US20060095025A1
Expired / Lapsed
US
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Cardiac devices and methods for minimally invasive repair of ischemic mitral regurgitation
Assignee: General Hospital Corp
•
Filing: 2003-08-01
•
Granted: —
•
Expires: 2023-08-01
Abstract
Abstract Novel apparatus and minimally invasive methods to treat atrioventricular valve regurgitation that is a result of tethering of chordae attaching atrioventricular valve leaflets to muscles of the heart, such as papillary muscles and muscles in the heart wall, thereby restricting the closure of the leaflets. Catheter embodiments for delivering and positioning chordal severing and elongating instruments are described.
Inventors
- 👤 Robert Levine
- 👤 Emmanuel Messas
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-22 23:58
CPC Classifications
A; A61; A61B; A61B17/00; A61B17/00234; A61B17/22; A61B17/221; A61B18/00; A61B18/18; A61B18/20; A61B18/22; A61B18/24; A61B18/04; A61B18/12; A61B18/14; A61B18/1492; A61B2017/00238; A61B2017/00243; A61B2017/00292; A61B2017/003; A61B2017/00349; A61B2017/00831; A61B2017/00867; A61B17/22031; A61B2017/22035; A61B17/32; A61B17/320016; A61B2017/32004; A61F; A61F2/00; A61F2/02; A61F2/24; A61F2/2442; A61F2/2454; A61F2/2457
Claims Analysis
Total Claims: 59
Claim 1
Independent Claim
61 words
1 . An apparatus for treating atrioventricular valve regurgitation, comprising: a cutting instrument for severing at least one chord attaching an atrioventricular leaflet to a internal cardiac muscle; and a positioning catheter through which the cutting instrument is positioned proximate the at least one chord, the catheter including an opening through which the cutting instrument severs the at least one chord.
Claim 2
Dependent Claim
61 words
1 . An apparatus for treating atrioventricular valve regurgitation, comprising: a cutting instrument for severing at least one chord attaching an atrioventricular leaflet to a internal cardiac muscle; and a positioning catheter through which the cutting instrument is positioned proximate the at least one chord, the catheter including an opening through which the cutting instrument severs the at least one chord.
Claim 3
Dependent Claim
29 words
2 . The apparatus of claim 1 , wherein the cutting instrument comprises a blade having a cutting edge diameter approximating the diameter of the at least one chord.
Claim 4
Dependent Claim
21 words
3 . The apparatus of claim 1 , wherein the cutting instrument comprises an optical fiber for delivering ablative laser energy.
Claim 5
Dependent Claim
16 words
4 . The apparatus of claim 1 , wherein the cutting instrument comprises a radiofrequency electrode.
Claim 6
Dependent Claim
26 words
5 . The apparatus of claim 1 , wherein the catheter has a curved end suitable to allow engagement of chords attached to a posterior leaflet.
Claim 7
Dependent Claim
15 words
6 . The apparatus of claim 1 , wherein the catheter includes a steerable tip.
Claim 8
Dependent Claim
21 words
7 . The apparatus of claim 6 , wherein the catheter further comprises coaxial steering wires for steering the catheter tip.
Claim 9
Dependent Claim
34 words
8 . The apparatus of claim 1 , wherein the cutting instrument is reversibly extendable through the opening, the opening being located at the end of the catheter proximate the at least one chord.
Claim 10
Dependent Claim
33 words
9 . The apparatus of claim 1 , wherein the opening comprises a notch in the catheter having a cross-sectional notch area greater than the cross-sectional area of the at least one chord.
Claim 11
Dependent Claim
37 words
10 . The apparatus of claim 9 , wherein the notch includes at least one protruding edge defining a portion of the notch for limiting motion of the at least one chord when positioned within the notch.
Claim 12
Dependent Claim
23 words
11 . The apparatus of claim 1 , wherein the cutting instrument further comprises a means for grasping the at least one chord.
Claim 13
Dependent Claim
26 words
12 . The apparatus of claim 11 , wherein the means comprises a wire having a deformed end for partially encompassing the at least one chord.
Claim 14
Dependent Claim
25 words
13 . The apparatus of claim 12 , wherein the wire is composed of a shape memory material that deforms at or near body temperature.
Claim 15
Dependent Claim
44 words
14 . The apparatus of claim 11 , wherein the grasping means is reversibly extendable through the opening, the opening being located at the end of the catheter proximate the at least one chord, so as to retract a grasped chord toward the opening.
Claim 16
Dependent Claim
36 words
15 . The apparatus of claim 1 , further comprising a pair of operable jaws disposed at the end of the positioning catheter proximate the at least one chord for grasping the at least one chord.
Claim 17
Dependent Claim
40 words
16 . The apparatus of claim 1 , further comprising a pair of pivoting pincers disposed at the end of the positioning catheter proximate the at least one chord for pinioning the at least one chord in a closed position.
Claim 18
Dependent Claim
24 words
17 . The apparatus of claim 1 , further comprising an introducer catheter for advancing the positioning catheter toward the at least one chord.
Claim 19
Dependent Claim
33 words
18 . The apparatus of claim 17 , wherein the introducer catheter further comprises a directing arm through which the positioning catheter is maneuvered to the position proximate the at least one chord.
Claim 20
Dependent Claim
28 words
19 . The apparatus of claim 17 , wherein the introducer catheter further comprises a means for temporarily stabilizing the position of the introducer catheter within the LV.
Claim 21
Dependent Claim
40 words
20 . The apparatus of claim 19 , wherein the stabilization means comprises: one or more contact elements reversibly extendable from the introducer catheter so as to contact an internal surface of the heart cavity at one or more points.
Claim 22
Dependent Claim
31 words
21 . The apparatus of claim 20 , wherein the contact element is composed of a shape memory elastic material that assumes the shape desired upon extension from the introducer catheter.
Claim 23
Dependent Claim
28 words
22 . The apparatus of claim 17 , further comprising an ultrasound transducer for imaging a region proximate the at least one chord located on the introducer catheter.
Claim 24
Dependent Claim
72 words
23 . The apparatus of claim 17 , wherein the positioning catheter protrudes from within the introducer catheter through an opening in the introducer catheter; and further comprising a plurality of positioning wires similarly disposed within and protruding from the introducer catheter, the positioning wires attached to the positioning catheter so as to enable steering of the end of the positioning catheter by selectively tensioning on one or more of the wires.
Claim 25
Dependent Claim
34 words
24 . The apparatus of claim 17 , wherein the introducer catheter further comprises an imaging device oriented so as to image a region near the mitral valve including the at least one chord
Claim 26
Dependent Claim
64 words
25 . The apparatus of claim 24 , wherein the imaging device is comprised of a imager selected from the group consisting of: a two-dimensional matrix array of piezoelectric crystals, a linear phased array and means for rotating the array within the catheter so as to produce a three-dimensional image, a magnetic resonance coil, and fiber optics for transmitting and receiving near infrared energy.
Claim 27
Dependent Claim
35 words
26 . Method of treating atrioventricular valve regurgitation related to restricted leaflet closure by leaflet tethering, comprising the step of: percutaneously severing at least one chord attaching an atrioventricular leaflet to an internal cardiac muscle.
Claim 28
Dependent Claim
35 words
26 . Method of treating atrioventricular valve regurgitation related to restricted leaflet closure by leaflet tethering, comprising the step of: percutaneously severing at least one chord attaching an atrioventricular leaflet to an internal cardiac muscle.
Claim 29
Dependent Claim
21 words
27 . The method of claim 26 , further comprising step of: grasping the at least one chord prior to severing.
Claim 30
Dependent Claim
18 words
28 . The method of claim 26 , wherein the at least one chord is a basal chord.
Claim 31
Dependent Claim
41 words
29 . The method of claim 26 , wherein the at least one chord comprises two chords, wherein a first one of the chords attaches to an anterior leaflet, and a second one of the chords attaches to a posterior leaflet.
Claim 32
Dependent Claim
19 words
30 . The method of claim 26 , wherein the at least one chord comprises a pair of chords.
Claim 33
Dependent Claim
28 words
31 . The method of claim 30 , wherein the pair of chords comprises two chords of an anterior leaflet closest to the central axis of the ventricle.
Claim 34
Dependent Claim
26 words
32 . The method of claim 26 , further comprising the step of: positioning a cutting device proximate the at least one chord via a catheter.
Claim 35
Dependent Claim
69 words
33 . The method of claim 32 , wherein the positioning step includes advancing the cutting device via a pathway selected from the group consisting of: retrograde via the aterial system into the left ventricle, through the venous system and right atrium into the left atrium across the atrial septum, directly through a wall of the heart, and percutaneously through a small incision in the chest wall and pericardium.
Claim 36
Dependent Claim
21 words
34 . The method of claim 32 , wherein the advancing step is assisted through the percutaneous use of robotic tools.
Claim 37
Dependent Claim
29 words
35 . The method of claim 26 , further comprising steps of: imaging a cardiac region including the at least one chord prior to and during the severing process.
Claim 38
Dependent Claim
18 words
36 . The method of claim 35 , wherein the imaging comprises transducing ultrasound energy to the region.
Claim 39
Dependent Claim
23 words
37 . The method of claim 36 , wherein the ultrasound energy is transduced from the chest surface, esophagus, or within the heart.
Claim 40
Dependent Claim
30 words
38 . The method of claim 37 , wherein the ultrasound energy transduced from within the heart is provided by an ultrasound transducer positioned proximate the at least one chord.
Claim 41
Dependent Claim
22 words
39 . The method of claim 35 , wherein the imaging comprises optically imaging the region through one or more optical fibers.
Claim 42
Dependent Claim
21 words
40 . The method of claim 35 , wherein an ultrasound transducer is similarly positioned proximate the at least one chord.
Claim 43
Dependent Claim
40 words
41 . An apparatus for treating atrioventricular valve regurgitation, comprising: an instrument for elongating at least one chord attaching an atrioventricular leaflet to a internal cardiac muscle; and a means for delivering the instrument proximate the at least one chord.
Claim 44
Dependent Claim
40 words
41 . An apparatus for treating atrioventricular valve regurgitation, comprising: an instrument for elongating at least one chord attaching an atrioventricular leaflet to a internal cardiac muscle; and a means for delivering the instrument proximate the at least one chord.
Claim 45
Dependent Claim
60 words
42 . The apparatus of claim 41 , wherein the instrument further comprises: two nodes; at least one length of artificial chordal material connecting the two nodes; means for affixing each node at a respective predetermined position along the at least one chord; and means for severing a segment of the at least one chord between the two affixed nodes.
Claim 46
Dependent Claim
22 words
43 . The apparatus of claim 41 , further comprising means for adjusting the at least one length of artificial chordal material.
Claim 47
Dependent Claim
32 words
44 . The apparatus of claim 42 , wherein the means for severing comprises a means selected from the group consisting of radiofrequency electrode(s), blades, or optical fibers delivering ablative laser energy.
Claim 48
Dependent Claim
97 words
45 . The apparatus of claim 42 , wherein each node comprises: a first mateable part and a second mateable part, each part having a recess for receiving a portion of the at least one chord; wherein the means for affixing each node comprises a mechanism for attaching the first mateable part to the second mateable part selected from the group consisting of an adhesive applied to surfaces of the mateable parts, a plurality of connecting pegs and holes disposed at corresponding locations on the mateable parts, and a heating element to anneal together the mateable parts.
Claim 49
Dependent Claim
158 words
46 . The apparatus of claim 41 , wherein: the instrument further comprises two nodes, each node comprised of two mateable parts each having a recess for receiving a portion of the at least one chord, at least one predetermined length of artificial chordal material connecting the two nodes, means for affixing each node at a respective predetermined position along the at least one chord, and means for severing a segment of the at least one chord between the two affixed nodes, and wherein each node; and the delivering means comprises: two jaws, each jaw housing a corresponding one of the two mateable parts of each node and at least one of the jaws housing the at least one predetermined length of artificial chordal material, a controllable hinge mechanism from which the two jaws pivot, and a catheter through which the jaws, controllable hinge mechanism and instrument are advanced to a position proximate the at least one chord.
Claim 50
Dependent Claim
36 words
47 . A method for treating atrioventricular valve regurgitation related to restricted leaflet closure by leaflet tethering, comprising the steps of: elongating at least one chord attaching an atrioventricular valve leaflet to an internal cardiac muscle.
Claim 51
Dependent Claim
36 words
47 . A method for treating atrioventricular valve regurgitation related to restricted leaflet closure by leaflet tethering, comprising the steps of: elongating at least one chord attaching an atrioventricular valve leaflet to an internal cardiac muscle.
Claim 52
Dependent Claim
65 words
48 . The method of claim 47 , wherein the elongating step further comprises the steps of: delivering two nodes to position proximate the least one chord, the nodes being connected to each other by a length of artificial chordal material; securing the two nodes to the at least one chord; and severing the at least one chord at a position between the two nodes.
Claim 53
Dependent Claim
20 words
49 . The method of claim 48 , further comprising the step of adjusting the length of artificial chordal material.
Claim 54
Dependent Claim
27 words
50 . The method of claim 48 , wherein the severing step further comprises applying radiofrequency energy to the at least one chord between the two nodes.
Claim 55
Dependent Claim
54 words
51 . The method of claim 48 , wherein the step of securing each node further comprises the steps of: enclosing a portion of the at least one chord between a first mateable part and a second mateable part of each node; and adhering the first part to the second part of each node.
Claim 56
Dependent Claim
26 words
52 . The method of claim 51 , wherein the adhering step comprises applying heat to anneal the surfaces of the mateable parts of each node.
Claim 57
Dependent Claim
27 words
53 . The method of claim 51 , wherein the adhering step comprises curing an adhesive applied to the surfaces of the mateable parts of each node.
Claim 58
Dependent Claim
39 words
54 . The method of claim 51 , wherein the adhering step comprises pressing the two mateable parts of each node together so as to interconnect pegs and holes at corresponding locations on each surface of the mateable parts.
Claim 59
Dependent Claim
81 words
55 . The method of claim 47 , wherein the delivering step further comprises the steps of: advancing a hinged housing containing the two nodes through an introducer catheter by an approach selected from the list consisting of: retrograde via the aterial system into the left ventricle, through the venous system and right atrium into the left atrium across the atrial septum, directly through a wall of the heart, and percutaneously through a small incision in the chest wall and pericardium.
References Cited (Backward Citations)
US4960424A
Cited
US5052402A
Cited
US5558644A
Cited
US5607389A
Cited
US6283127B1
Cited
US20030145865A1
Cited
US5972030A
Cited
US6451054B1
Cited
US20020100485A1
Cited
US6651672B2
Cited
US5507795A
Cited
US5643248A
Cited
US5957863A
Cited
US5626578A
Cited
US5868768A
Cited
US6129758A
Cited
US5800450A
Cited
US5853368A
Cited
US6269819B1
Cited
US5779715A
Cited
US20030105519A1
Cited
US6770083B2
Cited
US6461366B1
Cited
US6027514A
Cited
US5906630A
Cited
US6165183A
Cited
US6695866B1
Cited
US6080175A
Cited
US6113395A
Cited
US6251128B1
Cited
US6402679B1
Cited
US6355030B1
Cited
US6432039B1
Cited
US20020013571A1
Cited
US6752813B2
Cited
US6629534B1
Cited
US20030018358A1
Cited
US6626899B2
Cited
US6312447B1
Cited
US6626930B1
Cited
US6537314B2
Cited
US20020161378A1
Cited
US20020173811A1
Cited
US20040034380A1
Cited
US6575971B2
Cited
US20030120341A1
Cited
US6540666B1
Cited
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