JPH09509585A - 心臓内処置のための装置及び方法 - Google Patents
心臓内処置のための装置及び方法Info
- Publication number
- JPH09509585A JPH09509585A JP7516199A JP51619995A JPH09509585A JP H09509585 A JPH09509585 A JP H09509585A JP 7516199 A JP7516199 A JP 7516199A JP 51619995 A JP51619995 A JP 51619995A JP H09509585 A JPH09509585 A JP H09509585A
- Authority
- JP
- Japan
- Prior art keywords
- patient
- valve
- heart
- intercostal
- penetration
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
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- A61M2039/0279—Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body for introducing medical instruments into the body, e.g. endoscope, surgical tools
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2202/00—Special media to be introduced, removed or treated
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
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- A61M2205/3344—Measuring or controlling pressure at the body treatment site
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- A—HUMAN NECESSITIES
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- A61M2205/00—General characteristics of the apparatus
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- A61M2205/3355—Controlling downstream pump pressure
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- A—HUMAN NECESSITIES
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- A61M2205/00—General characteristics of the apparatus
- A61M2205/36—General characteristics of the apparatus related to heating or cooling
- A61M2205/366—General characteristics of the apparatus related to heating or cooling by liquid heat exchangers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/12—Blood circulatory system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S623/00—Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
- Y10S623/902—Method of implanting
- Y10S623/904—Heart
Abstract
Description
Claims (1)
- 【特許請求の範囲】 1.患者の心臓又は大血管の内腔内で非開胸式外科的インタベンションを行う方 法であって、 心肺バイパスを確立し、 患者の心臓を停止させ、 患者の胸郭の経皮的肋間貫入部を貫通するスコープを通して、患者の胸郭の 内部を視認し、 患者の胸郭の経皮的肋間貫入部を通って挿入される切開手段を用いて、心臓 又は大血管の壁内に内部貫入部を形成し、更に、 前記スコープによる視覚化の下で前記内腔内で外科的処置を実行するために 、経皮的肋間貫入部及び前記内部貫入部を通ってインタベンション器具を挿入す る、 ことを特徴とする方法。 2.血管内カテーテルの遠位端部の膨張可能部材により、患者の冠状動脈と患者 の腕頭動脈との間で患者の大動脈を閉鎖することにより、患者の心臓を停止させ 、 更に、患者の心筋層に心臓麻痺流体を灌流させる、 ことを特徴とする請求の範囲第1項に記載の方法。 3.経皮的肋間貫入部に位置決めされたカニューレを通って、前記インタベンシ ョン器具を挿入する、 ことを特徴とする請求の範囲第1項に記載の方法。 4.前記外科的処置が、心臓弁を外科的に処置する操作を含む、 ことを特徴とする請求の範囲第1項に記載の方法。 5.更に、経皮的肋間貫入部及び前記内部貫入部を通って挿入される切開器具を 用いて、心臓弁の少なくとも一部を除去する操作を含む、 ことを特徴とする請求の範囲第4項に記載の方法。 6.更に、経皮的肋間貫入部及び前記内部貫入部を通って、前記内腔内に交換弁 を挿入する操作を含む、 ことを特徴とする請求の範囲第4項に記載の方法。 7.更に、経皮的肋間貫入部及び前記内部貫入部を通って挿入される器具を用い て、前記交換弁を前記内腔内に固定する操作を含む、 ことを特徴とする請求の範囲第6項に記載の方法。 8.経皮的肋間貫入部内に位置決めされたカニューレを通って、前記交換弁を挿 入する、 ことを特徴とする請求の範囲第6項に記載の方法。 9.患者の胸郭の右横部分に、経皮的肋間貫入部を形成する、 ことを特徴とする請求の範囲第4項に記載の方法。 10.前記内部貫入部を、患者の左心房の壁に形成する、 ことを特徴とする請求の範囲第9項に記載の方法。 11.前記心臓弁が、僧帽弁である、 ことを特徴とする請求の範囲第10項に記載の方法。 12.前記心臓弁が、大動脈弁である、 ことを特徴とする請求の範囲第10項に記載の方法。 13.患者の心臓の心臓弁を非開胸式に交換する方法であって、 心肺バイパスを確立し、 患者の心臓を停止させ、 患者の胸郭の経皮的肋間貫入部を貫通するスコープを通して、患者の胸郭の 内部を視認し、 患者の胸郭の経皮的肋間貫入部を通って挿入される切開手段を用いて、患者 の心臓の壁に内部貫入部を形成し、 患者の胸郭の経皮的肋間貫入部及び前記内部貫入部を通って、心臓の室内に 交換弁を位置決めし、 心臓内の弁位置に前記交換弁を固定する、 ことを特徴とする方法。 14.血管内カテーテルの遠位端部の膨張可能部材により、患者の冠状動脈と患者 の腕頭動脈との間で患者の大動脈を閉鎖することにより、患者の心臓を停止させ 、 更に、患者の心筋層に心臓麻痺流体を灌流させる、 ことを特徴とする請求の範囲第13項に記載の方法。 15.前記心臓弁が、僧帽弁であり、 前記弁位置が、僧帽弁の位置である、 ことを特徴とする請求の範囲第13項に記載の方法。 16.前記室が、患者の心臓の左心房である、 ことを特徴とする請求の範囲第15項に記載の方法。 17.前記経皮的肋間貫入部を、患者の胸郭の右横部分に配設した、 ことを特徴とする請求の範囲第13項に記載の方法。 18.更に、経皮的肋間貫入部及び前記内部貫入部を通って挿入される切開器具を 用いて、患者の心臓弁の少なくとも一部を除去する操作を含む、 ことを特徴とする請求の範囲第13項に記載の方法。 19.更に、経皮的肋間貫入部及び前記内部貫入部を通って挿入される寸法決め器 具を用いて、患者の心臓弁を寸法決めする操作を含む、 ことを特徴とする請求の範囲第13項に記載の方法。 20.挿入器を用いて、前記交換弁を位置決めし、前記挿入器が、細長い軸と該軸 の遠位端部に位置して前記交換弁を保持する手段とを有する、 ことを特徴とする請求の範囲第13項に記載の方法。 21.前記固定する操作が、弁位置で弁輪に前記交換弁を縫合する操作を含む、 ことを特徴とする請求の範囲第13項に記載の方法。 22.前記縫合する操作が、 弁位置で弁輪に複数の縫合糸を縫着し、 前記内部貫入部及び経皮的肋間貫入部を通って患者の体外に縫合糸を引き出 し、 前記交換弁に縫合糸を縫着する操作を含む、 ことを特徴とする請求の範囲第21項に記載の方法。 23.更に、縫合糸を、患者の体外に配設した編成リングの周りの離間した位置に 、径方向に配列する操作を含む、 ことを特徴とする請求の範囲第22項に記載の方法。 24.更に、前記交換弁を前記弁位置に位置決めする際に、前記縫合糸を前記編成 リング内に張力をかけて保持する操作を含む、 ことを特徴とする請求の範囲第23項に記載の方法。 25.経皮的肋間貫入部内に位置決めしたカニューレを通って、前記交換弁を挿入 する、 ことを特徴とする請求の範囲第13項に記載の方法。 26.患者の心臓又は大血管内で非開胸式外科的インタベンションを行うための装 置であって、 患者の胸郭の肋間領域に、経皮的貫入部を形成するための手段と、 胸郭の内腔を視認するために、患者の胸郭の肋間領域を貫通するように形成 された視覚化スコープと、 胸腔の外側の位置から、患者の心臓を停止させる手段と、 酸素注入血液を患者の動脈系に送出する手段を含む、心肺バイパス装置と、 患者の心臓又は大血管の壁内に内部貫入部を形成するために、経皮的肋間貫 入部を通って胸腔内に位置決め可能な切開手段と、 心臓又は大血管内で外科的処置を実行するために、経皮的肋間貫入部及び前 記内部貫入部を通って位置決め可能な、インタベンション手段と、 を備えた、ことを特徴とする装置。 27.前記心臓を停止させる手段が、血管内カテーテルから成り、 該血管内カテーテルが、患者の冠状動脈と患者の腕頭動脈との間の上行大動 脈を閉鎖するための膨張可能な手段と、該膨張可能な手段の上流に位置して上行 大動脈内に心臓麻痺流体を送出するための内腔とを有する、 ことを特徴とする請求の範囲第26項に記載の装置。 28.前記インタベンション手段が、交換弁を患者の心臓内の弁位置に固定する手 段から成る、 ことを特徴とする請求の範囲第26項に記載の装置。 29.更に、経皮的肋間貫入部内に位置決め可能で内腔を有するカニューレを備え 、該内腔を通って、前記交換弁を胸腔内に挿入し得る、 ことを特徴とする請求の範囲第28項に記載の装置。 30.前記交換弁が、心臓の弁輪への取り付けのための環状部を備え、該環状部が 、前記カニューレの内腔の断面高さと等しいかそれより小さい外径と、肋間領域 の幅より小さい断面幅とを有する、 ことを特徴とする請求の範囲第28項に記載の装置。 31.更に、患者の心臓弁の少なくとも一部を切除するために、経皮的肋間貫入部 及び前記内部貫入部を通って位置決め可能な切断手段を備えた、 ことを特徴とする請求の範囲第28項に記載の装置。 32.更に、経皮的肋間貫入部及び前記内部貫入部を通って位置決め可能で、患者 の心臓弁の弁輪を寸法決めするための手段を備えた、 ことを特徴とする請求の範囲第28項に記載の装置。 33.前記寸法決めするための手段が、細長い軸と、該軸の遠位端部に位置する寸 法決め手段とを含み、弁輪の近傍に前記寸法決め手段を位置決めするように、経 皮的肋間貫入部及び前記内部貫入部を通って前記軸と前記寸法決め手段とを挿入 し得る、 ことを特徴とする請求の範囲第32項に記載の装置。 34.更に、前記交換弁を患者の心臓内に挿入するための手段を備え、該挿入手段 が、前記交換弁を解放可能に保持するための手段を遠位端部に有する細長い軸を 含む、 ことを特徴とする請求の範囲第28項に記載の装置。 35.前記挿入手段が、更に、 前記軸の近位端部から操作されて、経皮的肋間貫入部を通って挿入するため の第一の位置から前記弁位置に取り付けるための第二の位置まで前記交換弁を前 記軸に対して軸回動させるための手段、を含む、 ことを特徴とする請求の範囲第34項に記載の装置。 36.前記交換弁を固定するための手段が、 経皮的肋間貫入部を通って位置決め可能で、前記交換弁を前記弁位置で弁輪 に縫合するための手段、を含む、 ことを特徴とする請求の範囲第28項に記載の装置。 37.更に、 前記弁輪に縫合糸を縫着した後に、胸腔の外側で縫合糸を離間した位置に維 持するための編成手段、を備えた、 ことを特徴とする請求の範囲第36項に記載の装置。 38.経皮的肋間貫入部内に配設されて内腔を有するカニューレの近位端部に、前 記編成手段を固定し、前記交換弁が該内腔を通って胸腔内に挿入され得る、 ことを特徴とする請求の範囲第37項に記載の装置。 39.更に、 前記編成手段上に設けられ、患者の心臓内への前記交換弁の縫合糸に沿った 挿入を容易にするために縫合糸の端部にかかる張力を維持するための手段、を備 えた、 ことを特徴とする請求の範囲第37項に記載の装置。 40.更に、 患者の胸郭の肋間領域を通って位置決め可能で、心臓又は大血管の壁内の内 部貫入部を開口させるための開創手段、を備えた、 ことを特徴とする請求の範囲第26項に記載の装置。 41.患者の胸郭の右横部分の経皮的貫入部から心臓又は大血管の内部に到達する ように、前記インタベンション手段を形成した、 ことを特徴とする請求の範囲第26項に記載の装置。 42.前記インタベンション手段の長さが、少なくとも約20cmである、 ことを特徴とする請求の範囲第41項に記載の装置。 43.患者の心臓内の心臓弁の非開胸式交換を容易にするための経皮的アクセスカ ニューレであって、 患者の胸郭の肋間領域に配置されるように形成され、遠位端部と近位端部と その間を延びる内腔とを有し、該内腔が交換弁を通過せしめるように形成された 、カニューレ本体と、 前記内腔内に位置決め可能で、肋間領域の幅より小さい断面幅と、該断面幅 より大きい断面高さとを有するオブチュレータと、を備えた、 ことを特徴とするアクセスカニューレ。 44.前記弁人工器官が、前記オブチュレータの断面高さに等しいかそれより小さ い外径を有する環状取付部を備えた、 ことを特徴とする請求の範囲第43項に記載のアクセスカニューレ。 45.前記断面高さが、前記断面幅の約2〜6倍である、 ことを特徴とする請求の範囲第43項に記載の装置。 46.前記オブチュレータが、略矩形の断面を有する、 ことを特徴とする請求の範囲第43項に記載の装置。 47.前記オブチュレータが、略楕円形の断面を有する、 ことを特徴とする請求の範囲第43項に記載の装置。 48.前記カニューレ本体の前記内腔が、応力を受けない状態で肋間領域の幅より 小さい幅と前記弁人工器官の外径より大きい高さとを有する断面形を備えた、 ことを特徴とする請求の範囲第44項に記載の装置。 49.前記内腔が、略矩形の断面を有する、 ことを特徴とする請求の範囲第48項に記載の装置。 50.前記内腔が、略楕円形の断面を有する、 ことを特徴とする請求の範囲第48項に記載の装置。 51.前記内腔の断面高さが、前記内腔の断面幅の2〜6倍である、 ことを特徴とする請求の範囲第48項に記載の装置。 52,更に、 前記カニューレ本体の近位端部に、前記内腔を通って延びる複数の縫合糸を 離間して保持するための手段を備えた、 ことを特徴とする請求の範囲第43項に記載の装置。 53.前記縫合糸保持手段が、前記カニューレ本体の近位端部で前記内腔の円周方 向に離間した位置に、複数のスロットを含む、 ことを特徴とする請求の範囲第52項に記載の装置。 54.更に、 前記カニューレ本体の近位端部に、縫合糸にかかる張力を維持するための手 段を備えた、 ことを特徴とする請求の範囲第52項に記載の装置。 55.前記張力を維持するための手段が、縫合糸を通過せしめる内部通路と、該縫 合糸に摩擦的に係合するように前記通路の円周方向に間隔を置いて配設された複 数の手段とを有する、編成リングから成る、 ことを特徴とする請求の範囲第54項に記載の装置。 56.前記編成リングが、内側リングと、該内側リングに回転可能に連結された外 側リングと、前記内側リングの円周方向に間隔を置いて配設された第1の複数の 開口部と、前記外側リングの円周方向に間隔を置いて配設された第2の複数の開 口部と、を備え、前記外側リングが第1の回転位置にあるとき前記第1及び第2 の複数の開口部が整合し、前記外側リングが第2の回転位置にあるとき不整合す る、 ことを特徴とする請求の範囲第55項に記載の装置。 57.患者の体腔内での外科的インタベンションを容易にするためのカニューレ装 置であって、 遠位端部と近位端部とその間を延びる内腔とを有し、該内腔が外科的器具を 挿通し得るように形成されたカニューレ本体と、 前記カニューレ本体の近位端部に位置し、体腔から前記内腔を通って延びる 複数の縫合糸を、体腔の外側で離間した位置に保持するための編成手段と、を備 えた、 ことを特徴とするカニューレ装置。 58.前記カニューレ本体を、患者の胸郭の肋間領域に位置決めし得るように形成 した、 ことを特徴とする請求の範囲第57項に記載のカニューレ装置。 59.前記編成手段が、内部通路と該内部通路の円周方向に間隔を置いて配設され た複数の縫合糸保持手段とを有する、第1の編成リングから成る、 ことを特徴とする請求の範囲第57項に記載のカニューレ装置。 60.前記第1の編成リングが、前記カニューレ本体の近位端部に対して、前記内 部通路を前記内腔に整合させて、固定されている、 ことを特徴とする請求の範囲第59項に記載のカニューレ装置。 61.前記縫合糸保持手段が、前記第1の編成リングの前記内部通路の円周方向に 間隔を置いて配設された複数のスロットから成る、 ことを特徴とする請求の範囲第59項に記載のカニューレ装置。 62.更に、 前記カニューレ本体の近位端部に、縫合糸を張力がかかった状態に維持する ための手段を備えた、 ことを特徴とする請求の範囲第60項に記載のカニューレ装置。 63.前記縫合糸を張力がかかった状態に維持するための手段が、前記第一の編成 リングから離間した第二の編成リングから成り、該第二の編成リングが、内部通 路と、前記内部通路の円周方向に間隔を置いて配設されて縫合糸を張力がかかっ た状態に保持するための複数の手段とを有する、 ことを特徴とする請求の範囲第62項に記載のカニューレ装置。 64.前記縫合糸を張力がかかった状態に保持するための手段が、前記第二の編成 リング内に設けられて縫合糸を摩擦的に係合させるためのスリットから成る、 ことを特徴とする請求の範囲第63項に記載のカニューレ装置。 65.前記縫合糸を張力がかかった状態に維持するための手段が、前記第一の編成 リング内に設けられて縫合糸を摩擦的に係合させるためのスリットから成る、 ことを特徴とする請求の範囲第62項に記載のカニューレ装置。 66.更に、 胸郭の外側で前記編成手段に近接して交換弁を保持するための手段を備え、 それにより、体腔から前記カニューレの内腔を通って延びる縫合糸を、前記交換 弁に縫着すると共に前記編成手段に固定し得るようにした、 ことを特徴とする請求の範囲第58項に記載のカニューレ装置。 67.前記内腔が、体腔内への前記交換弁の挿入を容易にするように、形成されて いる、 ことを特徴とする請求の範囲第66項に記載のカニューレ装置。 68.患者の心臓の弁位置に交換弁を配設するための胸腔鏡装置であって、 遠位端部と近位端部とを有し、患者の胸郭の肋間領域を通って位置決めし得 るように形成された細長い把手と、 該把手の遠位端部に位置し、肋間領域を通る挿入の向きで交換弁を解放可能 に保持するための手段と、を備えた、 ことを特徴とする胸腔鏡装置。 69.前記把手の長さが少なくとも約20cmである、 ことを特徴とする請求の範囲第68項に記載の胸腔鏡装置。 70.更に、 肋間領域を通る挿入の第一の向きから、前記弁位置に配置するための第二の 向きまで、前記把手に対して前記交換弁を軸回動させるための手段、を備えた、 ことを特徴とする請求の範囲第68項に記載の胸腔鏡装置。 71.前記軸回動手段が、前記把手の近位端部に配設されたアクチュエータを含む 、 ことを特徴とする請求の範囲第68項に記載の胸腔鏡装置。 72.更に、 前記把手の近位端部に、前記保持手段から前記交換弁を解放するための手段 を備えた、 ことを特徴とする請求の範囲第68項に記載の胸腔鏡装置。 73.心臓弁の非開胸式交換のための人工器官組立体であって、 環状取付部と該取付部に連結された可動弁部とを有する交換弁と、 前記取付部に解放可能に取り付けられ、患者の胸郭の肋間領域を通って前記 交換弁を挿入し得るように形成されたホルダ手段と、を備えた、 ことを特徴とする人工器官組立体。 74.前記肋間領域が一定の肋間幅を有し、前記交換弁と前記ホルダ手段とが共に 、前記肋間幅より小さい幅の断面形を有する、 ことを特徴とする請求の範囲第73項に記載の人工器官組立体。 75.前記交換弁の前記取付部が、前記肋間幅より大きい外径を有する、 ことを特徴とする請求の範囲第74項に記載の人工器官組立体。 76.前記ホルダ手段が、前記交換弁に取り付けられる遠位端部と該遠位端部の反 対側の近位端部とを有する細長い把手を備え、該把手が、前記交換弁を肋間領域 から患者の心臓内に挿入し得るように形成されている、 ことを特徴とする請求の範囲第73項に記載の人工器官組立体。 77.胸郭の右横部分から心臓内に前記交換弁を位置決めし得るように、前記把手 の長さが少なくとも約20cmである、 ことを特徴とする請求の範囲第76項に記載の人工器官組立体。 78.前記把手が、前記交換弁を解放するための手段を備え、該解放手段が、前記 把手の近位端部から作動され得るように形成されている、 ことを特徴とする請求の範囲第76項に記載の人工器官組立体。 79.前記把手が、肋間領域を通る挿入のための第1の向きから、患者の心臓内で の取り付けのための第2の向きまで、前記交換弁を軸回動させるための手段を備 え、該軸回動手段が、前記把手の近位端部から作動され得るように形成されてい る、 ことを特徴とする請求の範囲第76項に記載の人工器官組立体。 80.前記肋間領域の幅が、約20mmより小さい、 ことを特徴とする請求の範囲第73項に記載の人工器官組立体。 81.前記交換弁と前記保持手段とが、滅菌パック内に収容されている、 ことを特徴とする請求の範囲第73項に記載の人工器官組立体。
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PCT/US1994/013305 WO1995015715A1 (en) | 1993-12-06 | 1994-11-18 | Devices and methods for intracardiac procedures |
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- 1994-11-18 AT AT95901941T patent/ATE277556T1/de not_active IP Right Cessation
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2010531709A (ja) * | 2007-06-26 | 2010-09-30 | セント ジュード メディカル インコーポレイテッド | 崩壊可能/拡張可能な人工心臓弁を移植するための装置及び方法 |
JP2009131361A (ja) * | 2007-11-29 | 2009-06-18 | Akita Univ | 大動脈弁輪縫縮用のバンドホールダー |
Also Published As
Publication number | Publication date |
---|---|
ATE277556T1 (de) | 2004-10-15 |
WO1995015715A1 (en) | 1995-06-15 |
AU702940B2 (en) | 1999-03-11 |
DE69434040D1 (de) | 2004-11-04 |
EP0732890A4 (en) | 1997-11-05 |
US5571215A (en) | 1996-11-05 |
JP3717929B2 (ja) | 2005-11-16 |
DE69434040T2 (de) | 2005-10-06 |
AU1099595A (en) | 1995-06-27 |
EP0732890A1 (en) | 1996-09-25 |
ES2229229T3 (es) | 2005-04-16 |
EP0732890B1 (en) | 2004-09-29 |
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