WO1998049963A1 - Procede et dispositif servant a effectuer une revascularisation transmyocardique - Google Patents

Procede et dispositif servant a effectuer une revascularisation transmyocardique Download PDF

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Publication number
WO1998049963A1
WO1998049963A1 PCT/IL1998/000214 IL9800214W WO9849963A1 WO 1998049963 A1 WO1998049963 A1 WO 1998049963A1 IL 9800214 W IL9800214 W IL 9800214W WO 9849963 A1 WO9849963 A1 WO 9849963A1
Authority
WO
WIPO (PCT)
Prior art keywords
heart
laser
predetermined pattern
scanner
patient
Prior art date
Application number
PCT/IL1998/000214
Other languages
English (en)
Inventor
Michael Slatkine
Gerald Talpalariu
Ricardo Schleifer
Ytzhak Rozenberg
Original Assignee
Laser Industries Ltd.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Laser Industries Ltd. filed Critical Laser Industries Ltd.
Priority to AU72311/98A priority Critical patent/AU7231198A/en
Publication of WO1998049963A1 publication Critical patent/WO1998049963A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/201—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through a hollow tube, e.g. forming an articulated arm ; Hand-pieces therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation

Definitions

  • the present invention relates generally to laser devices and biomedical
  • the invention relates to laser-based
  • TMR revascularization
  • Drugs such as vasodilators, and angioplasty, where a balloon catheter
  • vein grafts taken from other parts of the body.
  • TMR Revasculahzation
  • Patent No. 5,554,152 (Aita, et al.).
  • the apparatus disclosed is a laser connected
  • the apparatus is inserted into the chest cavity into contact with the heart.
  • the heart is
  • the laser beam is delivered by an articulated optical arm or a fiber
  • optic element in pulses of 50 Joules.
  • TMR revasculahzation
  • Scanning is preferably with a
  • invention may be performed either by open chest surgery or endoscopically.
  • beam will be in communication with the heart, preferably at an area proximate a
  • ECG electrocardiogram
  • a laser beam of a sufficient energy for heart tissue ablation may be
  • Additional channels may
  • the apparatus disclosed for this second embodiment is similar to that disclosed in the first embodiment, and where necessary, is adapted for
  • FIG. 1 is a schematic diagram of a first embodiment of the present
  • FIG. 2 is diagram of an ECG (ECG signal);
  • FIG. 3 is a diagram of a spiral scanning pattern generated by the flash
  • FIG. 4 is a cross sectional view of a heart with a channel cut therein by
  • FIG. 5 is a schematic diagram of a second embodiment of the present
  • FIG. 6 is a cross-sectional of view of the working channel of the
  • FIG. 7 is a photograph of a dog heart treated in accordance with the
  • FIGs. 1-4 show a first embodiment of the method of the present
  • This first embodiment involves accessing the heart 20 by opening the
  • a surgeon 22 places a flash scanner 24, that emits a focused
  • the flash scanner 24 is computer
  • the flash scanner 24 is connected to a laser source (L) 32, that is coupled to
  • SS synchronization system
  • deactivation preferably in the form of pulses of laser energy, based on the
  • ECG electrocardiogram
  • the ECG is shown in detail in FIG.
  • FIG. 1 With specific reference to FIG. 1 , the heart (beating) is shown having
  • the patient is placed on the requisite life support
  • the flash scanner 24 is positioned proximate the heart 20, preferably
  • This flash scanner 24 focuses the laser
  • Patent No. 5,411 ,502 (Zair) (the '502 patent), this patent being incorporated by
  • These flash scanners 24 employ mirrors, whose movements can be
  • Continuous mirror movement involves scanning in a
  • Step mirror movement involves
  • the laser source (L) 32 preferably includes a laser, such as a CW
  • 08/346,878 (above), preferably of low power (approximately 60-200 Watts).
  • Alternate lasers may include pulsed excimer and pulsed Erbium-YAG lasers.
  • the laser source 32 is also under the control of the above discussed computer control
  • the ECG (ECG signal) 36 shows the patent's
  • heartbeat cycle as four different waveforms (waves), Q, R, S, T.
  • synchronization system (SS) 34 is connected with the ECG machine (for example,
  • pulsing occur in the time interval between the R and T waves
  • ECG ECG signal
  • this time period is also known as systole or the systolic
  • the preferred scanning occurs as the spot 40 is
  • the spot 40 is preferably focused at a focal length of approximately 50
  • single or multiple channels 38 may be cut into the heart
  • scanning is adjacent to an area, such as a
  • ventricle 20a in need of increased blood circulation.
  • the scanning is such that once the channel 38 is formed, the portion of
  • the channel opening through the epicardium 26 is temporarily covered while a
  • FIG. 4 there is shown the heart 20 with the resultant
  • channel 38 cut therein by scanning. While only a single channel 38 is shown in
  • channel 38 extend from the epicardium 26, through the myocardium 44 and
  • additional channels may be formed by
  • FIG. 5 shows a second embodiment of the present invention, where
  • channels 38 are cut into the heart 20 by scanning, similar to the first embodiment,
  • This method initially involves making an incision in the chest cavity, preferably subxyphoid, to
  • the heart 20 is accessed, preferably at an area proximate the
  • ventricle 20a by conventional instrumentation, including a standard rigid
  • endoscope 50 (through the incision), that is preferably advanced to a point
  • the endoscope 50 is a conventional multiple channel endoscope, and
  • a viewing channel 51 (FIG. 5) and an operating
  • This endoscope could also be a conventional thorasoscope
  • the viewing channel 51 is fitted with standard optics (not shown) and
  • the operating channel 52 receives the flash scanner (SC)
  • This flash scanner 24' that emits a focused beam 24a' of laser energy. This flash scanner 24' is
  • the flash scanner 24' is connected to the laser
  • the endoscope 50 also includes a conventional
  • control mechanism 54 for steering it, upon its advancement toward the heart 20,
  • the focused beam 24a' of laser energy extends
  • FIG. 7 were scanned with the flash scanner (described above) and cut in the
  • the flash scanner was set to a scanning
  • the channels 1 , 2, 3 extended completely through the heart

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Electromagnetism (AREA)
  • Optics & Photonics (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Otolaryngology (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)

Abstract

L'invention concerne un procédé servant à découper le tissu cardiaque (20), de manière à créer un canal ou une pluralité de canaux (38) afin de revasculariser une partie souhaitée du myocarde du malade, chacun de ces canaux s'étendant au moins partiellement à travers le coeur. Ce procédé consiste à utiliser un scanner (24) communiquant avec une source laser (L) servant à produire un faisceau (24a) d'énergie laser permettant de découper le tissu cardiaque quand on met en service ladite source, à mettre en service ladite source laser (L) et à balayer une zone du coeur avec ce faisceau (24a) d'énergie laser afin de produire de l'énergie servant à découper le tissu cardiaque et, de ce fait, de créer les canaux (38).
PCT/IL1998/000214 1997-05-08 1998-05-07 Procede et dispositif servant a effectuer une revascularisation transmyocardique WO1998049963A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU72311/98A AU7231198A (en) 1997-05-08 1998-05-07 Method and apparatus for performing transmyocardial revascularization

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IL120811 1997-05-08
IL12081197A IL120811A0 (en) 1997-05-08 1997-05-08 Method and apparatus for performing transmyocardial revascularization

Publications (1)

Publication Number Publication Date
WO1998049963A1 true WO1998049963A1 (fr) 1998-11-12

Family

ID=11070118

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL1998/000214 WO1998049963A1 (fr) 1997-05-08 1998-05-07 Procede et dispositif servant a effectuer une revascularisation transmyocardique

Country Status (3)

Country Link
AU (1) AU7231198A (fr)
IL (1) IL120811A0 (fr)
WO (1) WO1998049963A1 (fr)

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000056233A1 (fr) 1999-03-22 2000-09-28 Saphir Medical Products Gmbh Appareil chirurgical a jet de liquide sous pression pour la revascularisation transmyocardiale
FR2797581A1 (fr) 1999-08-20 2001-02-23 Saphir Medical Products Gmbh Procede et appareil chirurgical a jet de liquide sous pression pour la revascularisation transmyocardiale
US6217575B1 (en) 1999-02-24 2001-04-17 Scimed Life Systems, Inc. PMR catheter
US6468271B1 (en) 1999-02-24 2002-10-22 Scimed Life Systems, Inc. Device and method for percutaneous myocardial revascularization
US6533779B2 (en) 2001-01-16 2003-03-18 Scimed Life Systems, Inc. PMR catheter and associated methods
US6544220B2 (en) 2001-02-14 2003-04-08 Scimed Life Systems, Inc. Fluid jet PMR
US6607523B1 (en) 1999-03-19 2003-08-19 Asah Medico A/S Apparatus for tissue treatment
US6676654B1 (en) 1997-08-29 2004-01-13 Asah Medico A/S Apparatus for tissue treatment and having a monitor for display of tissue features

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4307726A (en) * 1978-04-24 1981-12-29 Paulson James C Diagnostic evaluation, measurement, and analysis of functional activity in body organs that utilize transmembrane ion polarization and depolarization
US5125926A (en) * 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized pulsed laser system
US5411502A (en) * 1992-01-15 1995-05-02 Laser Industries, Ltd. System for causing ablation of irradiated material of living tissue while not causing damage below a predetermined depth
US5554152A (en) * 1990-12-18 1996-09-10 Cardiogenesis Corporation Method for intra-operative myocardial revascularization
US5733278A (en) * 1994-11-30 1998-03-31 Laser Industries Limited Method and apparatus for hair transplantation using a scanning continuous-working CO2 laser

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4307726A (en) * 1978-04-24 1981-12-29 Paulson James C Diagnostic evaluation, measurement, and analysis of functional activity in body organs that utilize transmembrane ion polarization and depolarization
US5125926A (en) * 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized pulsed laser system
US5554152A (en) * 1990-12-18 1996-09-10 Cardiogenesis Corporation Method for intra-operative myocardial revascularization
US5411502A (en) * 1992-01-15 1995-05-02 Laser Industries, Ltd. System for causing ablation of irradiated material of living tissue while not causing damage below a predetermined depth
US5733278A (en) * 1994-11-30 1998-03-31 Laser Industries Limited Method and apparatus for hair transplantation using a scanning continuous-working CO2 laser

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6676654B1 (en) 1997-08-29 2004-01-13 Asah Medico A/S Apparatus for tissue treatment and having a monitor for display of tissue features
USRE38670E1 (en) 1997-08-29 2004-12-14 Asah Medico A/S Apparatus for tissue treatment
US6217575B1 (en) 1999-02-24 2001-04-17 Scimed Life Systems, Inc. PMR catheter
US6468271B1 (en) 1999-02-24 2002-10-22 Scimed Life Systems, Inc. Device and method for percutaneous myocardial revascularization
US6607523B1 (en) 1999-03-19 2003-08-19 Asah Medico A/S Apparatus for tissue treatment
WO2000056233A1 (fr) 1999-03-22 2000-09-28 Saphir Medical Products Gmbh Appareil chirurgical a jet de liquide sous pression pour la revascularisation transmyocardiale
FR2797581A1 (fr) 1999-08-20 2001-02-23 Saphir Medical Products Gmbh Procede et appareil chirurgical a jet de liquide sous pression pour la revascularisation transmyocardiale
US6533779B2 (en) 2001-01-16 2003-03-18 Scimed Life Systems, Inc. PMR catheter and associated methods
US6544220B2 (en) 2001-02-14 2003-04-08 Scimed Life Systems, Inc. Fluid jet PMR

Also Published As

Publication number Publication date
IL120811A0 (en) 1997-09-30
AU7231198A (en) 1998-11-27

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