JP6152115B2 - 心臓弁の機能を改善するための装置および方法 - Google Patents
心臓弁の機能を改善するための装置および方法 Download PDFInfo
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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
- A61F2/02—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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2463—Implants forming part of the valve leaflets
-
- 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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2445—Annuloplasty rings in direct contact with the valve annulus
-
- 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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2454—Means for preventing inversion of the valve leaflets, e.g. chordae tendineae prostheses
-
- 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0008—Fixation appliances for connecting prostheses to the body
- A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
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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
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Engineering & Computer Science (AREA)
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- Heart & Thoracic Surgery (AREA)
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Description
この開示は、概して医療装置および方法の分野に関する。本開示は、より具体的には心臓弁の機能を改善するための医療装置、特に心臓弁の小葉の改善に関する。
図1は、心臓12、僧帽弁18、および左心室14の一部を示す。僧帽弁の境界に沿って弁輪20がある。この弁は2つの尖または小葉22、24を有する。これら尖または小葉22、24は、対応する接続腱索26、28を介して乳頭筋27、29にそれぞれ接続されている。正常で健康な個体においては、対向する小葉の自由端が弁を閉鎖する。しかしながら、個体によっては閉鎖が完全でなく、その結果、弁閉鎖不全とも呼ばれる逆流、すなわち左心房への血液の逆流が生じ、そのために心臓の効力が低下し患者に重大な影響を及ぼす可能性がある。図2は、小葉22、24が適切に閉鎖しない僧帽弁18を示す。これは一般的に弁輪20が拡大したときに生じる。これを矯正するための外科的処置の1つとして、小葉24の一部を除去し切り口を縫合することが挙げられる。この処置によって弁輪20をより正常な位置に引戻す。しかしながら、小葉24の強度は変化する。心臓機能の効力低下についての同様の問題は、小葉は適切に閉鎖するが小葉のうち一方または双方に血液が左心房に向かって流れるほどの孔が開いている場合に生じる。
US2005/0107871が開示する弁移植片または人工器官は、患者の心臓において修復すべき弁の小葉のうちの1つを覆うように構成されたスカートまたは人工弁小葉を含む。ある実施の形態において、心臓弁人工器官は、湾曲部材とスカートとを含む。湾曲部材は、第1および第2の端部を有し、患者の心臓の弁輪のうちの1つの一部に沿って部分リングを形成するように構成してもよい。これに代えて、湾曲部材が、弁輪全体に沿って延びるように構成された完全なリングを形成してもよい。スカートは、湾曲部材に沿って延び湾曲部材に依存する。この人工器官は特に僧帽弁閉鎖不全症の治療に役立つ。この場合、人工器官を僧帽弁に僧帽弁輪に沿って固定するときにスカートが後小葉を覆いスカートの対向する縁部と前小葉が接合されるように、スカートを構成してもよい。加えて、湾曲部材を僧帽弁輪の後部分に固定するときに弁輪のさらなる拡張を最小にするまたはなくすことができる。
いくつかの実施の形態は、僧帽弁等の目的部位において、2つの金属部同士を十分に密着させかつこれら2つの金属部の間の領域を封止する。
次に、本開示の具体的な実施の形態について添付の図面を参照しながら説明する。しかしながら、この開示は、数多くのさまざまな形態で実施し得るものであり、本明細書に記載の実施の形態に限定されると解釈されてはならない。むしろ、これら実施の形態は、この開示が、詳細で完璧となるように、かつ、本開示の範囲を当業者に十分に伝えるように、提供される。添付の図面に示される実施の形態の詳細な説明で使用される用語は、本開示を限定することを意図したものではない。図面において、同様の番号は同様の要素を示す。
Claims (10)
- 弁組織を備える心臓弁の機能を改善するための医療装置であって、前記弁組織は、前記弁組織の外側部分の弁輪と前記弁組織の内側部分の複数の小葉(24)とを含み、前記医療装置は、
少なくとも第1の部分的に可撓性の小葉補強パッチ(30)を備え、前記パッチはその内側部分(34)とその外側部分(32)の間に伸長部を有し、前記外側部分(32)は前記弁輪の方向を向くように構成され、前記内側部分は前記弁組織の前記内側部分の方向を向くように構成され、
前記可撓性小葉補強パッチ(30)の前記内側部分(34)の少なくとも一部分は、動作時、前記複数の小葉(24)のうちの少なくとも1つが前記内側部分(34)の前記一部分に対して並ぶように、構成され、前記内側部分(34)の前記一部分は前記複数の小葉(24)を補強するように配置され、組織固定部(35)が前記可撓性小葉補強パッチ(30)の前記外側部分(32)に接続され、
前記組織固定部(35)は第1のループ状支持体であり、
前記組織固定部(35)は前記弁輪が延びている範囲全体に対する接合部を提供し、
少なくとも1本の糸(80,90)の第1の端部が前記可撓性小葉補強パッチ(30)の前記内側部分(34)に装着されるように構成され、前記少なくとも1本の糸(80,82,90)の第2の端部は、小葉(24)以外の、腱索(28)または乳頭筋(29)等の心構造に接続されるように構成される、医療装置。 - 前記心臓弁の、前記第1の小葉補強パッチ(30)の反対側に配置可能な第2の可撓性小葉補強パッチ(114)をさらに備える、請求項1に記載の医療装置。
- 前記可撓性小葉補強パッチ(30)は、様々な厚みを有する、請求項1または2に記載の医療装置。
- 前記可撓性小葉補強パッチ(30)の前記内側部分(34)は、前記複数の小葉(24)のうちの少なくとも1つに一体化されるように構成される、請求項1〜3のいずれか1項に記載の医療装置。
- 前記可撓性小葉補強パッチ(30)の前記内側部分は、生体分解性材料および/または生体吸収性材料からなる、請求項1〜4のいずれか1項に記載の医療装置。
- 前記可撓性小葉補強パッチ(30)の前記内側部分(34)は、前記複数の小葉(24)のうちの少なくとも1つに対して並ぶように構成され、接着剤、大釘、フォーク状部材、尖鋭部材、フック、留め金または掛け金等の締結手段を含む、請求項1〜5のいずれか1項に記載の医療装置。
- 前記組織固定部(35)は、前記弁輪の方向を向いている、前記可撓性小葉補強パッチ(30)の前記外側部分(32)を固定するように構成され、前記組織固定部(35)は、接着剤、大釘、フォーク状部材、尖鋭部材、フック、留め金または掛け金等の締結手段を含む、請求項6に記載の医療装置。
- 第2の可撓性小葉補強パッチ(114)が第2の固定部(112)に接続され、前記第2の可撓性小葉補強パッチ(114)および前記第2の固定部(112)は、心臓(12)の左心室の内側に配置される、請求項1に記載の医療装置。
- 前記小葉補強パッチ(30)の幅は少なくとも部分的に不均一である、請求項1〜8のいずれか1項に記載の医療装置。
- 前記小葉補強パッチ(30)は、前記組織固定部(35)から、前記組織固定部と前記少なくとも1つの小葉(24)の自由端(60)の間の部分のうちの少なくとも一部にわたって延びている、請求項1〜9のいずれか1項に記載の医療装置。
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP11188656.0 | 2011-11-10 | ||
EP11188656.0A EP2591754B1 (en) | 2011-11-10 | 2011-11-10 | A device and a method for improving the function of a heart valve |
US201161558787P | 2011-11-11 | 2011-11-11 | |
US61/558,787 | 2011-11-11 | ||
PCT/EP2012/072272 WO2013068535A1 (en) | 2011-11-10 | 2012-11-09 | A device and a method for improving the function of a heart valve |
Publications (3)
Publication Number | Publication Date |
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JP2014533157A JP2014533157A (ja) | 2014-12-11 |
JP2014533157A5 JP2014533157A5 (ja) | 2015-12-24 |
JP6152115B2 true JP6152115B2 (ja) | 2017-06-21 |
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JP2014540479A Active JP6152115B2 (ja) | 2011-11-10 | 2012-11-09 | 心臓弁の機能を改善するための装置および方法 |
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US (3) | US10172711B2 (ja) |
EP (2) | EP2591754B1 (ja) |
JP (1) | JP6152115B2 (ja) |
CN (1) | CN103930069B (ja) |
CA (1) | CA2852169C (ja) |
IN (1) | IN2014DN03069A (ja) |
WO (1) | WO2013068535A1 (ja) |
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US8870950B2 (en) | 2009-12-08 | 2014-10-28 | Mitral Tech Ltd. | Rotation-based anchoring of an implant |
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WO2013021374A2 (en) | 2011-08-05 | 2013-02-14 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
CA3040390C (en) | 2011-08-11 | 2022-03-15 | Tendyne Holdings, Inc. | Improvements for prosthetic valves and related inventions |
EP2591755A1 (en) | 2011-11-12 | 2013-05-15 | Medtentia International Ltd Oy | Device and method for improving fixation of a medical device |
US9827092B2 (en) | 2011-12-16 | 2017-11-28 | Tendyne Holdings, Inc. | Tethers for prosthetic mitral valve |
US9345573B2 (en) | 2012-05-30 | 2016-05-24 | Neovasc Tiara Inc. | Methods and apparatus for loading a prosthesis onto a delivery system |
WO2014022124A1 (en) | 2012-07-28 | 2014-02-06 | Tendyne Holdings, Inc. | Improved multi-component designs for heart valve retrieval device, sealing structures and stent assembly |
WO2014021905A1 (en) | 2012-07-30 | 2014-02-06 | Tendyne Holdings, Inc. | Improved delivery systems and methods for transcatheter prosthetic valves |
EP2948103B1 (en) | 2013-01-24 | 2022-12-07 | Cardiovalve Ltd | Ventricularly-anchored prosthetic valves |
US10463489B2 (en) | 2013-04-02 | 2019-11-05 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US11224510B2 (en) | 2013-04-02 | 2022-01-18 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10478293B2 (en) | 2013-04-04 | 2019-11-19 | Tendyne Holdings, Inc. | Retrieval and repositioning system for prosthetic heart valve |
US9572665B2 (en) | 2013-04-04 | 2017-02-21 | Neovasc Tiara Inc. | Methods and apparatus for delivering a prosthetic valve to a beating heart |
US9610159B2 (en) | 2013-05-30 | 2017-04-04 | Tendyne Holdings, Inc. | Structural members for prosthetic mitral valves |
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EP2747707B1 (en) | 2015-04-01 |
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EP2747707A1 (en) | 2014-07-02 |
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