Device for intracardiac suture

Abstract: Disclosed is an device for intracardiac suture, comprising: a rod 3 provided with a grip member 31 at a proximal end thereof and having a flexible end portion; a piercing catheter 2 having a lumen 21 for movably holding the rod 3 and a flexible distal end portion with a piercing needle 25 at a distal end thereof, and provided with a hemostatic means 24 at a proximal end thereof; a sheath 1 having a lumen 11 for movably holding the piercing catheter 2 and provided with a hemostatic means 14 at a proximal end thereof; and a engaging member 4 being accommodatable in the lumen 21 of the piercing catheter 2 and being fittable a suture thereto; wherein the engaging member 4 accommodated in the piercing catheter 2 can be pushed out of the piercing catheter 2 by pushing said rod 3. The device is applicable to intracardiac suture for various configurations of ASD.

Description: FIELD OF THE INVENTION The present invention relates to a device for intracardiac suture and, more particularly, to a device for intracardiac suture procedure suitable for surgical technique, so-called transcatheter atrioseptopexy, in which a sewing device is inserted into a peripheral blood vessel and manipulated into the heart by cardiocatheterization under cross-sectional echocardiography to sew an atrial septal defect (ASD) by direct suturing. BACKGROUND OF THE INVENTION In general, congenital cardiac diseases such as ASD have been treated by surgical operation. As a matter of course, such a surgical operation includes not only treatment of the affected part but also thoracotomy or laparotomy and causes a lot of damage to a patient. In particular, it causes serious damage to child patients who are poor in physical strength. Recently, a non-operative method for occlusion of atrial septal defects has been developed, in which a cardiocatheter is transvascularly inserted into the heart. This method is known as a percutaneous transluminal therapeutic catheterization, and the first clinical success in this method has been reported in 1976 by King and Mill. In the King et al's method, an atrial septal defect is closed by introducing a pair of umbrella-like members for the left atrium and the right atrium into the both atria with an insertion tool composed of a double-layered catheter and a core wire coaxially arranged therein, placing the members on the opposite sides of the defect, and locking them together at a central hub which crosses the defect. However, this method requires use of a very large-sized insertion tool and hard umbrella-like members, thus making it impossible to apply it to children, especially to preschool children. For this reason, as a result of efforts to miniaturize such a device, Rashkind developed a single-umbrella type plug having a hook and succeeded in clinical application to a child in 1977. However, this method has such a defect that the plug is hooked on an unintended side of the heart because of being provided with the hook. Once the umbrella-like member is opened, it is impossible to change the hooked position as well as to draw back the device from the heart. This requires an emergent surgical operation when the plug is hooked on an unintended side of the heart. In order to overcome such disadvantages, Rashkind had further developed a plug comprising two umbrella-shaped occuluders having eight stainless steel struts and being connectable to each other. The device has been put into clinical use widely for occlusion of patent ductus arteriosus. Japanese unexamined patent application No. 5-237128 filed by James E. Lock, et al. discloses an interatrial occlusion device comprising two umbrella-shaped members composed of eight stainless steel struts like in the Rashkind's device, each strut being provided at a central part thereof with a spring coil. This device is firmly fixed to the thin interatrial septum by closely adhering two umbrella-shaped members to each other in the overlapping state. This device is called as a clam shell-shaped interatrial occuluder because of its configuration similar to that of a clam being a bivalve. The procedure is carried out by inserting an elongated sheath with a thickness of 11 French through the femoral vein. This device has been widely used for closing atrial septal defects by means of percutaneous transluminal therapeutic catheterization since the device can be applied to patients with a weight of 8 kg and above. However, there is a limitation to the applications of these occlusion plugs since only the occlusion plugs with a uniform shape is prepared for various configurations of atrial septal defects and since the occlusion of a defective opening or hole requires use of an occlusion plug twice the size of the defective opening or hole, these devices can be applied only to a relatively small defective openings or holes present in the central part of the atrioventricular septum. In addition, there is a fear of bad effects due to use of occlusion plugs since there is no data on long-term use of the occlusion plug left in the heart. The present inventors have already proposed a catheter assembly for intracardiac suture according to the preamble of claim 1, which is applicable to various configurations of ASD and can percutaneously sew and closed ASD, as disclosed in Japanese unexamined patent application No. 7-171173. This catheter assembly, comprises a piercing member and a tabular member. Using this catheter assembly, the piercing member is placed at the edge of the defective opening or hole in the heart, and the defective opening or hole is closed by tabular member. This catheter assembly is advantageous in that it is applicable to various configurations of ASD, but is disadvantageous for the following reasons. In the method using this catheter assembly, since the piercing member having a sharp edge at a distal end is pierced into the edge of the defective opening or hole in the heart and since the tabular member left in the heart for a long period of time to close the defective opening or hole, the method will be accompanied by some postoperative troubles. In addition, since the tubular member must be so large that it can close the defective opening or hole, such a large foreign substance is left in the body after the operation. For these reasons, further improvements in the catheter assembly for its safty have been desired. US-A-4,235,238 discloses a further device for coeliac tissue-suture. SUMMARY OF THE INVENTION It is an object of the present invention to provide a catheter assembly for intracardiac suture operation, which is suitable for various configurations of ASD, can be handled with ease and can surely sew and close the defective opening or hole. As a result of our assiduous studies for solving the problems in the prior art, the present inventors have got a technical idea of employing an engaging member capable of being engaged with ASD and functioning as the fixation end for a suture to close the ASD. Based on this technical idea, we have completed the present invention. According to the present invention, the above object is achieved by a device for intracardiac suture as defined in claim 1. The dependent claims define preferred and advantageous embodiments of the invention. The piercing catheter and the sheath are provided at the respective proximal ends thereof with a side injection channel for injecting heparinized physiological saline into the suturing site. The distal end portion of the sheath may be bent at a predetermined angle. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a schematic view of a device for intracardiac suture according to the present invention. Fig. 2 shows the device of Fig. 1, in which the engaging member has been pushed out from the top of device. Fig. 3 is a sectional view of the sheath of the device of Fig. 1. Fig. 4 is a sectional view of the piercing catheter of the device of Fig. 1. Fig. 5 to 10 is are explanatory views illustrating intracardiac suture with the device of the invention. DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION Preferred embodiments of the invention are described herein under with reference to the drawings attached hereto. Referring now to Figs. 1 to 4, there is shown the device for intracardiac suture according to the present invention comprising: a rod 3 provided with a grip member 31 at a proximal end thereof and having a flexible end portion; a piercing catheter 2 having a lumen 21 for movably holding the rod 3 and a flexible distal end portion with a piercing needle 25 at a distal end thereof, and provided with a hemostatic means 24 at a proximal end thereof; a sheath 1 having a lumen 11 for movably holding the piercing catheter 2 and provided with a hemostatic means 14 at a proximal end thereof; and a engaging member 4 being accommodatable in the lumen 21 of the piercing catheter 2 and being fittable a suture thereto; wherein the engaging member 4 accommodated in the piercing catheter 2 can be pushed out of the piercing catheter 2 by pushing said rod 3. As in Fig. 3, the sheath 1 is composed of a sleeve 12 with a lumen 11 for free insertion of the piercing catheter 2. The sleeve 12 is provided at its proximal end with a connector 13. The connector 13 has an inlet of the lumen 11, i.e., an insertion hole 145 for the piercing catheter 2, and is provided with the hemostatic means or a hemostatic valve 14 to prevent leakage of the blood during surgical operation. The hemostatic valve 14 is not limited in construction. For example, as in Fig. 3, the homeostatic valve 14 is composed of a screw-hole or nut-like means 144 provided in the rear end of the connector 13, and a packing 141 with a central through-hole 142, and a bolt-like member 143 engaged with the screw-hole 144. By driving the bolt-like member 143 in, the packing 141 is pressed against the bottom wall of the screw-hole 144 to adjust the inner diameter of the through-hole 142. Further, the connector 13 is generally provided with a side injection channel 16 for injecting heparinized physiological saline into the suturing site to prevent occurrence of blood coagulation during surgical operation, and the side injection channel 16 is connected to a side injection tube 17. Preferably the distal portion of the sleeve 12 is made bendable in correspondence with the bending of the piercing catheter 2. As the material for the sleeve 12 of the sheath 1, there may be used synthetic resins such as fluororesins (e.g., polytetrafluoroethylene), polypropylene, polyethylene, polyamide, polyethylene terephthalate, polyurethane and the like, and also meshed or coiled stainless steel (e.g., SUS 304). The connector 13 is generally made from a synthetic resin that includes polypropylene, ABS (acrylonitrile-butadiene-styrene) resins, polyvinyl chloride, polyethylene, polyethylene terephthalate and the like, or even from a metal such as stainless steel, brass or the like. The packing 141 of the hemostatic valve 14 may be made from a material with rubber elasticity, for example, synthetic rubber, such as silicone rubber or isoprene rubber, or natural rubber. As the material for the bolt-like means, there may be used synthetic resins such as polycarbonate, ABS resin and the like. As in Fig. 4, the piercing catheter 2 is composed of a sleeve 22 having a lumen 21 for movably holding the hooking catheter 3 and provided at a distal end with a piercing needle 25 and at a proximal end with a connector 23. The connector 23 has an inlet of the lumen 21, i.e., a insertion hole 245 for the hooking catheter 3, and is provided with a hemostatic means (or a hemostatic valve) 24 to prevent leakage of the blood during surgical operation. The hemostatic valve 24 has the same structure as that of the hemostatic valve 14 of the sheath 1, and is composed of a packing 241, a through-hole 242, a bolt-like member 243 and a nut member 244, as in Fig. 4. Further, the connector 23 is generally provided with a side injection channel 26 for injecting heparinized physiological saline into the suturing site to prevent coagulation of the blood during surgical operation. The side injection channel 26 is connected to a side injection tube 27. The distal portion 28 of the piercing catheter 2 adjacent to the piercing needle 25 is easily bendable. Preferably, as in Fig. 4, the distal portion 28 is bent in correspondence with the shape of the distal portion 11 of the sheath 1. When the piercing catheter 2 is slid forward in the lumen 11 of the sheath 1 and when the top of the connector 23 of the piercing catheter 2 is brought into contact with the bottom of the connector 13 of the sheath 1, then a predetermined length of the piercing needle 25 is put out of the sheath 1, as in Fig. 6. The length of the piercing needle 25 put out is preferably such that the edge of the piercing needle 25 is fully put out. Regarding the material of the piercing catheter 2, the sleeve 22 is preferably made of meshed or coiled stainless steel, while the connector 23 is generally made from a synthetic resin such as polypropylene, ABS resin, polyvinyl chloride, polyethylene and polyethylene terephthalate, or a metal such as stainless steel, brass or the like. Preferably, the bendable distal portion 28 may be made from a synthetic resin such as nylon, polyethylene, polyethylene terephthalate or the like, or a meshed or coiled stainless steel. The piercing needle 25 may be generally made of stainless steel such as SUS 304 or the like. The rod 3 is a long member, provided with a grip member 31 at a proximal end and at a distal end portion 32 being flexible. The length of the rod 3 is such that, when the rod 3 is slid forward in the piercing catheter 2 and when the top of the grip member 31 is brought into contact with the bottom of the connector 23 of the piercing catheter 2, then the engaging member 4 accommodated in the lumen 21 of the piercing catheter 2 is pushed out of the piercing needle 25 of the piercing catheter 2. Using the device of the invention, the piercing needle 25 is pierced through an atrial septum and the engaging member 4 is pushed to the opposite side of the atrial septum. Then, the engaging member 4 is released from the device and is positioned on the opposite side of the suture thread "T" fixed to the engaging member 4 via the atrial septum. Then, by stretching the suture thread "T", the engaging member 4 can no more move toward the direction of stretching the suture thread "T". Thus, the engaging member 4 is engaged with the wall of the atrial septum. For this, for example, a small hole ( not shown ) is formed in the center of the engaging member 4, through which the suture thread "T" can be fitted to the engaging member 4. For example, the engaging member 4 is made from the same material as for the suture thread "T" , and the suture thread "T" may be hot-sealed with the engaging member 4. The shape of the engaging member 4 is not specifically defined that it can be engaged with the wall of tan atrial septum. For example, the engaging member 4 may be in any form of tubular or bead-like ones, or in any other form. Regarding the materials for the engaging member and the suture thread, the engaging member may be made from any of metal, ceramic, synthetic resin, and the like, and the suture thread may be made from any of silk, polyamide, polypropylene and the like. Using the thus-constructed device for intracardiac suture according to the present invention, ASD atrioseptopexy is carried out in the following manner. This atrioseptopexy will be explained below, making reference to the accompanying drawings of Fig. 5 to 10. Firstly, the catheter assembly "A" comprises the sheath 1, the piercing catheter 2, the rod 3 and the engaging member 4 and in which both the top of the sheath 1 and the top of the piercing needle 25 of the piercing catheter 2 are in the same position, as shown in Fig. 1. The catheter assembly is maneuvered into a sheath( not shown ), which has been previously maneuvered into the right atrium of a patient's heart through the femoral vein of its right leg, and is introduced into the right atrium of the patient's heart. After the distal end portion of the catheter assembly "A" has been introduced into the right atrium, the piercing needle 25 is put out.of the tip of the sheath 1, by pushing the connector 23 of the piercing catheter 2 forward by one hand, while holding the sheath 1 by the other hand, as in Fig. 5. Next, the assembly "A" is pushed to puncture the interatrial septum "S" with the piercing needle 25, whereby the distal end portion of the assembly "A" is introduced into the left atrium, as in Fig. 6. Next, the engaging member 4 is pushed out of the piercing needle 25 of the distal end of the piercing catheter 2 by pushing the rod 3 forward by one hand , while holding the sheath 1 by the other hand as in Fig. 7. Thus, the suture thread "T1" in the right atrium is fixed in the atrial septum "S" by means of the engaging member 4 as an anchor in the left atrium. Next, the piercing needle 25, is accommodated in the sheath 1 by pushing the piercing catheter 2, and the catheter assembly "A" is taken out of the body. Next, another catheter assembly "B" which is the same as the catheter assembly "A" and which comprises the sheath 10, the piercing catheter 20, the rod 30 and the engaging member 40, is introduced into the right atrium, using the same sheath as that used for introducing the assembly "A" into the right atrium, as in Fig.8. After the catheter assembly "B" has introduced into the right atrium, the engaging member 40 is pushed out the left atrium and the suture thread "T2" is fixed in the atrial septum "S", in the same manner as that for the catheter assembly "A", as in Fig. 9. Next, the assembly "B" is taken out of the body also in the same manner as that for the catheter assembly "A", and the suture threads "T1" and "T2" are ligated together, using a suture-ligating device ( not shown ), and the unnecessary parts of the threads are cut off. In that manner, the ASD atrioseptopexy is finished, as in Fig. 10. In case of two or more stitches being required, the same process as above is repeated. As mentioned above, use of the device for intracardiac suture of the invention makes it possible to close the affected part by direct suture, so that it can be applied to any form of the atrial septal defect. Further, it is possible to close the atrial septal defect certainly. The intracardiac suture by the device of the invention is safe, because of leaving smaller foreign substances in the heart than the foreign substances left by using the conventional ASD device of the occlusion plugs type. Although the present invention has been fully described in connection with the preferred embodiments thereof with reference to the accompanying drawings, it is to be noted that various changes and modifications are apparent to those skilled in the art.

Claims: A device for intracardiac suture, comprising: a rod (3) provided with a grip member (31) at a proximal end thereof and having a flexible distal end portion (32); a catheter (2) having a lumen (21) for movably holding the rod (3) and a flexible distal end portion (28); a sheath (1) having a lumen (11) for movably holding the catheter (2); and an engaging member (4) being accommodatable in the lumen (21) of the catheter (2), being fittable a suture thereto, and being adapted to be pushed out of and releasable from the distal end portion (28) of the catheter (2) by pushing said rod (3), whereby hemostatic means (11, 24) to prevent leakage of blood during surgical operation are provided at proximal ends of the catheter (2) and the sheath (1), characterized in that the catheter (2) is a piercing catheter with a piercing needle (25) at a distal end of the flexible distal end portion (28) of the catheter and that the catheter (2) and the sheath (1) are provided at the respective proximal ends thereof with a side injection channel (16, 26) for injecting heparinized physiological saline into the suturing site. The device for intracardiac suture according to claim 1, wherein a distal end portion of the sheath (1) is bent at a predetermined angle.

Inventors: KISHIGAMI YOSHIKAZU, KOIKE KAZUYUKI, MIYAGAWA KATSUYA, KISHIGAMI, YOSHIKAZU, KOIKE, KAZUYUKI, MIYAGAWA, KATSUYA
Applicants: NIPRO CORP, NIPRO CORPORATION
Application year: 1998
Main classification: A61B17
IPC codes: A61B17