JPH02156961A - Coronary vein cavity catheter - Google Patents

Abstract

PURPOSE:To permit a catheter to be inserted into CS in a short time from the vein of thigh part by the simple operation by forming the top edge into S-figure form and specifying the ratio between the depth of the second curved part from the top edge and the opened port diameter. CONSTITUTION:The top edge part on the insertion side of a catheter is formed into S-figure form. The top edge part is nearly straight line form, and the end point of the straight line part L is represented by A. The top point in the second curved part from the top edge is represented by T, and a tangential line is drawn at the top point T. The point where the straight line which is parallel to this tangential line and passes through A crosses with the periphery of the root of the curved part is represented by B. The depth (d) of the curved part is defined by the length of the vertical line drawn onto the straight line AB from the top point T, and the opened port width W is defined by the length AB. The ratio between the depth (d) and the opened port width W is set to 1:0.65-0.95. As the material for the catheter, polyethylene and polyurethane are desirably used.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to a coronary sinus catheter used for measuring coronary blood flow, collecting coronary venous blood (measuring cardiac metabolites), and the like.

[Conventional technology] The coronary sinus (coronary sinus) opens into the right atrium.
Coronary sinus catheterization, in which a catheter is inserted into the C8 (hereinafter abbreviated as C8), is one of the important procedures for measuring coronary blood flow, myocardial metabolites, and electrophysiological examination of the heart. Inserting a catheter into C8
Due to the anatomical position of C8, it was generally performed from the ulnar vein, cubital vein, or internal oblique vein. For this reason, the shape of the catheter is such that its tip is gently arched to facilitate insertion through these veins.

[Problem that the invention attempts to solve] The above conventional technology has the following problems.

■ Insertion into C8 is not necessarily easy.

Inserting a conventional CS catheter into C8 from the ulnar, cubital, or internally inclined vein requires some experience, and even for an experienced person, it takes about 40 minutes on average. Particularly in the case of children under 10 years old, insertion into C8 was almost impossible.

If it is difficult to insert the catheter into C8, you will tend to forcefully manipulate the catheter, which may damage the inner walls of the right atrium, right ventricle, or blood vessels, or even cause accidents such as perforation. A CS catheter that can be inserted has been desired.

■ Difficult to insert from the femoral vein.

The technique of percutaneously inserting a catheter from the femoral vein via a sheath and a guide wire is widely used because it is safe and easy, without the need to expose blood vessels.

However, with conventional CS catheters, insertion from the femoral vein is almost impossible. Furthermore, in the case of patients who require examination using a CS catheter, a so-called right heart catheter is often inserted through the femoral vein and various examinations are required. However, since the conventional CS catheter could not be inserted from the femoral vein at the same time as the right heart catheter, it was necessary to newly secure the ulnar, cubital, or internal vein just for the CS catheter.

The present invention aims to solve the problems of the prior art described above.

[Means for solving the problem] The present invention has an S-shaped tip and a ratio of the depth d of the second curved portion from the tip to the opening diameter W of 1:0°65 to 0.9.
5, a coronary sinus catheter. An example of the coronary sinus catheter of the present invention is shown in FIG. The distal end portion of this catheter on the insertion side is S-shaped as shown in FIG. The leading edge portion is approximately a straight line, and this portion is referred to as L.

Let A be the end point of this straight line (the point where the curve starts).

Second curved part from the tip (corresponding to the lower half of the figure 8)
Let the vertex of be the king, and draw a tangent at the vertex T. Let B be the point where a straight line parallel to this tangent and passing through A intersects around the base of the curved part. The depth d of the curved portion is defined by the length of a perpendicular line drawn from the apex T to the straight line AB, and the opening diameter W is defined by the length of AB.

In the present invention, the ratio of depth d to opening diameter W is 1:0.
65 to 0.95. The length of L is usually 0.47~'1
．． 8 cm, and d and W are usually 3.5 to 5 each.
．． 50m, 2.5-4.5cm.

As the material for the catheter of the present invention, polyethylene, polyurethane, polyamide, polytetrafluoroethylene, polyester, polyvinyl chloride, etc. can be used, but polyethylene and polyurethane are preferable. To improve blood compatibility, the catheter itself may be made of antithrombotic segmented polyurethane, or the exterior or both the exterior and lumen of the catheter may be coated with an antithrombotic material, such as cardiosan, segmented polyurethane, or polyethylene oxide chains. It is also possible to coat it with a polymer or the like. It is also possible to graft polymerize acrylamide, acrylic acid, methacrylic acid, hydroxyethyl methacrylate, vinylpyrrolidone, a monomer having a polyethylene oxide chain, etc. to the inner and outer surfaces of the catheter.

Other means to improve blood compatibility include bioactive substances with anticoagulant effects such as heparin, prostaglandins and their derivatives, urokinase, streptokinase, heparan 5A acid, and antithrombin, or plasma proteins such as albumin. can also be immobilized on the catheter surface. It can also be coated with various hydrophilic polymers to facilitate catheter insertion.

The diameter of the catheter is not particularly limited, but the outer diameter is 1 to 3 m.
m is preferably 1.6 to 2.7 mm.

In order to make it opaque to X-rays, it is preferable to impregnate it with bismuth salt, barium salt, or the like. The catheter needs to be stiff enough to accurately transmit the torque to the tip when it is rotated, so in some cases a mesh or braid made of stainless steel or the like is inserted into the catheter wall. It may be necessary or desirable to do so.

Catheters of the present invention may incorporate a basing electrode, one or more thermistors for temperature measurement, or an optical fiber for measuring oxygen saturation within C8, singly or in combination. For example, if a catheter incorporating a basing electrode and a thermistor is used, coronary venous blood flow can be measured from changes in the temperature of coronary venous blood when a heat indicator at a constant temperature is injected at a constant rate. It can be done while applying. It is also possible to create a so-called multi-lumen catheter in which the lumen of the catheter is divided into two or more. For example, by advancing a catheter with two lumens to the human cardiac vein deep in O8, and creating catheter openings at both the O8 location and the human cardiac vein, blood can be drawn and indicators can be injected at each location. can be done.

[Example 1] From a 6 French polyurethane tube, d = 2.5 cm, w = 2.0 cm, and L = 1.3 cm in Fig. 2.
A CS catheter was created by bending/JOing the distal end so that it was as follows. 62 children aged 6 months to 11 years old (average 3.
OS catheterization was performed on a 5-year-old child with underlying heart disease using the catheter of the present invention at the same time as right heart catheterization.

After securing the femoral vein using the usual sheath method, a guide wire was inserted up to the right shoulder, and a CS catheter was inserted using this as a lead wire. After removing the guidewire, the inside of the catheter was flushed with heparinized saline. Next, the catheter was slowly advanced and rotated clockwise to insert the catheter tip into the right ventricular inflow section. The catheter was then inserted into C8 by rotating the catheter roughly clockwise and slowly pulling it back. The X-ray image obtained when the contrast agent was injected confirmed that the tip of the catheter was at C8. The catheter could be easily inserted into C8 on the gold side. O from the time the catheter was inserted into the femoral vein
The average time required to insert a catheter in 8 was 40.3±
It was 18.7 seconds.

[Comparative Example 1] A catheter was made by bending the tip of the same polyurethane tube as in Example 1 into a gentle arch shape. The shape is second
In the figure, w = 5.5 cm, d = 1.5 cm, and the L portion is omitted. We attempted to insert a catheter into C8 from the ulnar vein in 6 patients aged 6 months to 11 years old, but C8 failed.
There were 2 patients (33%) who were able to insert the catheter into C8, and the average time required to insert the catheter into C8 was 33 minutes. The other four cases took more than 70 minutes, so C.
We gave up on inserting a catheter into patient No. 8. An attempt was made to insert this catheter into C8 from the femoral vein, but within 60 minutes the catheter was inserted into C8.
Of the 6 cases, O cases were able to be inserted into 8.

[Example 2] A polyurethane catheter having the same shape as Example 1 was produced, in which a thermistor was incorporated at a position of 1.2 cm from the tip of the catheter exterior and at a position of 2.0 cm from the tip of the catheter lumen. Insertion of a catheter from the femoral vein was attempted in the same manner as in Example 1 using five Japanese monkeys.

It can be inserted on the gold side, and the time required to insert it is 63.
It lasted 2±5 seconds. When 35 ml of glucose at room temperature was flowed per minute through the catheter and the coronary venous flow rate was determined by the thermodilution method using a Gudman J-7 flow, it was found that 25
~53 m1/min.

Next, 0.5 mm from the tip of the catheter having the shape shown in Figure 2.
A balloon catheter was made with a balloon at the cm position. After inserting this catheter into C8 from the femoral vein, we inflated the balloon to stop the blood flow to the right atrium, and calculated the coronary venous flow rate from the amount of blood flowing out through the catheter.The measured value was determined by the thermodilution method described above. The absolute value of the difference was 1.2 to 2.9 ml/min, with an average of 1.7 ml/min, indicating good agreement.

[Comparative Example] A catheter with the same shape as Comparative Example 1 was made, and Japanese monkey 5
An attempt was made to insert the cephalic ulnar vein into C8.

Two animals were able to insert it within 60 minutes, and the average time required to insert it into C8 was 48 minutes. In addition, when the coronary vein blood flow was measured using the same method as in Example 2 using Thermoflow manufactured by Gudman, it was found that the blood flow rate was 38 to 45 m.
l/min.

[Effects of the Invention] According to the present invention, a catheter can be inserted into C8 from the femoral vein in a short time with a simple operation using the sheath method. It is possible to insert the catheter into C8 even in children who have difficulty inserting it into C8 using conventional catheters. In addition, a right heart catheter can be inserted at the same time and from the same location.

[Brief explanation of the drawing]

FIG. 1 shows an example of the coronary sinus catheter of the present invention. FIG. 2 shows an example of the shape of the tip portion on the insertion side of the catheter of the present invention.

Claims (1)

[Claims] (1) The tip is S-shaped and the ratio of the depth d of the second curved part from the tip to the opening diameter w is 1:0.65 to 0.95.
Coronary sinus catheter.