US20040019377A1 — Method and apparatus for reducing mitral regurgit…

Claim 1

Independent Claim 110 words

1 . A method for reducing mitral regurgitation, the method comprising the steps of: inserting a flexible delivery catheter into a coronary sinus of a patient in a vicinity of a posterior leaflet of a mitral valve; anchoring a distal end of the catheter in the coronary sinus; moving an elongated body through the catheter and into a position within the catheter and in the vicinity of the posterior leaflet, the body being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior annulus anteriorly and thereby improve leaflet coaption.

Claim 2

Dependent Claim 110 words

1 . A method for reducing mitral regurgitation, the method comprising the steps of: inserting a flexible delivery catheter into a coronary sinus of a patient in a vicinity of a posterior leaflet of a mitral valve; anchoring a distal end of the catheter in the coronary sinus; moving an elongated body through the catheter and into a position within the catheter and in the vicinity of the posterior leaflet, the body being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior annulus anteriorly and thereby improve leaflet coaption.

Claim 3

Dependent Claim 33 words

2 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises engaging barbs on the catheter with internal wall portions of the coronary sinus.

Claim 4

Dependent Claim 37 words

3 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises inflating a balloon attached to the catheter, the balloon engaging internal wall portions of the coronary sinus.

Claim 5

Dependent Claim 36 words

4 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises expanding a stent adjacent the catheter, the stent engaging internal wall portions of the coronary sinus.

Claim 6

Dependent Claim 34 words

5 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises engaging hooks attached to the catheter with internal wall portions of the coronary sinus.

Claim 7

Dependent Claim 34 words

6 . The method in accordance with claim 5 wherein the hooks are fixed on a stent and are caused to engage the wall portions of the coronary sinus by expansion of the stent.

Claim 8

Dependent Claim 24 words

7 . The method in accordance with claim 5 wherein engaging the hooks with the internal wall comprises perforating the wall with the hooks.

Claim 9

Dependent Claim 40 words

8 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises expanding an expandable foam body attached to the catheter, the foam body engaging internal wall portions of the coronary sinus.

Claim 10

Dependent Claim 44 words

9 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises expanding a plurality of selected ones of balloons and foam bodies disposed around the catheter and having gaps therebetween to facilitate blood flow therethrough.

Claim 11

Dependent Claim 40 words

10 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises expanding a compressed wire ball fixed to the catheter, the expanded wire ball engaging internal wall portions of the catheter.

Claim 12

Dependent Claim 51 words

11 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises moving a cam member mounted in the catheter into a position for engaging internal wall portions of the catheter and expanding a diameter of the catheter to engage the coronary sinus.

Claim 13

Dependent Claim 53 words

12 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises flowing adhesive through lumens in the catheter and extending lengthwise thereof, and into side ports in communication with the lumens, to bond the catheter distal end to wall portions of the coronary sinus.

Claim 14

Dependent Claim 32 words

13 . The method in accordance with claim 1 wherein anchoring the catheter comprises providing a mesh fixed to the exterior wall of the catheter for encouraging in-growth of patient body materials.

Claim 15

Dependent Claim 56 words

14 . The method in accordance with claim 1 wherein the anchoring of the distal end of the catheter comprises applying a vacuum to a lumen in the catheter and extending lengthwise thereof, and to side ports in communication with the lumen, to draw wall portions of the coronary sinus to wall portions of the catheter.

Claim 16

Dependent Claim 40 words

15 . The method in accordance with claim 1 and comprising the further step of anchoring a proximal end of the catheter by suturing a sewing cuff fixed to the proximal end of the catheter to a patient's outer skin.

Claim 17

Dependent Claim 34 words

16 . The method in accordance with claim 1 and comprising the further step of sealing closed a proximal end of the catheter by using a cap which plugs into the catheter proximal end.

Claim 18

Dependent Claim 32 words

17 . The method in accordance with claim 1 comprising the further step of sealing closed a proximal end of the catheter by crimping a wire mesh upon the catheter proximal end.

Claim 19

Dependent Claim 24 words

18 . The method in accordance with claim 1 and including the further step of releasably locking the elongated body in the delivery catheter.

Claim 20

Dependent Claim 56 words

19 . The method in accordance with claim 18 wherein the locking of the elongated body in the delivery catheter comprises moving at least one cam member connected to the elongated body and disposed in the catheter, by manipulation of a wire connected to the cam member and extending to a proximal end of the catheter.

Claim 21

Dependent Claim 101 words

20 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a flexible strand into a coronary sinus; anchoring at least a distal end of the strand in the coronary sinus proximate an anterior interventricular vein; interconnecting a proximal end of the strand and a cinch actuation structure; and operating the cinch activation structure to pull the strand taut; whereby to cause the strand to approach a straight configuration and a mid-portion of the strand to engage a posterior wall of the mitral valve annulus, which pushes a posterior mitral valve leaflet anteriorly and thereby improve coaptation.

Claim 22

Dependent Claim 101 words

20 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a flexible strand into a coronary sinus; anchoring at least a distal end of the strand in the coronary sinus proximate an anterior interventricular vein; interconnecting a proximal end of the strand and a cinch actuation structure; and operating the cinch activation structure to pull the strand taut; whereby to cause the strand to approach a straight configuration and a mid-portion of the strand to engage a posterior wall of the mitral valve annulus, which pushes a posterior mitral valve leaflet anteriorly and thereby improve coaptation.

Claim 23

Dependent Claim 29 words

21 . The method in accordance with claim 20 wherein anchoring the distal end of the strand comprises inflating a balloon attached to the distal end of the strand.

Claim 24

Dependent Claim 31 words

22 . The method in accordance with claim 20 wherein anchoring of the distal end of the strand is effected by a stent which anchors to walls of the coronary sinus.

Claim 25

Dependent Claim 41 words

23 . The method in accordance with claim 20 wherein anchoring of the distal end of the stent comprises fixing at least one of barbs and hooks on the distal end of the stent for engaging walls of the coronary sinus.

Claim 26

Dependent Claim 47 words

24 . The method in accordance with claim 20 wherein anchoring of the distal end of the strand comprises fixing at least one of a wireball, a cam, adhesive outlets, and vacuum openings on the distal end of the strand for engaging walls of the coronary sinus.

Claim 27

Dependent Claim 23 words

25 . The method in accordance with claim 20 and including the further step of anchoring the strand at a proximal portion thereof.

Claim 28

Dependent Claim 35 words

26 . The method in accordance with claim 25 wherein the anchoring of the strand at the proximal portion thereof is effected by use of a selected one of an expandable body and a flange.

Claim 29

Dependent Claim 111 words

27 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible delivery catheter for insertion into a coronary sinus of a patient in a vicinity of a posterior leaflet of a mitral valve; structure for anchoring a distal end of said catheter in said coronary sinus; an elongated body for moving through said catheter and into a position within the catheter and in the vicinity of the posterior leaflet, the body being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 30

Dependent Claim 111 words

27 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible delivery catheter for insertion into a coronary sinus of a patient in a vicinity of a posterior leaflet of a mitral valve; structure for anchoring a distal end of said catheter in said coronary sinus; an elongated body for moving through said catheter and into a position within the catheter and in the vicinity of the posterior leaflet, the body being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 31

Dependent Claim 28 words

28 . The assembly in accordance with claim 27 wherein said anchoring structure comprises barbs on said catheter for engaging with internal wall portions of the coronary sinus.

Claim 32

Dependent Claim 30 words

29 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a balloon attached to said catheter, the balloon engaging internal wall portions of the coronary sinus.

Claim 33

Dependent Claim 35 words

30 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a stent adjacent said catheter, said stent being adapted upon expansion thereof for engaging internal wall portions of the coronary sinus.

Claim 34

Dependent Claim 30 words

31 . The assembly in accordance with claim 27 wherein said anchoring structure comprises hooks attached to said catheter and adapted to engage internal wall portions of the coronary sinus.

Claim 35

Dependent Claim 34 words

32 . The assembly in accordance with claim 31 wherein said hooks are fixed on a stent and are adapted to engage the wall portions of the coronary sinus by expansion of the stent.

Claim 36

Dependent Claim 24 words

33 . The assembly in accordance with claim 31 wherein said hooks are adapted for engaging with the internal wall and perforating the wall.

Claim 37

Dependent Claim 38 words

34 . The assembly in accordance with claim 27 wherein said anchoring structure comprises an expandable foam body attached to said catheter, said foam body being adapted upon expansion for engaging internal wall portions of the coronary sinus.

Claim 38

Dependent Claim 37 words

35 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a plurality of selected ones of balloons and foam bodies disposed around the catheter and having gaps therebetween to facilitate blood flow therethrough.

Claim 39

Dependent Claim 35 words

36 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a compressed wire ball fixed to said catheter, said wire ball being expandable to engage internal wall portions of the catheter.

Claim 40

Dependent Claim 46 words

37 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a cam member mounted in said catheter and moveable into a position for engaging internal wall portions of said catheter and expanding a diameter of said catheter to engage the coronary sinus.

Claim 41

Dependent Claim 53 words

38 . The assembly in accordance with claim 27 wherein said anchoring structure comprises lumens in said catheter and extending lengthwise thereof, and side ports in communication with the lumens, the lumens and ports being adapted to flow adhesive therethrough, to bond the catheter distal end to wall portions of the coronary sinus.

Claim 42

Dependent Claim 31 words

39 . The assembly in accordance with claim 27 wherein said anchoring structure comprises a mesh fixed to the exterior wall of said catheter for encouraging in-growth of patient body materials.

Claim 43

Dependent Claim 56 words

40 . The assembly in accordance with claim 27 wherein said anchoring structure comprises lumens in said catheter and extending lengthwise thereof, and side ports in communication with the lumens, the lumens and the ports being adapted to convey a vacuum therethrough to draw wall portions of the coronary sinus into engagement with catheter wall portions.

Claim 44

Dependent Claim 45 words

41 . The assembly in accordance with claim 27 and comprising second anchor structure for anchoring a proximal end of said catheter, said second anchor structure comprising a sewing cuff fixed to the proximal end of said catheter, for suturing to a patient's outer skin.

Claim 45

Dependent Claim 34 words

42 . The assembly in accordance with claim 27 and further comprising a cap for sealing closed a proximal end of said catheter, said cap being adapted to plug into the catheter proximal end.

Claim 46

Dependent Claim 40 words

43 . The assembly in accordance with claim 27 and further comprising a cap for sealing closed a proximal end of said catheter, the cap comprising a wire mesh crimpable upon the catheter proximal end to seal the proximal end.

Claim 47

Dependent Claim 35 words

44 . The assembly in accordance with claim 27 wherein said catheter is provided with at least one prolapse resistant portion comprising a reinforced portion which is less flexible than a remainder of said catheter.

Claim 48

Dependent Claim 42 words

45 . The assembly in accordance with claim 27 , wherein said elongated body is provided at one end thereof with a rounded non-traumatic tip, and strain relief taper, and in width-wise cross-section, a selected one of round and generally rectangular cross-section.

Claim 49

Dependent Claim 23 words

46 . The assembly in accordance with claim 27 wherein said elongated body comprises an elastomeric outer portion disposed upon a core member.

Claim 50

Dependent Claim 27 words

47 . The assembly in accordance with claim 46 wherein the core member comprises a selected one of a substantially rigid rod and a substantially rigid tube.

Claim 51

Dependent Claim 31 words

48 . The assembly in accordance with claim 47 wherein the core member is a tube comprising a selected one of (i) empty and (ii) filled with a substantially rigid material.

Claim 52

Dependent Claim 18 words

49 . The assembly in accordance with claim 46 wherein said outer portion is formed with barbs thereon.

Claim 53

Dependent Claim 23 words

50 . The assembly in accordance with claim 27 wherein said elongated body is provided with strain relief steps at either end thereof.

Claim 54

Dependent Claim 24 words

51 . The assembly in accordance with claim 27 wherein said elongated body is provided with strain relief segments mounted on a central rod.

Claim 55

Dependent Claim 28 words

52 . The assembly in accordance with claim 27 wherein said elongated body is comprised of a selected one of (i) nickel titanium and (ii) an alloy thereof.

Claim 56

Dependent Claim 36 words

53 . The assembly is accordance with claim 27 wherein said body is anchored in said catheter by a selected one of barbs on said body, stents adjacent said body, and hooks attached to said body.

Claim 57

Dependent Claim 21 words

54 . The assembly in accordance with claim 27 wherein said body is anchored in said catheter by an expansion member.

Claim 58

Dependent Claim 24 words

55 . The assembly in accordance with claim 54 wherein the expansion member comprises a selected one of a balloon and an expandable foam.

Claim 59

Dependent Claim 35 words

56 . The assembly in accordance with claim 27 wherein said body is anchored in said catheter by a selected one of an adhesive, a vacuum, an annular lock, a wedge lock, and a cam.

Claim 60

Dependent Claim 101 words

57 . The assembly in accordance with claim 27 wherein said elongated body comprises: an inner tubular member having a plurality of slots extending width-wise of said inner tubular member; and an outer tubular member rotatably disposed on said inner tubular member, said outer tubular member having a plurality of slots extending width-wise of said outer tubular member; the slots of said inner and outer tubular members being alignable with each other to permit bending of said elongated body; and the slots of said inner and outer tubular members being movable to unaligned positions such that said elongated body resists bending.

Claim 61

Dependent Claim 101 words

58 . An assembly for reducing mitral regurgitation, the assembly comprising a flexible catheter having as a part thereof an elongated substantially rigid portion, said catheter being adapted for insertion into a coronary sinus of a patient and adapted to be moved to a position placing the rigid portion in a vicinity of a posterior leaflet of a mitral valve, the rigid portion being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior leaflet anteriorly and thereby improve leaflet coaptation.

Claim 62

Dependent Claim 101 words

58 . An assembly for reducing mitral regurgitation, the assembly comprising a flexible catheter having as a part thereof an elongated substantially rigid portion, said catheter being adapted for insertion into a coronary sinus of a patient and adapted to be moved to a position placing the rigid portion in a vicinity of a posterior leaflet of a mitral valve, the rigid portion being adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, to move the posterior leaflet anteriorly and thereby improve leaflet coaptation.

Claim 63

Dependent Claim 140 words

59 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible guide wire for insertion into a coronary sinus of a patient; a flexible delivery catheter for disposition around said guide wire and adapted for insertion into the coronary sinus; an elongated substantially rigid body fixed to a distal end of a push rod and adapted to advance in said catheter to a vicinity of a posterior leaflet of a mitral valve of the patient; a detachable joint by which said push rod may be separated into distal and proximal portions; and a break-away joint by which said catheter may be separated into distal and proximal portions; whereby after said body is in the vicinity of the posterior leaflet, said push rod and said catheter proximal portions may be removed form the site and withdrawn from the patient.

Claim 64

Dependent Claim 140 words

59 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible guide wire for insertion into a coronary sinus of a patient; a flexible delivery catheter for disposition around said guide wire and adapted for insertion into the coronary sinus; an elongated substantially rigid body fixed to a distal end of a push rod and adapted to advance in said catheter to a vicinity of a posterior leaflet of a mitral valve of the patient; a detachable joint by which said push rod may be separated into distal and proximal portions; and a break-away joint by which said catheter may be separated into distal and proximal portions; whereby after said body is in the vicinity of the posterior leaflet, said push rod and said catheter proximal portions may be removed form the site and withdrawn from the patient.

Claim 65

Dependent Claim 105 words

60 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible strand adapted to advance into and through a coronary sinus; an anchor at a distal end of said strand for securing the distal end in a fixed position in the coronary sinus; a cinch activation structure connected to a proximal portion of said strand and operable by an operator to pull said strand taut; whereby to cause said strand to approach a straight configuration, with a mid-portion of said strand adapted to engage a posterior wall of a mitral valve annulus, to urge a posterior mitral valve leaflet anteriorly to improve coaptation.

Claim 66

Dependent Claim 105 words

60 . An assembly for reducing mitral regurgitation, the assembly comprising: a flexible strand adapted to advance into and through a coronary sinus; an anchor at a distal end of said strand for securing the distal end in a fixed position in the coronary sinus; a cinch activation structure connected to a proximal portion of said strand and operable by an operator to pull said strand taut; whereby to cause said strand to approach a straight configuration, with a mid-portion of said strand adapted to engage a posterior wall of a mitral valve annulus, to urge a posterior mitral valve leaflet anteriorly to improve coaptation.

Claim 67

Dependent Claim 15 words

61 . The assembly in accordance with claim 60 wherein said anchor comprises a balloon.

Claim 68

Dependent Claim 15 words

62 . The assembly in accordance with claim 60 wherein said anchor comprise a stent.

Claim 69

Dependent Claim 31 words

63 . The assembly in accordance with claim 60 wherein said anchor comprises a body having at least one of barbs and hooks thereon for engaging walls of the coronary sinus.

Claim 70

Dependent Claim 30 words

64 . The assembly in accordance with claim 60 and further comprising an anchor at a proximal portion of said strand for securing the proximal portion in a selected location.

Claim 71

Dependent Claim 17 words

65 . The assembly in accordance with claim 64 wherein said proximal portion anchor comprises a balloon.

Claim 72

Dependent Claim 23 words

66 . The assembly in accordance with claim 64 wherein said proximal portion anchor comprises a flange portion of said cinch activation structure.

Claim 73

Dependent Claim 121 words

67 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a guidewire into a coronary sinus of a patient; advancing a catheter around the guidewire and into the coronary sinus; providing a push rod having an elongated substantially rigid body fixed to a distal portion thereof; advancing the push rod through the catheter until the body is in a vicinity of a posterior leaflet of a mitral valve of the patient; detaching a proximal portion of the catheter from a distal portion of the catheter; detaching a proximal portion of the push rod from a distal portion of the push rod; and removing the proximal portions of the catheter and the push rod from the patient.

Claim 74

Dependent Claim 121 words

67 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a guidewire into a coronary sinus of a patient; advancing a catheter around the guidewire and into the coronary sinus; providing a push rod having an elongated substantially rigid body fixed to a distal portion thereof; advancing the push rod through the catheter until the body is in a vicinity of a posterior leaflet of a mitral valve of the patient; detaching a proximal portion of the catheter from a distal portion of the catheter; detaching a proximal portion of the push rod from a distal portion of the push rod; and removing the proximal portions of the catheter and the push rod from the patient.

Claim 75

Dependent Claim 49 words

68 . The method in accordance with claim 1 including the further steps of: before inserting the flexible delivery catheter, inserting a guidewire into the coronary sinus; inserting the flexible catheter into the coronary sinus over the guidewire; and moving the elongated body by means of a push rod.

Claim 76

Dependent Claim 58 words

69 . The assembly in accordance with claim 27 , the assembly further comprising: a guidewire for insertion into the coronary sinus; said delivery catheter being adapted for insertion into the coronary sinus overriding said guidewire; and a push rod for moving the elongated body within said catheter to the position in the vicinity of the posterior leaflet.

Claim 77

Dependent Claim 98 words

70 . An assembly for reducing mitral regurgitation, the assembly comprising: a guidewire for insertion into a coronary sinus of a patient; an elongated body adapted to override said guidewire and move into the coronary sinus; and a push rod adapted to override said guidewire and push said elongated body into the coronary sinus and to a vicinity of a posterior leaflet; the body being adapted to straighten a natural curvature of at lest a portion of the coronary sinus in the vicinity of the posterior leaflet, to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 78

Dependent Claim 98 words

70 . An assembly for reducing mitral regurgitation, the assembly comprising: a guidewire for insertion into a coronary sinus of a patient; an elongated body adapted to override said guidewire and move into the coronary sinus; and a push rod adapted to override said guidewire and push said elongated body into the coronary sinus and to a vicinity of a posterior leaflet; the body being adapted to straighten a natural curvature of at lest a portion of the coronary sinus in the vicinity of the posterior leaflet, to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 79

Dependent Claim 104 words

71 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a guidewire into a coronary sinus of a patient; mounting a substantially rigid elongated body having an axial central lumen therein on a proximal end of the guidewire and passing the body distally from the guidewire proximal end; mounting a push rod having an axial central lumen therein on the proximal end of the guidewire and moving the push rod along the guidewire to push the body distally in the coronary sinus to a vicinity of a posterior leaflet, to move a posterior annulus anteriorly to improve leaflet coaptation.

Claim 80

Dependent Claim 104 words

71 . A method for reducing mitral regurgitation, the method comprising the steps of: advancing a guidewire into a coronary sinus of a patient; mounting a substantially rigid elongated body having an axial central lumen therein on a proximal end of the guidewire and passing the body distally from the guidewire proximal end; mounting a push rod having an axial central lumen therein on the proximal end of the guidewire and moving the push rod along the guidewire to push the body distally in the coronary sinus to a vicinity of a posterior leaflet, to move a posterior annulus anteriorly to improve leaflet coaptation.

Claim 81

Dependent Claim 30 words

72 . The method in accordance with claim 71 and comprising the further step of removing the guidewire and the push rod, and leaving the body in the coronary sinus.

Claim 82

Dependent Claim 20 words

73 . The assembly in accordance with claim 27 wherein said elongated body is of a shape memory alloy material.

Claim 83

Dependent Claim 18 words

74 . The assembly in accordance with claim 27 wherein said elongated body is of a superelastic material.

Claim 84

Dependent Claim 184 words

75 . An elongated body for introduction into a coronary sinus, the body comprising: an elastomeric sleeve substantially closed at both ends thereof, said sleeve defining two internal chambers in axial alignment with each other, the chambers being separated by a wall having an aperture therein; a rod slidably disposed in the aperture and entering into the two chambers, said rod having a distal flexible portion, a middle rigid portion, and a proximal flexible portion; and a pull wire extending from the proximal end of said rod and through a proximal end of said sleeve; said rod being positionable such that one of the flexible portions of said rod is disposed in the aperture in the chamber wall, rendering the body flexible; and said rod being positionable by manipulation of said pull wire to cause the rod rigid portion to be disposed in the aperture in the chamber wall, rendering the wall rigid; whereby the body may be rendered flexible so as to be moved to the coronary sinus and may be rendered rigid so as to effect a change in coronary leaflet coaptation.

Claim 85

Dependent Claim 184 words

75 . An elongated body for introduction into a coronary sinus, the body comprising: an elastomeric sleeve substantially closed at both ends thereof, said sleeve defining two internal chambers in axial alignment with each other, the chambers being separated by a wall having an aperture therein; a rod slidably disposed in the aperture and entering into the two chambers, said rod having a distal flexible portion, a middle rigid portion, and a proximal flexible portion; and a pull wire extending from the proximal end of said rod and through a proximal end of said sleeve; said rod being positionable such that one of the flexible portions of said rod is disposed in the aperture in the chamber wall, rendering the body flexible; and said rod being positionable by manipulation of said pull wire to cause the rod rigid portion to be disposed in the aperture in the chamber wall, rendering the wall rigid; whereby the body may be rendered flexible so as to be moved to the coronary sinus and may be rendered rigid so as to effect a change in coronary leaflet coaptation.

Claim 86

Dependent Claim 113 words

76 . A method for reducing mitral regurgitation comprising: inserting apparatus into the coronary sinus of a patient in the vicinity of the posterior leaflet of the mitral valve, the apparatus having a distal end, a proximal end and an intermediate portion, the apparatus being configured so that when the apparatus is positioned in the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, the distal and proximal ends will apply a posteriorly-directed force to the walls of the coronary sinus and the intermediate portion will apply an anteriorly-directed force to the walls of the coronary sinus, whereby to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 87

Dependent Claim 113 words

76 . A method for reducing mitral regurgitation comprising: inserting apparatus into the coronary sinus of a patient in the vicinity of the posterior leaflet of the mitral valve, the apparatus having a distal end, a proximal end and an intermediate portion, the apparatus being configured so that when the apparatus is positioned in the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, the distal and proximal ends will apply a posteriorly-directed force to the walls of the coronary sinus and the intermediate portion will apply an anteriorly-directed force to the walls of the coronary sinus, whereby to move the posterior annulus anteriorly and thereby improve leaflet coaptation.

Claim 88

Dependent Claim 96 words

77 . Apparatus for reducing mitral regurgitation comprising: a body having a distal end, a proximal end and an intermediate portion, the body being configured so that when the body is positioned in the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, the distal and proximal ends will apply a posteriorly-directed force to the walls of the coronary sinus, and the intermediate portion will apply an anteriorly-directed force to the walls of the coronary sinus, whereby to move the posterior annulus of the mitral valve anteriorly and thereby improve leaflet coaptation.

Claim 89

Dependent Claim 96 words

77 . Apparatus for reducing mitral regurgitation comprising: a body having a distal end, a proximal end and an intermediate portion, the body being configured so that when the body is positioned in the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, the distal and proximal ends will apply a posteriorly-directed force to the walls of the coronary sinus, and the intermediate portion will apply an anteriorly-directed force to the walls of the coronary sinus, whereby to move the posterior annulus of the mitral valve anteriorly and thereby improve leaflet coaptation.

Method and apparatus for reducing mitral regurgitation

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