons are provided on the pair of end support portions. First and second chordae insertion ports, each of which is formed to have a diameter larger than the diameter of the cord and through which the artificial chordae are inserted, and across the first and second chordae insertion ports in the longitudinal direction The biometric instrument according to (12) above, comprising: an extended chordae guide portion and an instrument gripping portion formed at an intermediate portion in the longitudinal direction of the chord guide portion.
(14) The biometric instrument according to any one of (1) to (13) above, and the leaflet of a heart valve and the papillary muscle located downstream of the valve leaflet in a normal blood flow direction. An auxiliary tool set comprising: an artificial chordae forming auxiliary tool used for connecting with an artificial chord.
(15) In the artificial chordae forming auxiliary tool, a pair of end support portions that respectively support the leaflets and the papillary muscles are provided at both ends in the longitudinal direction, and the artificial tendon is provided on the pair of end support portions. A first and a second chordae insertion port through which the artificial chordae are inserted and formed with a diameter larger than the diameter of the chord,
The assist according to (14), wherein the diameters of the first and second chordae insertion openings of the artificial chordae forming auxiliary tool and the first insertion opening of the biometric instrument are substantially the same. Ingredient set.
(16) Each of the biometric device and the artificial chordae forming auxiliary device has a plurality of each,
The plurality of artificial chordae forming auxiliary tools include those having different longitudinal dimensions of the artificial chordae forming auxiliary tools, and
The auxiliary tool set according to (14) or (15), wherein the plurality of artificial chordae forming auxiliary tools each have a longitudinal dimension that is smaller than a longitudinal dimension of the biometric instrument.
(17) From the above (14) to (16), the artificial chordae forming auxiliary tool has a recording portion in which the longitudinal dimension of the artificial chordae forming auxiliary tool is recorded so as to be visible from the outside. ) Auxiliary device set according to any one of the above.

DESCRIPTION OF SYMBOLS 10 ... End part contact part 12 ... Scale for measurement 20 ... 1st insertion port 30 ... 2nd insertion port 40 ... Measurement part 42 ... Protrusion part 44 ... Movable part 50 ... Grip 60 ... Opening 60a ... Narrow region 60b ... Wide region 70 ... Artificial thread guide 70a ... Through hole 70b ... Recess 100, 100a, 100b ... biometric instrument 110 ... one end 112 ... other end 120 ... outer peripheral surface 150, 152 ... pack 200 ... artificial chord 201-artificial thread 202 ... puncture needle 203・ ・ ・ Tamadome 204 ... Pad 205 ... Sewing part 206 ... Pad 208 ... Knot 210 ... Valve leaflet 212 ... Papillary muscle 212a ... Papillary muscle 212b ... Papillary muscle 214 ... chord 220 ... marker 221 ... ink absorbing part 300 ... heart 302 ... Left atrium 304 ... Left ventricle 306 ... Right atrium 308 ... Right ventricle 310 ... Mitral valve 312 ... Tricuspid valve 314 ... Aortic valve 316 ... Pulmonary artery valve 320 ... Aorta 322 ... Pulmonary vein 400 ... Artificial chordae forming aid 402 ... Tweezers 410 ... Peripheral surface 412 ... Slit part 412a ... Widening part 412b ... Thin Width part 414 ... Central lumen 416 ... Easy tearing part 420, 421 ... End part support part 422, 423 ... First and second chordae insertion port 430 ... 440 ... Instrument gripping part 444 ... Recording part 500 ... Auxiliary tool sets L1-L4 ... Dimensions W1, W2 ... Minimum opening widths W3, W4 ... Opening widths W5, W6 ... ... Outer opening width

Claims (17)

A biometric instrument for measuring a distance between a first part in a living body and a second part physically separated from the first part,
An end contact portion capable of contacting the first part is provided at one end in the longitudinal direction of the biometric instrument,
A first insertion port through which an artificial thread that is provided in the end contact portion and is sewn to the first part is inserted;
The artificial yarn that is provided in the other end in the longitudinal direction opposite to the end contact portion, or in an intermediate portion that is an intermediate region between the end contact portion and the other end, and is inserted into the first insertion port. A withdrawing portion that is drawn outward of the biometric instrument;
A biometric instrument that includes a measuring unit that is provided in the intermediate part and measures the distance between the first part and the second part.   The biometric instrument according to claim 1, further comprising a gripping part for gripping the biometric instrument at a position biased toward the other end in the longitudinal direction.   The biometric instrument according to claim 1, further comprising an artificial thread guide portion extending in the longitudinal direction across the first insertion port and the drawing portion.   The biometric instrument according to claim 3, wherein the artificial yarn guide portion has an opening portion continuously opened in the longitudinal direction with an opening width capable of receiving the artificial yarn. The drawer is provided at the other end;
The minimum opening width of the said opening part observed in the cut surface cut | disconnected in the direction orthogonal to the said longitudinal direction is larger in the said intermediate part than the both-ends area | region of the said longitudinal direction. Biometric measuring instrument. The drawer is provided at the other end;
The biometric instrument according to claim 4 or 5, wherein an outer peripheral opening width of the opening observed on an outer peripheral surface of the biometric instrument is larger in the intermediate portion than in both end regions in the longitudinal direction.   The biometric instrument according to claim 1, wherein the measurement unit is an outer peripheral surface of the biometric instrument.   The biometric instrument according to any one of claims 1 to 7, wherein the measurement unit includes a projecting part that projects outward from an outer peripheral surface of the biometric instrument and extends in the longitudinal direction.   The biometric instrument according to any one of claims 1 to 8, wherein the measurement unit has a measurement scale capable of measuring a predetermined distance in the longitudinal direction from the end contact portion.   The biometric instrument according to any one of claims 1 to 9, further comprising a movable part capable of moving the measurement part in the longitudinal direction. The second part is a leaflet of a heart valve;
The biometric instrument according to any one of claims 1 to 10, wherein the first part is a papillary muscle located downstream of the valve leaflet in a normal blood flow direction. The biometric device is used to select the size of an artificial chordae forming auxiliary tool used for connecting the leaflets and the papillary muscles with an artificial chord,
Having an artificial thread guide portion extending in the longitudinal direction across the first insertion port and the drawing portion;
In the state where the artificial tendon sewn to the papillary muscle is guided by the artificial thread guide and the end abutting portion is in contact with the papillary muscle, the measuring unit is configured to connect the papillary muscle and the valve. The biometric instrument according to claim 11, which measures a distance from the apex.   In the artificial chordae forming auxiliary tool, a pair of end support portions that respectively support the leaflets and the papillary muscles are provided at both ends in the longitudinal direction, and the diameter of the artificial chordae is formed at the pair of end support portions. The first and second chordae insertion ports, each of which is formed with a larger diameter than the artificial chordae, and extends in the longitudinal direction across the first and second chordae insertion ports. The biomedical instrument according to claim 12, further comprising: a chordae guide portion formed in the above-described manner; and an instrument gripping portion formed at an intermediate portion in the longitudinal direction of the chordae guide portion.   The biometric device according to any one of claims 1 to 13, and a leaflet of a heart valve and a papillary muscle located downstream of the leaflet in a normal blood flow direction are connected by an artificial chord. And an auxiliary tool set for artificial chordal cord formation. In the artificial chordae forming auxiliary tool, a pair of end support portions that respectively support the leaflets and the papillary muscles are provided at both ends in the longitudinal direction, and the diameter of the artificial chordae is formed at the pair of end support portions. A first and second chordae insertion opening formed with a larger diameter than the artificial chordae,
The assisting tool according to claim 14, wherein the diameter of the first and second chordae insertion openings of the artificial chordae forming assisting tool and the diameter of the first insertion opening of the biometric instrument are substantially the same. set. Each of the biometric instrument and the artificial chordae forming auxiliary tool has a plurality,
The plurality of artificial chordae forming auxiliary tools include those having different longitudinal dimensions of the artificial chordae forming auxiliary tools, and
The auxiliary tool set according to claim 14 or 15, wherein the dimensions of the plurality of artificial chordae forming auxiliary tools in the longitudinal direction are all less than the longitudinal dimension of the biometric measuring tool.   17. The artificial chordae forming auxiliary tool has a recording portion in which the longitudinal dimension of the artificial chordae forming auxiliary tool is recorded so as to be visible from the outside. 17. Auxiliary tool set according to

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