WO2010067463A1 - Instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique et procédé de capture d’une pièce de tissu dans la chirurgie de remplacement de valve aortique - Google Patents

Instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique et procédé de capture d’une pièce de tissu dans la chirurgie de remplacement de valve aortique Download PDF

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Publication number
WO2010067463A1
WO2010067463A1 PCT/JP2008/072898 JP2008072898W WO2010067463A1 WO 2010067463 A1 WO2010067463 A1 WO 2010067463A1 JP 2008072898 W JP2008072898 W JP 2008072898W WO 2010067463 A1 WO2010067463 A1 WO 2010067463A1
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WO
WIPO (PCT)
Prior art keywords
aortic valve
tissue piece
tool
tissue
capturing
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PCT/JP2008/072898
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English (en)
Japanese (ja)
Inventor
裕啓 柳
澤田眞一
Original Assignee
株式会社カルディオ
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Publication date
Application filed by 株式会社カルディオ filed Critical 株式会社カルディオ
Priority to PCT/JP2008/072898 priority Critical patent/WO2010067463A1/fr
Publication of WO2010067463A1 publication Critical patent/WO2010067463A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/01—Filters implantable into blood vessels
    • A61F2/013—Distal protection devices, i.e. devices placed distally in combination with another endovascular procedure, e.g. angioplasty or stenting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2427—Devices for manipulating or deploying heart valves during implantation

Definitions

  • the present invention relates to a tissue piece capturing tool for aortic valve replacement surgery for suppressing the invasion of a tissue piece remnant that may be generated by aortic valve resection in an aortic valve replacement operation, and a tissue piece for aortic valve replacement surgery.
  • the present invention relates to a capturing device set and a tissue fragment capturing method in aortic valve replacement surgery.
  • aortic valve replacement surgery is widely performed as a treatment for aortic stenosis or aortic regurgitation caused by aortic valvular disease.
  • the aortic valve replacement operation refers to an operation in which the aortic valve is removed and replaced with a mechanical valve or a biological valve introduced from the outside in order to treat aortic stenosis or aortic regurgitation caused by aortic valvular disease.
  • Aortic valvular disease refers to a state in which the aortic valvular membrane hinders opening and closing movements, and when it develops, the blood transfusion efficiency of the heart decreases. In principle, it is considered a serious disease requiring surgical treatment.
  • Aortic stenosis refers to a condition where the opening of the aortic valve is not successful
  • aortic valve insufficiency refers to a condition where the closure is not successful.
  • the aortic valve is resected from an incision made by previously incising the ascending aortic wall near the leaflet of the aortic valve.
  • aortic valve replacement surgery when aortic valve is excised, a minute tissue fragment residue may be generated, and the tissue fragment residue generated by the excision may enter the ventricle. If the tissue piece has entered the ventricle, if the operation is completed as it is, the tissue piece will remain in the ventricle or other organs.
  • the capture device such as gauze
  • the size of the capture device such as gauze needs to be sufficient to block the aortic valve.
  • the maximum inner diameter on the annulus side of the aortic valve is approximately 15 to 25 mm for adults. That is, it is necessary to use a capturing tool having a size of 15 to 25 mm.
  • the gap between the leaflets of the aortic valve is generally 3 to 7 mm when the maximum length is an adult. Therefore, the capturing device such as gauze cannot pass through the gap between the leaflets as it is.
  • the present invention provides a tissue piece capturing device for aortic valve replacement surgery that can close the aortic valve before excising the leaflets, a tissue piece capturing device set for aortic valve replacement surgery, and aortic valve replacement.
  • An object of the present invention is to provide a method for capturing a tissue piece in an operation.
  • a tissue fragment capturing tool for aortic valve replacement surgery comprises: A contracted state that is shaped and sized to pass through the gap of the aortic valve leaflet from the aorta side toward the left ventricle side, and a shape that closes the aortic valve annulus in the left ventricle and closes the aortic valve; An expanded state having a size, and prior to the replacement operation of the aortic valve, the aortic valve leaflet is passed from the aorta side toward the left ventricle side in the contracted state, and after the introduction of the left ventricle In the expanded state, the aortic valve is closed in the vicinity of the aortic annulus, and the tissue piece residue is prevented from entering the left ventricle.
  • it is composed of a film-like material and inflates like a so-called balloon by injecting air.
  • the whole is made of an inflatable material that expands by absorbing liquid, and can be changed from a contracted state to an expanded state by absorbing liquid.
  • the structure includes an inflatable material that expands by absorbing liquid, and a sheet-like capturing portion that wraps the inflatable material, and the inflatable material absorbs the liquid.
  • the contracted state can be changed to the expanded state.
  • a sheet-like capture unit that captures the tissue piece and a movable support unit that supports and deforms the capture unit, and by deforming the capture unit through operation of the support unit, There is means for switching from the contracted state to the expanded state.
  • the support portion is at least one disc-like brush provided with a hair material radially from the center toward the outer periphery, and the capture portion is a cloth material covering the periphery of the brush.
  • the support portion is a plurality of disc-shaped brushes provided with hair material radially from the center toward the outer periphery, and the capturing portion is a disc-shaped brush inserted between the brushes. It is a cloth material.
  • the contraction state of the brush of the support part is a state where the disk-like brush is closed in an umbrella shape, and the expansion state is the disk-like brush.
  • the expansion state is the disk-like brush.
  • the technique using the tissue piece capturing device of the present invention is a new concept tissue piece capturing method that has never been known before, and there is no example that discloses such a capturing device.
  • the aortic valve gap of 3 to 7 mm can be inserted, and in the expanded state, the inner diameter of the 15 to 25 mm aortic valve on the annulus side can be closed.
  • a structure having a thread-like, tubular or rod-like recovery tool is provided, and one end of the recovery tool is left on the aorta side before and after the aortic valve replacement surgery.
  • one end of the recovery tool is pulled to pass through the aortic valve to enable recovery from the aortic side.
  • tissue piece capturing tool set for aortic valve replacement surgery of the present invention A tubular member introducer having an outer diameter capable of passing through the gap of the aortic valve leaflet; A tissue piece capturing device comprising a contracted state having a shape and size capable of passing through the inside of the introducer, and an expanded state having a shape and size that fits in the vicinity of the aortic valve annulus in the left ventricle and closes the aortic valve
  • An opening tool that pushes out the tissue piece capturing tool housed inside the introduction tool and releases it from the tubular member;
  • the introducer that houses the tissue piece capturing device in the contracted state is introduced into the gap of the aortic valve leaflet so that the left ventricle side from the aorta side.
  • the aorta is secured by allowing the tissue piece capturing device to be pushed out by the opening device and passing through the inside of the introducing device, and after the tissue piece capturing device is introduced into the left ventricle, the expanded state is established.
  • the aortic valve is closed in the vicinity of the annulus to prevent the tissue fragment residue from entering the left ventricle.
  • the tissue fragment capturing method in the aortic valve replacement surgery of the present invention A contracted state that is shaped and sized to pass through the gap of the aortic valve leaflet from the aorta side toward the left ventricle side, and a shape that closes the aortic valve annulus in the left ventricle and closes the aortic valve;
  • a tissue piece capture device with an expanded state that becomes a size Prior to the replacement operation of the aortic valve, the tissue piece capturing device is passed through the gap of the aortic valve leaflet from the aorta side toward the left ventricle side in the contracted state, and the expanded state after the introduction of the left ventricle
  • the aortic valve is closed in the vicinity of the aortic annulus, and the tissue fragment residue is prevented from entering the left ventricle.
  • FIG. 1 is a diagram showing an expanded state of a configuration example of a wide, substantially cylindrical, solid-shaped tissue piece capturing device 10a.
  • FIG. 2 is a configuration example of a wide, substantially cylindrical, solid-shaped tissue piece capturing device 10a.
  • FIG. 3 is a diagram showing another contracted state of the tissue piece capturing device 10a.
  • FIG. 4 is a diagram showing an expanded state of a configuration example of the spherical three-dimensional tissue piece capturing device 10b.
  • FIG. 5 is a diagram showing a contracted state of the configuration example of the spherical solid-shaped tissue piece capturing tool 10b.
  • FIG. 6 shows an expanded state of the configuration example of the substantially bowl-shaped three-dimensional tissue piece capturing tool 10c.
  • FIG. 7 is a diagram showing a contracted state of a configuration example of a substantially scissor-shaped three-dimensional tissue piece capturing device 10c.
  • FIG. 8 is a configuration example of a conical substantially scissor-shaped tissue piece capturing device 10d.
  • FIG. 9 is a diagram showing a contracted state of a configuration example of the cone-shaped substantially scissor-shaped tissue piece capturing tool 10d.
  • FIG. 10 is a diagram showing an expanded state of a configuration example of a substantially donut-shaped capturing tool 10e whose central portion is closed with a membrane.
  • FIG. 11 is a diagram where the central portion is closed with a membrane.
  • FIG. 12 is a diagram showing a contracted state of a configuration example of a substantially donut-shaped three-dimensional capturing device 10e.
  • FIG. 12 is a diagram showing a contracted state of a tissue piece capturing device 10c by applying air pressure.
  • FIG. 14 is a diagram showing a configuration example in which the tissue piece capturing tool 10c is switched from the contracted state to the expanded state.
  • FIG. 14 is a diagram showing the contracted state of the tissue piece capturing tool 10e shown in FIG.
  • FIG. 16 is a diagram showing a configuration example of switching from the contracted state of the tissue piece capturing tool 10e shown in FIG. 11 to the expanded state of the tissue piece capturing tool 10e shown in FIG. 11.
  • FIG. 16 shows the contraction of the tissue piece capturing tool 10a shown in FIG.
  • FIG. 17 Shown in Figure 2 from the state
  • FIG. 17 is a diagram showing a configuration example of switching to the expanded state of the tissue piece capturing tool 10a.
  • FIG. 17 switches from the contracted state of the tissue piece capturing tool 10a shown in FIG. 3 to the expanded state of the tissue piece capturing tool 10a shown in FIG.
  • Fig. 18 is a diagram showing a configuration example.
  • Fig. 18 is a diagram showing a configuration example for switching from the contracted state of the tissue piece capturing device 10d shown in Fig. 9 to the expanded state of the tissue piece capturing device 10d shown in Fig. 8.
  • FIG. 20 is a diagram showing a configuration example in which the tissue piece capturing section 10 is deformed through operation of the support section.
  • FIG. 20 is a diagram showing a configuration example in which the tissue piece capturing section 10 is deformed through operation of the support section.
  • FIG. 20 shows a state in which the entire tissue piece capturing tool 10f is contracted by contracting the support ring 15 to the left and right.
  • FIG. 21 is a diagram showing another configuration example in which the tissue piece capturing unit 10 is deformed through the operation of the support unit.
  • FIG. 22 shows a state in which the support balloon 17 is deflated by removing air. It is a figure showing typically
  • FIG. 24 is a diagram showing an expanded state of a configuration example of a brush-shaped three-dimensional tissue piece capturing tool 10h.
  • FIG. 24 is a diagram showing a contracted state of a configuration example of the brush-shaped three-dimensional tissue piece capturing tool 10h.
  • FIG. 25 is a diagram showing an expanded state of the configuration example of the brush-shaped three-dimensional tissue piece capturing tool 10h ′ in which the hair material is covered with the cloth material.
  • FIG. 26 is a brush-like shape in which the hair material is covered with the cloth material.
  • FIG. 27 is a diagram showing a contracted state of a configuration example of a three-dimensional tissue piece capturing device 10h ′.
  • FIG. 27 is a diagram showing an expanded state of a configuration example of a tissue piece capturing device 10h ′′ in which a cloth material is sandwiched between bristle materials.
  • FIG. 28 is a diagram schematically showing an exploded view of two bristle materials of the tissue piece capturing tool 10h ′′ and a cloth material sandwiched between them.
  • FIG. 29 is a diagram of FIG. It is a figure which shows the structure provided with the collection
  • FIG. 30 is a view showing a configuration in which the recovery tool 30 is provided for the tissue piece capturing tool 10f with the support ring 15 shown in FIG. 19 of the first embodiment.
  • FIG. 31 shows the tissue piece capturing tool 10f as the introduction tool 40.
  • FIG. 32 is a view showing a state in which the tissue piece capturing tool 10f is released by pushing it from the inside of the introduction tool 40 to the outside through the release side opening 41.
  • FIG. FIG. 34 is a view showing a state in which the tissue piece capturing tool 10f is accommodated in the introduction tool 40.
  • FIG. 30 is a view showing a configuration in which the recovery tool 30 is provided for the tissue piece capturing tool 10f with the support ring 15 shown in FIG. 19 of the first embodiment.
  • FIG. 31 shows the tissue piece capturing tool 10f as the
  • FIG. 34 is a diagram showing that the tissue piece capturing tool 10f is pushed out from the introduction tool 40 to the outside through the release side opening 41.
  • FIG. 35 is a view showing a released state.
  • FIG. 35 is a view showing a state in which the tissue piece capturing tool 10g is accommodated in the introduction tool 40.
  • FIG. 36 is a view showing the tissue piece capturing tool 10g from the inside of the introduction tool 40. Outside through the opening 41
  • FIG. 37 is a view showing a state where the tissue piece capturing device 10 is pushed out by the push-out rod 50 as the opening device 50.
  • FIG. 38 is a view showing the leaflet of the aortic valve.
  • FIG. 39 is a diagram showing a procedure for dissecting the ascending aortic wall in the vicinity and providing an incision.
  • FIG. 39 passes the space 4 of the leaflet of the aortic valve 3 and introduces the introducer 40 up to the annulus 6 of the aortic valve 3.
  • FIG. 40 is a diagram showing a procedure for closing the aortic valve 3 by placing the tissue piece capturing device 10 in an expanded state and placing it in the vicinity of the aortic valve annulus.
  • FIG. 41 is a diagram showing the introducing device 40. It is a figure which shows the procedure which takes out from the incision to the exterior of the ascending aorta
  • tissue piece capturing device for aortic valve replacement surgery the tissue piece capturing device set for aortic valve replacement surgery, and the tissue piece capturing method in aortic valve replacement surgery according to the present invention will be described in detail with reference to the preferred embodiments shown in the accompanying drawings.
  • the present invention is not limited to these examples.
  • the tissue piece capturing device for aortic valve replacement surgery of the present invention suppresses invasion of a tissue piece residue into the left ventricle that may be caused by excision of the aortic valve in aortic valve replacement surgery.
  • Example 1 various structure examples of the tissue piece capturing tool 10 for aortic valve replacement surgery and a structure for switching between an expanded state and a contracted state of the tissue piece capturing tool will be described.
  • Example 2 a configuration example of the tissue piece capturing tool 10 with the recovery tool 30 is shown.
  • Example 3 an operation procedure for placing and removing the tissue piece capturing device 10 at a predetermined position of the ventricle using the introducing device 40 and the opening device 50 will be described.
  • FIG. 1 and FIG. 2 are diagrams showing a configuration example of a wide, substantially cylindrical three-dimensional tissue piece capturing tool 10a.
  • FIG. 1 shows an expanded state of the tissue piece capturing tool 10a
  • FIG. 2 shows a contracted state of the tissue piece capturing tool 10a. 1 and 2, (a) is a front view, (b) is a side view, and (c) is a perspective view.
  • the shape and size of the tissue piece capturing device 10a in the expanded state are not particularly limited as long as the shape and size are close to the aortic valve annulus in the left ventricle of the patient and close the aortic valve, but the size is not limited.
  • the capturing device 10 will be located in the vicinity of the aortic valve, and the operation such as excision of the valve leaflet will be performed. When working, the work space is compressed and obstacles occur. Therefore, about 1 to 30 mm is preferable.
  • the shape is a wide, substantially cylindrical three-dimensional shape, and the edge portion is a smooth curved surface.
  • This is a device for softening contact with human tissue when the aortic valve is closed, but it is not essential to adopt such a shape.
  • the shape and size of the tissue piece capturing device 10a in the contracted state are not limited as long as the shape and size can pass through the gap of the aortic valve leaflet from the aorta side toward the left ventricle side.
  • the shape is a thin cylindrical solid shape, and the edge portion is a smooth curved surface.
  • the size is 3 to 7 mm in diameter and 3 to 7 mm in height.
  • the tissue piece capturing device 10a of the present invention Prior to the aortic valve replacement operation, the tissue piece capturing device 10a of the present invention passes the gap between the aortic valve leaflets from the aorta side to the left ventricle side in the contracted state of FIG.
  • the gap between the aortic valve leaflets is about 3 to 7 mm, and the tissue piece capturing device 10a of the present invention can pass through in the contracted state of FIG. If the gap between the aortic valve leaflets is small and the tissue piece capturing tool 10a cannot pass, the leaflets may be cut to increase the gap.
  • the length of the incision is not limited, but if the maximum length is an incision of about 10 mm or less, there is no possibility of generating a tissue piece when making the incision.
  • the tissue piece capturing device 10a of the present invention passes through the gap of the aortic valve leaflet and introduces the left ventricle, and then enters the expanded state of FIG. The aortic valve is closed and the tissue piece residue is captured in a substantially cylindrical internal void. In this way, prior to the aortic valve replacement operation, the tissue piece capture device 10a can block the aortic valve so as to surround the annulus of the aortic valve, thereby preventing the tissue piece residue from entering the left ventricle.
  • FIG. 3 is an example of another contracted state of the tissue piece capturing tool 10a.
  • a part of the expanded state of FIG. 1 is contracted and the other part is expanded to be contracted. That is, although the outer diameter of the substantially cylindrical shape is reduced from the expanded state of FIG. 1, the height is increased and the whole is contracted into a compact shape.
  • the shape of the tissue piece capturing tool 10 of the present invention is not limited to that shown in FIGS. 1 and 2 or those shown in FIGS. 1 and 3, and various other shapes and sizes are possible.
  • FIGS. 1 and 2 an example of a spherical three-dimensional tissue piece capturing tool 10b is shown.
  • 4 and 5 are diagrams showing a configuration example of a spherical solid-shaped tissue piece capturing tool 10b.
  • FIG. 4 shows an expanded state of the tissue piece capturing tool 10b
  • FIG. 5 shows a contracted state of the tissue piece capturing tool 10b. 4 and 5, (a) is a front view, and (b) is a side view.
  • the capturing tool 10b has a spherical three-dimensional shape in the expanded state, has a shape and a size that fits in the vicinity of the aortic valve annulus, and closes the aortic valve.
  • the shape of the capturing device 10b does not necessarily have an accurate spherical shape, and even the non-spherical capturing device 10b may have a shape and size that can be accommodated in the vicinity of the aortic valve annulus.
  • the diameter of the sphere is 10 to 30 mm.
  • the capturing tool 10b has a thin cylindrical solid shape in a contracted state, and the edge portion has a smooth curved surface. This is a device for reducing contact with tissue at the time of introduction into the body, but it is not essential to adopt such a shape.
  • the size is 3 to 7 mm in diameter and 10 to 30 mm in height.
  • the tissue piece capturing device 10b of the present invention passes the gap between the aortic valve leaflets from the aorta side to the left ventricle side in the contracted state of FIG.
  • the gap between the aortic valve leaflets is about 3 to 7 mm, and the tissue piece capturing device 10b of the present invention can pass in the contracted state of FIG. If the gap between the aortic valve leaflets is small and the tissue piece capturing tool 10b cannot pass, the leaflets may be cut to increase the gap.
  • the length of the incision is not limited, but if the maximum length is an incision of about 10 mm or less, there is no possibility of generating a tissue piece when making the incision.
  • the tissue fragment capturing device 10b of the present invention passes through the gap of the aortic valve leaflet and introduces the left ventricle, and then enters the expanded state of FIG. Capture tissue debris.
  • FIG. 6 shows the expanded state of the tissue piece capturing tool 10c
  • FIG. 7 shows the contracted state of the tissue piece capturing tool 10c.
  • the capturing tool 10c has a substantially bowl-like three-dimensional shape in the expanded state, and has a shape and a size that fit in the vicinity of the aortic valve annulus, and has a substantially bowl-like shape.
  • the mouth closes the aortic valve.
  • the diameter of the ridge is 10 to 30 mm.
  • the edge portion is disclosed as a smooth curved surface. This is a device for softening contact with human tissue when the aortic valve is closed, but it is not essential to adopt such a shape.
  • FIG. 6 is a front view
  • FIG. 6 is a side view
  • the capturing tool 10c has a substantially bowl-like three-dimensional shape in the expanded state, and has a shape and a size that fit in the vicinity of the aortic valve annulus, and has a substantially bowl-like shape.
  • the mouth closes the aortic valve.
  • the diameter of the ridge is 10 to 30 mm.
  • the edge portion is disclosed as a smooth curved surface
  • the tissue piece capturing tool 10c has a three-dimensional shape with a thin cylindrical shape in the contracted state and a bowl shape inside.
  • the edge portion is disclosed as a smooth curved surface. This is a device for reducing contact with tissue at the time of introduction into the body, but it is not essential to adopt such a shape.
  • the size is 3 to 7 mm in diameter and 10 to 30 mm in length.
  • the tissue piece capturing device 10c of the present invention passes the gap between the aortic valve leaflets from the aorta side to the left ventricle side in the contracted state of FIG.
  • the gap between the aortic valve leaflets is about 3 to 7 mm, and the tissue piece capturing tool 10c of the present invention can pass in the contracted state of FIG. If the gap between the aortic valve leaflets is small and the tissue piece capturing device 10c cannot pass, the leaflets may be cut to increase the gap.
  • the length of the incision is not limited, but if the maximum length is an incision of about 10 mm or less, there is no possibility of generating a tissue piece when making the incision.
  • the tissue piece capturing device 10c of the present invention passes through the gap of the aortic valve leaflet and is introduced into the left ventricle, and then enters the expanded state of FIG.
  • FIG. 8 and FIG. 9 are diagrams showing a configuration example of a cone-shaped substantially scissor-shaped tissue piece capturing tool 10d.
  • FIG. 8 shows an expanded state of the tissue piece capturing tool 10d
  • FIG. 9 shows an expanded state of the tissue piece capturing tool 10d
  • the tissue piece capturing tool 10d has a conical substantially saddle-like three-dimensional shape in the expanded state, and has a shape and a size that fit in the vicinity of the aortic valve annulus.
  • the aortic valve is closed by a shaped mouth.
  • the diameter of the ridge is 10 to 30 mm.
  • the edge portion is disclosed as a smooth curved surface.
  • the trapping tool 10 d has a three-dimensional shape with a thin cylindrical shape in the contracted state and a bowl-like shape inside. In this example, the shape is almost the same as that in FIG. 7, and the edge portion has a smooth curved surface.
  • This is a device for reducing contact with tissue at the time of introduction into the body, but it is not essential to adopt such a shape.
  • the size is 3 to 7 mm in diameter and 10 to 30 mm in length.
  • the tissue piece capturing tool 10d of the present invention Prior to the aortic valve replacement operation, the tissue piece capturing tool 10d of the present invention passes the gap between the aortic valve leaflets from the aorta side toward the left ventricle side in the contracted state of FIG.
  • the gap between the aortic valve leaflets is about 3 to 7 mm, and the tissue piece capturing tool 10d of the present invention can pass in the contracted state of FIG. If the gap between the aortic valve leaflets is small and the tissue piece capturing device 10d cannot pass, the leaflets may be cut to increase the gap.
  • the length of the incision is not limited, but if the maximum length is an incision of about 10 mm or less, there is no possibility of generating a tissue piece when making the incision.
  • the tissue piece capturing device 10d of the present invention passes through the gap of the aortic valve leaflet and introduces the left ventricle, and then enters the expanded state of FIG.
  • the valve is closed and the tissue debris is captured in a substantially bowl-shaped internal space.
  • the tissue piece residue can be prevented from entering the left ventricle by closing the aortic valve so as to surround the annulus of the aortic valve with the tissue piece capturing tool 10d.
  • FIG. 11 are diagrams showing a configuration example of a substantially donut-shaped three-dimensional capturing tool 10e whose central portion is closed with a membrane.
  • FIG. 10 shows an expanded state of the tissue piece capturing tool 10e
  • FIG. 11 shows a contracted state of the tissue piece capturing tool 10e.
  • 10 and 11 (a) is a front view, (b) is a side view, (c) is a side sectional view, and (d) is a perspective view.
  • the tissue piece capturing device 10e has a substantially donut-shaped three-dimensional shape in which the central portion is closed with a membrane in the expanded state, and has a shape and size that fits in the vicinity of the aortic valve annulus. The aortic valve is blocked.
  • the outer diameter of the donut is 10 to 30 mm.
  • the edge portion is disclosed as a smooth curved surface. This is a device for softening contact with human tissue when the aortic valve is closed, but it is not essential to adopt such a shape.
  • the contracted state of the capturing tool 10e has a three-dimensional shape that is entirely contracted from the expanded state of FIG.
  • the outer diameter of the donut is 3 to 7 mm.
  • contact with a tissue is eased at the time of introduction into the body.
  • the tissue piece capturing tool 10e of the present invention Prior to the aortic valve replacement operation, the tissue piece capturing tool 10e of the present invention passes the gap between the aortic valve leaflets from the aorta side toward the left ventricle side in the contracted state of FIG.
  • the gap between the aortic valve leaflets is about 3 to 7 mm, and the tissue piece capturing tool 10e of the present invention can pass in the contracted state of FIG. If the gap between the aortic valve leaflets is small and the tissue piece capturing device 10e cannot pass, the leaflets may be cut to increase the gap.
  • the length of the incision is not limited, but if the maximum length is an incision of about 10 mm or less, there is no possibility of generating a tissue piece when making the incision.
  • the tissue piece capturing device 10e of the present invention passes through the gap of the aortic valve leaflet and is introduced into the left ventricle, and then enters the expanded state of FIG. 10 so that the aortic valve is surrounded by the portion corresponding to the mouth of the donut.
  • the valve is closed and the tissue debris is captured in a substantially bowl-shaped internal space.
  • the tissue piece residue can be prevented from entering the left ventricle by closing the aortic valve so as to surround the annulus of the aortic valve with the tissue piece capturing tool 10e.
  • the structure of the tissue piece capturing tool 10 is not limited, the volume can be reduced by a simple operation, and the volume can be increased to the original by a simple operation, for example, by shape recovery by shape memory ability.
  • a structure capable of forming is preferable. As such a structure, for example, a porous structure having shape memory ability or a fiber is preferable.
  • 12 and 13 are diagrams illustrating a configuration example in which the tissue piece capturing tool 10 is switched from the contracted state to the expanded state by applying air pressure.
  • FIG. 6 is a diagram illustrating a configuration example in which the tissue piece capturing device 10a illustrated in FIG.
  • FIG. 12 shows a contracted state before air pressure is applied to the tissue piece capturing tool 10a.
  • FIG. 13 shows a state in which the tissue piece capturing tool 10a is switched to the expanded state by applying air pressure. Both FIG. 12 and FIG. 13 are shown by side sectional views.
  • the tissue piece capturing tool 10 a includes a balloon 11 and an inlet 12 provided in the balloon 11.
  • a pressure supply tube 20 that can apply air pressure to the balloon 11 can be attached to the balloon 11 via the suction port 12.
  • the air pressure is decreased as shown in FIG. 12 to such an extent that it can pass through the gap between the leaflets of the aortic valve.
  • the tissue piece capturing device 10a in the state of FIG. 12 is passed through the gap between the leaflets in the horizontal direction in the drawing from the lower side, the tissue piece capturing device 10a is in a contracted state in the traveling direction.
  • the tissue piece capturing device 10a is passed as it is from the aortic valve leaflet side to the annulus side, and introduced into the vicinity of the aortic valve annulus in the left ventricle. Thereafter, as shown in FIG.
  • FIG. 14 shows a state before air pressure is applied to the tissue piece capturing tool 10e.
  • FIG. 15 shows a state in which the tissue piece capturing tool 10e is switched to the expanded state by applying air pressure.
  • 14A is a side sectional view
  • FIG. 14B is a perspective view with a part omitted.
  • FIG. 15 shows a side sectional view.
  • the tissue piece capturing device 10 e includes a balloon 11 and an inlet 12 provided in the balloon 11.
  • a pressure supply tube 20 that can apply air pressure to the balloon 11 can be attached to the balloon 11 via the suction port 12.
  • the left side of the tissue piece capturing tool 10 e is referred to as “lower part”, and the right side of the tissue piece capturing tool 10 e is referred to as “upper part”.
  • the tissue piece capturing device 10 e has a substantially donut shape with the center closed by a membrane. At the time of introduction, the air pressure is reduced to a contracted state and passed through the gap of the aortic valve leaflet.
  • the tissue piece capturing tool 10e is passed through the gap of the aortic valve leaflet and introduced to the vicinity of the aortic valve annulus in the left ventricle. Thereafter, the lower part is directed to the aortic valve inflow part side and the upper part is directed to the aortic valve outflow part side, and then the air pressure is applied from the suction port 12 to the balloon 11 through the pressure feeding tube 20 as shown in FIG. To close the aortic valve by inflating to an expanded state. Although the maximum diameter of the balloon 11 in the expanded state in which air pressure is applied is not limited, it is preferable not to apply excessive pressure in the vicinity of the aortic valve annulus.
  • the maximum diameter of the cross section of the balloon 11 is, for example, about 10 to 30 mm.
  • the length from the upper part to the lower part is not limited, since the ventricle is closed during operation and the tissue piece capturing device 10e cannot enter, if the length is too long, the tissue piece capturing device is located in the vicinity of the aortic valve. 10e is located, and the working space is compressed and an obstacle occurs when performing a surgical operation such as excision of the aortic valve leaflet. Therefore, for example, about 1 to 30 mm is preferable.
  • the material of the balloon 11 is not limited, and examples thereof include silicon resin, fluorine resin, nylon resin, polyurethane resin, polyethylene resin, various elastomers, and various blend materials.
  • the tissue piece capturing tool 10 may further include a capturing sheet that covers the outer layer of the balloon 11 in order to capture the tissue pieces more efficiently.
  • the structure of such a capture sheet is not limited, but a structure having high affinity with a tissue piece is preferable. As such a structure, for example, a rough surface, a fiber, a nonwoven fabric, or a porous material is preferable.
  • the material of the capture sheet is not limited, and examples thereof include silicon resin, fluororesin, nylon resin, polyurethane resin, polyethylene resin, various elastomers, cellulose, chitosan, and various blend materials.
  • FIG. 16 is a diagram illustrating a configuration example in which physiological saline is absorbed to switch from the contracted state of the tissue piece capturing device 10a illustrated in FIG. 1 to the expanded state of the tissue piece capturing device 10a illustrated in FIG. The upper part of FIG.
  • FIG. 16 shows a contracted state before the tissue piece capturing tool 10a absorbs the liquid.
  • the lower part of FIG. 16 shows an expanded state after the tissue piece capturing tool 10a has absorbed the liquid.
  • Both the upper view and the lower view of FIG. 16 are shown by side sectional views.
  • swelling raw material 13 will not be limited if it absorbs a liquid and expand
  • the compressed fiber lump is mentioned.
  • a raw material is not limited, For example, a cellulosic fiber is mentioned.
  • tissue piece capturing device 10a is maintained.
  • the volume can be expanded. If the size of the tissue piece capturing device 10a is large enough to pass through the gap between the leaflets of the aortic valve in the contracted state in which the expansion material 13 is dried, the side of the aortic valve leaflet is set to the advancing direction side. The gap can be passed. Thereafter, by exposing the tissue piece capturing tool 10a to a liquid such as physiological saline to increase the volume, the vicinity of the aortic valve annulus can be closed. FIG.
  • FIG. 17 is a diagram illustrating a configuration example of switching from the contracted state of the tissue piece capturing device 10a illustrated in FIG. 3 to the expanded state of the tissue piece capturing device 10a illustrated in FIG. 1 by absorbing physiological saline.
  • the upper part of FIG. 17 shows a contracted state before the tissue piece capturing tool 10a absorbs the liquid.
  • the lower part of FIG. 17 shows an expanded state after the tissue piece capturing tool 10a has absorbed the liquid.
  • Both the upper view and the lower view of FIG. FIG. 17 shows a tissue piece capturing device by forming a substantially cylindrical bag with a water-permeable sheet 14 that can be reduced, expanded, or folded, and filling the bag with a plurality of inflatable materials 13 that expand by absorbing liquid.
  • FIG. 17 It is a figure which shows the example which comprised 10a.
  • the upper part of FIG. 17 is a perspective view showing the tissue piece capturing tool 10a which has been dried to reduce the expanded material 13 and brought into a contracted state.
  • the lower view of FIG. 17 is a perspective view showing the tissue piece capturing tool 10a in an expanded state by absorbing the liquid and expanding the expansion material 13.
  • the water-permeable sheet 14 having a substantially cylindrical shape in the upper part of FIG. 17 is deformed by reducing a part thereof and expanding the other part, and has a substantially cylindrical outer diameter as shown in the lower part of FIG. The height is reduced by expanding.
  • FIG. 18 is a diagram illustrating a configuration example in which physiological saline is absorbed to switch from the contracted state of the tissue piece capturing device 10d illustrated in FIG. 9 to the expanded state of the tissue piece capturing device 10d illustrated in FIG. 18 shows a contracted state before the tissue piece capturing tool 10d absorbs the liquid.
  • the lower part of FIG. 18 shows an expanded state after the tissue piece capturing tool 10d has absorbed the liquid.
  • Both the upper and lower views of FIG. 18 are shown by side sectional views. In the contracted state shown in the upper diagram of FIG.
  • the aortic valve can be blocked by passing through the gap between the leaflets of the aortic valve, and then exposing the tissue piece capturing device 10 d to a liquid such as physiological saline and expanding it by absorbing water. it can.
  • swelling raw material 13 is not limited,
  • the compressed fiber lump is mentioned.
  • the raw material of the compressed fiber lump is not limited,
  • a cellulose fiber lump is mentioned.
  • the size of the compressed fiber lump when dried is preferably about 1 mm to 7 mm.
  • the size when the liquid is absorbed and expanded is not limited, for example, in the case of a cellulosic fiber lump, the volume increases about three times as compared with the time of drying.
  • the structure of the water-permeable sheet 14 is not limited, For example, a nonwoven fabric, the nonwoven fabric by which many holes were carried out, and a porous membrane are mentioned.
  • the raw material of the water-permeable sheet 14 is not limited, For example, what carried out the hydrophilic process of the hydrophobic fiber is mentioned.
  • the material of the hydrophobic fiber is not limited, and examples thereof include polyester, polypropylene, and polyethylene terephthalate.
  • FIG. 19 is a diagram illustrating a configuration example in which the tissue piece capturing unit 10 is deformed through the operation of the support unit.
  • FIG. 19A is a front view
  • FIG. 19B is a side view.
  • the tissue piece capturing tool 10 f for aortic valve replacement surgery includes a ring-shaped support portion 15 and a capture sheet 16 attached to the support portion 15.
  • the lower side of the tissue piece capturing tool 10 f is referred to as “lower part”
  • the upper side of the tissue piece capturing tool 10 f is referred to as “upper part”.
  • FIG. 19 the tissue piece capturing tool 10 f for aortic valve replacement surgery includes a ring-shaped support portion 15 and a capture sheet 16 attached to the support portion 15.
  • the lower side of the tissue piece capturing tool 10 f is referred to as “lower part”
  • the upper side of the tissue piece capturing tool 10 f is referred to as “upper part”.
  • FIG. 19 is a diagram illustrating a configuration example
  • the tissue piece capturing device 10f of the present invention has a substantially disk shape, and has a shape that fits in the vicinity of the aortic valve annulus when the tissue sheet is captured by the capturing sheet 16, for example. is doing.
  • the shape of the tissue piece capturing tool 10f is not necessarily a substantially disk shape, and may be any shape that can block the aortic valve. For example, it may be substantially cylindrical.
  • the tissue piece capturing device 10f is contracted to such an extent that it can pass through the gap between the leaflets of the aortic valve. For example, as shown in FIG.
  • the support ring 15 is contracted left and right to bring the entire tissue piece capturing device 10f into a contracted state, and the tissue piece capturing device 10f is passed through the gap between the aortic valve leaflets in the contracted state. Introduce up to the valve annulus. Thereafter, the aortic valve can be closed by adjusting the direction in which the tissue piece is captured by the capture sheet 16 and then in the expanded state shown in the upper diagram of FIG.
  • the maximum diameter of the support portion 15 is not limited, but is preferably about 10 to 30 mm, for example, because it needs to fit in the aortic valve. Also, the height of the ring-shaped support portion 15 is not limited.
  • the structure of the support ring 15 is not limited, but a structure that can be transformed into a contracted state by a simple operation and can be returned to an expanded state by a simple operation, for example, by shape recovery by shape memory ability, is preferable. .
  • a ring structure and a spring structure having shape memory ability are preferable.
  • the raw material of the support ring 15 is not limited, For example, stainless steel, titanium (Ti), tantalum (Ta), nitinol (Ni-Ti alloy), etc. are mentioned.
  • the structure of the capture sheet 16 is not limited, but a structure that can follow the deformation of the support ring 15 and can capture a tissue piece is preferable. As such a structure, a fiber, a nonwoven fabric, a porous structure, etc. are preferable, for example.
  • the material of the capture sheet 16 is not limited, and examples thereof include silicon resin, fluorine resin, nylon resin, polyurethane resin, polyethylene resin, various elastomers, and various blend materials. FIG.
  • FIG. 21 is a diagram illustrating another configuration example in which the tissue piece capturing unit 10 is deformed through the operation of the support unit 15.
  • FIG. 21A is a front view
  • FIG. 21B is a side view
  • FIG. 22 is a diagram schematically showing a contracted state.
  • the tissue piece capturing tool 10 g includes a support balloon 17 and a capture sheet 16 attached to the support balloon 17.
  • FIG. 21 shows a state in which air pressure is applied to the support balloon 17.
  • the tissue piece capturing tool 10g has a substantially disk shape in a state where air pressure is applied to the support balloon 17, and for example, when the tissue piece is captured by the capturing sheet 16, the aortic valve It has a shape that fits in the vicinity of the annulus.
  • the shape of the tissue piece capturing tool 10g is not necessarily a substantially disc shape when air pressure is applied, and may be any shape that can block the aortic valve inflow portion when air pressure is applied. For example, it may be substantially cylindrical.
  • the tissue piece capturing device 10g When introduced into the ventricle, the tissue piece capturing device 10g is reduced to such an extent that it can pass through the gap between the aortic valve leaflets. For example, as shown in FIG. 22, when the air is extracted from the support balloon 17, the entire tissue piece capturing tool 10g is in a contracted state. The tissue piece capturing tool 10g is set in a contracted state, is passed through the gap of the aortic valve leaflet, and is introduced to the vicinity of the aortic valve annulus.
  • the aortic valve can then be closed by adjusting the direction so that the tissue piece is captured by the capture sheet 16 and then returning the expanded state by applying air pressure to the support balloon 17.
  • the maximum diameter of the support balloon 17 in a state where air pressure is applied is not limited, it is preferable not to apply excessive pressure to the aortic valve, so that the support that closes the aortic valve in a state where it is in the vicinity of the aortic valve annulus is supported.
  • the maximum diameter of the cross section of the balloon 17 is preferably about 10 to 30 mm, for example.
  • the ventricle is closed at the time of surgery, and the tissue piece capturing device 10g cannot enter.
  • the material of the support balloon 17 may be a polymer material that can be stretched and is not limited.
  • polyethylene, polypropylene, polyester, polyurethane, polyamide, polyethylene terephthalate, polystyrene, polyvinyl alcohol, polyvinyl chloride, polyvinylidene chloride, Polymer materials such as polyimide, polyacetylene and polysulfone, and copolymers and mixtures thereof are applicable.
  • the structure of the capture sheet 16 is not limited, but a structure that can follow the deformation of the support balloon 17 and can capture a tissue piece is preferable. As such a structure, a fiber, a nonwoven fabric, a porous structure, etc. are preferable, for example.
  • the material of the capture sheet 16 is not limited, and examples thereof include silicon resin, fluororesin, nylon resin, polyurethane resin, polyethylene resin, various elastomers, cellulose, chitosan, and various blend materials.
  • FIG. 23 and FIG. 24 are diagrams showing a configuration example of a brush-shaped three-dimensional tissue piece capturing tool 10h.
  • FIG. 23 and FIG. 24 are diagrams showing a configuration example of a brush-shaped three-dimensional tissue piece capturing tool 10h.
  • FIG. 23 shows an expanded state of the tissue piece capturing tool 10h
  • FIG. 24 shows a contracted state of the tissue piece capturing tool 10h.
  • 23 and 24 (a) shows a side view and (b) shows a front view.
  • the tissue piece capturing tool 10 h sandwiches a large number of hair materials 191 along the longitudinal direction between the two core materials 18, and integrates these core materials 18 together.
  • the hair material 191 is radially provided around the core material 18 by twisting.
  • the tissue piece capturing tool 10h is not limited to such a configuration, and the hair material 191 is provided radially around the core material 18. Any configuration may be used as long as it is provided. In this example, as shown in FIGS.
  • the bristle material 191 is radially provided around the core material 18 in a direction perpendicular to the core material 18 in the expanded state, and the aortic valve annulus. It has a shape and size that fit in the vicinity and closes the aortic valve.
  • the outer diameter of the radial circle formed by the bristle material 191 around the core material 18 is 15 to 25 mm.
  • the contraction state of the tissue piece capturing tool 10h is reduced from the expanded state of FIG. 23 in the outer diameter of the radial circle formed by the bristle material 191 around the core material 18. It has a three-dimensional shape.
  • the outer diameter is 3 to 7 mm.
  • the contracted state is such that the disc-shaped bristle material 191 is closed like an umbrella
  • the expanded state is such that the disc-like bristle material 191 is opened like an umbrella, so that the umbrella can be opened and closed. It is supposed to be deformed.
  • the outer diameter of the radial circle formed by the bristle material 191 of the tissue piece capturing tool 10 h around the core material 18 can pass through the gap between the leaflets of the aortic valve. Shrink to the extent.
  • the tissue piece capturing tool 10h is passed through the gap of the aortic valve leaflet in the contracted state and introduced to the vicinity of the aortic valve annulus. Thereafter, the aortic valve can be closed by the expanded state shown in FIG.
  • the material of the hair material 191 is not limited, but a material having elasticity is preferable so that the tissue piece capturing tool 10h can be switched naturally from the contracted state to the expanded state without requiring external force.
  • a flexible material is preferable so as not to damage tissue such as a blood vessel wall.
  • polyamide, polyester, alkene polymer, diene polymer and the like can be mentioned.
  • the raw material of the core material 18 is not limited, the raw material which has the intensity
  • a material that is plastically deformed by applying an external force is preferable.
  • a metal, a synthetic resin monofilament, etc. are mentioned.
  • a tissue piece capturing tool 10h ′ which is a first configuration by combining cloth materials, is shown.
  • the support portion 15 is at least one disc-like brush provided with a hair material radially from the center toward the outer periphery, and the capturing portion 16 is a cloth material covering the periphery of the brush. is there.
  • the tissue piece capturing tool 10 h ′ has a configuration in which the periphery of the hair material 191 provided radially around the core material 18 is further covered with a cloth material 192. With such a configuration, the aortic valve can be closed more densely, so that more tissue fragment residue generated when the aortic valve is excised can be captured.
  • FIG. 25 shows an expanded state of the tissue piece capturing tool 10h ′
  • 26 shows a contracted state of the tissue piece capturing tool 10h ′.
  • 25 and 26 (a) shows a side view and (b) shows a front view.
  • the structure of the cloth material 192 is not limited, it is more preferable in performing the operation that the tissue piece capturing tool 10h ′ closes the aortic valve to the extent that the liquid such as blood is not completely blocked. Is preferred.
  • a nonwoven fabric, a nonwoven fabric with many holes, and a porous membrane are mentioned.
  • the raw material of the fabric material 192 which has water permeability is not limited, For example, what carried out the hydrophilic process of the hydrophobic fiber is mentioned.
  • the material of the hydrophobic fiber is not limited, and examples thereof include polyester, polypropylene, and polyethylene terephthalate.
  • a tissue piece capturing tool 10h ′′ which is a second configuration by combining cloth materials is shown.
  • a plurality of disc-shaped support members 15 are provided with hair materials radially from the center toward the outer periphery.
  • the tissue piece capturing tool 10 h ′′ has a configuration in which a cloth material 192 is sandwiched between brush-shaped three-dimensional hair materials 191 disposed along the longitudinal direction of the core material 18.
  • Fig. 28 is a schematic exploded view of two bristle materials 191 and a cloth material 192 sandwiched between them. It is a figure.
  • the material of the core material 18 is made of, for example, a general resin (ABS, PP, PE, PC, acrylic, PET), and in this configuration example, has a cylindrical shape.
  • the material of the bristle material 191 may also be made of a general resin, and is a ring shape in which resin hairs are planted in a circle. For example, the diameter of the ring is about 2 to 3 cm in diameter, and the thickness of the hair is 0.1 mm or less.
  • the bristle material 191 may have any configuration as long as the bridging material 191 is provided radially around the core material 18.
  • the material of the cloth material 192 is a fibrous material such as a non-woven fabric or gauze, and is preferably a fiber material that has water permeability and is not easily bent or twisted.
  • the raw material of the fabric material 192 which has water permeability is not limited, For example, what carried out the hydrophilic process of the hydrophobic fiber is mentioned. Examples thereof include polyester, polypropylene, and polyethylene terephthalate.
  • a non-woven cloth material 192 having substantially the same diameter is sandwiched between two circular brush-like bristle materials 191.
  • Adhesion between the bristle material 191 and the cloth material 192 is not performed, etc.
  • the structure is such that the cloth material 192 is inserted between the bristle material 191 as a so-called filter.
  • the cloth material 192 may have a diameter slightly larger than the diameter of the bristle material 191 in order to improve the adhesion between the blood vessel wall.
  • the bristle material 191 and the cloth material 192 may be bonded, it is necessary to consider so as not to disturb the blood flow.
  • a size of about 3 cm in the longitudinal direction is easy to use at the time of surgery, but in order to improve the operability at the time of insertion, a removable extension rod may be attached.
  • tissue piece capturing tool for aortic valve replacement surgery it is possible to start capturing the tissue fragment residue from the time of starting resection of the valve leaflet by attaching it to the surgical affected area. Compared to the capture tool, the tissue fragment residue can be captured more reliably and without leakage.
  • tissue piece capturing tool for aortic valve replacement surgery As a tissue piece capturing tool for aortic valve replacement surgery according to the second embodiment, a configuration example including a collection tool 30 joined to the tissue piece capturing tool 10 will be described.
  • the tissue piece capturing device of the present invention according to Example 2 is In addition to the tissue piece capturing tool 10 shown in the first embodiment, a thread-like, tubular or rod-like collecting tool 30 is provided, and one end of the collecting tool 30 is left on the aorta side before and after the aortic valve replacement operation.
  • the tissue piece capturing tool 10 can be recovered from the aorta side by pulling one end of the recovery tool 30 after the replacement operation.
  • FIG. 29 is a diagram illustrating a configuration in which a recovery tool 30 is provided to the tissue piece capturing tool 10a having a substantially cylindrical solid shape illustrated in FIG.
  • FIG. 29 shows a perspective view.
  • the recovery tool 30 is attached to the upper part of the tissue piece capturing tool 10a.
  • the attachment position is not limited to the upper part, and the recovery tool 30 is pulled in the blood flow direction after aortic valve replacement surgery. If the tissue piece capturing tool 10a can be recovered outside the body through the aortic valve gap, the recovery tool 30 may be joined to any position of the tissue piece capturing tool 10a.
  • FIG. 29 shows a diagram illustrating a configuration in which a recovery tool 30 is provided to the tissue piece capturing tool 10a having a substantially cylindrical solid shape illustrated in FIG.
  • FIG. 29 shows a perspective view.
  • the recovery tool 30 is attached to the upper part of the tissue piece capturing tool 10a.
  • the attachment position is not limited to the upper part, and the recovery tool 30 is pulled in the blood flow direction after
  • FIG. 30 is another configuration example of the tissue piece capturing device for aortic valve replacement surgery according to the second embodiment of the present invention, and the tissue piece capturing device 10f with the support ring 15 shown in FIG. 19 of the first embodiment. It is a figure which shows the structure provided with the collection
  • FIG. 30 shows a perspective view. As shown in FIG. 30, the recovery tool 30 is attached to the support ring 15 of the tissue piece capturing tool 10f, but the attachment position is not limited, and the recovery tool 30 is pulled in the direction of blood flow after aortic valve replacement surgery. As long as the tissue piece capturing device 10f can be recovered from the aortic valve gap to the outside of the body, any position of the support ring 15 may be used. In the example of FIG.
  • the recovery tool 30 is extended from the joint point with the support ring 15 to the vicinity of the center of the capture sheet 16 and further extended in a linear direction perpendicular to the capture sheet 16.
  • This is a device for positioning the end of the collection tool 30 located on the opposite side of the joint point with the support ring 15 in the vicinity of the center of the capture sheet 16 when viewed in a linear direction perpendicular to the capture sheet 16. .
  • the end of the recovery device 30 is grasped with a finger or the like.
  • the collection tool 30 may be stretched as it is in a linear direction perpendicular to the capture sheet 16 from the joint point with the support ring 15.
  • recovery tool 30 is not limited, For example, thread shape, tubular shape, or rod shape etc. are mentioned.
  • the length of the recovery tool 30 is not limited, and may be a length that allows the tissue piece capturing tool 10f to be recovered from the aortic valve gap outside the body by pulling the recovery tool 30 in the blood flow direction after the aortic valve replacement operation. That's fine. Therefore, for example, about 20 to 200 mm is preferable.
  • the structural example with the introduction tool 40 and the opening tool 50 is shown as a tissue piece capture tool set for aortic valve replacement operation concerning Example 3.
  • the introducer 40 is a tubular member having an outer diameter that can pass through the gap between the aortic valve leaflets.
  • the release tool 50 is a jig that pushes out the tissue piece capturing tool 10 housed inside the tubular member introduction tool 40 and releases it from the introduction tool.
  • the tissue piece capturing device 10 is in a contracted state and has a shape and size that can pass through the inside of the introduction device 40.
  • the introduction device 40 Prior to the replacement operation of the aortic valve, the introduction device 40 that houses the tissue piece capturing device is inserted into the aortic valve leaflet.
  • FIG. 31 and 32 are diagrams showing a configuration example of a tissue piece capturing tool set for aortic valve replacement surgery according to Example 3 of the present invention.
  • the tissue piece capturing tool 10f shown in Example 1 was used as an example of the tissue piece capturing tool 10.
  • FIG. 31 and 32 show perspective views.
  • FIG. 31 shows a state in which the tissue piece capturing tool 10f is accommodated in the introduction tool 40.
  • FIG. 32 shows a state in which the tissue piece capturing tool 10f is released by pushing it out from the inside of the introduction tool 40 through the release side opening 41.
  • FIGS. 33 and 34 are diagrams showing another configuration example of the tissue piece capturing tool set for aortic valve replacement surgery according to Example 3 of the present invention.
  • the tissue piece capturing tool 10f shown in Example 1 was used as an example of the tissue piece capturing tool 10.
  • the collection tool 30 is attached at the end portion of the collection sheet 30 near the center of the capture sheet 16.
  • 33 and 34 show perspective views.
  • FIG. 33 shows a state in which the tissue piece capturing tool 10f is housed in the introduction tool 40.
  • FIG. 34 shows a state in which the tissue piece capturing tool 10f is released by being pushed out from the inside of the introduction tool 40 through the release side opening 41.
  • the tissue piece capture tool 10f is pushed out from the inside of the introduction tool 40.
  • FIGS. 35 and 36 are diagrams showing another configuration example of the tissue piece capturing tool set for aortic valve replacement surgery according to Example 3 of the present invention.
  • the tissue piece capturing tool 10g deformed by the support balloon 17 shown in the first embodiment is used as an example of the tissue piece capturing tool 10.
  • 35 and 36 show perspective views.
  • FIG. 35 shows a state in which the tissue piece capturing tool 10g is housed in the introduction tool 40.
  • FIG. 36 shows a state in which the tissue piece capturing tool 10g is released by being pushed out from the inside of the introducing tool 40 through the release side opening 41.
  • the introduction tool 40 is substantially tubular and includes a release side opening 41 at one end in the long axis direction.
  • the introduction tool 40 includes an accommodation-side opening 42 at the other end. This is a device that enables the tissue piece capturing tool 10 to be accommodated in the introduction tool 40 through an opening different from the opening 41 on the release side. In addition, it is not limited so that the introduction tool 40 may be provided with such an accommodation side opening 42.
  • the introducer 40 is passed through the gap of the aortic valve leaflet, and the release side opening 41 is introduced to the vicinity of the aortic valve annulus. Thereafter, the tissue piece capturing tool 10g is released to the outside from the release side opening 41, and the aortic valve can be closed by adjusting the direction so that the tissue piece is captured by the capturing sheet 16.
  • the diameter of the diameter of the cylindrical cross section of the introducer 40 is not limited, but is preferably about 3 to 10 mm, for example, because it is necessary to pass through the gap of the aortic valve leaflet.
  • the length in the major axis direction of the introduction tool 40 is not limited as long as it is a length that can accommodate the tissue piece capturing tool 10g.
  • the raw material of the introduction tool 40 is not limited, For example, various polymers, such as a polypropylene, an acrylonitrile butadiene styrene copolymer (ABS), polymethylpentene, etc. are mentioned.
  • FIG. 37 is a view showing a state in which the tissue piece capturing tool 10 is pushed out by the push-out rod 50 as the opening tool 50.
  • the tissue piece capturing tool 10 housed therein is pushed out, and the tissue piece capturing tool 10 is opened to the outside from the release side opening 41. . If the release side opening 41 is positioned near the aortic valve annulus in the ventricle, the tissue piece capturing tool 10 is opened near the aortic valve annulus.
  • FIGS. 38 to 41 are views for explaining the placement procedure of the tissue piece capturing tool 10 for aortic valve replacement surgery in the vicinity of the aortic valve annulus according to the present invention.
  • this procedure it is a structural example with the collection
  • the tissue piece capturing device 10 is first introduced into the ascending aorta 2 in the heart 1 by being introduced through the incision in a state of being accommodated in the introduction device 40 as a contracted state.
  • the valve is passed through the leaflet gap 4 and introduced to the vicinity 6 of the annulus of the aortic valve 3 (see FIG. 39).
  • a notch may be provided in advance in the leaflet of the aortic valve 3, and this notch may be used as an introduction path for the tissue piece capturing tool 10.
  • the length of the cut is not limited, but a cut having a maximum length of about 10 mm or less is preferable because there is no risk of a tissue piece being formed when the cut is made, and the tissue piece does not enter the ventricle.
  • tissue piece capturing device for aortic valve replacement surgery can be applied to a patient requiring aortic valve replacement surgery as an instrument for assisting the surgery. While preferred embodiments of the invention have been illustrated and described, it will be appreciated that various changes can be made without departing from the scope of the invention. Therefore, the technical scope of the present invention is limited only by the description of the appended claims.

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Abstract

La présente invention concerne un instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique qui peut fermer la valve aortique avant d’enlever les cuspides de la valve. Ledit instrument peut empêcher l’invasion du résidu d’une pièce de tissu, qui est formée en association avec le retrait de la valve aortique dans une chirurgie pour remplacer la valve aortique cardiaque, dans le ventricule gauche. Ledit instrument peut être dans un état contracté avec une forme et une taille permettant le passage de celui-ci à travers l’espace entre les cuspides de valve aortique du côté aortique au côté du ventricule gauche ainsi que dans un état dilaté avec une forme et une taille permettant le placement de celui-ci à proximité des anneaux de la valve aortique dans le ventricule gauche de manière à fermer la valve aortique. Avant la chirurgie pour remplacer la valve aortique cardiaque, l’instrument dans l’état contracté est passé à travers l’espace entre les cuspides de la valve aortique du côté aortique au côté du ventricule gauche. Après introduction dans le ventricule gauche, l’instrument est amené dans l’état dilaté de manière à fermer la valve aortique à proximité des anneaux de la valve aortique dans le ventricule gauche. Par conséquent, il devient possible de prévenir l’invasion du résidu d’une pièce de tissu dans le ventricule gauche.
PCT/JP2008/072898 2008-12-10 2008-12-10 Instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique et procédé de capture d’une pièce de tissu dans la chirurgie de remplacement de valve aortique WO2010067463A1 (fr)

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PCT/JP2008/072898 WO2010067463A1 (fr) 2008-12-10 2008-12-10 Instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique et procédé de capture d’une pièce de tissu dans la chirurgie de remplacement de valve aortique

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PCT/JP2008/072898 WO2010067463A1 (fr) 2008-12-10 2008-12-10 Instrument pour capturer une pièce de tissu à utiliser dans la chirurgie de remplacement de valve aortique et procédé de capture d’une pièce de tissu dans la chirurgie de remplacement de valve aortique

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011101782A (ja) * 2009-10-15 2011-05-26 Jms Co Ltd 心臓弁手術用補助具
WO2020211943A1 (fr) * 2019-04-18 2020-10-22 Clearstream Technologies Limited Dispositifs d'embolisation et leurs procédés de fabrication

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JPH10500587A (ja) * 1994-03-16 1998-01-20 ハートポート インコーポレイテッド 心臓外科処置を行なう装置
JP2002536115A (ja) * 1999-02-10 2002-10-29 ハートポート インコーポレイテッド 心臓弁を移植するための方法および装置
JP2003508107A (ja) * 1999-08-31 2003-03-04 マイクロ・セラピューティクス・インコーポレーテッド 液体塞栓組成物の注入制御装置
JP2003513751A (ja) * 1999-11-17 2003-04-15 セガン，ジャック 経皮ルートによって心臓弁を交換するためのデバイス
JP2005230427A (ja) * 2004-02-23 2005-09-02 Terumo Corp 生体内組織閉鎖装置

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JPH10500587A (ja) * 1994-03-16 1998-01-20 ハートポート インコーポレイテッド 心臓外科処置を行なう装置
JP2002536115A (ja) * 1999-02-10 2002-10-29 ハートポート インコーポレイテッド 心臓弁を移植するための方法および装置
JP2003508107A (ja) * 1999-08-31 2003-03-04 マイクロ・セラピューティクス・インコーポレーテッド 液体塞栓組成物の注入制御装置
JP2003513751A (ja) * 1999-11-17 2003-04-15 セガン，ジャック 経皮ルートによって心臓弁を交換するためのデバイス
JP2005230427A (ja) * 2004-02-23 2005-09-02 Terumo Corp 生体内組織閉鎖装置

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011101782A (ja) * 2009-10-15 2011-05-26 Jms Co Ltd 心臓弁手術用補助具
WO2020211943A1 (fr) * 2019-04-18 2020-10-22 Clearstream Technologies Limited Dispositifs d'embolisation et leurs procédés de fabrication
US11439402B2 (en) 2019-04-18 2022-09-13 Clearstream Technologies Limited Embolization devices and methods of manufacturing the same

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