DE10049813C1 - Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz - Google Patents
Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen HerzInfo
- Publication number
- DE10049813C1 DE10049813C1 DE2000149813 DE10049813A DE10049813C1 DE 10049813 C1 DE10049813 C1 DE 10049813C1 DE 2000149813 DE2000149813 DE 2000149813 DE 10049813 A DE10049813 A DE 10049813A DE 10049813 C1 DE10049813 C1 DE 10049813C1
- Authority
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- Germany
- Prior art keywords
- hollow catheter
- cutting tool
- opening
- cutting edge
- cutting
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22097—Valve removal in veins
Abstract
Beschrieben wird eine Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz mit einem Hohlkatheter, der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt, einer am distalen Ende des Hohlkatheters vorgesehenen Schervorrichtung, die eine fluiddicht mit dem Hohlkatheter verbundene Abschlußkappe vorsieht, die wenigstens eine Öffnung mit wenigstens einer, die Öffnung begrenzenden Schneidkante aufweist, mit einem innerhalb der Abschlußkappe linear- oder drehbeweglich gelagerten Schneidwerkzeug mit einer Schnittkante, die gegen die Schneidkante der Abschlußkappe bewegbar ist, sowie ein von dem Schneidwerkzeug umgebenes Volumen, das mit dem Hohlkatheter proximalwärts verbunden ist, und mit einem Raumbereich, der distalseits zum Schneidwerkzeug von diesem und der Abschlußkappe eingeschlossen ist, der mit Gas oder einer Flüssigkeit befüllt und/oder mit einem mechanischen Expansionsmittel versehen ist und als Antrieb zur Bewegung des Schneidwerkzeuges dient.
Description
Die Erfindung bezieht sich auf eine Vorrichtung zum lokalen Abtrag einer
Aortenklappe am menschlichen oder tierischen Herz.
Bei einer Vielzahl von Patienten kommt es vor, dass sich im Laufe der Zeit
irreversible Ablagerungen an der Herzklappe bilden, insbesondere an der
Aortenklappe, häufig in Form von Kalkablagerungen oder sonstigen
Materialdepositionen. Durch derartige Materialablagerungen an der Aortenklappe,
die in einem gesunden Zustand als ein feines flexibles Gewebesegel ausgebildet ist,
kommt es zu einer irreversiblen Versteifung der Aortenklappe, wodurch insbesondere
der Blutabfluss aus dem Herzen erheblich in Mitleidenschaft gezogen wird.
Blutunterversorgung im gesamten Körper ist die Folge, so dass in einem derart
fortgeschrittenen Stadium akuter Handlungsbedarf besteht, will man
schwerwiegende Folgen für den Patienten vermeiden. Bisher bekannte
medikamentöse Behandlungsmethoden zeigen jedoch nur begrenzten Erfolg, so
dass nach heutiger Kenntnis eine Verkalkung von Aortenklappen lediglich durch
einen schwerwiegenden chirurgischen Eingriff begegnet werden kann. Üblicherweise
wird in diesem Fall im Rahmen einer Sternotomie der Brustkorb eines Menschen
geöffnet um Zugang zum Herz und insbesondere zu den verkalkten Aortenklappen
zu erhalten, die mit bekannten Schneidewerkzeugen aus dem Körper extrahiert
werden. Beispielsweise eignen sich hierzu Extraktionswerkzeuge wie sie in den
amerikanischen Druckschriften US 6,033,419 sowie US 5,827,316 beschrieben sind.
Nach erfolgtem operativen Eingriff und Wiederverschluss des Brustkorbes steht dem
Patienten eine langwierige Heilungsdauer bevor, die in den meisten Fällen von einer
ebenso langwierigen Rehabilitationszeit gefolgt ist.
Aus der US 5,720,760 geht eine Resektionsvorrichtung hervor mit einem
kanülenartig ausgebildeten Schneidkopf mit zwei relativ beweglichen Schnittkanten,
doch ist diese Resektionsvorrichtung nicht zum Aortenabtrag geeignet zumal die
Ansteuerung wenigstens einer Schnittkante über eine geradlinig starre Verbindung
vom proximalen Ende der Kanülenanordnung aus erfolgt. Eine deratige Anordnung
kann aufgrund der Starrheit nicht durch das Gefäßsystem zur Aortenklappe geführt
werden.
Bislang sind keine Möglichkeiten bekannt, die Entfernung einer verkalkten
Aortenklappe unter Umgehung der vorstehend genannten Sternotomie
durchzuführen.
Der Erfindung liegt daher die Aufgabe zugrunde, eine Vorrichtung zum lokalen
Abtrag einer verkalkten Aortenklappe am menschlichen oder tierischen Herz derart
auszubilden, so dass ein chirurgischer Eingriff minimal invasiv durchgeführt werden
kann, ohne die vorstehend genannten Nachteile bei der Sternotomie in Kauf nehmen
zu müssen. Es gilt insbesondere eine Vorrichtung anzugeben, mit der es möglich ist,
eine verkalkte Aortenklappe sicher und schonend zu entfernen, ohne dabei die
Herztätigkeit während des minimal invasiven Eingriffes in Mitleidenschaft zu ziehen.
Die Lösung der der Erfindung zugrunde liegende Aufgabe ist im Anspruch 1
angegeben. den Lösungsgedanken vorteilhaft weiterbildende Merkmale sind
Gegenstand der Unteransprüche sowie der Beschreibung unter Bezugnahme auf die
Ausführungsbeispiele zu entnehmen.
Erfindungsgemäß ist eine Vorrichtung zum lokalen Abtrag einer Aortenklappe
vorzugsweise am menschlichen Körper derart ausgebildet, dass ein Hohlkatheter
vorgesehen ist, der zumindest im distalen Bereich flexibel ausgebildet ist und sich
durch intrakorporales Einbringen in den Aortenbogen dem natürlichen Verlauf des
Aortenbogens anpasst. Am distalen Ende des Hohlkatheters ist eine
Schervorrichtung vorgesehen, die eine fluiddicht mit dem Hohlkatheter verbundene
Abschlusskappe vorsieht, die wenigstens eine Öffnung mit wenigstens einer die
Öffnung begrenzenden Schneidkante aufweist. Schließlich ist innerhalb der
Abschlusskappe linear- oder drehbeweglich gelagert ein Schneidwerkzeug mit einer
Schnittkante vorgesehen, die gegen die Schneidkante der Abschlusskante bewegbar
ist. Schließlich ist ein von dem Schneidwerkzeug umgebendes Volumen vorgesehen,
das mit dem Hohlkatheter proximalwärts verbunden ist. Um das Schneidwerkzeug
innerhalb der Abschlusskappe auszulenken, schließen das Schneidwerkzeug und die
Abschlusskappe einem distalseitig angeordneten Raumbereich ein, in dem ein
Antriebsmodul vorgesehen ist, das aus einem Gas, einer Flüssigkeit befüllt und/oder
aus einem mechanischen Expansionsmittel besteht.
Mit dem erfindungsgemäß ausgebildeten Werkzeug ist es möglich, den Hohlkatheter
über einen Schnitt im Leistenbereich eines Patienten über entsprechende
intrakorporale Gefäßkanäle in die Aorta einzuführen und dem Aortaverlauf folgend
die Schervorrichtung an der verkalkten Aortenklappe zu positionieren. Hierzu ist der
Hohlkatheter insbesondere im distalen Bereich flexibel ausgebildet, so dass der
Hohlkatheter mit seinem distalen Ende ohne dabei den natürlichen Verlauf der Aorta
zu schädigen oder gar zu verformen unmittelbar im Bereich der verkalkten
Aortaklappe positioniert werden kann. Zu Zwecken der Navigation sowie
Positionierung des Katheters innerhalb des menschlichen oder tierischen Gefäßes ist
der Hohlkatheter mit geeigneten Seilzugvorrichtungen ausgestattet, die innerhalb des
Hohlkatheters über entsprechend vorgesehene Kanäle verlaufen. Die Seilzüge
können proximalseits entsprechend von einem geeignet geschulten Personal bedient
werden. Ferner dienen dillatierbare Volumen in Form von ballonartigen Gebilden, die
an der Außenwand des Hohlkatheters angebracht sind und über entsprechende
Zuleitungen dillatiert werden können, ebenso zu Zwecken der Navigation und
Positionierung, Zentrierung und Fixierung. So sind Hohlkatheterlängen von einem
Meter und mehr durchaus denkbar und üblich, doch bemisst sich die Länge
grundsätzlich nach der Körpergröße des zu behandelnde Patienten.
Die Positionierung und Navigation des distalen Endes des Hohlkatheters erfolgt
vorzugsweise unter Röntgenbeobachtung oder mit geeigneten ähnlichen
Beobachtungstechniken, so dass die Katheterspitze exakt im Bereich der verkalkten
Aortenklappe positioniert werden kann.
Die erfindungsgemäß ausgebildete Schervorrichtung soll anhand der nachstehenden
Figuren näher erläutert werden.
Die Erfindung wird nachstehend ohne Beschränkung des allgemeinen
Erfindungsgedankens anhand von Ausführungsbeispielen unter Bezugnahme auf die
Zeichnung exemplarisch beschrieben. Es zeigen:
Fig. 1 schematisierte, perspektivische Darstellung des Hohlkatheters,
Fig. 2 Querschnitt durch das distale Ende der Schervorrichtung sowie
Fig. 3 schematisierte Gesamtdarstellung der Vorrichtung.
In Fig. 1 ist eine schematisierte, perspektivische Darstellung des Hohlkatheters 1
dargestellt. Die Figur gestattet einen perspektivischen. Einblick in das Innere des
proximalseitigen Endes des Hohlkatheters 1, an dessen distalen Ende die
Schervorrichtung 2 vorgesehen ist. Um den Hohlkatheter 1 in das entsprechende
Aortengefäß einzuführen und das distale Ende mit der Schervorrichtung 2 gezielt an
den Ort der Aortenklappe zu navigieren, sind innerhalb des Hohlkatheters 1
Navigationsseilzüge 3 vorgesehen, die proximalseitig von einer Bedienperson
entsprechend betätigt werden. Zu Zwecken der genauen Positionierung des
Hohlkatheters innerhalb der Aorta sind im distalen Bereich des Hohlkatheters 1
zusätzliche, aufblasbare Ballone 4 vorgesehen, die die Schervorrichtung 2 inmitten
der Aorta zu zentrierten vermögen. Nicht dargestellt sind die Zuleitungen zum
Befüllen der Ballone, die vorzugsweise ebenso wie die Navigationsseilzüge 3
innerhalb des Hohlkatheters 1 verlaufen.
In der Querschnittsdarstellung gemäß Fig. 2 ist die Schervorrichtung 2 detaillierter
dargestellt. Die Schervorrichtung 2 weist eine Abschlusskappe 5 auf, die fluiddicht
mit dem Hohlkatheter 1 an ihrem proximalseitigen Ende verbunden ist (nicht in Fig.
2 dargestellt). Die Abschlusskappe 5 weist eine Öffnung 6 auf, deren proximal
Öffnungsseite eine Schneidkante 7 vorsieht. Im Inneren der
Abschlusskappe 5 ist ein längsbewegliches Schneidwerkzeug 8 vorgesehen (siehe
Doppelpfeil bezüglich seiner Längsbeweglichkeit), das ebenso wie die
Abschlusskappe 5 eine Öffnung 9 vorsieht. Die Öffnung 9 des Schneidwerkzeuges
8 entspricht in ihrer Geometrie und Größe der Öffnung 6 der Abschlussklappe 5.
Beide Öffnungen 9 und 6 weisen eine Öffnungsweite w von etwa 3-10 mm auf und
sehen eine Öffnungstiefe t in der gleichen Größenordnung vor.
Das Schneidwerkzeug 8 weist an seiner distalen Öffnungsseite eine
schart ausgebildete Schnittkante 10 auf, die gleichsam wie die Schneidkante 7 spitz
ausgebildet ist. Ferner umschließt das Schneidwerkzeug 8 ein inneres Volumen 11,
das lediglich über die Öffnungen 9 offen ausgebildet ist.
Das Schneidwerkzeug 8 ist innerhalb der Abschlusskappe 5 längsbeweglich koaxial
zur gedachten Längsachse des Hohlkatheters 1 angeordnet, so dass das
Schneidwerkzeug 8 wechselweise distal- und proximalseitig derart bewegbar ist, so
dass die Schnittkante 10 des Schneidwerkzeuges 8 unterhalb der Schneidkante 7
der Aschlusskappe 5 gelangen kann, wodurch das Volumen 11 vollständig
eingeschlossen ist.
Um das Schneidwerkzeug 8 innerhalb der Abschlusskappe 5 in der vorstehend
beschriebenen Weise auszulenken, schließen das Schneidwerkzeug 8 und die
Abschlusskappe 5 ein distalseitig angeordnetes Volumen (Raumbereich) 12 ein, in dem ein
Antriebsmodul vorgesehen sein kann. So ist es zum einen möglich, innerhalb des
Volumens 12 Gas einzubringen, das durch lokale Erhitzung expandiert und das
Schneidwerkzeug 8 proximalwärts bewegt. Der Energieeintrag kann beispielsweise
mit Hilfe eines Lasers erfolgen, dessen Licht auf die Außenwand der
Abschlusskappe 5 gerichtet ist und diese lokal erhitzt oder direkt in den Hohlraum 12
eingebracht werden. Laserlicht kann beispielsweise mit geeigneter Kathetertechnik
an die vorstehend beschriebene Stelle der Abschlusskappe geleitet werden. Andere
Formen der Energieeinbringung sind denkbar.
Ferner ist es möglich innerhalb des Volumens 12 Flüssigkeit einzubringen, die über
einen entsprechend, nicht dargestellten Zuleitungskanal durch den Hohlkatheter 1
extrakorporal zugeführt werden kann. Durch entsprechendes Anlegen einer
schwingenden Flüssigkeitssäule innerhalb des Zuleitungskanals, die in dem Volumen
12 mündet, kann das Schneidwerkzeug 8 gezielt innerhalb der Abschlusskappe 5
ausgelenkt werden.
Schließlich ist es denkbar, ein mechanisches Expansionsmittel, beispielsweise eine
Feder innerhalb des Volumens 12 einzubringen, die über entsprechende
Wirkmechanismen entspannt und komprimiert werden kann.
Befindet sich das Schneidwerkzeug 2 im Bereich einer verkalkten Aortaklappe, so ist
das Schneidwerkzeug derart relativ zur Aortaklappe zu positionieren, dass zumindest
Teile der Aortaklappe in das Innere der Öffnungen 6 und 9 hineinragen. In diesem
Fall wird wie vorstehend beschrieben, das Schneidwerkzeug 8 proximalwärts
getrieben, wodurch die Schnittkante 10 gegen die Schneidkante 7 getrieben wird und
das innerhalb des Volumens 11 hineinragende Teil der Aortaklappe gezielt
abgeschnitten werden kann. Der abgeschnittene Teil der Klappe gelangt nun über
das Volumen 11 in das Innere des Hohlkanals 1 und kann durch entsprechende
Absaugtechnik extrakorporal verbracht werden. Um zu vermeiden, dass Material aus
dem Volumen 11 aus der Schervorrichtung austritt, ist proximalseitig am
Schneidwerkzeug 8 ein Flatterventil 13 vorgesehen, das einen entsprechenden
Rückfluss unterbindet. Überdies dient das Flatterventil 13 auch als Anschlagfläche
zum distalseitigen Verschieben des Schneidwerkzeugs 8 bspw. mittels Impulswellen
oder einem Flüssigkeitsstrom, den man proximalseits zum Flatterventil anlegt
Mit Hilfe der in Fig. 2 dargestellten Schervorrichtung ist es möglich, die verkalkte
Aortaklappe stückweise abzuschneiden und die abgeschnittenen Teile extrakorporal
sicher zu verbringen.
Vorzugsweise ist das Schneidwerkzeug 8 aus leichtem Material gefertigt,
beispielsweise aus Keramik (lange scharfe Kante), um eine möglichst trägheitsfreie
Bewegung des Schneidwerkzeuges 8 zu gewährleisten.
In Fig. 3 ist der gesamte Hohlkatheter 1 mit der erfindungsgemäß ausgebildeten
Schervorrichtung 2 dargestellt. Proximalseitig zum Hohlkatheter 1 befinden sich
Manipulationsvorrichtungen M zum Betätigen des Hohlkatheters zu Zwecken seiner
Einführung in die Aorta. Zusätzlich sind ein Spülbehälter 14 sowie ein Auffanggefäß
15 vorgesehen, um einen gezielten Transport von abgetrennten Gewebematerial aus
dem Hohlkatheter 1 zu gewährleisten.
Der Hohlkatheter selbst ist vorzugsweise aus Kunststoffmaterial gefertigt, das über
hochflexible Eigenschaften verfügt, so dass sich ein leichtes Anschmiegen des
Hohlkatheters 1 beispielsweise an den Aortenbogen ergibt.
Die Schervorrichtung 2 ist vorzugsweise auswechselbar über einen Konektor 16 mit
dem distalen Ende des Hohlkatheters 1 verbindbar. Auf diese Weise ist es möglich,
bei Verschleiß der Schnitt- und Schneidkante die Schervorrichtung 2 vom
Hohlkatheter 1 zu trennen und entsprechend auszuwechseln.
1
Hohlkatheter
2
Schervorrichtung
3
Navigationsseilzüge
4
Ballon
5
Abschlusskappe
6
Öffnung
7
Schneidkante
8
Schneidwerkzeug
9
Öffnung
10
Schnittkante
11
Volumen
12
Volumen (Raumbereich)
13
Flatterventil
14
Behälter mit Spülflüssigkeit
15
Auffanggefäß
16
Konektor
Claims (11)
1. Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder
tierischen Herz mit
einem Hohlkatheter (1), der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt,
einer am distalen Ende des Hohlkatheters (1) vorgesehenen Schervorrichtung (2), die eine fluiddicht mit dem Hohlkatheter (1) verbundene Abschlußkappe (5) vorsieht, die wenigstens die Öffnung (6) mit wenigstens einer, die Öffnung (6) begrenzenden Schneidkante (7) aufweist,
mit einem innerhalb der Abschlußkappe (5) linear- oder drehbeweglich gelagerten Schneidwerkzeug (8) mit einer Schnittkante (10), die gegen die Schneidkante (7) der Abschlußkappe (5) bewegbar ist, sowie ein von dem Schneidwerkzeug (8) umgebendes Volumen (11), das mit dem Hohlkatheter (1) proximalwärts verbunden ist und
mit einem Raumbereich (12), der distalseits zum Schneidwerkzeug (8) von diesem und der Abschlußkappe (5) einschlossen ist, der mit Gas oder einer Flüssigkeit befüllt und/oder mit einem mechanischen Expansionsmittel versehen ist und als Antrieb zur Bewegung des Schneidwerkzeuges (8) dient.
einem Hohlkatheter (1), der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt,
einer am distalen Ende des Hohlkatheters (1) vorgesehenen Schervorrichtung (2), die eine fluiddicht mit dem Hohlkatheter (1) verbundene Abschlußkappe (5) vorsieht, die wenigstens die Öffnung (6) mit wenigstens einer, die Öffnung (6) begrenzenden Schneidkante (7) aufweist,
mit einem innerhalb der Abschlußkappe (5) linear- oder drehbeweglich gelagerten Schneidwerkzeug (8) mit einer Schnittkante (10), die gegen die Schneidkante (7) der Abschlußkappe (5) bewegbar ist, sowie ein von dem Schneidwerkzeug (8) umgebendes Volumen (11), das mit dem Hohlkatheter (1) proximalwärts verbunden ist und
mit einem Raumbereich (12), der distalseits zum Schneidwerkzeug (8) von diesem und der Abschlußkappe (5) einschlossen ist, der mit Gas oder einer Flüssigkeit befüllt und/oder mit einem mechanischen Expansionsmittel versehen ist und als Antrieb zur Bewegung des Schneidwerkzeuges (8) dient.
2. Vorrichtung nach Anspruch 1,
dadurch gekennzeichnet, dass der Hohlkatheter (1) eine Länge aufweist, die einer
Gefäßlänge zwischen der Leiste und dem Herzen eines Menschen entspricht.
3. Vorrichtung nach Anspruch 1 oder 2,
dadurch gekennzeichnet, das innerhalb des Hohlkatheters (1) und/oder an er
Außenwand des Hohlkatheters (1) Mittel zur Positionierung des Hohlkatheters (1) innerhalb
eines Gefäßes vorgesehen sind.
4. Vorrichtung nach Anspruch 3,
dadurch gekennzeichnet, dass die Mittel zur Navigation Seilzüge (3) oder dillatierbare
Volumina sind.
5. Vorrichtung nach einem der Ansprüche 1 bis 4,
dadurch gekennzeichnet, dass das Schneidwerkzeug (8) innerhalb der Abschlußkappe
wechselseitig distal- und proximalwärts zum Hohlkatheter (1) bewegbar ist.
6. Vorrichtung nach Anspruch 5,
dadurch gekennzeichnet, dass das Schneidwerkzeug (8) eine Schneidöffnung (9) vorsieht,
an deren distalseits orientierter Offnungsseite die Schnittkante (10) vorgesehen ist,
dass die Schneidkante (7) der Öffnung (6) in der Abschlußkappe (5) an ihrer proximalseits
orientierten Öffnungsseite angebracht ist, und
dass bei Bewegung des Schneidwerkzeuges (8) Schnittkante (10) und Schneidkante (7)
einander passieren.
7. Vorrichtung nach einem der Ansprüche 1 bis 6,
dadurch gekennzeichnet, dass das von dem Schneidwerkzeug (8) umgebende
Volumen (11) über eine Ventilanordnung mit dem Hohlkatheter (1) proximalwärts verbunden
ist.
8. Vorrichtung nach einem der Ansprüche 1 bis 7,
dadurch gekennzeichnet, dass die Öffnung (9) des Schneidwerkzeugs (8) sowie die
Öffnung (6) der Abschlußkappe (5) in etwa eine gleiche Öffnungsweite sowie -tiefe
aufweisen, d. h. einen gleichen Öffnungsabstand in Richtung einer gedachten
Hohlkatheterlängsachse sowie eine gleiche Öffnungstiefe in Richtung senkrecht zur
gedachten Hohlkatheterlängsachse.
9. Vorrichtung nach Anspruch 8,
dadurch gekennzeichnet, dass die Öffnungsweite sowie -tiefe im Bereich zwischen
3 bis 10 mm liegen.
10. Vorrichtung nach einem der Ansprüche 1 bis 9,
dadurch gekennzeichnet, dass das Gas mittels Energieeintrag expandiert, die
Flüssigkeit mittels einer schwingenden Flüssigkeitssäule auslenkbar ist und das
mechanische Expansionsmittel mechanisch auslenkbar ist.
11. Vorrichtung nach einem der Ansprüche 1 bis 10,
dadurch gekennzeichnet, dass das Schneidwerkzeugs (8) aus Keramik, aus einer
leichten Metallegierung oder aus Titan gefertigt ist.
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DE2000149813 DE10049813C1 (de) | 2000-10-09 | 2000-10-09 | Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz |
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DE2000149813 DE10049813C1 (de) | 2000-10-09 | 2000-10-09 | Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz |
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