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EP0230996A2
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EP
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Pressure-Controlled Intermittent Coronary Sinus Occlusion
Assignee: Mohl Werner MD
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Filing: 1987-01-26
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Granted: —
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Expires: 2007-01-26
Abstract
Abstract The coronary sinus is intermittently occluded by use of means for occluding the sinus. a pressure transducer (50) for sensing the fluid pressure within the sinus and providing corresponding fluid pressure signals. and a controller (28) responsive to the tranducer and arranged to provide trigger signals to the occluding means to trigger an occlusion and to interrupt the occlusion. the system being characterized in that the controller is arranged to estimate a plateau level of the fluid pressure during each occlusion and for providing a trigger signal to interrupt each occlusion on the basis of the estimate. The duration of the interruption before the next occlusion is controlled in response to the volume flow in the sinus during the interruption. Pharmacological agents are injected into the sinus during the occlusion. for retroprofusion to the heart tissue. An analysis of heart function is obtained by analyzing the local pressure maxima in successive heartbeats during occlusion. Initiation of the next occlusion is timed based on fluid pressure signals taken from the sinus during occlusion. The degree of tissue at risk of infarction (or the amount of infarcted tissue) is estimated based on the fluid pressure signals.
Inventors
- 👤 Werner Mohl
- 👤 Marc Joshua Tolkoff
Bibliographic Details
Application Number
—
Jurisdiction
EP
Data Source
google_patents
Last Synchronized
2026-11-02 22:25
CPC Classifications
A; A61; A61B; A61B17/00; A61B17/12; A61B17/12022; A61B17/12099; A61B17/12109; A61B17/12131; A61B17/12136; A61B5/00; A61B5/02; A61M; A61M1/00; A61M1/36; A61M1/3613; A61M25/00; A61M25/01; A61M25/02; A61M25/04; A61M60/00; A61M60/10; A61M60/122; A61M60/126; A61M60/135; A61M60/143; A61M60/20; A61M60/247; A61M60/253; A61M60/268; A61M60/295; A61M60/30; A61M60/31; A61M60/32; A61M60/40; A61M60/424; A61M60/427; A61M60/497; A61M60/50; A61M60/508; A61M60/515; A61M60/531; A61M60/538; A61M60/554; A61B2017/00017; A61B2017/00022; A61B2017/00137; A61B2017/00154; A61B2017/00535; A61B2017/00557; A61B2017/00681; A61B2017/00694; A61B2017/00703; A61B90/00; A61B90/06; A61B2090/064; A61M2025/0001; A61M2025/0003; A61M25/10; A61M25/1018; A61M2025/102; A61M2025/1043; A61M2025/1052; A61M2205/00; A61M2205/33; A61M2205/3331; A61M2205/3344; A61M2205/3355; A61M2205/50; A61M2230/00; A61M2230/30; A61M60/274; A61M60/80; A61M60/802; A61M60/833
Claims Analysis
Total Claims: 56
Claim 1
Independent Claim
99 words
Apparatus (10) for intermittently occluding a coronary sinus comprising means for occluding said sinus, a pressure transducer (50) for sensing the fluid pressure within said sinus and providing corresponding fluid pressure signals, and a controller (28) responsive to said transducer having means for providing trigger signals to said occluding means to trigger an occiusion and to interrupt said occlusion, said apparatus being characterized in that said controller includes means to estimate a plateau level of said fluid pressure during each occlusion and means to provide the trigger signal to interrupt each said occlusion on the basis of said estimate.
Claim 2
Dependent Claim
99 words
Apparatus (10) for intermittently occluding a coronary sinus comprising means for occluding said sinus, a pressure transducer (50) for sensing the fluid pressure within said sinus and providing corresponding fluid pressure signals, and a controller (28) responsive to said transducer having means for providing trigger signals to said occluding means to trigger an occiusion and to interrupt said occlusion, said apparatus being characterized in that said controller includes means to estimate a plateau level of said fluid pressure during each occlusion and means to provide the trigger signal to interrupt each said occlusion on the basis of said estimate.
Claim 3
Independent Claim
22 words
The apparatus of claim I further characterized in that each said occlusion is interrupted before said fluid pressure reaches said plateau level.
Claim 4
Independent Claim
98 words
The apparatus of claim I further characterized by said controller comprising sensing circuitry for sensing said fluid pressure signals, first analysis circuitry for determining and storing a local maximum value of said pressure for each heartbeat from said stored sensed signals, second analysis circuitry for estimating in real time said plateau level from said stored local maximum values, and comparison circuitry for comparing a predetermined percentage of said estimated plateau level with successive said local maximum values and generating said trigger signals for triggering interruption of each occlusion at a time dependent on the result of said comparison.
Claim 5
Dependent Claim
34 words
The apparatus of claim 2 or 3 further characterized by said predetermined percentage calculated from a range of 70-98% or a calculated value thereof of x% + n (n = heart cycles or time).
Claim 6
Dependent Claim
14 words
The apparatus of claim 4 further chracterized by said predetermined percentage being about 94%.
Claim 7
Dependent Claim
28 words
The apparatus of claim 3 wherein said second analysis circuitry includes means for estimating said plateau level by fitting said stored local maximum values to an exponential curve.
Claim 8
Independent Claim
34 words
The apparatus of claim I further characterized in that said occluding means comprises an inflatable element in said sinus, and a pump for selectably inflating said inflatable element in response to said trigger signals.
Claim 9
Independent Claim
27 words
The apparatus of claim I further characterized in having means responsive to the volume flow in said sinus for commencing each period of occlusion of said sinus.
Claim 10
Independent Claim
45 words
The apparatus of claim I further characterized in having means to display the pressure maxima for the succession of heartbeats that occurs during an occlusion to enable evaluation of the relationship of said maxima for indication of the state of health of the heart tissue.
Claim 11
Independent Claim
30 words
The apparatus of claim I further characterized in having means during said occlusion to infuse a pharmacological agent into said sinus, whereby said agent can be retroperfused to heart tissue.
Claim 12
Dependent Claim
72 words
II. A method for intermittently occluding a coronary sinus, comprising providing means for occluding said sinus and for measuring the local pressure maximum within said sinus during each heartbeat, causing occlusion of said sinus, measuring the local pressure maxima for successive heartbeats during said occlusion, said method being characterized by the steps of estimating the plateau level of said local pressure maxima, and interrupting said occlusion on the basis of said estimate.
Claim 13
Dependent Claim
72 words
II. A method for intermittently occluding a coronary sinus, comprising providing means for occluding said sinus and for measuring the local pressure maximum within said sinus during each heartbeat, causing occlusion of said sinus, measuring the local pressure maxima for successive heartbeats during said occlusion, said method being characterized by the steps of estimating the plateau level of said local pressure maxima, and interrupting said occlusion on the basis of said estimate.
Claim 14
Independent Claim
20 words
The method of claim II further characterized in that said interrupting occurs before said fluid pressure reaches said plateau level.
Claim 15
Dependent Claim
26 words
The method of claim 11 further comprising interrupting said occlusion when a said local pressure maximum reaches at least a predetermined percentage of said plateau level.
Claim 16
Dependent Claim
24 words
The method of claim 13 further characterized in that said predetermined percentage is at least 700/0 and less than 98% and a calculated constant.
Claim 17
Dependent Claim
15 words
The method of claim 14 further characterized in that said predetermined percentage is about 94%.
Claim 18
Dependent Claim
30 words
The method of claim 11 further characterized in commencing the next period of occlusion of said sinus in response to the volume flow following cessation of the preceding occlusion period.
Claim 19
Dependent Claim
89 words
Apparatus for intermittently occluding a coronary sinus comprising means for occluding said sinus, and a controller having means for providing trigger signals to said occluding means to trigger an occlusion and to interrupt said occluison, said apparatus being characterized in that a sensor is provided for delivering flow signals indicative of the volume flow of fluid in said sinus during periods when said occlusion is being interrupted, and said controller is arranged to trigger the initiation of the next said occlusion at a time determined by said flow signals.
Claim 20
Dependent Claim
89 words
Apparatus for intermittently occluding a coronary sinus comprising means for occluding said sinus, and a controller having means for providing trigger signals to said occluding means to trigger an occlusion and to interrupt said occluison, said apparatus being characterized in that a sensor is provided for delivering flow signals indicative of the volume flow of fluid in said sinus during periods when said occlusion is being interrupted, and said controller is arranged to trigger the initiation of the next said occlusion at a time determined by said flow signals.
Claim 21
Dependent Claim
21 words
The apparatus of claim 17 characterized in that said flow signals represent the velocity of flow of fluid in said sinus.
Claim 22
Dependent Claim
28 words
The apparatus of claim 17 wherein said sensor comprises means for determining said flow signals based on the fluid pressure in said sinus as a function of time.
Claim 23
Dependent Claim
72 words
The apparatus of claim 17 further characterized in that said controller includes sampling circuitry for sampling said flow signals and storing said samples, analysis circuitry for determining from said stored samples the time when the peak of said volume flow occurs during each period of interruption of said occlusion, and trigger circuitry for delivering a trigger signal to trigger the next said occlusion at a time determined by when said peak occurs.
Claim 24
Dependent Claim
26 words
The apparatus of claim 20 wherein said trigger circuitry further comprises means for delivering said trigger signal to trigger said next occlusion after said peak occurs.
Claim 25
Dependent Claim
34 words
The apparatus of claim 17 further characterized in that said occluding means comprises an inflatable element in said sinus and a pump for selectably inflating said inflatable element in response to said trigger circuitry.
Claim 26
Independent Claim
66 words
A method for intermittently occluding a coronary sinus comprising providing means for occluding said sinus, occluding said sinus, and thereafter interrupting said occlusion, the method being characterized by the steps of determining the flow within said sinus during said interruption, determining the time of the peak of said flow, and triggering the next occlusion of said sinus at a time determined by when said peak occurs.
Claim 27
Independent Claim
66 words
A method for intermittently occluding a coronary sinus comprising providing means for occluding said sinus, occluding said sinus, and thereafter interrupting said occlusion, the method being characterized by the steps of determining the flow within said sinus during said interruption, determining the time of the peak of said flow, and triggering the next occlusion of said sinus at a time determined by when said peak occurs.
Claim 28
Independent Claim
57 words
A method for aiding analysis of heart function comprising occluding the coronary sinus for a period of time spanning a plurality of successive heartbeats, measuring the fluid pressure in said sinus. displaying a plot of said fluid pressure against time during said occlusion, and analyzing the successive local pressure maxima which occur respectively in said successive heartbeats.
Claim 29
Independent Claim
57 words
A method for aiding analysis of heart function comprising occluding the coronary sinus for a period of time spanning a plurality of successive heartbeats, measuring the fluid pressure in said sinus. displaying a plot of said fluid pressure against time during said occlusion, and analyzing the successive local pressure maxima which occur respectively in said successive heartbeats.
Claim 30
Dependent Claim
89 words
Apparatus (10) for intermittently occluding a coronary sinus comprising means for occluding said sinus, and a controller (28) having means for providing trigger signals to said occluding means to trigger an occlusion and to interrupt said occlusion, said apparatus being characterized in that a pressure transducer (50) is provided for sensing the fluid pressure within said sinus during said occlusion and providing corresponding fluid pressure signals, and said controller is arranged to trigger the initiation of the next said occlusion at a time based on said fluid pressure signals.
Claim 31
Dependent Claim
89 words
Apparatus (10) for intermittently occluding a coronary sinus comprising means for occluding said sinus, and a controller (28) having means for providing trigger signals to said occluding means to trigger an occlusion and to interrupt said occlusion, said apparatus being characterized in that a pressure transducer (50) is provided for sensing the fluid pressure within said sinus during said occlusion and providing corresponding fluid pressure signals, and said controller is arranged to trigger the initiation of the next said occlusion at a time based on said fluid pressure signals.
Claim 32
Dependent Claim
23 words
The apparatus of claim 25 wherein said controller triggers said initiation on the basis of successive pressure maxima of said fluid pressure signais.
Claim 33
Dependent Claim
23 words
The apparatus of claim 25 wherein said controller triggers said initiation on the basis of successive pressure minima of said fluid pressure signals.
Claim 34
Dependent Claim
31 words
The apparatus of claim 25 wherein said controller triggers said initiation on the basis of a combination of parameters derived from successive pressure maxima and minima of said fluid pressure signals.
Claim 35
Dependent Claim
26 words
The apparatus of claim 28 wherein said controller triggers said initiation on the basis of fitting said pressure maxima and said pressure minima to exponential curves.
Claim 36
Dependent Claim
11 words
The apparatus of claim 28 wherein said parameters include heart rate.
Claim 37
Dependent Claim
16 words
The apparatus of claim 29 wherein said parameters include the asymptotic plateaus of said exponential curves.
Claim 38
Dependent Claim
16 words
The apparatus of claim 29 wherein said parameters include the time constants of said exponential curves.
Claim 39
Independent Claim
65 words
A method for intermittently occluding a coronary sinus comprising providing means for occluding said sinus, occluding said sinus, and thereafter interrupting said occlusion, the method being characterized by the steps of: sensing the fluid pressure within said sinus during said occlusion and providing corresponding fluid pressure signals, and triggering the initiation of the next said occlusion at a time based on said fluid pressure signals.
Claim 40
Independent Claim
65 words
A method for intermittently occluding a coronary sinus comprising providing means for occluding said sinus, occluding said sinus, and thereafter interrupting said occlusion, the method being characterized by the steps of: sensing the fluid pressure within said sinus during said occlusion and providing corresponding fluid pressure signals, and triggering the initiation of the next said occlusion at a time based on said fluid pressure signals.
Claim 41
Dependent Claim
23 words
The method of claim 33 wherein said triggering is based on successive pressure maxima and successive pressure minima of said fluid pressure signals.
Claim 42
Dependent Claim
23 words
The method of claim 34 wherein said triggering is based on a combination of parameters derived from said successive pressure maxima and minima.
Claim 43
Dependent Claim
22 words
The method of claim 35 wherein said triggering is based on fitting said pressure maxima and said pressure minima to exponential curves.
Claim 44
Dependent Claim
11 words
The method of claim 35 wherein said parameters include heart rate.
Claim 45
Dependent Claim
16 words
The method of claim 35 wherein said parameters include the asymptotic plateaus of said exponential curves.
Claim 46
Dependent Claim
16 words
The method of claim 35 wherein said parameters include the time constants of said exponential curves.
Claim 47
Dependent Claim
65 words
Apparatus for analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising means for intermittently occluding the coronary sinus of said heart, a pressure transducer for sensing the pressure within said sinus and providing corresponding fluid pressure signals, and means for estimating the amount of said tissue at risk of infarction on the basis of said fluid pressure signals.
Claim 48
Dependent Claim
65 words
Apparatus for analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising means for intermittently occluding the coronary sinus of said heart, a pressure transducer for sensing the pressure within said sinus and providing corresponding fluid pressure signals, and means for estimating the amount of said tissue at risk of infarction on the basis of said fluid pressure signals.
Claim 49
Dependent Claim
27 words
The apparatus of claim 40 wherein said means for estimating bases said estimation on parameters derived from local maxima and local minima of said fluid pressure signals.
Claim 50
Dependent Claim
62 words
Apparatus for analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising means for intermittently occluding the coronary sinus of said heart, a pressure transducer for sensing the pressure within said sinus and providing corresponding fluid pressure signals, and means for estimating the amount of infarcted said tissue on the basis of said fluid pressure signals.
Claim 51
Dependent Claim
62 words
Apparatus for analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising means for intermittently occluding the coronary sinus of said heart, a pressure transducer for sensing the pressure within said sinus and providing corresponding fluid pressure signals, and means for estimating the amount of infarcted said tissue on the basis of said fluid pressure signals.
Claim 52
Dependent Claim
27 words
The apparatus of claim 42 wherein said means for estimating bases said estimation on parameters derived from local maxima and local minima of said fluid pressure signals.
Claim 53
Independent Claim
54 words
A method of analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising intermittently occluding the coronary sinus of said heart, sensing the pressure within said sinus and providing corresponding fluid pressure signals, and estimating the amount of tissue at risk of infarction based on fluid pressure signals.
Claim 54
Independent Claim
54 words
A method of analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising intermittently occluding the coronary sinus of said heart, sensing the pressure within said sinus and providing corresponding fluid pressure signals, and estimating the amount of tissue at risk of infarction based on fluid pressure signals.
Claim 55
Independent Claim
54 words
A method of analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising intermittently occluding the coronary sinus of said heart, sensing the pressure within the sinus and providing corresponding fluid pressure signals, and estimating the amount of infarcted tissue on the basis of the fluid pressure signals.
Claim 56
Independent Claim
54 words
A method of analyzing the degree of tissue damage in a heart subjected to inadequate arterial blood flow comprising intermittently occluding the coronary sinus of said heart, sensing the pressure within the sinus and providing corresponding fluid pressure signals, and estimating the amount of infarcted tissue on the basis of the fluid pressure signals.
References Cited (Backward Citations)
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