WO2000049952A1 - Technique permettant d'utiliser des ondes de pression focalisees dans la revascularisation myocardique - Google Patents
Technique permettant d'utiliser des ondes de pression focalisees dans la revascularisation myocardique Download PDFInfo
- Publication number
- WO2000049952A1 WO2000049952A1 PCT/US2000/004484 US0004484W WO0049952A1 WO 2000049952 A1 WO2000049952 A1 WO 2000049952A1 US 0004484 W US0004484 W US 0004484W WO 0049952 A1 WO0049952 A1 WO 0049952A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- heart
- cardiac tissue
- focusing
- providing
- lithotriptor
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—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
- A61B17/225—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 for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
-
- 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
- A61B17/22004—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 using mechanical vibrations, e.g. ultrasonic shock waves
-
- 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
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00694—Aspects not otherwise provided for with means correcting for movement of or for synchronisation with the body
- A61B2017/00703—Aspects not otherwise provided for with means correcting for movement of or for synchronisation with the body correcting for movement of heart, e.g. ECG-triggered
-
- 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
- A61B2017/22082—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 after introduction of a substance
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N7/00—Ultrasound therapy
- A61N2007/0078—Ultrasound therapy with multiple treatment transducers
Definitions
- the present invention generally relates to cardiovascular disease. More specifically, the invention relates to myocardial revascularization. Those skilled in the art will recognize the benefits of applying the present invention to similar fields not discussed herein.
- Extra-corporeal shock-wave lithotripsy is a medical procedure that has traditionally been used to disintegrate renal (kidney) stones.
- the term, lithotripsy is derived from a Greek work which literally means “stone crushing”.
- This medical "stone crushing” technique has been demonstrated to be effective on kidney, upper ureteral and biliary stones (gallstones) in human patients. The technique is noninvasive and eliminates the need for the more conventional stone removal procedures, such as open surgery.
- LMR Laser Myocardial Revascularization
- a CO sub 2 laser is used to produce channels in the heart wall from the epicardium through the endocardium. This procedure follows a surgical cutdown. External pressure is used to stop bleeding from the interior of the heart to the outside. Dr. Mirhoseini has documented that although the channel is sealed at the epicardial layer, it remains patent in the endocardial and myocardial layers. Laser energy is transmitted from the laser to the epicardium by means of an articulated arm device that is commonly used for CO sub 2 laser surgery.
- the present invention improves upon the prior art by providing a non-invasive method of trans-myocardial revascularization.
- the invention further contemplates using commercially available lithotriptors to produce focused acoustic waves.
- the waves may be directed to heart tissue and thereby induce a controlled injury sufficient to improve cardiac function.
- Control of the focus of the lithotriptor may provide the ability to create specific patterns of injury to the heart or to provide a diffuse injury over a relatively large portion of the heart wall.
- Figure 1 depicts an electro-hydraulic lithotriptor.
- Figure 2 depicts a diffuse injury pattern.
- Figure 3 depicts an array of injuries.
- Figure 4 depicts a stereotactic lithotriptor.
- FIG. 1 depicts a patent 10 positioned in tank 15. Tank 15 is filled with water 17.
- Figure 1 further depicts a spark gap electrode 20 which generates shock waves 30. Shock waves 30 propagate through water 17 until shock waves 30 contact patient 10.
- the shock wave 30 may be directed to any part of the patient's body 10 through careful positioning of the patient 10 relative to the electrode 20 and by using a parabolic reflector 25 to focus the wave 30.
- Electro-hydraulic systems create a diverging pulse or explosion of energy which may be distributed over an area of 15-20 square mm.
- Other systems include piezoelectric methods are available from Wolf. Inc. and electromagnetic methods from Siemens.
- piezoelectric systems create a focused shock wave by arranging a number of piezoelectric crystals in an array. That array may be affixed to the interior surface of a concave dish and thereby create focused waves.
- the converging wave of piezoelectric system may be focused on an area as small as 2-3 square mm.
- this system may be used with a patient who is positioned on a cushion or bag which is filled with water or an acoustic gel.
- any of the known lithotripsy systems available may, in the inventive method, be used to create an injury to cardiac tissue.
- energy from the lithotriptor 35 may be diffusely focused on a relatively large portion 40 of the heart.
- Figure 3 depicts lithotriptor 35 intensely focused on the heart in such a way as to produce an array 45 of injured tissue.
- Careful control of the lithotripsy system may be required to take full advantage.
- the system may be controlled by an ECG gating system to time the pulses with the patient's heart beats.
- ECG gating system to time the pulses with the patient's heart beats.
- Other acoustic or x-ray imaging systems could be used to control the focal point of the wave as the heart is moving.
- Figure 4 depicts a stereotactic lithotripsy system which uses a number (3 shown) of spark gap wave generators 20 to direct and manipulate the pressure waves 30 from different angles for more precise control of the location of the injury to patient 10.
- An advantage of this system is that each of the generators 20 can be of lower energy but the focal points sees the same effective energy. This will result in precise focusing with little collateral damage to surrounding tissue.
- drugs or genes may also be provided to augment the procedure and thereby improve any angiogenic affect.
- a wide variety of drugs or genes are known in the art including but not limited to thrombolytics, glycoproteins, anti-thrombotics, recombinant glycoproteins, anti-proliferatives, recombinant glycoproteins, antiarrhythmics, peptides, beta blockers, calcium channel blockers, recombinant peptide/proteins, vasodilators, recombinant peptide/proteins, genetic material, vasoconstrictors, inorganic ions or glycoproteins.
- Drugs may delivered locally, systemically or directly to a desired area of the heart. Drugs may be delivered before, after or during the lithotripsy procedure. While the specification describes the preferred designs, materials, methods of manufacture and methods of use, those skilled in the art will appreciate the scope and spirit of the invention with reference to the appended claims.
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Vascular Medicine (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Mechanical Engineering (AREA)
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Abstract
L'invention concerne une technique permettant de produire une réponse angiogénique dans un tissu cardiaque au moyen d'un lithotriteur.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US13717199P | 1999-02-23 | 1999-02-23 | |
US60/137,171 | 1999-02-23 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2000049952A1 true WO2000049952A1 (fr) | 2000-08-31 |
Family
ID=22476121
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2000/004484 WO2000049952A1 (fr) | 1999-02-23 | 2000-02-22 | Technique permettant d'utiliser des ondes de pression focalisees dans la revascularisation myocardique |
Country Status (1)
Country | Link |
---|---|
WO (1) | WO2000049952A1 (fr) |
Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7704222B2 (en) | 1998-09-10 | 2010-04-27 | Jenavalve Technology, Inc. | Methods and conduits for flowing blood from a heart chamber to a blood vessel |
US10993805B2 (en) | 2008-02-26 | 2021-05-04 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US11065138B2 (en) | 2016-05-13 | 2021-07-20 | Jenavalve Technology, Inc. | Heart valve prosthesis delivery system and method for delivery of heart valve prosthesis with introducer sheath and loading system |
US11185405B2 (en) | 2013-08-30 | 2021-11-30 | Jenavalve Technology, Inc. | Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame |
US11197754B2 (en) | 2017-01-27 | 2021-12-14 | Jenavalve Technology, Inc. | Heart valve mimicry |
US11337800B2 (en) | 2015-05-01 | 2022-05-24 | Jenavalve Technology, Inc. | Device and method with reduced pacemaker rate in heart valve replacement |
US11357624B2 (en) | 2007-04-13 | 2022-06-14 | Jenavalve Technology, Inc. | Medical device for treating a heart valve insufficiency |
US11517431B2 (en) | 2005-01-20 | 2022-12-06 | Jenavalve Technology, Inc. | Catheter system for implantation of prosthetic heart valves |
US11564794B2 (en) | 2008-02-26 | 2023-01-31 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US11589981B2 (en) | 2010-05-25 | 2023-02-28 | Jenavalve Technology, Inc. | Prosthetic heart valve and transcatheter delivered endoprosthesis comprising a prosthetic heart valve and a stent |
Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE3146628A1 (de) * | 1981-11-25 | 1983-06-01 | Dornier System Gmbh, 7990 Friedrichshafen | "ausloesevorrichtung fuer stosswellen zu therapeutischen zwecken" |
US4693247A (en) * | 1986-09-29 | 1987-09-15 | Trutek Research, Inc. | Triggering circuit |
DE3812838A1 (de) * | 1987-03-21 | 1989-11-02 | Schubert Werner | Kleines geraet fuer die stosswellenbehandlung eigentlicher erkrankungen |
US4957099A (en) * | 1988-02-10 | 1990-09-18 | Siemens Aktiengesellschaft | Shock wave source for extracorporeal lithotripsy |
DE4312264A1 (de) * | 1993-04-15 | 1994-10-20 | Siemens Ag | Therapieeinrichtung zur Behandlung von Leiden des Herzens und herznaher Gefäße |
DE19543741C1 (de) * | 1995-11-24 | 1997-05-22 | Wolf Gmbh Richard | Elektroakustischer Wandler |
WO1998007469A1 (fr) * | 1996-08-22 | 1998-02-26 | Storz Medical Ag | Methode therapeutique pour le coeur, etc. et dispositif pour mettre ladite methode en oeuvre |
-
2000
- 2000-02-22 WO PCT/US2000/004484 patent/WO2000049952A1/fr active Application Filing
Patent Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE3146628A1 (de) * | 1981-11-25 | 1983-06-01 | Dornier System Gmbh, 7990 Friedrichshafen | "ausloesevorrichtung fuer stosswellen zu therapeutischen zwecken" |
US4693247A (en) * | 1986-09-29 | 1987-09-15 | Trutek Research, Inc. | Triggering circuit |
DE3812838A1 (de) * | 1987-03-21 | 1989-11-02 | Schubert Werner | Kleines geraet fuer die stosswellenbehandlung eigentlicher erkrankungen |
US4957099A (en) * | 1988-02-10 | 1990-09-18 | Siemens Aktiengesellschaft | Shock wave source for extracorporeal lithotripsy |
DE4312264A1 (de) * | 1993-04-15 | 1994-10-20 | Siemens Ag | Therapieeinrichtung zur Behandlung von Leiden des Herzens und herznaher Gefäße |
DE19543741C1 (de) * | 1995-11-24 | 1997-05-22 | Wolf Gmbh Richard | Elektroakustischer Wandler |
WO1998007469A1 (fr) * | 1996-08-22 | 1998-02-26 | Storz Medical Ag | Methode therapeutique pour le coeur, etc. et dispositif pour mettre ladite methode en oeuvre |
Cited By (14)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7704222B2 (en) | 1998-09-10 | 2010-04-27 | Jenavalve Technology, Inc. | Methods and conduits for flowing blood from a heart chamber to a blood vessel |
US7736327B2 (en) | 1998-09-10 | 2010-06-15 | Jenavalve Technology, Inc. | Methods and conduits for flowing blood from a heart chamber to a blood vessel |
US8216174B2 (en) | 1998-09-10 | 2012-07-10 | Jenavalve Technology, Inc. | Methods and conduits for flowing blood from a heart chamber to a blood vessel |
US8597226B2 (en) | 1998-09-10 | 2013-12-03 | Jenavalve Technology, Inc. | Methods and conduits for flowing blood from a heart chamber to a blood vessel |
US11517431B2 (en) | 2005-01-20 | 2022-12-06 | Jenavalve Technology, Inc. | Catheter system for implantation of prosthetic heart valves |
US11357624B2 (en) | 2007-04-13 | 2022-06-14 | Jenavalve Technology, Inc. | Medical device for treating a heart valve insufficiency |
US11154398B2 (en) | 2008-02-26 | 2021-10-26 | JenaValve Technology. Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US10993805B2 (en) | 2008-02-26 | 2021-05-04 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US11564794B2 (en) | 2008-02-26 | 2023-01-31 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US11589981B2 (en) | 2010-05-25 | 2023-02-28 | Jenavalve Technology, Inc. | Prosthetic heart valve and transcatheter delivered endoprosthesis comprising a prosthetic heart valve and a stent |
US11185405B2 (en) | 2013-08-30 | 2021-11-30 | Jenavalve Technology, Inc. | Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame |
US11337800B2 (en) | 2015-05-01 | 2022-05-24 | Jenavalve Technology, Inc. | Device and method with reduced pacemaker rate in heart valve replacement |
US11065138B2 (en) | 2016-05-13 | 2021-07-20 | Jenavalve Technology, Inc. | Heart valve prosthesis delivery system and method for delivery of heart valve prosthesis with introducer sheath and loading system |
US11197754B2 (en) | 2017-01-27 | 2021-12-14 | Jenavalve Technology, Inc. | Heart valve mimicry |
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