US20040059351A1
Expired / Lapsed
US
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Methods and apparatus for atrioventricular valve repair
Assignee: Cedars-Sinai Medical Center
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Filing: 2003-07-28
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Granted: —
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Expires: 2023-07-28
Abstract
Abstract Methods and devices are disclosed for minimally invasive procedures in the heart. In one application, a catheter is advanced from the left atrium through the mitral valve and along the left ventricular outflow tract to orient and stabilize the catheter and enable a procedure such as a “bow tie” repair of the mitral valve. Right heart procedures are also disclosed.
Inventors
- 👤 Neal Eigler
- 👤 Matthew Price
- 👤 Robert Siegel
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-23 12:45
CPC Classifications
A; A61; A61B; A61B17/00; A61B17/04; A61B17/0469; A61B17/0491; A61B17/00234; A61B2017/00238; A61B2017/00243; A61B2017/00292; A61B2017/003; A61B2017/00743; A61B2017/00778; A61B2017/00783; A61B2017/0472; A61B17/06; A61B17/06066; A61B2017/0608; A61B17/22; A61B2017/22038; A61B2017/22051; A61B2017/22065; A61B2017/22069
Claims Analysis
Total Claims: 88
Claim 1
Independent Claim
76 words
1 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter antegrade through the mitral valve, through the aortic valve and into the aorta, such that the procedure zone is positioned upstream from the aortic valve; and performing a procedure from the procedure zone.
Claim 2
Dependent Claim
76 words
1 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter antegrade through the mitral valve, through the aortic valve and into the aorta, such that the procedure zone is positioned upstream from the aortic valve; and performing a procedure from the procedure zone.
Claim 3
Dependent Claim
27 words
2 . A method of performing a procedure in the heart as in claim 1 , wherein the advancing step comprises advancing the catheter along a guidewire.
Claim 4
Dependent Claim
52 words
3 . A method of performing a procedure in the heart as in claim 2 , additionally comprising the steps of positioning a flow directed catheter through the mitral valve, through the aortic valve and into the aorta, advancing the guidewire through the flow directed catheter, and removing the flow directed catheter.
Claim 5
Dependent Claim
24 words
4 . A method of performing a procedure in the heart as in claim 2 , wherein the guidewire is a flow directed guidewire.
Claim 6
Dependent Claim
24 words
5 . A method of performing a procedure in the heart as in claim 1 , wherein the catheter is a flow directed catheter.
Claim 7
Dependent Claim
41 words
6 . A method of performing a procedure in the heart as in claim 1 , wherein the advancing step comprises advancing the catheter to position the procedure zone within a flow path between the mitral valve and the aortic valve.
Claim 8
Dependent Claim
27 words
7 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure zone comprises an opening carried by the catheter.
Claim 9
Dependent Claim
29 words
8 . A method of performing a procedure in the heart as in claim 2 , wherein the opening comprises an opening in a side wall of the catheter.
Claim 10
Dependent Claim
55 words
9 . A method of performing a procedure in the heart as in claim 2 , wherein the catheter comprises an outer tubular wall having a central lumen, and an inner elongate flexible body extendable through the central lumen, and the procedure zone comprises an opening at a distal end of the outer tubular wall.
Claim 11
Dependent Claim
23 words
10 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises a diagnostic procedure.
Claim 12
Dependent Claim
23 words
11 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises a therapeutic procedure.
Claim 13
Dependent Claim
23 words
12 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises an imaging procedure.
Claim 14
Dependent Claim
24 words
13 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises a hemodynamic monitoring procedure.
Claim 15
Dependent Claim
23 words
14 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises an ablation procedure.
Claim 16
Dependent Claim
24 words
15 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises an atrioventricular valve repair.
Claim 17
Dependent Claim
35 words
16 . A method of performing a procedure in the heart as in claim 1 , further comprising the step of transluminally advancing the catheter through the intra atrial septum prior to the advancing step.
Claim 18
Dependent Claim
29 words
17 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises grasping at least one leaflet of the mitral valve.
Claim 19
Dependent Claim
36 words
18 . A method of performing a procedure in the heart as in claim 1 , wherein the procedure comprises attaching the anterior leaflet of the mitral valve to the posterior leaflet of the mitral valve.
Claim 20
Dependent Claim
90 words
19 . A method of orienting a first and second tissue grasper with respect to the mitral valve, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end, a distal end and first and second tissue graspers spaced apart from the distal end; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; and positioning the catheter such that the first and second tissue graspers are adjacent the mitral valve.
Claim 21
Dependent Claim
90 words
19 . A method of orienting a first and second tissue grasper with respect to the mitral valve, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end, a distal end and first and second tissue graspers spaced apart from the distal end; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; and positioning the catheter such that the first and second tissue graspers are adjacent the mitral valve.
Claim 22
Dependent Claim
27 words
20 . A method as in claim 19 , further comprising the step of extending at least the first tissue grasper radially outwardly from the flexible body.
Claim 23
Dependent Claim
55 words
21 . A method as in claim 20 , wherein the extending step comprises advancing the first tissue grasper from a first position in which a longitudinal axis of the tissue grasper extends generally parallel with the flexible body, to a second position in which the axis is inclined with respect to the flexible body.
Claim 24
Dependent Claim
35 words
22 . A method as in claim 20 , wherein the extending step comprises advancing the first tissue grasper distally along a pathway which is inclined with respect to a longitudinal axis of the catheter.
Claim 25
Dependent Claim
80 words
23 . A method of grasping a mitral valve leaflet, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end and a distal end; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; deploying a tissue grasper from a position on the catheter spaced apart from the distal end, and grasping a mitral valve leaflet using the tissue grasper.
Claim 26
Dependent Claim
80 words
23 . A method of grasping a mitral valve leaflet, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end and a distal end; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; deploying a tissue grasper from a position on the catheter spaced apart from the distal end, and grasping a mitral valve leaflet using the tissue grasper.
Claim 27
Dependent Claim
23 words
24 . A method of grasping a mitral valve leaflet as in claim 23 , wherein the grasping step comprises piercing the leaflet.
Claim 28
Dependent Claim
23 words
25 . A method of grasping a mitral valve leaflet as in claim 23 , wherein the grasping step comprises trapping the leaflet.
Claim 29
Dependent Claim
25 words
26 . A method of grasping a mitral valve leaflet as in claim 23 , wherein the grasping step comprises applying suction to the leaflet.
Claim 30
Dependent Claim
48 words
27 . A catheter for accessing the heart, comprising: an elongate flexible body, having a proximal end and a distal end; an anchor zone on a distal portion of the flexible body; and at least one tissue manipulator carried by the flexible body proximally of the anchor zone.
Claim 31
Dependent Claim
48 words
27 . A catheter for accessing the heart, comprising: an elongate flexible body, having a proximal end and a distal end; an anchor zone on a distal portion of the flexible body; and at least one tissue manipulator carried by the flexible body proximally of the anchor zone.
Claim 32
Dependent Claim
31 words
28 . A catheter as in claim 27 , wherein the minimum length of the anchor zone on the distal side of the tissue manipulator is at least about 3 cm.
Claim 33
Dependent Claim
31 words
29 . A catheter as in claim 27 , wherein the minimum length of the anchor zone on the distal side of the tissue manipulator is at least about 5 cm.
Claim 34
Dependent Claim
31 words
30 . A catheter as in claim 27 , wherein the minimum length of the anchor zone on the distal side of the tissue manipulator is at least about 10 cm.
Claim 35
Dependent Claim
29 words
31 . A catheter as in claim 27 , wherein the tissue manipulator is moveable between an axial orientation for transluminal navigation and an inclined orientation for manipulating tissue.
Claim 36
Dependent Claim
17 words
32 . A catheter as in claim 27 , comprising a first and a second tissue manipulator.
Claim 37
Dependent Claim
24 words
33 . A catheter as in claim 27 , wherein the first tissue manipulator comprises a tissue grasper for grasping a heart valve leaflet.
Claim 38
Dependent Claim
25 words
34 . A catheter as in claim 27 , comprising at least a first component which is axially moveable with respect to a second component.
Claim 39
Dependent Claim
86 words
35 . A method of performing an atrioventricular valve repair, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end, a distal end, and at least one leaflet grasper thereon; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; grasping at least a first leaflet of the mitral valve with the leaflet grasper; and securing the first leaflet to at least one other anatomical structure.
Claim 40
Dependent Claim
86 words
35 . A method of performing an atrioventricular valve repair, comprising the steps of: providing a catheter having an elongate, flexible body, with a proximal end, a distal end, and at least one leaflet grasper thereon; transluminally advancing the distal end from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; grasping at least a first leaflet of the mitral valve with the leaflet grasper; and securing the first leaflet to at least one other anatomical structure.
Claim 41
Dependent Claim
28 words
36 . A method of performing an atrioventricular valve repair as in claim 35 , wherein the securing step comprises securing the first leaflet to a second leaflet.
Claim 42
Dependent Claim
28 words
37 . A method of performing an atrioventricular valve repair as in claim 35 , wherein the securing step comprises securing the first leaflet to a valve annulus.
Claim 43
Dependent Claim
27 words
38 . A method of performing an atrioventricular valve repair as in claim 35 , wherein the securing step comprises advancing a suture through the first leaflet.
Claim 44
Dependent Claim
27 words
39 . A method of performing an atrioventricular valve repair as in claim 35 , wherein the securing step comprises attaching a clip to the first leaflet.
Claim 45
Dependent Claim
28 words
40 . A method of performing an atrioventricular valve repair as in claim 35 , wherein the securing step comprises attaching a tissue anchor to the first leaflet.
Claim 46
Dependent Claim
81 words
41 . A method of orienting a catheter with respect to the mitral valve, comprising the steps of: positioning a guidewire from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; advancing a catheter along the guidewire, the catheter having an anchor and a procedure site; and locating the anchor with respect to an anatomical feature such that the procedure site is at a predetermined orientation with respect to the mitral valve.
Claim 47
Dependent Claim
81 words
41 . A method of orienting a catheter with respect to the mitral valve, comprising the steps of: positioning a guidewire from the left atrium through the mitral valve and along the left ventricular outflow tract into the ascending aorta; advancing a catheter along the guidewire, the catheter having an anchor and a procedure site; and locating the anchor with respect to an anatomical feature such that the procedure site is at a predetermined orientation with respect to the mitral valve.
Claim 48
Dependent Claim
25 words
42 . A method of orienting a catheter as in claim 41 , wherein the positioning step includes the use of a flow directed structure.
Claim 49
Dependent Claim
31 words
43 . A method of orienting a catheter as in claim 41 , wherein the locating the anchor step comprises positioning a distal portion of the catheter within the ascending aorta.
Claim 50
Dependent Claim
37 words
44 . A method of orienting a catheter as in claim 41 , wherein the locating the anchor step comprises positioning the catheter such that it is approximately centered on the posterior leaflet of the mitral valve.
Claim 51
Dependent Claim
74 words
45 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter through the right atrium, through the right ventricle and into the pulmonary artery, such that the procedure zone is positioned at a treatment site; performing a procedure from the procedure zone.
Claim 52
Dependent Claim
74 words
45 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter through the right atrium, through the right ventricle and into the pulmonary artery, such that the procedure zone is positioned at a treatment site; performing a procedure from the procedure zone.
Claim 53
Dependent Claim
27 words
46 . A method of performing a procedure in the heart as in claim 45 , wherein the advancing step comprises advancing the catheter along a guidewire.
Claim 54
Dependent Claim
25 words
47 . A method of performing a procedure in the heart as in claim 46 , wherein the procedure is performed on the tricuspid valve.
Claim 55
Dependent Claim
25 words
48 . A method of performing a procedure in the heart as in claim 46 , wherein the procedure is performed on the pulmonic valve.
Claim 56
Dependent Claim
39 words
49 . A method of performing a procedure in the heart as in claim 45 , wherein the advancing step comprises advancing the catheter to position the distal end in the right ventricle outflow tract of the pulmonary artery.
Claim 57
Dependent Claim
23 words
50 . A method of performing a procedure in the heart as in claim 45 , wherein the procedure comprises a valve repair.
Claim 58
Dependent Claim
28 words
51 . A method of performing a procedure in the heart as in claim 45 , wherein the procedure comprises grasping at least one leaflet of a valve.
Claim 59
Dependent Claim
34 words
52 . A method of performing a procedure in the heart as in claim 45 , wherein the procedure comprises attaching a first leaflet of a valve to a second leaflet of a valve.
Claim 60
Dependent Claim
76 words
53 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter through at least two valves in the heart, through a first chamber in the heart and at least into a second chamber in the heart; and performing a procedure from the procedure zone.
Claim 61
Dependent Claim
76 words
53 . A method of performing a procedure in the heart, comprising the steps of: providing a catheter having an elongate flexible body, a proximal end, a distal end, and a procedure zone, spaced proximally apart from the distal end; advancing the catheter through at least two valves in the heart, through a first chamber in the heart and at least into a second chamber in the heart; and performing a procedure from the procedure zone.
Claim 62
Dependent Claim
28 words
54 . A method of performing a procedure in the heart as in claim 53 , comprising advancing the catheter through the mitral valve and the aortic valve.
Claim 63
Dependent Claim
23 words
55 . A method of performing a procedure in the heart as in claim 53 , wherein the procedure comprises a valve repair.
Claim 64
Dependent Claim
92 words
56 . A heart-valve repair apparatus, the apparatus comprising: a first cardiac catheter having a proximal end, a distal end, a hollow lumen, and two ports, wherein each of the ports communicate with the hollow lumen; a Valve Immobilization Catheter housed within the first catheter, the valve Immobilization Catheter having a proximal end, a distal end, and comprising a first leaflet immobilization support and opposite thereto a first fixating member; a second leaflet immobilization support and opposite thereto a second fixating member; fastening material having a first end and a second end.
Claim 65
Dependent Claim
92 words
56 . A heart-valve repair apparatus, the apparatus comprising: a first cardiac catheter having a proximal end, a distal end, a hollow lumen, and two ports, wherein each of the ports communicate with the hollow lumen; a Valve Immobilization Catheter housed within the first catheter, the valve Immobilization Catheter having a proximal end, a distal end, and comprising a first leaflet immobilization support and opposite thereto a first fixating member; a second leaflet immobilization support and opposite thereto a second fixating member; fastening material having a first end and a second end.
Claim 66
Dependent Claim
35 words
57 . The heart valve apparatus of claim 56 , wherein a receptacle for the first fixating member is within the first leaflet immobilization support and attached to the first end of the fastening material.
Claim 67
Dependent Claim
35 words
58 . The heart valve apparatus of claim 56 , wherein a receptacle for the second fixating member is within the second leaflet immobilization support and attached to the second end of the fastening material.
Claim 68
Dependent Claim
24 words
59 . The heart-valve repair apparatus of claim 56 , wherein the leaflet immobilization supports and fixating members are mounted on a guide wire.
Claim 69
Dependent Claim
24 words
60 . The heart-valve repair apparatus of claim 57 , wherein the leaflet immobilization supports are mounted to the guide wire via a spring.
Claim 70
Dependent Claim
41 words
61 . The heart-valve repair apparatus of claim 56 , wherein he leaflet immobilization supports are positioned towards the distal end of the Valve Immobilization Catheter and the fixating members are positioned towards the proximal end of the Valve Immobilization Catheter.
Claim 71
Dependent Claim
28 words
62 . The heart-valve repair apparatus of claim 59 , whereby moving the catheter in the proximal direction causes the leaflet immobilization supports to emerge from the ports.
Claim 72
Dependent Claim
44 words
63 . The heart-valve repair apparatus of claim 56 , wherein the leaflet immobilization supports and the ports are positioned towards the proximal end of the Valve Immobilization Catheter and the fixating members are positioned towards the distal end of the Valve Immobilization Catheter.
Claim 73
Dependent Claim
28 words
64 . The heart-valve repair apparatus of claim 61 , whereby moving the catheter in the distal direction causes the leaflet immobilization supports to emerge from the ports.
Claim 74
Dependent Claim
25 words
65 . The heart-valve repair apparatus of claim 56 , wherein the Valve Immobilization Catheter further comprises a semi-rigid curved portion as its distal end.
Claim 75
Dependent Claim
27 words
66 . The heart-valve repair apparatus of claim 56 , wherein the apparatus further comprises an inflatable balloon attached to the distal end of the firs catheter.
Claim 76
Dependent Claim
32 words
67 . The heart-valve repair apparatus of claim 56 , wherein the leaflet-immobilization supports are housed within the Valve Immobilization Catheter, and the Valve Immobilization Catheter is housed within the first catheter.
Claim 77
Dependent Claim
30 words
68 . The heart-valve repair apparatus of claim 56 , wherein the movement of the first catheter, Valve Immobilization Catheter, leaflet immobilization supports and fixating devices is visualized by fluoroscopy.
Claim 78
Dependent Claim
32 words
69 . The heart-valve repair apparatus of claim 56 , wherein the movement of the first catheter, Valve Immobilization Catheter, leaflet immobilization supports and fixating devices is visualized by transthoracic echocardiographic visualization.
Claim 79
Dependent Claim
32 words
70 . The heart-valve repair apparatus of claim 56 , wherein the movement of the first catheter, Valve Immobilization Catheter, leaflet immobilization supports and fixating devices is visualized by transesophageal echocardiographic visualization.
Claim 80
Dependent Claim
32 words
71 . The heart-valve repair apparatus of claim 56 , wherein the movement of the first catheter, Valve Immobilization Catheter, leaflet immobilization supports and fixating devices is visualized by intracardiac echocardiographic visualization.
Claim 81
Dependent Claim
31 words
72 . The heart-valve repair apparatus of claim 56 , wherein the movement of the first catheter, Valve Immobilization Catheter, leaflet immobilization supports and fixating devices is visualized by echocardiographic visualization.
Claim 82
Dependent Claim
26 words
73 . The heart-valve repair apparatus of claim 56 , wherein the adequacy of the repair to the heart valve is assessed by fluoroscopy and/or echocardiography.
Claim 83
Dependent Claim
148 words
74 . A method for repairing a heart valve, the method comprising: inserting a catheter proximal to first and second leaflets of a heart valve; engaging the first leaflet of the heart valve with a first leaflet immobilization support; engaging the second leaflet of the heart valve with a second leaflet immobilization support; advancing a first fixating member through the first leaflet immobilization support, engaging thereby a receptacle within the first leaflet immobilization support, wherein the receptacle is attached to a first end of fastening material; advancing a second fixating member through the second leaflet immobilization support, engaging thereby a receptacle within the second leaflet immobilization support, wherein the receptacle is attached to a second end of fastening material; retracting the fixating members, thereby pulling the fastening material through the leaflets; withdrawing the catheter, the leaflet immobilization supports, and the fixating members; and tying off the fastening material.
Claim 84
Dependent Claim
148 words
74 . A method for repairing a heart valve, the method comprising: inserting a catheter proximal to first and second leaflets of a heart valve; engaging the first leaflet of the heart valve with a first leaflet immobilization support; engaging the second leaflet of the heart valve with a second leaflet immobilization support; advancing a first fixating member through the first leaflet immobilization support, engaging thereby a receptacle within the first leaflet immobilization support, wherein the receptacle is attached to a first end of fastening material; advancing a second fixating member through the second leaflet immobilization support, engaging thereby a receptacle within the second leaflet immobilization support, wherein the receptacle is attached to a second end of fastening material; retracting the fixating members, thereby pulling the fastening material through the leaflets; withdrawing the catheter, the leaflet immobilization supports, and the fixating members; and tying off the fastening material.
Claim 85
Dependent Claim
42 words
75 . The method of claim 74 , wherein the catheter further comprises an inflatable balloon, and the method further comprises inflating the balloon during the step of inserting the catheter proximal to the first and second leaflets of the heart valve.
Claim 86
Dependent Claim
20 words
76 . The method of claim 75 , wherein the inflated balloon rests in the aortic valve anchoring the catheter.
Claim 87
Dependent Claim
57 words
77 . A method for repairing a cardiac atrioventricular valve comprising: a) positioning a leaflet immobilization device across a mitral valve by way of the ventricular outflow tract wherein the ventricular outflow tract orients the leaflet immobilization device so that immobilization of the leaflets will occur without interfering with papillary muscles, chordal structures, or other cardiac structures.
Claim 88
Dependent Claim
57 words
77 . A method for repairing a cardiac atrioventricular valve comprising: a) positioning a leaflet immobilization device across a mitral valve by way of the ventricular outflow tract wherein the ventricular outflow tract orients the leaflet immobilization device so that immobilization of the leaflets will occur without interfering with papillary muscles, chordal structures, or other cardiac structures.
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