JP2008528239A - 組織の可視化および操作システム - Google Patents
組織の可視化および操作システム Download PDFInfo
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Abstract
Description
本発明は、一般に体内の組織部位の可視化および/または操作に使用される医療器具に関する。特に本発明は、体内腔の組織部位、例えば心臓弁の周辺あるいは隣接組織といった、血液などの不透明な体液に囲まれているため一般に撮像が困難な組織を可視化および/または操作する器具および方法、または経中隔手順のために心房中隔組織を可視化および/または操作するための器具および方法に関する。
体内腔の内部領域を可視化する従来型の装置が知られている。例えば、インビボで体内から画像を生成するために超音波装置が使用されている。一般に超音波に由来する画像を強化する造影剤を用いる場合もそうでない場合も超音波が使用されている。
心臓などの体内腔での処置に使用される組織撮像および操作器具について以下に記載する。ここで周囲組織の可視化は、内腔に含まれる血液などの媒体によって、不可能ではないが困難となる。一般に、そのような組織撮像および操作器具は、展開カテーテルおよび撮像フードを通して撮像する組織に押し付けて、または隣接して配置する、任意の送達カテーテルまたはシースを備える。
下記の組織撮像および操作装置は、心臓のように動的に流れる血液で満たされた体内腔における組織部位のリアルタイム画像をインビボで提供でき、また撮像された組織部位に対して様々な手順を行うための血管内ツールおよび器具を提供することもできる。そのような装置は、例えば、左心房への経中隔アクセスの促進、冠状静脈洞へのカニューレ挿入、弁逆流/狭窄の診断、弁形成術、心耳閉合、不整脈病巣アブレーションなど多くの手順に利用できる。
Claims (55)
- 組織撮像および操作システムであって、
展開カテーテルであって、前記展開カテーテルを通して少なくとも1つの管腔を画定する、展開カテーテルと、
前記展開カテーテルから遠位に突き出し、内部に空きスペースを画定するフードであって、前記空きスペースは前記少なくとも1つの管腔と流体連通するフードと、
前記フード内または前記フードに沿って配置され、前記空きスペースに隣接する組織を可視化する可視化要素と、を備えるシステム。 - 送達カテーテルをさらに含み、前記送達カテーテルを通して前記展開カテーテルを送達できる、請求項1に記載のシステム。
- 前記展開カテーテルが操作可能である、請求項1に記載のシステム。
- 少なくとも1つのプッシュプルワイヤによって前記展開カテーテルが操作される、請求項3に記載のシステム。
- コンピュータ制御によって前記展開カテーテルが操作される、請求項3に記載のシステム。
- 前記フードが弾性材料を備える、請求項1に記載のシステム。
- 前記フードが、組織表面に押し付けて配置するための接触端を画定する、請求項1に記載のシステム。
- 前記フードが、コンパクトな送達形態から拡張した展開形態へ変化するように構成される、請求項1に記載のシステム。
- 前記フードが、前記拡張した展開形態へ自己拡張するよう構成される、請求項8に記載のシステム。
- 前記フードが超弾性または形状記憶合金の骨組を備える、請求項8に記載のシステム。
- 前記フードがひだのある表面を画定する、請求項1に記載のシステム。
- 前記フードが円錐形である、請求項1に記載のシステム。
- 前記空きスペースの体積を削減するため、前記フード内に弾性材料をさらに含む、請求項1に記載のシステム。
- 前記フードを前記カテーテルから選択的に展開して、前記空きスペースを選択的に変えられる、請求項1に記載のシステム。
- 前記フードが非膨張膜を備える、請求項1に記載のシステム。
- 前記フードがらせん状に広がる骨組を備える、請求項1に記載のシステム。
- 前記フードが少なくとも1つの支持部材を備える、請求項1に記載のシステム。
- 前記少なくとも1つの支持部材が、対応するプルワイヤを介して制御可能である、請求項17に記載のシステム。
- 前記フードが、間に膜が配置された複数の放射状に旋回する部材を備える、請求項1に記載のシステム。
- 前記フードが、それぞれ隣接する部材と重なるように構成された複数の放射状に広がる部材を備える、請求項1に記載のシステム。
- 前記可視化要素が、少なくとも1つの光ファイバー、CCD撮像装置、またはCMOS撮像装置を含む、請求項1に記載のシステム。
- 前記可視化要素が、前記展開カテーテルの遠位端内に配置される、請求項1に記載のシステム。
- 前記可視化要素が、前記展開カテーテルの長手方向軸に対して軸外に関節運動可能である、請求項1に記載のシステム。
- 前記フードに流体を注入するポンプをさらに含む、請求項1に記載のシステム。
- 前記ポンプが電子制御装置を介して制御されるよう構成されている、請求項24に記載のシステム。
- 取得したデータを無線送信するためのアンテナをさらに含む、請求項1に記載のシステム。
- 前記フード内に配置され、不透明な流体または破片の存在の検出に適したトランスデューサーをさらに含む、請求項1に記載のシステム。
- 前記フード上に配置され、物理パラメータを感知する少なくとも1つのセンサーをさらに含む、請求項1に記載のシステム。
- 前記フード上に配置され、組織を照明する少なくとも1つの発光ダイオードをさらに含む、請求項1に記載のシステム。
- 前記展開カテーテルを通じて送達可能ならせん状の組織係合器をさらに含む、請求項1に記載のシステム。
- 前記展開カテーテルを通じて送達可能なアブレーションプローブをさらに含む、請求項1に記載のシステム。
- 前記アブレーションプローブが、電圧を印加できるプローブ、冷凍アブレーションプローブ、またはレーザープローブを備える、請求項31に記載のシステム。
- 前記展開カテーテルおよび前記フードを通じて伸張可能なチューブ状のカニューレをさらに含む、請求項1に記載のシステム。
- 前記フードの接触端上に配置可能な組織アンカーアセンブリをさらに含む、請求項1に記載のシステム。
- 前記組織アンカーアセンブリが、縫合糸またはワイヤによって相互に連結された複数の個別アンカーを備える、請求項34に記載のシステム。
- 前記フードと流体連通する流体だめをさらに含む、請求項1に記載のシステム。
- 前記流体が生理食塩水、血漿、水、または過フッ化物液を含む、請求項36に記載のシステム。
- 浸漬した組織部位を撮像する方法であって、
展開カテーテルから遠位に突き出しているフードを、撮像する組織部位に押し付けて、または隣接して配置するステップと、
半透明な流体を前記展開カテーテルを介して前記フードに注入し、不透明な流体を前記フードから移動させるステップと、
前記半透明な流体を通して組織部位を可視化するステップと、を含む方法。 - フードを配置するステップが、前記展開カテーテルを経脈管的に心室へ到達させることを含む、請求項38に記載の方法。
- フードを配置するステップが、前記フードをコンパクトな送達形態から拡張した展開形態に展開することを含む、請求項38に記載の方法。
- フードを配置するステップが、前記組織部位に対して前記展開カテーテルを操作することを含む、請求項38に記載の方法。
- フードを配置するステップが、前記組織に対して前記フードの位置を安定化させることを含む、請求項38に記載の方法。
- 半透明な流体を注入するステップが、前記展開カテーテルによって画定される流体送達管腔を通じて、前記半透明の流体を前記フードにポンプで注入することを含む、請求項38に記載の方法。
- 半透明の流体を注入するステップが、生理食塩水、血漿、水、または過フッ化物液を前記フードに注入して血液を前記フードから移動させることを含む、請求項38に記載の方法。
- 前記半透明の流体を前記フードに注入する前に冷却するステップをさらに含む、請求項38に記載の方法。
- 前記半透明の流体を前記フードに注入する前に加熱するステップをさらに含む、請求項38に記載の方法。
- 撮像された組織から得たデータを無線送信するステップをさらに含む、請求項38に記載の方法。
- 前記組織部位を可視化するステップが、前記組織部位を照明するステップをさらに含む、請求項38に記載の方法。
- 前記組織部位を照明するステップが、1つまたは複数の発光ダイオードにより照明するステップを含む、請求項48に記載の方法。
- 前記組織部位を可視化するステップが、前記組織画像を記録するステップを含む、請求項38に記載の方法。
- 前記展開カテーテルを通して送達した治療ツールを用いて前記組織部位を処置するステップをさらに含む、請求項38に記載の方法。
- 撮像する第二の組織部位に前記フードを再配置するステップをさらに含む、請求項38に記載の方法。
- 前記フード内または前記フード外の物理パラメータを感知するステップをさらに含む、請求項38に記載の方法。
- 前記フードを介して組織部位に移植可能な部材を展開するステップをさらに含む、請求項38に記載の方法。
- 前記フードを介して組織部位に固定アセンブリを展開するステップをさらに含む、請求項38に記載の方法。
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US20190125166A1 (en) | 2019-05-02 |
EP1845854B1 (en) | 2012-09-19 |
JP4769256B2 (ja) | 2011-09-07 |
US20060184048A1 (en) | 2006-08-17 |
EP1845854A4 (en) | 2009-07-29 |
EP1845854A2 (en) | 2007-10-24 |
WO2006083794A2 (en) | 2006-08-10 |
JP2011152449A (ja) | 2011-08-11 |
WO2006083794A3 (en) | 2007-10-04 |
US20150190036A1 (en) | 2015-07-09 |
US20110060227A1 (en) | 2011-03-10 |
US7860555B2 (en) | 2010-12-28 |
US20190014975A1 (en) | 2019-01-17 |
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