PT1531762E - DISPOSITIVOS IMPLANTáVEIS PARA CONTROLAR A CIRCUNFERNCIA INTERNA DE UM ORIFICIO OU LUMEN ANATËMICO - Google Patents
DISPOSITIVOS IMPLANTáVEIS PARA CONTROLAR A CIRCUNFERNCIA INTERNA DE UM ORIFICIO OU LUMEN ANATËMICO 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
- A61F2/2445—Annuloplasty rings in direct contact with the valve annulus
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
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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
- A61F2/2466—Delivery devices therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
- A61B2017/00455—Orientation indicators, e.g. recess on the handle
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00778—Operations on blood vessels
- A61B2017/00783—Valvuloplasty
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
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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
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
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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
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
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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
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0013—Implantable devices or invasive measures
- A61F5/0076—Implantable devices or invasive measures preventing normal digestion, e.g. Bariatric or gastric sleeves
- A61F5/0079—Pyloric or esophageal obstructions
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Vascular Medicine (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Nursing (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Obesity (AREA)
- Child & Adolescent Psychology (AREA)
- Prostheses (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Description
ΕΡ 1 531 762/PT DESCRIÇÃO "Dispositivos implantáveis para controlar a circunferência interna de um orifício ou lúmen anatómico"
CAMPO TÉCNICO 0 presente invento refere-se, em geral, a dispositivos implantáveis e procedimentos, e refere-se, mais especificamente, a dispositivos implantáveis para controlar a circunferência interna de um orifício ou lúmen anatómico.
ANTECEDENTES DO INVENTO
Muitas estruturas anatómicas no corpo de mamífero são passagens ocas nas quais as paredes de tecido definem um lúmen central, o qual serve como uma conduta para o sangue, outros fluidos fisiológicos, matéria nutriente ou matéria residual que passa dentro da estrutura. Em muitos cenários fisiológicos, a disfunção pode resultar a partir de um lúmen estrutural que tanto é demasiado grande como demasiado pequeno. Na maior parte desses casos a disfunção pode ser aliviada através de mudanças intervencionais no tamanho do lúmen.
Assim, na cirurgia, existe muitas vezes a necessidade de reduzir a circunferência interna de um orifício ou outra estrutura anatómica aberta de modo a estreitar o tamanho do orifício ou abertura para alcançar um efeito fisiológico desejado. Muitas vezes, tais procedimentos cirúrgicos requerem a interrupção no escoamento fisiológico normal do sangue, de outros fluidos fisiológicos ou de outros conteúdos estruturais, através do orifício ou estrutura. 0 valor exacto do estreitamento necessário para o efeito desejado não pode, muitas vezes, ser totalmente apreciado até que o escoamento fisiológico através do orifício ou estrutura seja retomado. Seria vantajoso, por conseguinte, ter uns meios ajustáveis para alcançar este efeito de estreitamento, de tal modo que o grau de estreitamento possa ser mudado depois da sua implantação, mas depois de se ter retomado o escoamento normal no local. 2 ΕΡ 1 531 762/ΡΤ
Um exemplo de uma disfunção dentro de um lúmen anatómico encontra-se na área da cirurgia cardíaca e, especificamente, na reparação valvular. Aproximadamente um milhão de procedimentos cirúrgicos de coração aberto são agora realizados anualmente nos Estados Unidos, e vinte por cento destas operações estão relacionadas com as válvulas cardíacas. 0 campo da cirurgia cardíaca foi previamente transformado através da introdução do oxigenador em bomba, o que permitiu a realização da cirurgia de coração aberto. A cirurgia valvular do coração tornou-se possível pela introdução adicional das próteses mecânicas de válvula de esferas, tendo-se vindo a desenvolver muitas modificações e formas diferentes de válvulas de coração prostéticas. Contudo, a válvula prostética ideal está ainda por ser concebida, o que atesta a forma e função elegantes da válvula nativa do coração. Como resultado das dificuldades em engendrar uma válvula de coração prostética perfeita, tem surgido um interesse crescente na reparação de uma válvula nativa de um paciente. Estes esforços permitiram documentar igualmente a durabilidade a longo prazo relativamente à utilização de próteses mecânicas, com benefícios adicionais no que diz respeito a um desempenho ventricular melhor devido à preservação dos mecanismos subvalvulares e ao obviar da necessidade de anticoagulação crónica. A reparação da válvula mitral tornou-se numa das áreas que cresce mais rapidamente na cirurgia cardíaca de adultos nos dias de hoje. A doença da válvula mitral pode ser subdividida em perturbações intrínsecas da válvula e na patologia extrínseca à válvula mitral que afecta, por fim, a função valvular. Muito embora existam estas subdivisões, muitas das técnicas de reparação e abordagens operativas globais são similares nas várias patologias que existem.
Historicamente, a maior parte da patologia valvular era secundária em relação à doença reumática do coração, um resultado da infecção estreptocócica, que afecta mais comummente a válvula mitral, seguida pela válvula aórtica, e menos frequente a válvula pulmonar. Os resultados do processo infeccioso são a estenose mitral e a estenose aórtica, 3 ΕΡ 1 531 762/ΡΤ seguida da insuficiência mitral e da insuficiência aórtica. Com a chegada de melhores terapias por antibióticos, a incidência da doença reumática do coração entra em declínio, contando para uma percentagem mais pequena das condições valvulares do coração no mundo desenvolvido dos dias de hoje. A comissurotomia da estenose mitral reumática foi anteriormente um exemplo das reparações de válvula mitral comummente realizadas fora do domínio dos defeitos congénitos do coração. Contudo, as reparações das válvulas insuficientes reumáticas não foram ao encontro de bons resultados devido à patologia subjacente da válvula e à progressão da doença. A maioria das doenças da válvula mitral, para além da reumática, resulta numa insuficiência valvular que é geralmente acessível de reparar. A rotura de cordas é uma causa comum da insuficiência mitral, resultando numa área focal de regurgitação. De modo clássico, uma das primeiras reparações cirúrgicas aceites e com sucesso era para as cordas rompidas do folheto mitral posterior. A possibilidade técnica desta reparação, os seus resultados de boa capacidade de reprodução e a sua durabilidade a longo prazo levaram os cirurgiões pioneiros no campo da reparação de válvulas mitrais a tentarem reparações de outras patologias da válvula. 0 prolapso da válvula mitral é uma condição bem comum que conduz, ao longo do tempo, à insuficiência valvular. Nesta doença, o plano de coaptação dos folhetos anterior e posterior é "atrializado" em relação a uma válvula normal. Este problema pode ser prontamente reparado ao restaurar o plano de coaptação dentro do ventrículo.
Os músculos papilares dentro do ventrículo esquerdo suportam a válvula mitral e ajudam na sua função. A disfunção dos músculos papilares, quer devido a enfarte quer devido a isquémia a partir da doença da artéria coronária, conduz muitas vezes a insuficiência mitral (comummente referida como a insuficiência mitral isquémica). Dentro do âmbito da doença da válvula mitral esta é a área que cresce mais rapidamente no que diz respeito à reparação de válvulas. Historicamente, apenas os doentes com insuficiência mitral grave eram sujeitos a reparação ou substituição, existindo contudo um 4 ΕΡ 1 531 762/ΡΤ suporte crescente em termos de literatura de cirurgia relativamente à reparação de válvulas em pacientes com insuficiência moderada que se pode atribuir à insuficiência mitral isquémica. A reparação activa precoce de válvulas nesta população de pacientes tem vindo a mostrar um aumento da sobrevivência e uma melhoria da função ventricular a longo prazo.
Em adição, nos pacientes com cardiomiopatia dilatada, a etiologia da insuficiência mitral está na falta de coaptação dos folhetos de válvula a partir de um ventrículo dilatado. A regurgitação resultante é devida à falta de coaptação dos folhetos. Existe uma crescente tendência no que diz respeito à reparação destas válvulas, reparando deste modo a insuficiência e restaurando a geometria ventricular, melhorando assim a função ventricular global.
As duas características essenciais da reparação da válvula mitral são resolver a patologia valvular primária (caso exista) e suportar o anel ou reduzir a dimensão anular utilizando uma prótese que existe comummente na forma de um anel ou banda. 0 problema encontrado na reparação da válvula mitral é a incapacidade do cirurgião avaliar completamente a eficácia da reparação até o coração ter sido completamente fechado e o paciente ficar afastado do desvio cardiopulmonar. Uma vez que isto tenha sido conseguido, pode ser avaliada a função valvular na sala de operações utilizando a ecocardiografia trans-esofágica (TEE). Se for documentada uma insuficiência valvular residual significativa, o cirurgião terá de fazer parar de novo o coração, abrir de novo o coração, e depois voltar a reparar ou substituir a válvula. Isto aumenta os tempos globais da operação, anestesia e desvio e, por conseguinte, aumenta os riscos globais da operação.
Se a prótese utilizada para reduzir o anel for maior do que o tamanho ideal, a insuficiência mitral pode persistir. Se a prótese for demasiado pequena, pode dar-se a estenose mitral. Existe, por conseguinte, a necessidade de uma prótese ajustável que venha a permitir que um cirurgião ajuste a dimensão anular no local num coração que bate sob a 5 ΕΡ 1 531 762/ΡΤ orientação ΤΕΕ ou outras modalidades de diagnóstico, para conseguir uma função e suficiência valvular óptimas. A cirurgia cardíaca não é mais do que um exemplo de um cenário no qual seria desejável o ajustamento da dimensão anular de um orifício anatómico no local. Um outro exemplo é no campo da cirurgia gastrointestinal, onde o procedimento de fundoplicação de Nissen já vem há muito tempo a ser utilizado para estreitar a união gastro-esofágica para alívio do refluxo gástrico dentro do esófago. Nesta função, um cirurgião é convencionalmente confrontado com a tensão entre criar estreitamento suficiente para conseguir o controlo do refluxo, mas evitando o estreitamento excessivo que pode interferir com a passagem de conteúdos nutritivos do esófago para o estômago. De novo, seria desejável ter um método e aparelho através dos quais a extensão a que a união gastro-esofágica é estreitada pode ser ajustada no local para alcançar um equilíbrio óptimo entre estes dois interesses que rivalizam. À parte do problema de ajustar a circunferência interna das passagens do corpo no local, existe muitas vezes a necessidade na medicina e na cirurgia de colocar um implante prostético num local anatómico receptor desejado. Por exemplo, os métodos existentes propostos para reparação mitral percutânea incluem abordagens quer através do seio coronário quer por tentativas percutâneas de afixar o folheto mitral anterior ao folheto mitral posterior. Problemas clínicos e logísticos significativos são assistidos por ambas as tecnologias existentes. No caso dos procedimentos no seio coronário, o acesso percutâneo ao seio coronário é tecnicamente difícil e demorado de conseguir, com procedimentos que podem necessitar de várias horas para se aceder adequadamente ao seio coronário. Além disso, estes procedimentos empregam anéis anulares incompletos, os quais compreendem o seu efeito fisiológico. Tais procedimentos não são tipicamente eficazes em melhorar a regurgitação mitral em mais do que um grau clínico. Finalmente, os procedimentos no seio coronário carregam os riscos potencialmente desastrosos quer em relação a rasgos fatais quer em relação a tromboses catastróficas do seio coronário. 6 ΕΡ 1 531 762/ΡΤ
De modo similar, os procedimentos percutâneos que empregam suturas, grampos ou outros dispositivos para afixar os folhetos mitrais anteriores aos folhetos mitrais posteriores também têm capacidades de reparação limitadas. Tais procedimentos também são tipicamente ineficazes no proporcionar de uma reparação completa da regurgitação mitral. Além do mais, a experiência cirúrgica indica que tais métodos não são duráveis, com provável separação dos folhetos de válvula afixados. Estes procedimentos também falham no enfrentar da patofisiologia do anel mitral dilatado na doença isquémica do coração. Como resultado da patologia anatómica residual, não é provável qualquer remodelação ventricular ou melhoria da função ventricular com estes procedimentos.
Existe a necessidade, por conseguinte, de um sistema de distribuição que iria evitar a necessidade de uma cirurgia aberta em tais circunstâncias exemplificativas, e permitir que a distribuição, colocação e ajustamento de um implante prostético reduza o diâmetro de um tal anel mitral num procedimento percutâneo ou outro procedimento minimamente invasivo, conseguindo ao memso tempo resultados clínicos e fisiológicos que são pelo menos o equivalente dos rendimentos dos melhores procedimentos cirúrgicos abertos para estes mesmos problemas.
As aplicações cardíacas precedentes são apenas exemplos de algumas aplicações de acordo com o presente invento. Uma outra aplicação exemplificativa antecipada pelo presente invento é o campo da cirurgia gastrointestinal, onde o procedimento de fundoplicação de Nissen atrás mencionado tem vindo a ser utilizado há muito tempo para estreitar a união gastro-esofágica para alívio do refluxo gástrico dentro do esófago. Nesta função, um cirurgião é convencionalmente confrontado com a tensão entre criar um estreitamento suficiente para conseguir um controlo do refluxo, mas tendo de evitar um estreitamento excessivo que pode interferir com a passagem dos conteúdos nutritivos desde o esófago até ao estômago. Em adição, o "meteorismo gasoso" pode provocar a incapacidade de arrotar, uma complicação comum do sobre-estreitamento da união GE. Um implante prostético ajustável de acordo com o presente invento pode permitir o ajustamento no local num tal cenário sob avaliação fisiológica depois do
Claims (3)
- ΕΡ 1 531 762/ΡΤ 1/2 REIVINDICAÇÕES 1 - Dispositivo implantável (10, 100, 700, 800) para controlar a circunferência interna de um orifício ou lúmen anatómico, que compreende: um anel anular (15, 115, 705, 805); meios (500) pelos quais o referido anel anular pode ser preso ao tecido em torno de um orifício ou lúmen anatómico; meios (20, 130, 200, 300, 725, 825) associados ao referido anel anular para permitirem o ajustamento da circunferência do referido anel anular de uma primeira circunferência para uma segunda circunferência; e meios (20, 130, 200, 300, 720, 820) associados ao referido anel anular para manterem o referido anel na referida primeira circunferência e, quando do ajustamento do referido anel anular à referida segunda circunferência, para manterem o referido anel anular na referida segunda circunferência; pelo que a circunferência do referido orifício ou lúmen anatómico pode ser ajustada ao ajustar a circunferência do referido anel anular da referida primeira circunferência para a referida segunda circunferência; caracterizado por: os referidos meios pelos quais o referido anel anular pode ser preso ao tecido em torno de um orifício ou lúmen anatómico compreenderem uma pluralidade de ilhós (510) espaçados em torno da periferia do referido anel anular; em que os referidos ilhós (510) compreendem patilhas (530) constituídas por um material o qual é suficientemente flexível, tal que uma sutura pode ser colocada através da referida patilha e através do tecido subjacente para ancorar o referido anel anular no tecido em torno do referido orifício ou lúmen anatómico.
- 2 - Dispositivo implantável da reivindicação 1, em que os referidos ilhós (510) compreendem patilhas (530), e em que as referidas patilhas (530) definem orifícios (535) através dos quais pode ser colocada uma sutura, e depois através do tecido subjacente ancorar o referido anel anular ao tecido em torno do referido orifício ou lúmen anatómico. ΕΡ 1 531 762/ΡΤ 2/2
- 3 - Dispositivo implantável da reivindicação 1, em que o referido dispositivo compreende secções de ondulações (20) e ilhós (25) que alternam, espaçadas em torno da periferia do referido anel anular (15). Lisboa, 2010-07-14 ΕΡ 1 531 762/ΡΤ RESUMO "Dispositivos implantáveis para controlar a circunferência interna de um orifício ou lúmen anatómico" Implante, sistema para implantar, e método para empregar um implante para controlar a circunferência das passagens anatómicas internas, que corrigem as disfunções fisiológicas que resultam a partir de um lúmen estrutural que tanto é demasiado grande como demasiado pequeno. São descritos implantes, os quais empregam vários meios para ajustar e manter o tamanho de um orifício a que os mesmos são fixos. Os sistemas permitem que os implantes sejam implantados utilizando procedimentos minimamente invasivos, e permitem os ajustamentos finais às circunstâncias dos implantes depois de retomado o escoamento normal dos fluidos anatómicos no local. São descritos métodos para utilizar os implantes para tratar anormalidades de válvulas do coração, anormalidades gastro-esofágicas, incontinência anal e semelhantes.V___^ ΕΡ 1 531 762/ΡΤ 1/11Fig. 1Fig. 2 Fig. 3 ΕΡ 1 531 762/ΡΤ 2/11ΕΡ 1 531 762/ΡΤ 3/11535Fig. 11 Fig. 10 415 ΕΡ 1 531 762/ΡΤ 4/11 630 650Fig. 126t0 ΕΡ 1 531 762/ΡΤ 6/11Fig. 18 ΕΡ 1 531 762/ΡΤ 7/11Fia 19 Fia 20 ΕΡ 1 531 762/ΡΤ 8/11700715 705 ΓΜ Π ϋ 5 5J 5 ΓΤΤΊΠΙFia 22720 735 720725 / — 730 r 705705 FIG. 24 ΕΡ 1 531 762/ΡΤ 9/11850FIG27 ΕΡ 1 531 762/ΡΤ 10/11Fia 28 ΕΡ 1 531 752/PT 11/11 600Fia 29Fia 30
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2003
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- 2003-08-29 EP EP03791977A patent/EP1531762B1/en not_active Expired - Lifetime
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- 2003-08-29 RU RU2005108673/14A patent/RU2005108673A/ru not_active Application Discontinuation
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