US20130165967A1 - Heart occlusion devices - Google Patents

Heart occlusion devices Download PDF

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US20130165967A1
US20130165967A1 US13772801 US201313772801A US2013165967A1 US 20130165967 A1 US20130165967 A1 US 20130165967A1 US 13772801 US13772801 US 13772801 US 201313772801 A US201313772801 A US 201313772801A US 2013165967 A1 US2013165967 A1 US 2013165967A1
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single
disc
region
disc device
device
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US13772801
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Zahid Amin
Edward H. Cully
Warren Cutright
Coby C. Larsen
Steven J. Masters
Edward E. Shaw
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Gore W L and Associates Inc
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Gore W L and Associates Inc
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    • AHUMAN NECESSITIES
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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/12022Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12122Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder within the heart
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    • A61B17/12131Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
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    • A61B17/12131Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12168Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
    • A61B17/12172Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure having a pre-set deployed three-dimensional shape
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    • A61B2017/00557Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
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    • A61B2017/00606Implements H-shaped in cross-section, i.e. with occluders on both sides of the opening
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    • A61B2017/00615Implements with an occluder on one side of the opening and holding means therefor on the other
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    • A61B2017/00623Introducing or retrieving devices therefor
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    • A61B2017/00632Occluding a cavity, i.e. closing a blind opening
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    • A61B2017/00831Material properties
    • A61B2017/00853Material properties low friction, hydrophobic and corrosion-resistant fluorocarbon resin coating (ptf, ptfe, polytetrafluoroethylene)
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    • A61B2017/00867Material properties shape memory effect
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    • A61B17/12022Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205Introduction devices
    • A61B2017/12054Details concerning the detachment of the occluding device from the introduction device
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    • A61B2017/1205Introduction devices
    • A61B2017/12054Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/12095Threaded connection

Abstract

This disclosure is directed to an aperture occlusion device and a method for occluding an aperture, including a perimembranous ventricular septal defect. The aperture occlusion device includes a wire frame element. The wire frame forms geometric shapes that include an occluder region and a securing region. The occluder region and the securing region are separated by an attachment region including a waist. The occluder region and securing region can include membranous coverings. The device can be attached to a delivery hub. The wires forming the occluder region and securing region can have a shape-memory capability such that they can be collapsed and distorted in a sheath during delivery, but resume and maintain their intended shape after delivery.

Description

    CROSS-REFERENCES TO RELATED APPLICATIONS
  • This is a continuation-in-part of application Ser. No. 13/210,198, filed Aug. 15, 2011, which is a continuation-in-part of application Ser. No. 12/400,445, filed Mar. 9, 2009, which claims priority to U.S. Provisional Application Ser. No. 61/034,772, filed Mar. 7, 2008, both of which are incorporated herein by reference in their entireties.
  • FIELD OF THE INVENTION
  • The present invention is directed to a medical device and particularly to a device for closing congenital cardiac defects. The present invention is specifically directed to a heart occlusion device with a self-centering mechanism.
  • DESCRIPTION OF THE PRIOR ART
  • Heart occlusion devices for correcting congenital heart defects, such as atrial septal defects (“ASD”), patent foramen ovale (“PFO”) defects, ventricular septal defects (“VSD”), and patent ductus arteriosus (“PDA”) defects, are known to the medical field. The following companies manufacture different types of devices: AGA Medical, Microvena Corp./EV3 Medical, Velocimed/St. Jude Medical, Occlutech International, NMT Medical, Cardia, Inc., Solysafe S A, Sideris (Custom Medical, Inc.), W L Gore, and Cook, Inc.
  • A specific example of one such heart defect is a PFO. A PFO, illustrated in FIG. 1 at 6A, is a persistent, one-way, usually flap-like opening in the wall between the right atrium 2 and left atrium 3 of the heart 1. Because left atrial (LA) pressure is normally higher than right atrial (RA) pressure, the flap usually stays closed. Under certain conditions, however, right atrial pressure can exceed left atrial pressure, creating the possibility that blood could pass from the right atrium 2 to the left atrium 3, and blood clots could enter the systemic circulation. It is desirable that this circumstance be eliminated.
  • The foramen ovale 6A serves a desired purpose when a fetus is gestating in utero. Because blood is oxygenated through the umbilical chord and not through the developing lungs, the circulatory system of the fetal heart allows the blood to flow through the foramen ovale as a physiologic conduit for right-to-left shunting. After birth, with the establishment of pulmonary circulation, the increased left atrial blood flow and pressure results in functional closure of the foramen ovale. This functional closure is subsequently followed by anatomical closure of the two over-lapping layers of tissue: septum primum 8 and septum secundum 9. However, a PFO has been shown to persist in a number of adults.
  • The presence of a PFO defect is generally considered to have no therapeutic consequence in otherwise healthy adults. Paradoxical embolism via a PFO defect is considered in the diagnosis for patients who have suffered a stroke or transient ischemic attack (TIA) in the presence of a PFO and without another identified cause of ischemic stroke. While there is currently no definitive proof of a cause-effect relationship, many studies have confirmed a strong association between the presence of a PFO defect and the risk for paradoxical embolism or stroke. In addition, there is significant evidence that patients with a PFO defect who have had a cerebral vascular event are at increased risk for future, recurrent cerebrovascular events.
  • Accordingly, patients at such an increased risk are considered for prophylactic medical therapy to reduce the risk of a recurrent embolic event. These patients are commonly treated with oral anticoagulants, which potentially have adverse side effects, such as hemorrhaging, hematoma, and interactions with a variety of other drugs. The use of these drugs can alter a person's recovery and necessitate adjustments in a person's daily living pattern.
  • In certain cases, such as when anticoagulation is contraindicated, surgery may be necessary or desirable to close a PFO defect. The surgery would typically include suturing a PFO closed by attaching septum secundum to septum primum. This sutured attachment can be accomplished using either an interrupted or a continuous stitch and is a common way a surgeon shuts a PFO under direct visualization.
  • Umbrella devices and a variety of other similar mechanical closure devices, developed initially for percutaneous closure of atrial septal defects (ASDs), have been used in some instances to close PFOs. These devices potentially allow patients to avoid the side effects often associated with anticoagulation therapies and the risks of invasive surgery. However, umbrella devices and the like that are designed for ASDs are not optimally suited for use as PFO closure devices.
  • Currently available septal closure devices present drawbacks, including technically complex implantation procedures. Additionally, there are not insignificant complications due to thrombus, fractures of the components, conduction system disturbances, perforations of heart tissue, and residual leaks. Many devices have high septal profile and include large masses of foreign material, which may lead to unfavorable body adaptation of a device. Given that ASD devices are designed to occlude holes, many lack anatomic conformability to the flap-like anatomy of PFOs. The flap-like opening of the PFO is complex, and devices with a central post or devices that are self-centering may not close the defect completely, an outcome that is highly desired when closing a PFO defect. Hence, a device with a waist which can conform to the defect will have much higher chance of completely closing the defect. Even if an occlusive seal is formed, the device may be deployed in the heart on an angle, leaving some components insecurely seated against the septum and, thereby, risking thrombus formation due to hemodynamic disturbances. Finally, some septal closure devices are complex to manufacture, which may result in inconsistent product performance.
  • Devices for occluding other heart defects, e.g., ASD, VSD, PDA, also have drawbacks. For example, currently available devices tend to be either self-centering or non-self-centering and may not properly conform to the intra-cardiac anatomy. Both of these characteristics have distinct advantages and disadvantages. The non-self centering device may not close the defect completely and may need to be over-sized significantly. This type of device is usually not available for larger defects. Further, the self-centering device, if not sized properly, may cause injury to the heart.
  • Some have sharp edges, which may damage the heart causing potentially clinical problems.
  • Some devices contain too much nitinol/metal, which may cause untoward reaction in the patient and hence can be of concern for implanting physicians and patients.
  • Some currently marketed devices have numerous model numbers (several available sizes), making it difficult and uneconomical for hospitals and markets to invest in starting a congenital and structural heart interventional program.
  • The present invention is designed to address these and other deficiencies of prior art aperture closure devices. Furthermore, other desirable features and characteristics of the present invention will become apparent from the subsequent detailed description and the appended claims, taken in conjunction with the accompanying drawings and this section.
  • SUMMARY OF THE INVENTION
  • This document provides implantable occlusion devices and methods for occluding, for example, bodily apertures and channels. Some embodiments include frame elements, such as shape-memory wires, that are bent into patterns to form full and/or partial discs. Some embodiments are asymmetrical and include a full disc and a partial disc that are separated by a waist portion. Some embodiments include membranous coverings on the frame elements to enhance the occlusive properties of the device. Some embodiments include a self-centering feature.
  • Accordingly, one innovative aspect of the subject matter described in this specification may be embodied in a single-disc device for occluding an aperture within a body of a patient. The single-disc device comprises: an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane; an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of about 180 degrees or less.
  • In various implementations, the major axes of the securing members may be spaced symmetrically within the circular sector having an arc of about 180 degrees or less. The one or more securing members may each comprise one or more wire loops or wire prongs. The circular sector may have an arc of 150 degrees or less. The major axis of each of the one or more securing members may extend at an angle between 80 and 100 degrees with respect to the axis of the attachment region. The securing region may comprise three or more securing members. The disc plane may extend at an angle between 0 to 5 degrees with respect to the major axis of at least one of the one or more securing members. The disc plane may extend at an angle between 5 to 15 degrees with respect to the major axis of at least one of the one or more securing members. The occluder region may comprise a membrane configured to inhibit passage of blood, wherein the membrane covers at least a portion of the disc. The membrane may comprise a fluoropolymer. The membrane may comprise polytetrafluoroethylene. The membrane may comprise expanded polytetrafluoroethylene. The occluder region may further comprise an expandable balloon configured to restrict fluid flow through the aperture. The occluder region may comprise at least one anchor. The single-disc device may comprise one or more visual indicators configured to identify the orientation of the securing region. The disc plane may extend at an angle between 75 to 105 degrees with respect to the axis of the attachment region. The first end may be at the proximal end of the single-disc device, and the second end may be at the distal end of the single-disc device.
  • Another innovative aspect of the subject matter described in this specification may be embodied in a method of occluding a cardiac defect. The method comprises: providing a single-disc device; configuring the single-disc device in a delivery configuration and advancing the single-disc device to a delivery site; and deploying the single-disc device at the delivery site. The single-disk device comprises: an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane; an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less.
  • In various implementations, the method may further comprise coupling the single-disc device to a delivery catheter. The method may further comprise inserting the single-disc device and the delivery catheter into a delivery sheath. The frame element may collapse as the single-disc device is inserted into the delivery sheath. Deploying the single-disc device may comprise advancing the single-disc device through the delivery sheath such that at least a portion of the single-disc device exits the delivery sheath distal of the delivery sheath. The frame element may expand as the single-disc device exits the delivery sheath. Deploying the single-disc device may comprise pulling the delivery sheath away from the cardiac defect while maintaining a position of the single-disc device. Deploying the single-disc device may substantially occlude the cardiac defect.
  • Another innovative aspect of the subject matter described in this specification may be embodied in a system for occluding an aperture within a body of a patient. The system comprises: a single-disc occluder device; a deployment wire releasably attached to the first end of the single-disc device; a delivery catheter comprising a sheath configured to contain the deployment wire and the single-disc occluder device arranged in a delivery configuration, the delivery catheter configured to advance the single-disc device to a delivery site; and an actuator device attached to a proximal end of the delivery catheter, the actuator device being configured to remotely control deployment of the single-disc device at the delivery site. The single-disc device comprises: an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane; an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less.
  • Another innovative aspect of the subject matter described in this specification may be embodied in a method of occluding a blood vessel. The method comprises: providing a single-disc device; configuring the single-disc device in a delivery configuration and advancing the single-disc device to a delivery site in the vessel; and deploying the single-disc device at the delivery site in the vessel. The single-disc device comprises: an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane; an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less.
  • In various implementations, the method may further comprise coupling the single-disc device to a delivery catheter; inserting the single-disc device and the delivery catheter into a delivery sheath, wherein the frame element collapses as the single-disc device is inserted into the delivery sheath, and wherein the frame element expands as the single-disc device exits the delivery sheath. Deploying the single-disc device may comprise advancing the single-disc device through the delivery sheath, such that at least a portion of the single-disc device exits the delivery sheath distal of the delivery sheath.
  • The device of the present invention has many advantages:
      • Lower Profile: The occluder device of the present invention has a lower profile than available devices.
      • Conformable: The device is flexible and conformable to the patient anatomy, specifically the hole that is being closed. There are no sharp edges. The device is soft and hence less traumatic to the atrial tissue.
      • Self-Centering on Demand: Because of the unique way the two discs are connected, the device has self-centering characteristics. The uniqueness of this device is in the self-centering mechanism. In some embodiments, the waist of the device is made of four wires. In some embodiments, the waist of the device can be made of fewer than or more than four wires. The wires will have the capability to conform to the shape and size of the defect in the organ—a characteristic not seen in prior art devices. Therefore, the self-centering of the device is dependent upon the size and the shape of the defect. The wires will have enough radial force to maintain the self-centering configuration but will not be strong enough to press against the defect edges in a manner that exacerbates the defect. The device is fully repositionable and retrievable after deployment.
      • Custom Fit: The device has the further ability to be custom-fit within the defect using, for example, balloon-expansion of the waist. Because of the self-expanding nature of the waist, this will not be needed in most cases. However, in some cases in which custom expansion is needed (oval defects, tunnel defects), the waist size can be increased to conform to the defect by the balloon catheter expansion, or another suitable method. A balloon may be inserted through a hollow screw attachment on the device's delivery hub and delivery cable. The expansion will be possible before the release of the device, which will increase the margin of safety.
      • Fewer Sizes: The expandable waist requires fewer sizes to close a wider variety of differently-sized defects. Thus, a single device may offer physicians the ability to implant devices in several different sizes.
      • The device will be less thrombogenic as the discs will be covered with ePTFE. The ePTFE has been time-tested and found to be least thrombogenic. There is the ability to close defects up to 42 mm with very mild modifications.
      • Security: There will be the opportunity to remain tethered to the implanted device before releasing it, which is an extra security feature.
    Uses:
  • The device of the present invention should be appropriate for an ASD (atrial septal defect), PFO (patent foramen ovale), VSD (ventricular septal defect), and PDA (patent ductus arteriosus) with minor modifications. One skilled in the art would also recognize the device's application for use as a vascular occluder or plug as well as an atrial appendage occluder.
  • An important use of the device will also be in closure of an aperture in a left atrial appendage. The device can be modified to conform to the atrial appendage anatomy. The discs are modified so that the device is not extruded out with the heartbeats. Yet, the device is still soft enough to form adequate closure.
  • The discs can also be modified so that they become compatible for closure of veins and arteries. For this use, the connecting waist will become equivalent (or near equivalent) to the diameter of the discs. Other important uses will be in closure of coronary artery fistulas, arteriovenous fistulas, arteriovenous malformations, etc.
  • The objects and advantages of the invention will appear more fully from the following detailed description of the preferred embodiments of the invention made in conjunction with the accompanying drawings.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 is a schematic representation of a human heart including various septal defects.
  • FIG. 2 is a perspective view of the occluder device of the present invention.
  • FIG. 3 is a top plan view of the occluder device of FIG. 2.
  • FIG. 4 is a side plan view of the occluder device taken along lines in FIG. 2.
  • FIG. 5 is a side plan view of the occluder device taken along in FIG. 2.
  • FIG. 6 is a perspective view of the occluder device of FIG. 2, illustrating the covering 42.
  • FIG. 7 is a top plan view of the occluder device of FIG. 6.
  • FIG. 8 is a perspective view of the occluder device first emerging from the catheter.
  • FIG. 9 is a perspective view of the occluder device half-way emerged from the catheter.
  • FIG. 10 is a perspective view of the occluder device fully emerged from the catheter and separated from the deployment cable.
  • FIG. 11 is a perspective view of the occluder device of the present invention illustrating restriction wires encircling the waist of the occluder device.
  • FIG. 12A is a perspective view of a first alternative embodiment of the occluder device of the present invention.
  • FIG. 12B is a side plan view of the first alternative embodiment of the occluder device of the present invention as shown in FIG. 12A.
  • FIG. 13 is a side plan view of a second alternative embodiment of the occluder device of the present invention.
  • FIG. 14 is a side plan view of a third alternative embodiment of the occluder device of the present invention.
  • FIG. 15 is a side plan view of a fourth alternative embodiment of the occluder device of the present invention.
  • FIG. 16 is a side view of another exemplary alternative embodiment of the occluder device.
  • FIG. 17 is a side view of another exemplary alternative embodiment of the occluder device.
  • FIG. 18 is a perspective view of another exemplary alternative embodiment of the occluder device.
  • FIG. 19 is a plan view of another exemplary alternative embodiment of the occluder device, depicted with reference to planar quadrants in FIG. 19A.
  • FIG. 20 is a side view of another exemplary alternative embodiment of the occluder device.
  • FIG. 21A is a perspective view of another exemplary alternative embodiment of the occluder device.
  • FIG. 21B is a plan view of another exemplary alternative embodiment of the occluder device.
  • FIG. 21C is a plan view of another exemplary alternative embodiment of the occluder device.
  • FIG. 21D is a plan view of another exemplary alternative embodiment of the occluder device.
  • FIG. 21E is a plan view of another exemplary alternative embodiment of the occluder device.
  • FIG. 22 is a plan view of another exemplary alternative embodiment of the occluder device.
  • FIGS. 23A and 23B are a flowchart of an exemplary embodiment of a method for occluding an aperture defect in a heart to prevent the flow of blood therethrough, and that may be implemented using the occluder devices of FIGS. 2-22.
  • FIG. 24A is a schematic representation of a human heart including a perimembranous ventricular septal defect.
  • FIG. 24B is the schematic representation of the human heart of FIG. 24A including an exemplary asymmetrical occlusion device.
  • FIG. 25 is a schematic side view representation of an exemplary embodiment of an asymmetrical occlusion device.
  • FIG. 26 is a perspective view of an exemplary embodiment of an asymmetrical occlusion device.
  • FIGS. 27A and 27B are schematic representations of two exemplary embodiments of asymmetrical occlusion devices.
  • FIG. 28 is a schematic side view representation of another exemplary embodiment of an asymmetrical occlusion device.
  • DETAILED DESCRIPTION OF THE INVENTION
  • The following detailed description is merely exemplary in nature and is not intended to limit the disclosure or the application and uses of the disclosure. Furthermore, there is no intention to be bound by any theory presented in the preceding background information or the following detailed description.
  • The present invention provides a device for occluding an aperture within body tissue. One skilled in the art will recognize that the device and methods of the present invention may be used to treat other anatomical conditions in addition to those specifically discussed herein. As such, the invention should not be considered limited in applicability to any particular anatomical condition.
  • FIG. 1 illustrates a human heart 1, having a right atrium 2, a left atrium 3, a right ventricle 4, and a left ventricle 5. Shown are various anatomical anomalies 6A, 6B, and 6C. The atrial septum 7 includes septum primum 8 and septum secundum 9. The anatomy of the septum 7 varies widely within the population. In some people, the septum primum 8 extends to and overlaps with the septum secundum 9. The septum primum 8 may be quite thin. When a PFO is present, blood could travel through the passage 6A between septum primum 8 and septum secundum 9 (referred to as “the PFO tunnel”). Additionally or alternatively, the presence of an ASD could permit blood to travel through an aperture in the septal tissue, such as that schematically illustrated by aperture 6B. A VSD is similar to an ASD, except that an aperture 6C exists in the septum between the left and right ventricle of the heart.
  • PDA results from defects in the ductus arteriosus. The human blood circulation comprises a systemic circuit and a pulmonary circuit. In the embryonic phase of human development, the two circuits are joined to one another by the ductus arteriosus. The ductus connects the aorta (circulation to the body) to the pulmonary artery (pulmonary circuit). In normal development of an infant, this ductus closes after birth. If development is defective, it can happen that the ductus does not close, and as a result the two blood circuits are still joined even after birth.
  • Unless specifically described otherwise, “aperture” 6 will refer to the specific heart defects described above, including PFO 6A, ASD 6B, VSD 6C, perimembranous VSD 6D, and PDA among others.
  • As used herein, “distal” refers to the direction away from a catheter insertion location and “proximal” refers to the direction nearer the insertion location.
  • As used herein, “left” refers to the left chambers of the heart, including the left atrium and left ventricle. “Right” refers to the right chambers of the heart, including the right atrium and right ventricle.
  • As used herein, “superior” refers to the direction toward the head of the patient and “inferior” refers to the direction toward the feet of the patient.
  • As used herein, “memory” or “shape memory” refers to a property of materials to resume and maintain an intended shape despite being distorted for periods of time, such as during storage or during the process of delivery in vivo.
  • Referring now to FIGS. 2-5, the occluder device 10 of the present invention comprises two separate uniquely shaped memory wires 12, 14. The wire can be formed of biocompatible metals or polymers, such as bioresorbable polymers, shape memory polymers, shape memory metal alloys, biocompatible metals, bioresorbable metals, or combinations thereof. Specific examples include but are not limited to iron, magnesium, stainless steel, nitinol, or combinations of these and similar materials. A preferred metal for the present invention is a nitinol alloy. Nitinol (an acronym for Nickel Titanium Naval Ordnance Laboratory) is a family of intermetallic materials, which contain a nearly equal mixture of nickel (55 wt. %) and titanium. Other elements can be added to adjust or “tune” the material properties. Nitinol exhibits unique behavior, specifically, a well defined “shape memory” and super elasticity. In general, any biocompatible material with a memory capability can be used with the present invention. The thermal shape memory and/or superelastic properties of shape memory polymers and alloys permit the occluder 10 to resume and maintain its intended shape in vivo despite being distorted during the delivery process. In certain embodiments, the memory may also assist in pressing an aperture, such as a PFO tunnel, closed. The diameter or thickness of the wire depends on the size and type of the device, i.e., the larger the device, the larger the diameter of the wire. In general, wire having a diameter between about 0.2 mm and 0.8 mm can be used. As described further below in connection with FIGS. 12A, 12B, and 22, in certain embodiments more than two wires may be utilized.
  • The first wire 12 forms one or more first geometric forms 12A and one or more second geometric forms 12B. “Geometric forms” as used herein comprises symmetric as well as asymmetric forms. Relative to a delivery attachment mechanism or hub 30, discussed below in greater detail, the first geometric form 12A of the first wire 12 preferably comprises a distal geometric form, and the one or more second geometric forms 12B of the first wire preferably each comprise proximal geometric forms. In the embodiment of FIGS. 2-5, there is a single first, or distal, geometric form 12A of the first wire 12. Also in the embodiment of FIGS. 2-5, there are two second, or proximal, geometric forms 12B of the first wire 12 (namely, 12B(A) and 12B(B)). However, the number and configuration of the first and/or second geometric forms 12A, 12B of the first wire 12 may vary.
  • Similarly, the second wire 14 forms a first geometric form 14A and a second geometric form 14B. Relative to the hub 30, the first geometric form 14A of the second wire 14 preferably comprises a distal geometric form, and the second geometric form 14B of the second wire preferably comprises a proximal geometric form. In the embodiment of FIGS. 2-5, there is a single first, or distal, geometric form 14A of the second wire 14. Also in the embodiment of FIGS. 2-5, there are two second, or proximal, geometric forms 14B of the second wire 14 (namely, 14B(A) and 14B(B)). However, the number and configuration of the first and/or second geometric forms 14A, 14B of the second wire 14 may vary.
  • The first geometric forms 12A of the first wire 12 and the first geometric forms 14A of the second wire 14 form a first plate, such as a disc, or another otherwise relatively flat surface (hereinafter referred to as a “plate”) 16 in a first plane 218. The second geometric forms 12B of the first wire 12 and the second geometric forms 14B of the second wire 14 form a second plate 18 (also referred to as a “disc” in certain embodiments) in a second plane 220 that is parallel to and remote from the first plane 218. In the embodiment of FIGS. 2-5, the first and second plates 16, 18 each comprise one or more semi-circular discs (as described directly below). However, this may vary in some embodiments, for example as described further below in connection with FIGS. 21A-21E.
  • As shown in FIGS. 2-5, in these embodiments, each wire 12 or 14 forms a shape which mirrors that of the respective wire 14 or 12. Specifically, each wire 12, 14 forms a distal semi-circle or half-disc 12A, 14A in addition to two proximal quarter-circles or quarter-discs 12B, 12B′ or 14B, 14B′. The two proximal quarter-circles of each wire together form proximal semi-circles or half-discs 12B, 12B′ or 14B, 14B′. The two distal semi-circles of each respective wire 12A, 14A together comprise a distal circle or distal disc 16 of the occluder 10. The four proximal quarter-circles 12B, 12B′, 14B, 14B′, which form a “four-leaf clover” configuration, comprise a proximal circle or proximal disc 18 of the occluder 10.
  • The proximal semi-circle 12B, 12B′ or 14B, 14B′ of each wire is connected to the distal semi-circle 12A or 14A by waist portions (also referred to herein as waist components) 12C, 14C. As shown in FIG. 2, there are two waist portions 12C, 14C per wire. The four waist portions (two from each wire) 12C, 14C together comprise a restricted area or waist 20 of the occluder device 10. The distance between the waist portions, both within the same wire and from wire to wire, determines the size of the waist 20. The size of the waist 20 is dependent on the particular application and the size of the occluder device 10. The resiliency and memory of the waist portions 12C, 14C and capacity to expand radially serves as a self-centering mechanism of the occluder device 10 in apertures 6.
  • The Hub 30:
  • The two half-discs are not attached or joined to each other except at the junction of the delivery attachment mechanism or hub 30. The ends 12D, 14D of wires 12, 14 will be welded or otherwise connected to the hub 30.
  • Coverings 24A and 24B:
  • According to some embodiments of the present invention, the distal disc 16 and/or proximal disc 18 may include membranous coverings 24A and 24B, illustrated in FIGS. 6 and 7. The membranous coverings 24A and 24B ensure more complete coverage of aperture 6 and promote encapsulation and endothelialization of tissue, thereby further encouraging anatomical closure of the tissue and improving closure rate. The coverings 24A and 24B also help stabilize the occluder device 10.
  • The membranous coverings 24A and 24B may be formed of any flexible, biocompatible material capable of promoting tissue growth and/or act as a sealant, including but not limited to DACRON®, polyester fabrics, Teflon-based materials, ePTFE, polyurethanes, metallic materials, polyvinyl alcohol (PVA), extracellular matrix (ECM) or other bioengineered materials, synthetic bioabsorbable polymeric materials, other natural materials (e.g. collagen), or combinations of the foregoing materials. For example, the membranous coverings 24A and 24B may be formed of a thin metallic film or foil, e.g. a nitinol film or foil, as described in U.S. Pat. No. 7,335,426 (the entirety of which is incorporated herein by reference). The preferred material is Poly(tetrafluoroethene) (ePTFE), as it combines several important features such as thickness and the ability to stretch. Loops may also be stitched to the membranous coverings 24A and 24B to securely fasten the coverings to occluder 10. The coverings may alternatively be glued, welded or otherwise attached to the occluder 10 via the wires 12, 14.
  • Size:
  • As illustrated in FIGS. 2-7, the diameters of the distal disc 16 and proximal disc 18 are generally 5-8 mm larger than the diameter of the connecting waist 20. For example, if the diameter of the connecting waist 20 is 4 mm, the diameters of the discs 16,18 are generally about 9 mm each. Because of the flexibility in the waist 20, a 12 mm waist device will be able to be placed in a 6 mm to 12 mm defect. For larger waists 20 or larger devices, the diameter of the disc size will increase proportionately.
  • It is within the scope of the present invention to envision occluder devices available in 7 or more sizes, specifically waist size having the following diameters for different-sized apertures 6: 6 mm, 12 mm, 18 mm, 24 mm, 30 mm, 36 mm, and 42 mm. Occluder devices having waist size to fit other aperture sizes are also contemplated.
  • Operation:
  • In general, the occluder 10 may be inserted into an aperture 6 to prevent the flow of blood therethrough. As a non-limiting example, the occluder 10 may extend through a PFO 6A or an ASD 6B such that the distal disc 16 is located in the left atrium 3 and the proximal disc 18 is located in the right atrium 2 (as shown in the heart 1 in FIG. 1). The closure of apertures in these and other tissues, as well as other types of apertures, will become apparent as described below.
  • Referring now to FIGS. 8-10, the occluder device 10 is attached to a deployment cable 34 which is removably attached to the occluder device 10 at the hub 30. As illustrated in FIG. 10, one method of releasably attaching the deployment cable 34 to the hub 30 is by threaded engagement utilizing a screw end 36 which engages unseen female threads within the hub 30. Other known means of attachment can be used to releasably connect the deployment cable 34 to the hub 30.
  • When the deployment cable 34 is engaged with the hub 30, as illustrated in FIGS. 8 and 9, the occluder device 10 is initially housed within a flexible delivery catheter 40 having an open channel 42. Reference is made to FIG. 8 which illustrates the occluder device 10 in which the distal disc 16 is expanded, due to the memory expansion of the wires 12 and 14, and housed within the open channel 42 of the delivery catheter 40. During the initial stages of placement of the occluder device 10, both the distal disc 16 and proximal disc 18, as well as the coverings 24A and 24B, are housed within the open channel 42 of the delivery catheter 40. In this manner, the catheter 40 is fed into the blood vessel through an already placed sheath and advanced via the blood vessel system to a defect in the heart.
  • Once the delivery catheter 40 traverses the aperture that needs to be occluded, e.g., a hole in the heart, the device 10 will be partially advanced from the catheter 40 as illustrated in FIG. 8. As the device 10 leaves the catheter 40, the distal disc 16, which includes the covering 24A, begins to expand on the distal side of the aperture. Due to the memory capabilities of the wires 12 and 14, the occluder device 10 begins to return to its normal shape such that the distal disc 16 expands on the distal side of the aperture in the heart. Once the distal disc 16 is completely out of the catheter opening 42, as shown in FIG. 9, it 16 and the attached covering 24A become fully expanded. The catheter 40 is further withdrawn to expose the waist 20 which then begins to emerge and expand due to the memory shape of the wires 12 and 14. Advantageously, the waist 20 is designed to expand such that each of the wires forming the waist 20 are urged against the aperture in the heart causing a custom fit device of the occluder 10 within the aperture. As the catheter 40 is further withdrawn, the proximal disc 18 and the covering 24B begin their process of expansion on the proximal side of the aperture. When the proximal disc 18 is fully delivered from the catheter 40, it will expand and effectively form a seal over the aperture. The distal disc 16 and proximal disc 18 are secured in place by the action of the wires in the waist 20 urging against the aperture. At this stage, as shown in FIG. 10, the deployment cable 34 is removed from the hub 30 and the catheter 40 and the deployment cable 34 are removed from the body. The occluder device 10 is left in the heart at the region of the aperture. Over several months, cardiac tissue and other membranous structures will bind to the occluder device 10 thereby permanently locking the occluder device 10 to the specific area in the heart.
  • The two wires 12, 14 function to form round discs 16, 18 on each side of the tissue. The discs 16, 18 maintain the circular shape because of the memory capability of the wires 12, 14. The coverings 24A, 24B will stabilize the discs and will act to completely occlude the defect.
  • The wires 12, 14 at the waist portions 12C, 14C will be separated enough at the waist 20 to make the occluder device 10 self-centering. Due to the conformity of this design, the occluder device 10 can self-center within commonly (round, oval) shaped septal defects, as the waist 20 can adjust to any type of opening.
  • If a larger-diameter waist 20 is required, the waist 20 has the capability to expand (only if needed) to a larger size with the help of a balloon. In this manner, a center channel 50 extends through the deployment cable 34, the hub 30, and the screw end 36. A balloon (not shown) is urged through the center channel 50 after the occluder device has been removed from the catheter 40 and expanded, and preferably before the hub 30 has been attached from the deployment cable 34. The balloon is placed within the waist 20 and expanded. The waist 20 is dilatable, i.e., expandable, when gentle pressure of the balloon is applied. The dilation will expand the waist portions 12C, 14C. Once the desired diameter is reached, the balloon is deflated and removed by withdrawal through the center channel 50. Once the occluder device 10 appears stable, the device 10 is separated from the deployment cable 34 as discussed above. In the majority of cases, balloon dilation will not be required.
  • Restriction Wires 60, 62 (FIG. 11):
  • In order to increase stability in the occluder device 10 and to avoid significant crimping of the waist 20 or the proximal or distal discs 18, 16, the waist 20 can be encircled by one or more restriction wires 60, 62 as illustrated in FIG. 11. The restriction wires 60, 62 can be made of the same wire material as the wires 12 and 14, or they may be of a different material, such as plastic wire, fish line, etc. The restriction wires 60, 62 may be welded or otherwise connected to the waist portions 12C, 14C. The purpose of the restriction wires 60 or 62 is also to restrict the circumference of the waist 20 if necessary. Although one restriction wire 60 is generally suitable, a second restriction wire 62 can also be incorporated to further improve stability.
  • ALTERNATIVE EMBODIMENTS
  • Reference is now made to FIGS. 12-15 for alternative embodiments of the occluder device 10 of the present invention. Unless otherwise noted, the same reference numbers will be applied to similar structures in each embodiment.
  • Reference is made to FIGS. 12A and 12B for an alternative embodiment of the occluder device (labeled as occluder device 100 in FIGS. 12A and 12B). The occluder device 100 in this embodiment is designed for PDA procedures. This embodiment is similar to previously described embodiments except that it is comprised of four wires 112, 114, 116, 118 rather than two wires. In this case, each wire forms a mirror image of each of its neighboring wires. For example, wire 112 mirrors wire 114 as well as wire 118, etc. Each of the four wires 112, 114, 116, 118 forms a proximal quarter-disc 112B, 114B, 116B, 118B and a distal quarter-disc 112A, 114A, 116A, 118A. The proximal quarter-discs 112B, 114B, 116B, 118B together form a proximal disc 111 in a “four-leaf clover” configuration, and the distal quarter-discs 112A, 114A, 116A, 118A together form a distal disc 110 also in a “four-leaf clover” configuration. This embodiment also differs from previously-described embodiments in that the waist 20 is comprised of a single portion of each of the four wires 112, 114, 116, 118. This embodiment further differs from previously-described embodiments in that it comprises a second hub 119 with a screw mechanism. The second hub 119 connects to the distal disc 110 by distal ends 112E, 114E (116E, 118E behind 112E, 114E in FIG. 12B) of each of the four wires 112, 114, 116, 118, just as proximal ends 112D, 114D (116D, 118D behind 112D, 114D in FIG. 12B) connect to the proximal hub 30. The wires 112, 114, 116, 118 may be connected to the hubs 30, 119 by welding or other means known in the art. The length of the waist 20 will be anywhere from 4-8 mm. In addition, the distal disc 110 is typically 4-8 mm larger than the waist 20. However, the proximal disc 111 is generally 1-3 mm, preferably 2 mm, larger than the waist 20 diameter. Hence, the diameter of the distal disc 110 is larger than the diameter of the proximal disc 111.
  • Reference is now made to FIG. 13 for a second alternative embodiment of the occluder device 120. This embodiment, like the embodiment shown in FIGS. 12A and 12B, uses four wires 112, 114, 116, 118 and two hubs 30, 119. It is designed to close apertures in large arteries and veins. In occluder device 120, the distal and proximal discs 122 and 124 are modified so that they are compatible with closure of veins and arteries. For this use, the connecting waist 20 is equivalent or near equivalent to the diameter of each of the discs 122, 124. The diameter of the waist 20 will be 1 mm smaller than the discs 122, 124. The length of the waist will be 4-8 mm. This embodiment can be used in the closure of coronary artery fistulas, arteriovenous fistulas, and arteriovenous malformations.
  • Reference is made to FIG. 14 for a third alternative embodiment of the occluder device 130. The importance of the occluder device 130 will be in the closure of the left atrial appendage. The device 130 is modified to conform to the atrial appendage anatomy. The distal disc 132 is modified so that the device 130 is not extruded out with the heartbeats. For the left atrial appendage occluder device 130, the memory wire structure of the distal disc 132 is woven to form anywhere from 2 to 8 protuberances or hooks 136. Upon inserting the device 10 in an aperture in the left atrial appendage of the heart, the hooks 136 grip the outer portion of the left atrium heart tissue and thereby assist in keeping the device 130 from extruding out of the left atrial appendage with contraction of the heart. The proximal disc 134 is typically flat and similar to the disc formed by the proximal discs 18 in FIGS. 2-7. The proximal disc 134 abuts the inner atrial wall of the heart. Typically, the waist 20 will be about 4-8 mm in diameter. The length of the waist may range from 4 to 16 mm.
  • Reference is made to FIG. 15 for a fourth alternative embodiment of the occluder device 140. Occluder device 140 is intended to occlude perimembranous ventricular septal (“PVS”) defects. This embodiment, like the embodiment shown in FIGS. 12A and 12B, uses four wires 112, 114, 116, 118 and two hubs 30, 119. The occluder device 140 is different from some embodiments in that two of the four wires form truncated distal-quarter discs, with the effect that the distal disc 142 substantially misses half of the disc. Therefore, the device 140 has approximately 1.5 discs as opposed to two discs. The half distal disc 142 is also significantly longer than the proximal disc 144. Typically, the distal disc 142 will be 6-8 mm in diameter. In addition, the distal disc 142 converges or curves inwards at 143, i.e., it is angled to contact the ventricular septum when the device 140 is inserted in the PVS defect. (See below for details.) The lower edge of the proximal disc (opposite to the long distal disc) will be 3-4 mm larger than the waist, and the other half of the proximal disc will be 2-3 mm larger than the waist. The discs can also be modified to be of different shapes in the same device. Alternatively, the disc angle may be created by a straight distal disc 142 angled with respect to the plane perpendicular to the waist 20 in a slant fashion.
  • With reference to FIGS. 16-22, various additional exemplary alternative embodiments are provided with respect to the occluder device and/or components thereof. With reference to FIG. 16, certain embodiments of the occluder device 10 may have one or more plates 16, 18 and/or geometric forms 12A, 12B, 14A, 14B of different sizes and/or configurations as compared with the embodiment described above in connection with FIG. 2. For example, the distal (or first) plate 16 and the proximal (or second) plate 18 may be offset with respect to the hub 30, and/or one side of a plate 16, 18 may be relatively higher or farther from the hub 30 than the other, for example via an oblique shift. In the particular embodiment of FIG. 16, a center 202 of the hub 30 is not aligned with (and, rather, is offset against) a center 204 of the first plate 16, but is aligned with a center 206 of the second plate 18. In another embodiment, the distal plate 16 and the proximal plate 18 are of equal size, yet off set from each other via a shift in opposite directions from the hub.
  • In certain embodiments, the first and second plates 16, 18 are configured such that a first segment formed from a first portion of the first wire 12 (for example, corresponding to form 12B of FIG. 16) has a first length, a second segment formed from a first portion of the second wire 14 (for example, corresponding to form 14A of FIG. 16) has a second length, a third segment formed for a second portion of the first wire 12 (for example, corresponding to form 12A of FIG. 16) has a third length, and a fourth segment formed for a second portion of the second wire 14 (for example, corresponding to form 14B of FIG. 16) has a fourth length. The second length is substantially equal to the first length. The third length is greater than the first length. The fourth length is substantially equal to the third length.
  • The semi-circle or half-disc 12A of the first wire 12 (also referenced above as the first geometric form 12A of the first wire 12) may differ in size (for example, having a larger radius and therefore a larger surface area) from the semi-circle or half-disc 14A of the second wire 14 (also referenced above as the first geometric form 14A of the second wire 14). In certain other embodiments, the semi-circle or half-disc 12A of the first wire 12 and the semi-circle or half-disc 14A of the second wire 14 may be of the same size same as one another, but may collectively form a distal plate 16 that differs in size from the proximal plate 18. In one such embodiment, the distal plate 16 is smaller in surface area than the proximal plate 18.
  • For example, the distal plate 16 may be of the same size as in FIG. 2, while the proximal plate 18 is larger in surface area than depicted in FIG. 2. This may occur, by way of example, when certain of the proximal quarter-circles of the second geometric forms 12B, 14B are larger in surface area than depicted in FIG. 2. Certain proximal quarter-circles of the second geometric forms 12B, 14B may be larger in surface area than other, adjacent quarter-circles of the second geometric forms 12B, 14B. Such differing sizes of the proximal quarter-circles of the second geometric forms 12B, 14B may be present regardless of the relative sizes of the distal and proximal plates 16, 18.
  • FIG. 17 depicts an embodiment of an occluder device contemplated herein with a wider waist 20. In one exemplary embodiment, the first plate 16 and the second plate 18 are disposed further apart as compared with the example of FIG. 2, so that a total length 225 of the waist 20 is greater than eight millimeters. Preferably, in this embodiment, the length 225 of the waist 20 is greater than eight millimeters and less than or equal to ten millimeters. In one such example, a straight-line distance between the first plane 218 and the second plane 220 of FIG. 2 is greater than eight millimeters, and is preferably also less than or equal to ten millimeters.
  • FIG. 18 depicts an embodiment of an occluder device contemplated herein with a hook engagement system 230. The hook engagement system 230 comprises a hook 232 and a lanyard 234 coupled thereto. The hook 232 is connected to the first plate 16 or the second plate 18 (and to the first and/or second wires 12, 14 thereof) described above, preferably proximate one of the coverings 24A, 24B. The hook engagement system 230 is configured for engagement with a positioning system (not depicted). In one embodiment, the hook engagement system 230 is used to remove the occluder device 10 from the heart. In this regard, a loop of the lanyard 234 is positioned onto the hook 232, and the lanyard 234 is pulled in the direction away from the heart, thus pulling the occluder device 10 through the heart aperture and through the body. In another embodiment, the positioning system comprises a deployment system for deploying the occluder device 10, for example by grasping the hook 232 for movement of the occluder device 10 into a human heart in a desired position proximate an aperture. In a further embodiment, the positioning system comprises a repositioning system for repositioning the occluder device 10, for example by grasping the hook 232 for adjusting the position of the occluder device 10 for more ideal placement of the occluder device 10 proximate an aperture. In certain embodiments, the lanyard (and/or another connection feature) is part of the positioning system, and the hook may exist separately from the occluder device 10. The hook 232 is preferably used in connection with a screw device for further engagement with the positioning system, such as a screw and nut system used in conjunction with FIGS. 8-10 described above. For example, the hook 232 may be positioned internal to a screw and nut system during placement of the device. Alternatively, the hook 232 may be used in connection with a thread cord through an eyelet or an opening, so that the cord would need to be pulled in order to lose the connection with the occluder device 10. In addition, such a cord may be used for retrieval of the occluder device 10, for example by including multiple lumens, preferably with an opening or slit, as part of a catheter delivery system. Other engagement and positioning systems are also contemplated, e.g., detent pin/receptacle, clasp/ball, clasp/eyelet, and the like.
  • With reference to FIGS. 19 and 19A, an embodiment of an occluder device contemplated herein is depicted with overlapping wires at least at one plate. Overlapping wires add additional strength and rigidity to the plate of the occluder device. Specifically, the first geometric form 12A of the first wire 12 overlaps at least a portion of one region (for example, at least a portion of a common spatial quadrant, half-plane, and/or quartile) in common with the first geometric form 14A of the second wire 14 within the first plate 16. Alternatively, or in addition, the second geometric form 12B (not shown) of the first wire 12 overlaps at least a portion of one region (for example, at least a portion of a common spatial quadrant, half-plane, and/or quartile) in common with the second geometric form 14B (not shown) of the second wire 14 within the second plate 18 (not shown).
  • In a preferred embodiment, as illustrated in FIG. 19, the first geometric form 12A of the first wire 12 occupies at least three spatial quadrants 300, 301, and 302, two of which (namely, spatial quadrants 300 and 302) are shared in their entireties with the first geometric form 14A of the second wire 14. Likewise, the first geometric form 14A of the second wire 14 occupies at least three spatial quadrants 302, 303, and 300, two of which (namely, spatial quadrants 300 and 302) are shared in their entireties with the first geometric form 12A of the first wire 12. Similarly, the second geometric form 12B of the first wire 12 (not depicted in FIG. 19) occupies at least three spatial quadrants, two of which are shared in their entireties with the second geometric form 14B of the second wire 14 (not depicted in FIG. 19). Likewise, the second geometric form 14B of the second wire 14 occupies at least three spatial quadrants, two of which are shared in their entireties with the second geometric form 12B of the first wire 12.
  • FIG. 19A depicts an exemplary classification of planar quadrants for the first and second planes 218, 220 of FIG. 2 for reference with respect to the embodiment of FIG. 19. One skilled in the art will recognize that less or more than four quadrants can be utilized. With reference to FIG. 19A, the first plane 218 of FIG. 2 has a first quadrant 241(A), a second quadrant 242(A) that is adjacent to the first quadrant 241(A), a third quadrant 243(A) that is below the first quadrant 241(A), and a fourth quadrant 244(A) that is below the second quadrant 242(A) and adjacent to the third quadrant 243(A). The second plane 220 of FIG. 2 has a first quadrant 241(B), a second quadrant 242(B) that is adjacent to the first quadrant 241(B), a third quadrant 243(B) that is below the first quadrant 241(B), and a fourth quadrant 244(B) that is below the second quadrant 242 (B) and adjacent to the third quadrant 243(B). The first quadrant 241(A) of the first plane 218 is closer to the first quadrant 241(B) of the second plane 220 than to the second, third, or fourth quadrants 242(B), 243(B), 244(B) of the second plane 220. The second quadrant 242(A) of the first plane 218 is closer to the second quadrant 242(B) of the second plane 220 than to the first, third, or fourth quadrants 241(B), 243(B), 244(B) of the second plane 220. The third quadrant 243(A) of the first plane 218 is closer to the third quadrant 243(B) of the second plane 220 than to the first, second, or fourth quadrants 241(B), 242(B), 244(B) of the second plane 220. The fourth quadrant 244(A) of the first plane 218 is closer to the fourth quadrant 244(B) of the second plane 220 than to the first, second, or third quadrants 241(B), 242(B), 243(B) of the second plane 220.
  • With reference to the spatial quadrants set forth in FIG. 19A, in one preferred embodiment of FIG. 19, the first geometric form 12A of the first wire 12 extends through the first, second, and third quadrants 241(A), 242(A), 243(A) of the first plane 218. The first geometric form 14A of the second wire 14 extends through the first, third, and fourth quadrants 241(A), 243(A), and 244(A) of the first plane 218. Accordingly, in this embodiment, the first geometric forms 12A, 14A of the first and second wires 12, 14 share the first and third quadrants 241(A), 243(A) of the first plane 218 in common, for example to provide increased support and/or rigidity for the occluder device 10.
  • Also in one version of this embodiment of FIG. 19, the second geometric form 12B of the first wire 12 extends through the first, second, and third quadrants 241(B), 242(B), 243(B) of the second plane 220. The second geometric form 14B of the second wire 14 extends through the first, third, and fourth quadrants 241(B), 243(B), 244(B) of the second plane 220. Accordingly, in this version, the second geometric forms 12A, 14A of the first and second wires 12, 14 share the first and third quadrants 241(B), 243(B) of the second plane 220 in common, for example to provide increased support and/or rigidity for the occluder device 10.
  • However, this may vary in other versions or embodiments. For example, in another version of the embodiment depicted in FIG. 19, the second geometric form 12B of the first wire 12 extends through the third, fourth, and first quadrants 243(B), 244(B), 241(B) of the second plane 220, and the second geometric form 14B of the second wire 14 extends through the first, second, and third quadrants 241(B), 242(B), 243(B) of the second plane 220.
  • FIG. 20 depicts an embodiment of an occluder device contemplated herein with a clothes-pin shape. In the embodiment of FIG. 20, the first plate 16 and the second plate 18 described above are non-parallel, and form a non-zero angle 260 with respect to one another. The angle 260 is preferably greater than five degrees, is more preferably greater than ten degrees, and is most preferably approximately equal to twenty degrees.
  • Also in the embodiment of FIG. 20, the waist 20 is configured such that the above-referenced waist components 12C of the first wire 12 and the waist components 14C of the second wire 14 are unequal in size. For example, as shown in FIG. 20, each waist component 12C of the first wire 12 has a first length indicated by double arrow 261, and each waist component 14C of the second wire 14 has a second length indicated by double arrow 262 that is greater than the first length. The length is defined as the distance between the first plate 16 and the second plate 18 taken from a predetermined distance from the occluder device 10's center point. Each waist component 14C of the second wire 14 may also have a greater surface area and radius as compared to respective waist components 12C of the first wire 12. In addition, in the embodiment of FIG. 20, the waist components 12C of the first wire 12 and the waist components 14C of the second wire 14 are preferably configured such that the waist 20 is curved, with a non-zero angle of curvature. The angle of curvature of the waist 20 is preferably greater than five degrees, is more preferably greater than ten degrees, and is most preferably greater than twenty degrees.
  • FIGS. 21A-21E depict an embodiment of an occluder device contemplated herein in which one or more of the first and second plates 16, 18 are non-circular in their geometric shape(s). In one embodiment of FIG. 21A, at least the first plate 16 has a generally oval shape. In an embodiment of FIG. 21B, at least the first plate 16 has a generally rectangular shape. In an embodiment of FIG. 21C, at least the first plate 16 has a generally triangular shape. In an embodiment of FIG. 21D, at least the first plate 16 has a generally elliptical shape. In an embodiment of FIG. 21E, at least the first plate 16 has a generally keyhole shape. In certain versions, the first plate 16 and/or the second plate 18 have generally the same geometric shapes as one another. In certain other versions, the first plate 16 and/or the second plate 18 differ from one another. The first plate 16 and the second plate 18 may also comprise any number of other different geometric shapes.
  • FIG. 22 depicts an embodiment of an occluder device contemplated herein that is formed by more than two wires. Specifically, in the embodiment of FIG. 22, the occluder device 10 has three wires, namely: the first wire 12 and the second wire 14 described above, as well as a third wire 205. In some embodiments, four wires may be utilized. In some embodiments, six wires may be utilized. In some embodiments, the number of wires may differ further.
  • In the particular embodiment of FIG. 22, the three wires 12, 14, and 205 each form respective, non-overlapping thirds of each plane. Specifically, as depicted in FIG. 22, the first geometric form 12A of the first wire 12 is disposed within and extends through a first region 272 of the first plane 218 described above. The second geometric form 12B of the second wire 14 is disposed within and extends through a second region 274 of the first plane 218. A first geometric form 207 of the third wire 205 is disposed within and extends through a third region 276 of the first plane 218. The first geometric forms 12A, 14A, 207 of the first, second, and third wires 12, 14, 205 collectively form the first plate 16.
  • Within the first plane 218, the first region 272 is adjacent to the second region 274, with a common border 277 formed by the first and second wires 12, 14. The first region 272 is also adjacent to the third region 276, with a common border 278 formed by the first and third wires 12, 205. In addition, the third region 276 is also adjacent to the second region 274, with a common border 279 formed by the second and third wires 14, 205.
  • Similarly, the second geometric form 12B of the first wire 12, the second geometric form 14B of the second wire 14, and a second geometric form of the third wire 205 would likewise be disposed within and extend through three similar adjacent, non-overlapping regions of the second plane 220, collectively forming the second plate 18 (not depicted in FIG. 22). The various first and second components of the first, second, and third wires 12, 14, and 205 are preferably curved with an arch, such as is shown in FIG. 22. Similar combinations of any number of different amounts of wires can similarly be used to form any number of different forms.
  • As mentioned above, in certain embodiments, the occluder device 10 may include multiple hubs 30, for example as depicted in FIG. 15. The number and configuration of such multiple hubs 30 may vary in different embodiments. In one such embodiment, a first end of the first wire 12 is disposed at a first hub 30, and at least one of the second end of the first wire 12, the first end of the second wire 14, and/or the second end of the second wire 14 is disposed at a second hub (such as hub 119 of FIGS. 12B, 13, and/or 15). In one such exemplary embodiment, the first and second ends of the first wire 12 are disposed at the first hub 30, and the first and second ends of the second wire 14 are disposed at the second hub (such as the second hub 119 of FIG. 15). In another such exemplary embodiment, the first ends of the first and second wires 12, 14 are disposed at the first hub 30, and the second ends of the first and second wires 12, 14 are disposed at the second hub (such as the hub 119 of FIGS. 12B, 13, and/or 15), among other possible variations.
  • FIG. 23 is a flowchart of an exemplary embodiment of a method 2300 for occluding an aperture defect in a heart. The method 2300 can be utilized in connection with the heart 1 of FIG. 1 and the various embodiments of the occluder device 10 of FIGS. 2-22. Specifically, the method 2300 preferably utilizes one or more embodiments of the occluder devices 10 of FIGS. 2-22 to occlude an aperture defect of a heart, such as the aperture defect 6A of the heart 1 depicted in FIG. 1.
  • As depicted in FIG. 23, the method 2300 includes the step of providing an occluder device (step 2302). In various embodiments, the occluder device corresponds to the occluder device 10 depicted in any of the embodiments depicted in FIGS. 2-22 and/or described above. The occluder device preferably comprises a first flexible wire (such as wire 12 described above) and a second flexible wire (such as wire 14 described above). Each of the first and second wires is comprised of a shape memory material. Each of the first and second wires is shaped into first and second geometric forms (such as forms 12A, 12B, 14A, and 14B described above) around an inner region such that the first geometric form of the first wire and the first geometric form of the second wire form a first plate (such as plate 16 described above) in a first plane, and the second geometric form 12B of the first wire 12 and the second geometric form 14B of the second wire 14 form a second plate (such as plate 18 described above) in a second plane that is parallel to and remote from the first plane. The first and second plates are separated by a waist (such as waist 20 described above) formed from two portions of the first wire and two portions of the second wire. A sealed covering (such as covering 24A or 24B described above) is preferably disposed over at least one of the first and second plates. The covering provides a seal for the aperture defect (such as the defect 6A of the heart 1 described above). Each of the first and second wires has a first end and a second end. Each of the first and second ends of the first and second wires are connected to a hub (such as hub 30 described above). The hub further comprises a delivery attachment mechanism (for example, that includes or is used in connection with the catheter 40 described above) for attachment to a removable deployment cable (such as deployment cable 34 described above).
  • The method 2300 also includes the step of attaching the occluder device to the removable deployment cable (step 2304). The occluder device is placed within a flexible delivery catheter (such as the catheter 40 described above) having an open channel (such as the channel 42 described above) (step 2306). The catheter is fed into a blood vessel system (such as a blood vessel system of the heart 1 described above) and advanced via the blood vessel system to the aperture defect in the heart (step 2308). The catheter, with the occluder device disposed within, is similarly advanced through the aperture defect (step 2310).
  • In certain optional embodiments, a balloon sub-process 2312 is also utilized in occluding the aperture defect in the heart. In one such embodiment, depicted in FIG. 23, a balloon is advanced into the heart through the open channel toward the occluder device at the aperture defect (step 2314). The balloon is also inserted into the waist of the occluder device (step 2316). The balloon is then inflated (step 2318), in order to help position the occluder device proximate the heart defect. Once the occluder device is properly positioned, the balloon is deflated (step 2320) and then removed from the waist of the occluder device (step 2322).
  • In other optional embodiments, a hook sub-process 2324 may be utilized in occluding the aperture defect in the heart. In one such embodiment, depicted in FIG. 23, a hook (such as one or more of the hooks 136, 232 described above), is engaged with the delivery attachment mechanism (such as the catheter) (step 2326), preferably via a screw system. The hook is manipulated using the delivery attachment mechanism and used to reposition the occluder device (step 2328). In certain embodiments, the hook may also be utilized to retrieve the occluder device by exerting force on the delivery attachment mechanism in a direction away from the heart (step 2330).
  • The catheter next is withdrawn from the occluder device (step 2332). Preferably, the catheter is withdrawn from the occluder device in step 2332 in a manner such that the first plate of the occluder device expands on a first side of the aperture defect. In addition, the catheter is further withdrawn from the occluder device such that the second plate of the occluder device expands on a second side of the aperture defect (step 2334). Preferably, the catheter is withdrawn from the occluder device in step 2334 in a manner, such that the waist of the occluder device expands by memory retention within the aperture defect to self-center the occluder device. The catheter is then withdrawn from the blood vessel system (step 2336), and the deployment cable is removed from the hub of the occluder device (step 2338).
  • It will be appreciated that certain steps of the method 2300 may vary in certain embodiments. It will also be appreciated that certain steps of the method 2300 may occur in a different order than is depicted in FIG. 23. For example, the optional hook sub-process 2324 may be used before the optional balloon sub-process 2312. It will similarly be appreciated that certain steps of the method 230 may occur simultaneously with one another.
  • FIG. 24A is a schematic representation of a human heart 400 with a perimembranous VSD 6D. The heart 400 includes a right atrium 2, a left atrium 3, a right ventricle 4, and a left ventricle 5. The right ventricle 4 is separated from the left ventricle 5 by a ventricular septum 7. The ventricular septum 7 includes a perimembranous VSD 6D. The margins of the perimembranous VSD 6D are located partly in the membranous area of the ventricular septum 7 and partly in the muscular area of the ventricular septum 7. As depicted in FIG. 1, a perimembranous VSD 6D is located in an area of the ventricular septum 7 that is superior to a muscular VSD 6C.
  • A perimembranous VSD 6D can be more challenging to treat using an occlusion device than other types of VSDs, e.g., the muscular VSD 6C. One issue that makes perimembranous VSDs 6D more challenging to treat is their close proximity to other anatomical areas of the heart, such as the aortic valve 402, mitral valve 403, and tricuspid valve 405. In some instances, perimembranous VSDs 6D may be located juxta-aortic valve, juxta-mitral valve, and/or juxta-tricuspid valve. When treating perimembranous VSDs 6D using an occlusion device, any or all such valves can be potentially injured or impeded. For example, perimembranous VSDs 6D are often located in the left ventricle outflow tract just beneath the aortic valve 402. The short portion of the ventricular septum located superior to the perimembranous VSD 6D and inferior to the aortic valve 402 is the subaortic rim 404. Because of the close proximity to the aortic valve 402, the subaortic rim 404 area is generally too small to allow for a full occluder disc to be used in the left ventricle 5. That is, if a portion of an occluder disc is positioned on or applies pressure to the subaortic rim 404, the pressure or physical interference from the disc may impede the proper functioning of the aortic valve 402. Such pressure or physical interferences can result in adverse effects including, for example, aortic regurgitation.
  • Perimembranous VSDs 6D are also challenging to treat with an occlusion device because of their close proximity to the electrical conduction system of the heart known as the atrioventricular (AV) bundle. The AV bundle controls the contraction or beating of the chambers of the heart. The AV bundle includes specialized muscle fibers that regulate the heartbeat by conducting impulses from the AV node in the right atrium 2 to the right and left ventricles 4 and 5. A portion of the AV bundle tends to be located at the superior margin of a perimembranous VSD 6D, that is, in the subaortic rim 404 area. If pressure is applied to the subaortic rim 404 containing the AV bundle, the AV electrical signal can be slowed or disrupted, and cardiac arrhythmia can result. If an occluder device for treating a perimembranous VSD 6D contacts the subaortic rim 404, the pressure exerted on the AV bundle can result in adverse effects such as cardiac arrhythmia.
  • Accordingly, to avoid such adverse effects, in some embodiments it may not be practical or desirable to use a full 360 degree circular disc (a “full disc”) on the left side of an occlusion device, i.e., in the left ventricle 5. Rather, in some embodiments, a portion of a full disc (a “partial disc”) can be advantageously used on the left side. For example, in some embodiments, a partial disc having an arc of 180-240 degrees may be desirable. In some embodiments, a partial disc comprising a semi-circle of approximately 180 degrees is used on the left side. In some embodiments, a partial disc comprising a circular sector with an arc of less than 180 degrees is used. The partial disc can be oriented in relation to the heart 400 to substantially avoid contact with or applying pressure onto the subaortic rim 404. In some embodiments, the partial disc comprises two or more portions, or sub-discs, as described further below in reference to FIG. 26-28.
  • FIG. 24B is a schematic representation of a human heart 400, and a schematic representation of an asymmetrical occlusion device 440 installed in the perimembranous VSD 6D of the heart 400. In some embodiments, the asymmetrical occlusion device 440 is well-suited for treating a perimembranous VSD 6D because the asymmetrical occlusion device 440 does not make substantial contact with the subaortic rim 404. In some embodiments, the asymmetrical occlusion device 440 (shown in a side view) includes a full disc on the right side, i.e. in the right ventricle 4. On the left side, i.e., in the left ventricle 5, the asymmetrical occlusion device 440 includes a partial disc. In some embodiments, the partial disc contacts portions of the ventricular septum 7 that are located inferior to the subaortic rim 404 while avoiding substantial contact with the subaortic rim 404 or with the aortic valve 402, mitral valve 403, and tricuspid valve 405. An asymmetrical occlusion device 440 having such a partial disc configuration on the left side can occlude a perimembranous VSD 6D while avoiding adverse interference with one or more of the aortic valve 402, mitral valve 403, tricuspid valve 405, and/or the AV bundle of the heart 400.
  • FIG. 25 is a side view of a schematic illustration of the example asymmetrical occlusion device 440. In general, the asymmetrical occlusion device 440 includes three regions: (i) an occluder region 450, (ii) an attachment region 460, and (iii) a securing region 470. The attachment region 460 can interconnect the occluder region 450 to the securing region 470.
  • In some embodiments, the occluder region 450 includes a full disc 454 (shown in side view). When the asymmetrical occlusion device 440 is implanted in a heart to treat a perimembranous VSD, the full disc 454 can be located in the right ventricle abutting the ventricular septum (also refer to FIG. 24B). The full disc 454 may also be referred to as the proximal disc, because the full disc 454 can be proximal to a delivery catheter whereas the rest of the asymmetrical device 440 can be distal to the delivery catheter. The full disc 454 has a diameter 458 and a radius 478. In some embodiments, the diameter 458 is in the range of about 20-26 mm, about 16-30 mm, or about 10-36 mm. The diameter 458 is typically selected in general accordance with the size of the heart and the size of the VSD being treated. The full disc 454 defines at least one disc plane 452. Because FIG. 25 shows a side view of the asymmetrical occlusion device 440, the disc plane 452 is along the line shown for disc plane 452 and 90 degrees to the surface of the figure.
  • In some embodiments, the attachment region 460 of the asymmetrical occlusion device 440 includes a waist 466. When the asymmetrical occlusion device 440 is implanted in a heart, the waist 466 can pass through the aperture of the perimembranous VSD. In some embodiments, the waist 466 defines a transverse cross-sectional shape that can be represented by a circle with a diameter 468. In some embodiments, the waist diameter 468 is in the range of about 12-18 mm, about 8-22 mm, or about 4-26 mm. The waist diameter 468 can be selected in correlation with the size of the aperture of the perimembranous VSD being treated. In some patients, the aperture of the perimembranous VSD will be substantially non-circular, such as elliptical. In cases when the aperture is elliptical, in some embodiments the waist diameter 468 is selected in correlation to the minor axis of the elliptical aperture. In some embodiments, the waist 466 has an axial length 467. The axial length 467 can be selected in correlation to the axial length of the tunnel of the perimembranous VSD being treated. In some embodiments, the axial length 467 of the occluder device is adjustable by the clinician in situ during the implantation procedure. The attachment region 460 can define a longitudinal axis 462.
  • In some embodiments, the securing region 470 includes a partial disc 474. When the asymmetrical occlusion device 440 is implanted in a heart to treat a perimembranous VSD, the partial disc 474 can be located on the ventricular septum in the left ventricle such that the partial disc 474 is generally inferior to the aperture of the perimembranous VSD. The partial disc 474 may also be referred to as the distal disc because, during implantation of the asymmetrical device 440, the partial disc 474 can be distal in relation to the delivery catheter, whereas the rest of the asymmetrical device 440 can be proximal to the delivery catheter. As described further below in reference to FIG. 26, in some embodiments the partial disc 474 includes multiple portions or securing members (e.g., 480, 482, and 484 of FIG. 26) each having a major axis. In some embodiments, the major axes of the securing members generally define a partial disc plane 472. In some embodiments, the major axes of the securing members may not all reside on a common plane (see e.g., FIG. 28). The partial disc 474 can have a length 476 that generally defines, for example, the length of the securing members as measured from axis 462 to the free-ends of the securing members. In some embodiments, the length 476 is approximately equal to the radius 478 of the full disc 454. However, in some embodiments, the length 476 of the partial disc 474 is less than or greater than the radius 478 of the full disc 454. In some embodiments, the partial disc 474 has multiple securing members with disparate lengths (see e.g., FIG. 27A).
  • The relative orientations of the occluder region 450, attachment region 460, and securing region 470 with respect to each other will now be described. While the asymmetrical occlusion device 440 shown in FIG. 25 is used to explain the configuration of the regions with respect to each other, the example asymmetrical occlusion device 440 is merely one example embodiment of the occlusion devices provided herein. Other embodiments having regional configurations that are different than asymmetrical occlusion device 440 are also envisioned within the scope of this disclosure.
  • The angular relationship between the disc plane 452 and the axis 462 of the attachment region 460 is represented by angle 456. In the example asymmetrical occlusion device 440 embodiment shown, the axis 462 of the attachment region 460 is generally perpendicular to disc plane 452. That is, in this example, angle 456 is approximately 90 degrees. In some embodiments, the angle 456 is more than or less than 90 degrees (see e.g., FIG. 28). In general, the selection of an asymmetrical occlusion device 440 with a particular angle 456 can be made in accordance with the anatomy of the patient. That is, in some patients the aperture of the perimembranous VSD will be generally orthogonal to the nearby surface of the ventricular septum in the right ventricle. In that case, an asymmetrical occlusion device 440 with an angle 456 of about 90 degrees would be appropriate to treat the VSD. In some patients, the aperture of the perimembranous VSD may be at a non-orthogonal angle in relation to the nearby surface of the ventricular septum in the right ventricle. In such cases, an asymmetrical occlusion device 440 with an angle 456 that approximately matches the non-orthogonal angle of the aperture in relation to the nearby surface of the ventricular septum can be selected. In some embodiments, the angle 456 of the occluder device is adjustable by the clinician either before the implantation procedure or in situ during the implantation procedure.
  • The angular relationship between the disc plane 452 and the partial disc plane 472 is represented by angle 464. In the example asymmetrical occlusion device 440, the angle 464 is approximately 20 degrees. However, in some embodiments, the angle 464 is zero degrees. That is, in some embodiments the disc plane 452 and the partial disc plane 472 are substantially parallel to each other. In some embodiments, the angle 464 is within a range of about 0-60 degrees, about 10-50 degrees, or about 20-40 degrees. The angle 464 can be selected in accordance with the anatomy of the patient. Some patients may have the left and right surfaces of the ventricular septum near the perimembranous VSD substantially parallel to each other. In that case, an asymmetrical occlusion device 440 with an angle 464 of zero degrees may be selected. However, in some patients the left and right surfaces of the ventricular septum near the perimembranous VSD may be at a non-zero angle in relation to each other. In such cases, an asymmetrical occlusion device 440 with an angle 464 that is approximately equal to the angle between the left and right surfaces of the ventricular septum near the perimembranous VSD may be selected. In some embodiments, the angle 464 of the occluder device is adjustable by the clinician either before the implantation procedure or in situ during the implantation procedure.
  • It should be recognized that in some embodiments the force exerted on the ventricular septum by the full disc 454 and the partial disc 474 should be only a light pressure. A light amount of pressure can help the asymmetrical occlusion device 440 maintain proper position in relation to the anatomy of the patient's heart. However, too much pressure from the asymmetrical occlusion device 440 may induce adverse effects, such as adverse effects to the heart valves and AV bundle as described above.
  • FIG. 26 is a perspective view of an example asymmetrical occlusion device 440. In general, the asymmetrical occlusion device 440 includes a full disc 454, a waist 466, a partial disc 474, and a delivery attachment hub 30. The asymmetrical occlusion device 440 embodiment comprises two separate uniquely shaped memory wires 486 and 488. The wires 486 and 488 can be substantially similar to the wires 12 and 14 described above. While the example asymmetrical occlusion device 440 includes two wires 486 and 488, some embodiments use one wire, three wires, or four wires or more to form an asymmetrical occlusion device.
  • In some embodiments, the asymmetrical occlusion device 440 is self-centering. In some embodiments, the waist 466 is made of four wire portions as shown. In some embodiments, the waist 466 is made of more or fewer than four wire portions. In some embodiments, the wire portions of waist 466 substantially conform to the size and shape of the aperture of a perimembranous VSD. In some embodiments, the wire portions of waist 466 exert enough radial force to provide a self-centering feature, while not pressing against the aperture edges in a manner that exacerbates the defect or affects the functioning of the heart valves or AV bundle.
  • In some embodiments, the wire portions of the waist 466 are more rigid than the wire portions of the full disc 454 and the partial disc 474. In other words, in some embodiments, physical conformance by the asymmetrical occlusion device 440 to the landscape of the ventricular septum is primarily as a result of deflection by the full disc 454 and/or partial disc 474 rather than by deflection of the wire portions of the waist 466. In some such embodiments, the waist 466 should not inhibit the abilities of the full disc 454 and the partial disc 474 to conform to the topography of the underlying tissue that the discs 454 and 474 make contact with. In some embodiments, the asymmetrical occlusion device 440 is fully repositionable and retrievable after deployment.
  • In some embodiments, the full disc 454 and the partial disc 474 have membranous coverings similar to those of other embodiments described above (see e.g., FIGS. 6 and 7). In some embodiments, neither the full disc 454 nor the partial disc 474 have membranous coverings. In some embodiments, either the full disc 454 or the partial disc 474 has a membranous covering, while the other does not have a membranous covering. In some embodiments, the membranous coverings can ensure more complete coverage and occlusion of the aperture, and promote encapsulation and endothelialization of tissue to encourage anatomical closure of the aperture. The membranous coverings can be substantially as described above in reference to coverings 24A and 24B. In some embodiments, the encapsulation and endothelialization of tissue promoted by the membranous coverings avoid a need for supplementary anchoring devices, such as barbs and hooks. In some embodiments, supplementary anchoring devices are included irrespective of the presence of membranous coverings.
  • The partial disc 474 of example asymmetrical occlusion device 440 includes three securing members 480, 482, and 484. In some embodiments, each securing member 480, 482, and 484 is individually flexible. As such, the securing members 480, 482, and 484 are individually conformable to the topography of the ventricular septum tissue with which the securing members 480, 482, and 484 make contact. This configuration can help prevent or minimize device trauma to the ventricular septum, while substantially securing the asymmetrical occlusion device 440 in the desired location on the ventricular septum. Adverse effects, such as aortic regurgitation and cardiac block, can thereby be minimized or avoided altogether—despite the close proximity of the perimembranous VSD to the heart valves and AV bundle.
  • In some embodiments, the three securing members 480, 482, and 484 each include one or more visualization markers, such as radiopaque markers 490, 492, and 494. The markers can assist a clinician with radiographic visualization of the asymmetrical occlusion device 440 so that the clinician can orient the device as desired in relation to the anatomy of the patient. Radiopaque markers can also be included on other locations on the asymmetrical occlusion devices. In some embodiments, materials are added to the frame elements to enhance visualization of the frame elements.
  • The transcatheter implantation procedure of an asymmetrical occlusion device can be performed substantially as described in reference to FIGS. 8-10 above. In some embodiments, restriction wires are included to restrict the circumference of the waist 466, as desired.
  • FIGS. 27A and 27B are schematic representations of two embodiments of asymmetrical occlusion devices 500 and 550. These example embodiments illustrate some of the different design configurations that are possible by adjusting various features of the asymmetrical occlusion devices provided herein. For example, by altering certain features of the partial disc as described below, multiple design configurations and combinations are possible.
  • FIG. 27A illustrates an asymmetrical occlusion device 500 having a full disc 454 and a partial disc 510. The partial disc 510 includes three securing members 512, 514, and 516. In this embodiment, the side securing members 514 and 516 are mirror images of each other. In some embodiments, each securing member has its own unique design. In some embodiments, the partial disc 510 can be asymmetrical such that none of the securing members mirror each other.
  • The lengths and widths of the various securing members 512, 514, and 516 can be determined to provide the particular desired features of the partial disc 510. For example, in the embodiment of partial disc 510, the length 518 of the securing members 514 and 516 is less than the length 520 of the securing member 512. In some embodiments, the lengths of the securing members are greater than the radius of the full disc 454. In some embodiments, such as asymmetrical occlusion device 500, the lengths of the securing members are less than the radius of the full disc 454. Additionally, the widths of the securing members can be individually distinct, or the widths can be equivalent to the widths of other securing members. For example, the width 520 of securing members 514 and 516 are equal to each other and less than the width 522 of the securing member 512. In some embodiments, each securing member has an individually unique length and/or width. In some embodiments, two or more of the securing members, (but not all) have their lengths or widths in common. In some embodiments, all securing members have their lengths and widths in common.
  • Additional partial disc design characteristics that can provide particular desired features can include, for example, the number of securing members and the angular positioning of the securing members. For example, as the asymmetrical occlusion device 500 shows, in some embodiments three securing members 512, 514, and 516 are used. In some embodiments, more or fewer than three securing members are used. For example, in some embodiments, a single securing member is used as the partial disc. In some embodiments, four or more securing members are used as the partial disc.
  • The angular positions of the securing members can also be established as desired. For example, angle 524 of asymmetrical occlusion device 500 represents the angular position of the securing members 514 and 516 in relation to a plane containing the axis 504. In some embodiments, the angle 524 is approximately zero. In some embodiments, the angle 524 is anywhere between 0-90 degrees. For example, the angular position of securing member 512 in relation to a plane containing the axis 504 is approximately 90 degrees. As depicted by asymmetrical occlusion device 550, in some embodiments the angle 526 is approximately 45 degrees. As discussed above in reference to FIG. 25, the relative angles of the planes 452, 472 defined by the full disc 454 and the partial disc 474 are another design characteristic that can be selected in some embodiments.
  • In some embodiments, an open space 534 is located between adjacent securing members. In some embodiments, the securing members abut one another such that there is substantially no space between the edges of adjacent securing members. In some embodiments, the edges of adjacent securing members overlap each other.
  • In some embodiments, individual securing members are asymmetrical. That is, rather than having shapes that are mirror images of each other on opposite sides of its longitudinal axis, the shapes on opposite sides of the longitudinal axis can be different from each other. For example, in some embodiments, one side of a securing member has a substantially straight edge, while the other side of the same securing member has a curved edge.
  • FIG. 27B schematically depicts an asymmetrical occlusion device 550 including a full disc 454 and a partial disc 560. The partial disc 560 includes two securing members 528 and 530. In this embodiment, the two securing members 528 and 530 are mirror images of each other. However, in some embodiments, each securing member has its own unique design. In some embodiments, at least one securing member has a design unique from one or more of the other securing members. The securing members 528 and 530 are depicted as having an angular position of angle 526 in relation to the plane containing the axis 554. In this embodiment, the angle 526 is approximately 45 degrees. In some embodiments, angles of 0-90 degrees are possible.
  • Securing members 528 and 530 are depicted as having relatively wide widths 532 (as compared to securing members 514 and 516, for example). In some embodiments, such wide securing members may advantageously distribute the clamping forces exerted by the securing members over a larger area of the ventricular septum. By distributing the clamping force over a larger area, the pressure exerted on the ventricular septum can be lowered while maintaining a sufficient clamping force to substantially secure the occlusion device in the desired location.
  • FIG. 28 is a side view of a schematic representation of another embodiment of an asymmetrical occlusion device 600. This embodiment includes a full disc 610 with a disc plane 612, a waist 620 with an axis 622, and a partial disc 630 with securing members 632 and 634 having axes 636 and 638 respectively.
  • The asymmetrical occlusion device 600 illustrates additional design variations in regard to how the regions of an asymmetrical occlusion device can be configured in relation to each other. For example, the axis 622 of the waist 620 is at an acute angle 614 in relation to the disc plane 612. Such a feature can be useful, for example, with perimembranous VSD apertures that are at a non-orthogonal angle in relation to the nearby surface of the ventricular septum in the right ventricle. In addition, the asymmetrical occlusion device 600 illustrates that individual securing members can each be oriented at different angles in relation to the full disc plane 612. For example, the axis 636 of securing member 632 is at an acute angle 640 in relation to the disc plane 612, while the axis 638 of securing member 634 is approximately parallel to the disc plane 612. The ability to have securing members at various angles in relation to the full disc plane 612 can enable an asymmetrical occlusion device to be shaped in correlation to the particular anatomy of the patient, and result in less potential for disruption to the heart valves and AV bundle.
  • Some embodiments may comprise any combinations of the embodiments described herein and/or described in the drawings. It is understood that the disclosure is not confined to the particular construction and arrangement of parts herein illustrated and described, but embraces such modified forms thereof as come within the scope of the following claims. Additionally, it will be appreciated that various embodiments may be freely combined together, and/or that various features of different embodiments may be freely combined together.
  • While at least one exemplary embodiment has been presented in the foregoing detailed description, it should be appreciated that a vast number of variations exist. It should also be appreciated that the exemplary embodiment or exemplary embodiments are only examples, and are not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the foregoing detailed description will provide those skilled in the art with a convenient road map for implementing an exemplary embodiment of the invention, it being understood that various changes may be made in the function and arrangement of elements described in an exemplary embodiment without departing from the scope of the invention as set forth in the appended claims and their legal equivalents.

Claims (29)

    We claim:
  1. 1. A single-disc device for occluding an aperture within a body of a patient, comprising:
    an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane;
    an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and
    a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of about 180 degrees or less.
  2. 2. The single-disc device of claim 1, wherein the major axes of the securing members are spaced symmetrically within the circular sector having an arc of about 180 degrees or less.
  3. 3. The single-disc device of claim 1, wherein the one or more securing members each comprise one or more wire loops or wire prongs.
  4. 4. The single-disc device of claim 1, wherein the circular sector has an arc of 150 degrees or less.
  5. 5. The single-disc device of claim 1, wherein the major axis of each of the one or more securing members extends at an angle between 80 and 100 degrees with respect to the axis of the attachment region.
  6. 6. The single-disc device of claim 1, wherein the securing region comprises three or more securing members.
  7. 7. The single-disc device of claim 1, wherein the disc plane extends at an angle between 0 to 5 degrees with respect to the major axis of at least one of the one or more securing members.
  8. 8. The single-disc device of claim 1, wherein the disc plane extends at an angle between 5 to 15 degrees with respect to the major axis of at least one of the one or more securing members.
  9. 9. The single-disc device of claim 1, wherein the occluder region comprises a membrane configured to inhibit passage of blood, wherein the membrane covers at least a portion of the disc.
  10. 10. The single-disc device of claim 9, wherein the membrane comprises a fluoropolymer.
  11. 11. The single-disc device of claim 9, wherein the membrane comprises polytetrafluoroethylene.
  12. 12. The single-disc device of claim 9, wherein the membrane comprises expanded polytetrafluoroethylene.
  13. 13. The single-disc device of claim 1, wherein the occluder region further comprises an expandable balloon configured to restrict fluid flow through the aperture.
  14. 14. The single-disc device of claim 1, wherein the occluder region comprises at least one anchor.
  15. 15. The single-disc device of claim 1, comprising one or more visual indicators configured to identify the orientation of the securing region.
  16. 16. The single-disc device of claim 1, wherein the disc plane extends at an angle between 75 to 105 degrees with respect to the axis of the attachment region.
  17. 17. The single-disc device of claim 1, wherein the first end is at the proximal end of the single-disc device and the second end is at the distal end of the single-disc device.
  18. 18. A method of occluding a cardiac defect, comprising:
    providing a single-disc device comprising:
    an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane;
    an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and
    a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less;
    configuring the single-disc device in a delivery configuration and advancing the single-disc device to a delivery site; and
    deploying the single-disc device at the delivery site.
  19. 19. The method according to claim 18, comprising coupling the single-disc device to a delivery catheter.
  20. 20. The method according to claim 19, comprising inserting the single-disc device and the delivery catheter into a delivery sheath.
  21. 21. The method according to claim 20, wherein the frame element collapses as the single-disc device is inserted into the delivery sheath.
  22. 22. The method according to claim 20, wherein deploying the single-disc device comprises advancing the single-disc device through the delivery sheath, such that at least a portion of the single-disc device exits the delivery sheath distal of the delivery sheath.
  23. 23. The method according to claim 22, wherein the frame element expands as the single-disc device exits the delivery sheath.
  24. 24. The method according to claim 20, wherein deploying the single-disc device comprises pulling the delivery sheath away from the cardiac defect while maintaining a position of the single-disc device.
  25. 25. The method according to claim 18, wherein deploying the single-disc device substantially occludes the cardiac defect.
  26. 26. A system for occluding an aperture within a body of a patient, comprising:
    a single-disc occluder device comprising:
    an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane;
    an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and
    a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less;
    a deployment wire releasably attached to the first end of the single-disc device;
    a delivery catheter comprising a sheath configured to contain the deployment wire and the single-disc occluder device arranged in a delivery configuration, the delivery catheter configured to advance the single-disc device to a delivery site; and
    an actuator device attached to a proximal end of the delivery catheter, the actuator device being configured to remotely control deployment of the single-disc device at the delivery site.
  27. 27. A method of occluding a blood vessel, comprising:
    providing a single-disc device comprising:
    an occluder region comprising a frame element, the frame element comprising a plurality of wire portions, the plurality of wire portions configured to form a disc at a first end of the single-disc device, wherein the disc generally defines a disc plane;
    an attachment region with an axis that extends transversely to the disc plane, the attachment region comprising an occluder region attachment end and a securing region attachment end, the occluder region attachment end being connected to the occluder region; and
    a securing region connected to the securing region attachment end and at a second end of the single-disc device, the securing region comprising one or more securing members, wherein a major axis of each of the one or more securing members extends transversely to the axis of the attachment region and all major axes of the one or more securing members are generally located within a circular sector having an arc of 180 degrees or less;
    configuring the single-disc device in a delivery configuration and advancing the single-disc device to a delivery site in the vessel; and
    deploying the single-disc device at the delivery site in the vessel.
  28. 28. The method according to claim 27, comprising:
    coupling the single-disc device to a delivery catheter;
    inserting the single-disc device and the delivery catheter into a delivery sheath, wherein the frame element collapses as the single-disc device is inserted into the delivery sheath, and wherein the frame element expands as the single-disc device exits the delivery sheath.
  29. 29. The method according to claim 28, wherein deploying the single-disc device comprises advancing the single-disc device through the delivery sheath, such that at least a portion of the single-disc device exits the delivery sheath distal of the delivery sheath.
US13772801 2008-03-07 2013-02-21 Heart occlusion devices Pending US20130165967A1 (en)

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US3477208 true 2008-03-07 2008-03-07
US12400445 US9119607B2 (en) 2008-03-07 2009-03-09 Heart occlusion devices
US13210198 US9138213B2 (en) 2008-03-07 2011-08-15 Heart occlusion devices
US13772801 US20130165967A1 (en) 2008-03-07 2013-02-21 Heart occlusion devices

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US13772801 US20130165967A1 (en) 2008-03-07 2013-02-21 Heart occlusion devices
PCT/US2014/017129 WO2014130535A1 (en) 2008-03-07 2014-02-19 Heart occlusion devices
US15086449 US9474517B2 (en) 2008-03-07 2016-03-31 Heart occlusion devices
US15299173 US20170035435A1 (en) 2008-03-07 2016-10-20 Heart occlusion devices

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US13210198 Continuation-In-Part US9138213B2 (en) 2008-03-07 2011-08-15 Heart occlusion devices

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US15086449 Continuation US9474517B2 (en) 2008-03-07 2016-03-31 Heart occlusion devices

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US15086449 Active US9474517B2 (en) 2008-03-07 2016-03-31 Heart occlusion devices
US15299173 Pending US20170035435A1 (en) 2008-03-07 2016-10-20 Heart occlusion devices

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US9474517B2 (en) 2016-10-25 grant

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