WO2018077372A1

WO2018077372A1 - Heart implant

Info

Publication number: WO2018077372A1
Application number: PCT/EP2016/001796
Authority: WO
Inventors: Mario HEINTZE; Youssef Biadillah
Original assignee: Coramaze Technologies Gmbh
Priority date: 2016-10-28
Filing date: 2016-10-28
Publication date: 2018-05-03

Abstract

The invention relates to a heart implant comprising an expandable closure element (1), particularly configured to close or at least reduce a remaining gap between the closed leaflets of a heart valve, preferably the mitral valve, the closure element (1 ) having an axial extension between a lower end (1 b) and an upper end (1a), at least one anchoring element (2), particularly expandable anchoring element (2), preferably for fixing the heart implant to a lumen of the heart, being attached to the closure element (1 ) at the lower (1 b) and/or upper end (1a), preferably only at one of these ends, wherein the closure element (1) comprises adjustment means (6a, 6b) for variable adjusting the radial cross section of the closure element (1) by changing the distance between the lower end (1b) and the upper end (1a) of the closure element (1).

Description

Heart implant

Technical Field

The invention relates to a heart implant, particularly a heart implant being configured to reduce or eliminate a heart valve insufficiency after implantation into the heart.

Background of the invention

Typically, such implants are positioned in such a way that a closure element of the implant is situated in the valve annulus and closes a remaining gap of the closed valve leaflets. For that purpose, the closure element is connected to at least one anchoring element, for example an anchoring cage, being configured to fix the closure element within the heart in the desired position i.e. in the valve annulus preferably to be contacted by the closing valve leaflets.

In a possible embodiment disclosed in applicants own prior patent filings the closure element may be formed by an inflatable sheath / membrane that is positioned, preferably coaxially positioned around an attachment element, preferably a tubular attachment element and fixed to this attachment element at the respective ends of the sheath / membrane to get a fluid tight space around the attachment element. Such a fluid tight sheath may be inflated with a fluid. The areas of attaching the sheath to the attachment element also define the upper and lower end of the closure element. In another embodiment disclosed in applicants own prior patent filings the closure element may be also formed of a sheath/membrane being supported by an expanded part of an attachment element, preferably tubular attachment element. The expanded part may formed a scaffold structure, preferably a meshed scaffold structure that supports des sheath from the inside. By expanding the attachment element / scaffold structure also the sheath expands in cross section and contacts the underlying scaffold structure formed by the expanded attachment element. The sheath also here prevents blood from passing through the valve in a closed leaflet state and may be also fluid tight. But in this case the sheath is not necessarily fluid tight from the beginning of implantation. The sheath may have pores for allowing blood to enter the inner space of the closure element but may not allow clotted blood to escape from the inner space of the closure element. The blood may get clotted more and more by time and may close the sheath and thus formed closure element accordingly.

The implant of the invention relates to any kind of closure element and preferably to the afore-mentioned ones.

It is known in the state of the art to use an anchoring element punctured into the myocardium of the ventricle for fixation of the closure element. Besides this invasive way modern implants provide a less invasive fixation just by contacting the interior wall of the atrium and/or ventricle with the outer surface areas of an anchoring element formed of an expanded cage that is connected to the closure element. Such cage typically is in a collapsed state for feeding the entire implant through a catheter into the heart where it is expanded after release from the catheter for fixation purposes. The invention relates to such implants having an expandable, preferably mesh-like cage formed of strips for anchoring purposes. A cage may also be formed without meshes, particularly just by several side-by-side- lying strips having no interconnection. The invention in general also relates to non- meshed cages and any other suitable anchoring element(s) attached to the closure element for fixation purposes. It is furthermore disclosed in applicants own prior patent filings that the attachment element, preferably tubular attachment element has a lower end and an upper end and is split into several strips at least at the upper end, the strips forming an expandable cage as mentioned, particularly for fixing the heart implant to the atrium of the heart by surface contact between an exterior surface of the

expandable cage (the several strips) and an interior atrium surface.

The mentioned positions "lower" and "upper" or directions mentioned in this disclosure are to be understood in the intended position of the implant if it is correctly implanted in the heart. In the heart the atrium is positioned above the ventricle and accordingly the lower end of the closure element faces the ventricle, particularly is positioned in the ventricle and the upper end faces the atrium, particularly is positioned in the atrium if correctly implanted. A middle part of the closure element between the upper and lower end is passing through the valve annulus of the valve that is to be treated, preferably the mitral or tricuspid valve.

The attachment element, particularly the tubular attachment element preferably the so formed scaffold structure and the strips of an anchoring cage may originate from one single tube by cutting the tubular wall several times, preferably in an axial direction the mentioned strips all start their extension from an annular upper end area of the attachment element / scaffold structure and preferably are equally spaced along the circumference of this end. Such a cage may also be formed of strips starting their extension at the lower end of the attachment element.

An anchoring cage is preferably formed by splitting and merging strips thus forming a half mesh between the points of splitting and merging. This embodiment is also preferred for the invention described in this disclosure.

A cage having several meshes is formed that way for solely fixing the heart implant to the atrium and/or ventricle of the heart by surface contact between the exterior cage surface and the interior surface of the respective heart lumen (atrium or ventricle). Preferably the invention relates to an implant having a cage only on the atrial side of the closure element. A cage being formed of several expanded strips originating from a cut tube by radial expansion provides the advantage that the strips may generate a radial force being essentially perpendicular to the axis of extension of the (tubular) attachment element to keep the anchoring cage in place after implantation and expansion. The anchoring cage is sufficiently compliant in radial direction in order to adapt its shape to the atrium.

The afore-mentioned different types of closure element and in general any closure element are typically designed in a predetermined shape, particular in a

predetermined radial cross section. Since the gap in the native heart depend on the degree of degradation it is often not possible to sufficiently treat the valve with a single kind of shaped closure element.

Accordingly, it is an object of the invention to provide an implant having the capability to treat different gap sizes between the closed native valve leaflets.

Even though the application of the implant and method is preferred in regard to humans the implant and method of treatment may be also applied to animals, particularly mammalian animals.

Summary of the invention

The object is solved by a heart implant comprising an expandable closure element, particularly configured to close or at least reduce a remaining gap between the closed leaflets of a heart valve, preferably the mitral or tricuspid valve, the closure element having an axial extension between a lower end and an upper end, at least one anchoring element, particularly expandable anchoring cage, preferably for fixing the heart implant to a lumen of the heart, being attached to the closure element at the lower and/or upper end, preferably only at one of these ends, wherein the closure element comprises adjustment means for variable adjusting the radial cross section of the closure element by changing the distance between the lower end and the upper end of the closure element. The closure element and the anchoring element may be realized in general as mentioned before in the introductory part.

The invention makes use of the fact, that any material or construction if changed in length in the direction of a linear axis will simultaneously and of itself change the width of its cross section in a direction perpendicular, i.e. radial to the regarded axis. The ratio in change of length and cross sectional width is defined by the Poisson factor of the regarded material or construction. In typical, i.e. non-auxetic material / construction the width of the radial cross section gets bigger if the axial length is shortened. In auxetic materials / constructions this behavior is inverted.

Accordingly, if the distance between the lower and upper end of the closure element, particular of the scaffold structure, preferably meshed scaffold structure is changed this will automatically lead to a change in the radial cross section of the closure element. Typically, in a non-auxetic mesh construction of a scaffold, for example if rhombic or honeycomb mesh shapes are used, the distance between the two ends of the closure element need to be reduced in order to enlarge the radial cross section perpendicular to the direction or reduction. In closure elements having a circular cross section typically the diameter of the closure element gets changed if the distance of the ends is changed.

Even though closure elements having a meshed scaffold structure, to which a sheath is attached are preferred for this invention the invention also applies to closure elements having an inflatable sheath surrounding a central attachment element. If such a sheath is elastic it may also be broadened in radial cross section, particularly if it is partially or fully filled with a fluid. Of course such an elastic sheath may be enlarged in cross section simply by increasing the internal pressure but such kind of operation is not advisable. If the length is reduced the sheath will be less stretched if a broadening in cross section is needed.

Accordingly, the invention provides to get the desired broadening with less internal pressure of the fluid compared to a closure element making no use of the invention. According to a preferred embodiment of the invention the adjustment means are positioned in the internal volume of the closure element, particularly the expanded closure element. Consequently, any such means are enhoused by the closure element and may not harm the leaflets since any contact is prevented.

Preferably the adjustment means is connectable or releasable connected to an operating means for operating the adjustment means. The operating means may have a length configured to be fed from the proximal end of a catheter through the entire length of the catheter to the distal end of the catheter. The proximal end of the catheter is understood to be the end lying outside of a treated patient and the distal one is the end in the heart. This embodiment ensures that a surgeon may cause the desired change in cross section of the closure element by operating the operating means from outside the patient. Any change in cross section may be observed in live X-ray images. For that purpose the closure element may comprise x-ray marker.

Preferably the adjustment means is operable by pulling and/or turning the operating means. The operating may be formed of a pull wire, for example made of metal or of a torque transmitting bendable shaft in order to achieve this.

A surgeon may manually operate the operation means but it is also possible that at the proximal end of the catheter the operating means is connectable / connected to a controller that actively controls the amount of change in cross section of the closure element, particularly by measuring the force, preferably pulling force applied to the operating means or the number of revolutions performed with the operating means. Such controller may comprise at least one actor to pull / push or turn the operating means.

An operation means may comprise one or several elements to be operated that are fed through the catheter. Typically the number of such elements corresponds to the number of elements in the adjustments means that are intended to cause the length change. It is also possible to provide a single operation element, for example a single pull wire or torque transmitting shaft, the generated force or torque of it being split in the implant for example by means of a gear mechanism in order to operate several adjustment elements of the adjustment means

simultaneously.

In a preferred embodiment operating means (one or more operating elements of it) is disconnectable from the adjustment means and retractable out of the inner volume of the closure element through an opening of the closure element, particularly the opening being self-closing or remaining open to allow blood to enter the inner volume.

A self-closing may be achieved for example by using an elastic material, for example silicone, that is punctured by the operation means. The operation means may enter the inner volume of the closure element on or near the middle axis of the closure element, particularly meaning the axis along the change in length is done. In a case in which the closure element comprises a central tubular element that is surrounded by a sheath the operation means may enter the inner volume through a central opening in the tubular attachment element.

If an opening remains after retracting the operation means this opening and maybe also others may be used to have blood entering the inner volume of the closure element that gets clotted by time and seals the closure element,

particularly its sheath by time.

In a preferred embodiment the adjustment means comprises at least one pair, preferably at least two or more pairs of associated first and second adjustment elements, one of these adjustment element being attached near or to the lower end of the closure element and the other being attached near or to the upper end of the closure element.

There is no need to have the adjustment element attached exactly to the

respective ends of the closure element. In fact this may be counter-productive if several such elements are used in a closure element. Typically a closure element comprises a tapered section near the lower and near the upper end. The middle section that serves to coapt with the leaflets is positioned in between these sections. It is sufficient for the invention if the elements are attached to the upper and lower end of the middle section, which is understood to be near to the end of the closure element. Accordingly reducing the axial length of the middle section reduces the distance between the lower and upper ends. The compression of the middle section automatically broadens the cross section of this middle section in radial direction.

The invention now makes use of the fact that a change in the relative position of the two adjustment elements of each pair is performed by the operating means an this changes the axial distance between the ends of the closure elements since these adjustments elements are connected to axially spaced fixation points of the closure element.

If the closure element comprises several pairs of adjustment elements it is preferred that these several pairs are equally spaced in circumferential direction along the inner periphery of the closure element, particularly the expanded closure element / scaffold structure.

In a furthermore preferred embodiment the two respective adjustment elements of a pair are disengaged and axially separated in a first position, particularly a compressed position of the closure element and engaged to each other in a second position, particularly an at least partially expanded position of the closure element.

According to the invention at least one of the adjustment elements, particularly the upper one may be pullable by the operating means from the first to the second position, particularly the operating means being fed through the lower adjustment element and connected to the upper adjustment element.

It is also possible the second position is automatically achieved to the effect of self-expansion of the closure element, particularly its scaffold structure. This may bring the two elements of such a pair at least in close proximity or directly in contact or engagement, since the self-expansion will also reduce the distance between the ends of the closure element.

After engaging the two element of such a pair the operating means may be used by the surgeon to enlarge the cross section of the closure element starting from the point of first engagement. If a selected cross section if found to be not correct it may be amended towards even bigger or again towards smaller a cross section.

Each pair of adjustment elements may form a one-way ratchet mechanism, preferably a releasable one-way ratchet mechanism, particularly having several, preferably equally spaced stop positions. The cross section may be amended in several steps using such a mechanism. The ratchet may be releasable by using a releasing element at one of the two elements particularly the one that is entered by the other. For example the entrance area may be enlarged or a stop member may be retracted using the releasing element in order to move the other adjustment element opposite to the one-way direction.

In another embodiment the two elements may form a nut-screw connection, one of the adjustment elements being a nut and the other a rotatable screw, particularly the screw being driven by the operating means. The invention may provide that the rotatable screw is rotatably attached to or near the end of the closure element, preferably the upper end. For example, the screw may be attached to a bearing.

The two adjustment elements may also form a telescopic construction in which one of the elements is guided in the other. The two elements may be formed of tubes that fit together. Also here a ratchet mechanism may be realized between the two elements for example being effective between the two opposite lateral areas of the tubes. One of the two tubes may have a releasing element for releasing the ratchet.

As mentioned before the closure element may comprise a central, preferably tubular attachment element to which an inflatable sheath is attached, the

attachment element comprising the adjustment means, particularly a single pair of two engaged / engagable adjustment elements and being adjustable in length between the fixation points of the inflatable sheath. Here the two adjustment elements may be telescopic and may form together the central attachment element.

The closure element ^'may also comprise an expandable / expanded scaffold structure, preferably a meshed scaffold structure being covered by a sheath / membrane, the at least one pair of adjustment elements being connected to the scaffold structure, particularly near or at its lower and upper ends.

Also in this construction the adjustment means may just comprise one single pair of adjustment elements, preferably positioned on the middle axis of the closure element. The two adjustment elements may be connected to or near the

respective ends of the closure elements in such a way that the force exerted by the two elements is evenly distributed to the circumference of the closure element. This may be performed by attaching the elements to several points at or near the ends that have an annular configuration around the longitudinal axis of the closure element.

Using the disclosed implant a method of treating heart valve insufficiency of a diseased heart valve may be provided according to which the implant is pushed in a collapsed state through a catheter to an implantation site in the heart, the implant is released from the catheter into the heart, the closure element is positioned in the valve annulus, particularly of the mitral or tricuspid valve and at least one anchoring element is positioned, particularly fixed in the heart, preferably in the atrium. Now the closure element is expanded and adjusted in its radial cross section by changing the axial distance between the lower and upper end of the closure element using an operating means connected to an adjustment means in the closure element and operated at the proximal end of the catheter. Blood regurgitation is reduced by the expanded and adjusted closure element due to the better fit of the cross section of the closure element and the gap between the closed valve leaflets. Afterwards the operating means may be retracted through the catheter and the catheter is retracted as a last step. Description of the drawings

Figure 1 : shows an implant of the invention having an expanded anchoring cage and a closure element being partially expanded. The closure element comprises a first embodiment

Figure 1A: shows the working principle

Figure 2: shows the same implant in a expanded state of the closure element

Figure 2A: shows different stages in broadening a closure element

Figure 3: shows an implant having expanded anchoring cage and closure element and a second embodiment of the invention

Figure 4: shows an implant having expanded anchoring cage and closure element and a third embodiment of the invention

Detailed description of the drawings

All figures show an implant having a closure element 1 and an anchoring element 2. The anchoring element 2 is formed of an expandable cage that is shown in expanded configuration. The cage is positioned above the closure element 1 and intended to fix the entire implant in the atrium of the heart. The closure element 1 is intended to be positioned in the valve annulus of the mitral valve.

The cage comprises several strips that emerge from the upper end 1 a of the closure element 1 upwards, are bent by 180 degree and extend back towards the closure element 1. The strips comprise split strip regions 2ss and merged strip regions 2ms. At least in the top area the cage 2 comprises a mesh construction. The cage is resilient in radial direction, i.e. perpendicular to the central axis A and may adapt to the shape of the atrium. Fixation is just done by a form fit or force fit between atrial wall and cage 2. In general, the cage is also resilient in axial direction of axis A due to the fact that the lower strip ends 2a of the cage are free and the strips 2ms, 2ss between the lower end and upper end of the cage 2 are curved. So the lower free strip ends 2a may be moved upwards and the entire cage compressed in axial direction.

An upper part 3a of an attachment element is surrounded by the cage 2, the lower part 3b of the attachment element forms part of the closure element 1.

In the figures the closure elements comprise a mechanism to adjust the radial cross section. The operating means for operating the adjustment means are fed into the inner space of the closure element through an opening 1c in the lower end 1 b of the closure element 1 and may be retracted out of the closure element.

The description so far is valid for all figures.

In figures 1 ,2 and 3 the lower part 3b of the attachment element forms an expandable scaffold 3b having meshes, the meshes 5 being not shown in figure 1 but indicated in figures 2 and 3.

In figures 1 , 2, 3 the scaffold 3b is surrounded by a sheath 4. The scaffold 3b and the sheath 4 form the closure element 1 and the sheath 4 and the not shown leaflets may coapt. The sheath 4 may be formed of a foil or preferably of a textile, particularly a polymer textile. In these figures 1 , 2, 3 a slight distance is shown between sheath 4 and scaffold 3b. This is just for better visibility of the two parts. In the real implant the sheath 4 will directly contact the scaffold 3b and will be supported by it.

In figure 1 the scaffold 3b is partially expanded. The closure element 1 comprises several pairs of adjustment elements 6a, 6b, only one pair is shown in solid lines, the other just indicated by dashed lines. Again this is for better visibility. The several pairs 6a, 6b may be equally spaced along the inner circumference of the scaffold 3b. A respective pair of adjustment elements 6a, 6b forms a ratchet. In this

configuration the two elements 6a, 6b are not yet engaged, because only in the non-engaged state the closure element 1 it totally collapsible. By self-expanding the scaffold 3b and/or by pulling the operating wire 7 in the direction of arrow 8 the upper adjustment element 6a is drawn into the lower adjustment element 6b and both are engaged. The closure element 1 will further expand to reach this situation.

Figure 2 shows the expanded state of the closure element 1. The elements 6a, 6b are engaged and by pulling the wire 7 even more the lower adjustment element 6b may lock the upper adjustment element 6a in a second position, the first being shown here. The possible stop positions are defined by the radial projections 6c of the element 6a.

Pulling the wire 7 will move the upper end 1a of the closure element 1 towards the lower end 1 b, decreasing their distance. The radial cross section of the scaffold 3b, particularly its diameter, and thus also of the entire closure element 1 will increase simultaneously .

The principle of broadening the width W of the radial cross section of a meshed construction by reducing the axial length L is depicted in figure 1A. In this figure the adjustment elements 6a, 6b are illustrated as screw and nut, not yet engaged.

If the radial cross section or diameter of the closure element 1 is to be reduced a release wire 9 that is connected to the lower adjustment element 6b may be pulled thus opening the lower adjustment element 6b by retracting its stop element.

The operating wire 7 and the release wire 9 may be fed through a lower opening in the closure element situate on the central axis A. This opening may be self closing if the wires 7 / 9 have been retracted. Disconnecting the wires from the two adjustment element may be performed by exerting a pulling force beyond a threshold force or any other suitable means. In addition, figure 2A illustrates in more detail the broadening by just showing the closure element 1 and no other details of the implant. In this cross sectional view two pairs of adjustment elements 6a, 6b are depicted on opposite side of the inner periphery of the scaffold structure 3b. Furthermore, it is schematically shown that the closure element 1 - of which the sheath is not shown here - is positioned in the valve annulus 12. In the upper left depiction a significant gap 13 exist between the closed leaflet 14 and the closure element 1. The lower adjustment elements 6b are not yet engaged to the upper one 6a and the closure element 1 is still close to the compressed state.

According to the upper right depiction of Figure 2A the two elements 6a, 6b are engaged by drawing the pulling wire 7 or by self-expansion of the scaffold. The closure element is expanded to a first diameter D being still too small to close the gap 13.

As can be seen in the lower depiction of figure 2A the diameter D gets increased by furthermore pulling the wire 7 so that the ratchet realized by elements 6a and 6b is in the second stop position. Now the gap is closed and the leaflets 14 coapt the closure element 1.

Figure 3 shows an embodiment having just a different kind of adjustment means. The adjustment means is formed of a nut-screw-connection, the upper adjustment element 6a forming a screw and the lower one 6b forming a nut. The screw 6a is rotatably connected near or at the upper end 1a of the scaffold / closure element. The nut 6b is connected near or at the lower end 1 b.

A torque transmitting operating shaft 7 is attached to the lower end of the screw thus allowing the screw to be turned. By turning the screw the relative position of screw 6a and nut 6b is changed and thus also the distance between the ends 1a und 1 b of the closure element 1 or scaffold 3b. Accordingly the radial cross section may be amended in the same way by just a different mechanism. This figure 3 just shows the engaged position of the screw and nut. Also here a disengaged position exists if the closure element 1 is in the compressed state. As already mentioned in the general description it is not essential to the invention that the two adjustment elements 6a and 6b are exactly attached to the ends 1a and 1 b of the scaffold / closure element. It is sufficient that they are attached near to these ends. It is just essential to the invention that the attachment positions of the two elements 6a and 6b bridge an axial length of the scaffold / closure element that may be compressed, preferably this axial length comprising at least one mesh, more preferred at least two or even more preferred more than two meshes.

Figure 3 also shows that the operating means, a torque transmitting shaft 7 is fed through the catheter 10 and may be operated by a controller 11. Such a controller may comprise an actor to turn the shaft 7 and it may also count the number of revolution to provide a measure for the diameter / radial cross section of the closure element 1.

Figure 4 shows a different kind of closure element 1 connected to the same kind of anchoring cage 2.

The lower part 3b of the attachment element comprises two adjustment element 6a and 6b, these elements being telescopic i.e. one element surrounds the other and both elements may be moved relative. Here the lower one surrounds the upper one.

A ratchet mechanism is also realized in this construction, but in this construction no disengaged position exists. A fluid tight sheath or membrane 4 is attached to the lower part 3b of the attachment element and forms the surface of the closure element 1 to which the leaflets will coapt.

A pulling wire 7 form an operation means attached to the upper element 6a, that runs through the catheter (not shown) and may be pulled by a surgeon to effect a telescopic movement between the two elements 6a, 6b. The axial length of the inflated sheath 4 may be reduced and the radial cross section enlarged due to the constant volume in the interior space of the sheath 4.

Claims

1. Heart implant comprising a. An expandable closure element (1 ), particularly configured to close or at least reduce a remaining gap between the closed leaflets of a heart valve, preferably the mitral valve, the closure element (1 ) having an axial extension between a lower end (1 b) and an upper end (1a),

b. at least one anchoring element (2), particularly expandable anchoring

element (2), preferably for fixing the heart implant to a lumen of the heart, being attached to the closure element (1 ) at the lower (1 b) and/or upper end (1a), preferably only at one of these ends,

wherein c. the closure element (1 ) comprises adjustment means (6a, 6b) for variable adjusting the radial cross section of the closure element (1 ) by changing the distance between the lower end (1 b) and the upper end (1a) of the closure element (1 ).

2. Heart implant according to claim 1 , wherein the adjustment means (6a, 6b) are positioned in the internal volume of the closure element (1 ), particularly the expanded closure element (1 ).

3. Heart implant according to claim 1 or 2, wherein the adjustment means (6a, 6b) is connectable or releasable connected to an operating means (7) for operating the adjustment means (6a, 6b), the operating means (7) having a length configured to be fed from the proximal end of a catheter (10) through the entire length of the catheter (10) to the distal end of the catheter (10).

4. Heart implant according to anyone of the preceding claims, wherein the

adjustment means (6a, 6b) is operable by pulling and/or turning the operating means (7).

5. Heart implant according

proximal end of the cat!

connected to a controller (11 ) controlling the amount of change in cross section of the closure element (1 ), particularly by measuring the force, preferably pulling force applied to the operating means or the number of revolutions performed with the operating means (7).

6. Heart implant according to anyone of the preceding claims, wherein the operating means (7) is disconnectable from the adjustment means (6a, 6b) and retractable out of the inner volume of the closure element (1 ) through an opening (1 c) of the closure element (1 ), particularly the opening (1c) being self-closing or remaining open to allow blood to enter the inner volume.

7. Heart implant according to anyone of the preceding claims, wherein the operating means (7) is realized by a. a force transmitting wire, particularly a pull wire b. a torque transmitting bendable shaft

8. Heart implant according to anyone of the preceding claims, wherein the

adjustment means (6a,^" 6b) comprises at least one pair, preferably at least two or more pairs of associated first and second adjustment elements (6a, 6b), one of these adjustment elements (6b) being attached near or to the lower end (1a) of the closure element (1 ) and the other (6a) being attached near or to the upper end (1a) of the closure element (1 ), particularly the relative position of the two adjustment elements (6a, 6b of each pair being adjustable by the operating means (7).

9. Heart implant according to claim 8, wherein several pairs of adjustment elements (6a, 6b) are equally spaced along the inner periphery of the closure element (1 ), particularly the expanded closure element (1 ).

10. Heart implant according to claim 8 or 9, wherein the two respective adjustment elements (6a, 6b) of a pair are disengaged and axially separated in a first position, particularly a compressed position of the closure element (1 ) and engaged to each other in a second position, particularly an at least partially expanded position of th

elements (6a), particula

(7) from the first to the second position, particularly the operating means (7) being fed through the lower adjustment element (6b) and connected to the upper adjustment element (6a).

11. Heart implant according to claim 8 or 9 or 10, wherein each pair of adjustment elements (6a, 6b) forms a a. releasable one-way ratchet mechanism, particularly having several,

preferably equally spaced stop positions b. a nut-screw connection, one of the adjustment elements being a nut (6b) and the other a rotatable screw (6a), particularly the screw (6a) being driven by the operating means (7). c. a telescopic mechanismen, particularly of one tubular adjustment element (6a) being axially movable in the other tubular adjustment element (6b).

12. Heart implant according to anyone of the preceding claims, wherein the closure element (1 ) comprises a central, preferably tubular attachment element (6a, 6b) to which an inflatable sheath (4) is attached, the attachment element (6a, 6b) comprising the adjustment means (6a, 6b), particularly a single pair of two engaged / engagable adjustment elements (6a, 6b) and being adjustable in length between the fixation points of the inflatable sheath (4) .

13. Heart implant according to anyone of the preceding claims 8 to 11 , wherein the closure element (1 ) comprises an expandable / expanded scaffold structure (3b) , preferably a meshed scaffold structure (3b) being covered by a sheath / membrane (4), the pairs of adjustment elements (6a, 6b) being connected to the scaffold structure (3b), particularly near or at its lower and upper ends (1 a, 1 b).

14. Method of treating heart valve insufficiency of a diseased heart valve having a remaining gap (13) between closed valve leaflets (14), comprising implanting an implant according to anyone of the preceding claims wherein a. the implant is pushed in a collapsed state through a catheter (10) to an implantation site in the heart, b. the implant is rel

element (1 ) posil

and at least one anchoring element (2) positioned, particularly fixed in the heart, preferably the atrium, c. the closure element (1 ) is expanded and adjusted in its radial cross section by changing the axial distance between the lower and upper end (1a, 1 b) of the closure element (1 ) using an operating means (7) connected to an adjustment means (6a, 6b) in the closure element (1 ) and operated at the proximal end of the catheter (10), d. reducing blood regurgitation by the expanded and adjusted closure

element (1 ) and thus preventing or at least reducing the remaining gap (13) between the closed valve leaflets (14), e. retracting the operation means (7) through the catheter (10) and retracting the catheter (10).