Abstract:
The present invention is an assembly comprising a prosthetic valve to be implanted; a radially expandable stent comprising at least one zone intended to be expanded to allow the stent, in the expanded state, to bear against the wall of the body duct to be fitted with the valve, this bearing making it possible to immobilize this stent with respect to this wall; and means for mounting the valve with respect to the stent, making it possible to connect the valve to the stent in such a way that the placement of the stent allows the valve to be mounted in the body duct, and expansion means such as a balloon catheter being provided to trigger expansion of the stent at the implantation site. According to the invention, the valve and the stent are designed in such a way that, at the moment when the stent is expanded, the valve is situated outside the zone or zones of the stent that are subjected to said expansion means. The invention thus consists in separating the valve and said zone or zones to be expanded, so that the expansion of the stent can be effected with an expansion force suitable for perfect anchoring of this stent in the wall of the body duct to be fitted with the valve, and without any risk of destruction or damage of the valve.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of U.S. application Ser. No. 11/829,682, filed Jul. 27, 2007, which is a continuation of U.S. application Ser. No. 10/482,270, filed Jul. 6, 2004, now U.S. Pat. No. 7,252,682, which is the U.S. national phase under §371 of International Application No. PCT/FR02/02352, filed on Jul. 4, 2002, which was published in a language other than English and which claimed priority from French Application No. 01/08898, filed on Jul. 4, 2001, the disclosures of which are hereby incorporated by reference in their entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to an assembly for placing a prosthetic valve in a lumen of the body, especially a heart valve, and in particular an aortic valve. 
     2. Background Art 
     Documents WO 91/17720, WO 98/29057 and EP 1 057 460 each describe an assembly, including the prosthetic valve to be implanted; a radially expandable framework, called a stent, which is able, in the expanded state, to bear against the wall of the body duct to be fitted with the valve, this bearing making it possible to immobilize this stent with respect to this wall; and means for fixing the valve to the stent. The placement of the stent permits mounting of the valve in the body duct, eliminating the need for an external access route and, thus, a direct surgical intervention. 
     However, major drawbacks of this technique are that it entails a risk of the valve being damaged by the balloon used to expand the stent, and it limits the force of expansion that can be imparted to the stent. This limitation has repercussions on the anchoring of the stent, making a displacement of said assembly possible. This limitation also has repercussions on the leaktightness of the stent in the area of the valvular ring which is particularly affected when calcified zones give the valvular ring an irregular form and/or a certain rigidity. 
     Another drawback of the prior art technique is that of directly joining the commissures of the valvules to the stent. The result of this is that an expansion of the stent, and thus of the valve, different than that intended may cause poor coaptation of the valvules and, consequently, defective functioning of the valve. The stent therefore has to undergo a predetermined expansion, which prevents or complicates adaptation of this stent to the anatomical variations. 
     In the case of implantation of an aortic valve, the prior art technique also has drawbacks in that it necessitates very exact positioning of the stent in the aorta so that the valve is located opposite the natural valvular ring, and it entails a risk of blocking the apertures of the coronary arteries that open out at the coronary ostia. 
     BRIEF SUMMARY OF THE INVENTION 
     The present invention aims to overcome these various drawbacks. The assembly of the present invention comprises a prosthetic valve to be implanted; a radially expandable framework, or stent, comprising at least one zone intended to be expanded to allow the stent, in the expanded state, to bear against the wall of the body duct to be fitted with the valve, this bearing making it possible to immobilize the stent with respect to this wall; and means for mounting the valve with respect to the stent, making it possible to connect the valve to the stent in such a way that the placement of the stent allows the valve to be mounted in the body duct, and expansion means such as a balloon catheter being provided to trigger expansion of the stent at the implantation site. According to the invention, the valve and the stent are designed in such a way that, at the moment when the stent is expanded, the valve is situated outside the zone or zones of the stent that are subjected to said expansion means. The invention thus consists in separating the valve and said zone or zones to be expanded, so that the expansion of the stent can be effected with an expansion force suitable for perfect anchoring of this stent in the wall of the body duct to be fitted with the valve, and without any risk of destruction or damage of the valve. 
     According to one possibility, the stent comprises a zone for mounting of the valve, which zone is distinct from the zone or zones of the stent to be expanded, and said mounting means connect the valve to this mounting zone. The expansion of the stent thus triggers the deployment of the valve. 
     According to another possibility, said mounting means are designed in such a way that the valve is axially movable with respect to the stent between a position of non-implantation, in which it is situated outside the zone or zones of the stent that are to be expanded, and a position of implantation, which it can reach after expansion of the stent in the body duct, in which it is immobilized axially with respect to the stent. 
     The valve can thus form a subassembly separate from the stent prior to placement of this stent in the body duct, and it can be placed in the stent once the latter has been implanted. Alternatively, the valve is connected to the stent before said stent is placed in the body duct to be treated, and consequently it is introduced into this duct with the stent; said mounting means then comprise means of displacement so that, once the stent has been expanded, the valve can be displaced between said position of non-implantation and said position of implantation. 
     Said mounting means can then comprise one or more of the following arrangements:
         fastening members such as spikes, hooks or claws that are mounted on the valve and are able to be inserted into the wall delimiting said body duct; these fastening members can be oriented radially with respect to the valve so as to be able to be inserted into said wall upon radial deployment of the valve, or they can be oriented tangentially with respect to the valve so as to be able to be inserted into said wall upon a pivoting of the valve about its axis or upon a longitudinal movement with respect to the stent;   burstable vesicles that are filled with biological adhesive or other suitable adhesive product and are placed on the outer face of the valve, these vesicles being able to burst when the valve is brought into its position of implantation, in particular by their being crushed between the valve and the stent;   at least one circular or helical wire or band integrated in the peripheral wall of the valve and having a shape memory, so that it keeps the valve pressed against the stent in the position of implantation of this valve;   conduits formed in, or fixed on, the peripheral wall of the valve, and rods formed on the stent, or vice versa, these rods being able to be engaged and being able to slide through these conduits as the valve moves from its position of non-implantation to its position of implantation, it being possible to provide means such as hooks in order to immobilize these conduits with respect to these rods in said position of implantation; wires can be connected to the ends of said rods and can pass through said conduits in order to easily guide these rods in these conduits.       

     Preferably, the means for mounting the valve with respect to the stent are designed in such a way that, beyond a threshold of expansion of the stent, they permit a different expansion of the valve and of the stent, so that a variation in the degree of expansion of the stent has no effect on the degree of expansion of the valve. 
     The valve is thus not connected directly to the stent and in particular is not connected to the stent in the area of the commissures of its valvules; in the expanded position of the stent, it can have a predetermined diameter appropriate to it, independently of the diameter of the stent. After implantation, the valve thus has a configuration ensuring that it functions properly irrespective of the degree of expansion of the stent, and this expansion of the stent can be adapted to the anatomical variability encountered at the implantation site. 
     The stent and/or the valve can comprise one or more elements limiting the maximum diameter of expansion of the valve, in particular in the area of the commissure points of this valve. These elements can be longitudinal wires belonging to the stent, or a framework element belonging to the valve. 
     Preferably, the valve has a peripheral wall with a diameter not constant in the axial direction, in particular a frustoconical shape whose diameter decreases in the distal direction, and the zone of the stent intended to receive this peripheral wall of the valve has a shape corresponding to that of this peripheral wall. This peripheral wall and this zone of the stent thus define a determined position of mounting of the valve in the stent, and they ensure that the valve is held in position in the stent. The stent advantageously has a middle portion with a smaller diameter than its end portions. It can in particular have the general form of two inverted truncated cones or an hourglass shape. 
     In the case where the assembly according to the invention permits mounting of an aortic valve, the stent is thus at a distance from the wall of the body duct, in particular by means of a conical or hourglass shape, allowing body fluid to pass to the coronary vessels in the area of the coronary ostia. The valve has a shape corresponding to that zone of the stent in whose area it is intended to be mounted. 
     Advantageously, the valve has a peripheral wall; the stent has, in the distal continuation of that zone of the stent intended to receive the valve, a foldable portion; this foldable portion is movable between an extended position, in which it is situated in the distal continuation of said zone, and a folded position, in which it is placed against the inner face of the peripheral wall of the valve and traps this peripheral wall between it and said zone of the stent, and retaining means are provided for keeping this foldable portion in this folded position. The peripheral wall of the valve is thus pressed against the stent, which ensures leaktightness of the valve with respect to the stent. 
     According to a preferred embodiment of the invention in this case, said retaining means are formed by a wire made of a material that is rigid but has a degree of elastic flexibility, for example a metal material having an undulated form and extending over the entire circumference of said foldable portion. Preferably, the stent comprises a sheath made of an impermeable biocompatible material and at least partially covering it. This sheath forms a fixation base for the valve and at the same time a means of sealing between the stent and the wall of the body duct. The sheath can advantageously have lateral openings that can be positioned opposite the coronary ostia at the time of implantation and thus avoid any zone of stagnation or non-circulation of the blood. 
     Advantageously, in the case where the assembly according to the invention comprises said foldable portion, this foldable portion is formed by a continuation of said sheath, forming a sleeve beyond that zone of the stent intended to receive the valve. Perfect leaktightness is thus obtained between the valve and the stent. The stent preferably has, fixed on said sheath, at least one inflatable peripheral chamber that can be inflated in order to form a seal ensuring leaktightness between the stent and the wall of the body duct to be fitted with the valve. This leaktightness is thus guaranteed notwithstanding the possible presence of calcified portions that give a cardiac ring an irregular shape. 
     Advantageously in this case, the stent has two inflatable peripheral chambers placed either side of that portion of the stent intended to bear against a cardiac valvular ring. The stent can have a cylindrical portion that can bear against a cardiac valvular ring, and a distal portion connected to this cylindrical portion. This distal portion at least partially forms said zone intended to receive the peripheral wall of the valve. The advantage is that said wall of impermeable biocompatible material is situated, in the area of this portion, at a distance from the wall of the body duct, that, in the case of implantation of an aortic valve, eliminates the risk of masking the coronary ostia. 
     The stent can also have a frustoconical or widened proximal portion whose diameter decreases in the distal direction and able, in the case of implantation of a heart valve, to bear against the wall of the ventricle or corresponding auricle of the heart. With this proximal portion it is possible to define the position of the stent, and thus subsequently of the valve, with respect to the zone of implantation. It also helps ensure complete immobilization of the stent. The stent can also have a supplementary bearing portion connected by filiform rods to said distal portion or to said cylindrical portion, these filiform rods having lengths such that this supplementary bearing portion is positioned beyond the coronary ostia. According to an additional characteristic, the stent has hooks that are movable between a retracted position, which they occupy before expansion of the stent, and a position of deployment into which they are brought upon deployment of the stent and in which they are inserted into a wall delimiting the body duct. 
     The stent can also have a portion near to the valvular ring, or situated opposite or on this valular ring, and having a high radial force, that is to say a radial force able to erase the local anatomical irregularities, for example calcifications, with a view to reinforcing the leaktightness at the junction between the stent, the sheath and the wall of the treated duct. This portion can be deployed with the aid of an expansion system with a high radial force and low compliance, for example a balloon. 
     The above embodiments and methods of use are explained in more detail below. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES 
         FIG. 1  is a side view of an expandable framework called a stent, which forms part of the assembly; 
         FIG. 2  is a longitudinal section through a sheath forming part of the assembly, according to a first embodiment; 
         FIG. 3  is a longitudinal section through a heart valve forming part of the assembly, according to this first embodiment; 
         FIG. 4  is view of a detail of the stent, on an enlarged scale; 
         FIG. 5  is a view of another detail of the stent, on an enlarged scale, in a state of non-expansion of the stent; 
         FIG. 6  is a view of the same detail, in cross section along the line VI-VI in  FIG. 5 ; 
         FIG. 7  is a view similar to  FIG. 5 , in a state of expansion of the stent; 
         FIG. 8  and [sic] a view of the same detail, in cross section along the line VIII-VIII in  FIG. 7 ; 
         FIG. 9  is a longitudinal section through the assembly according to the invention, after implantation in an aorta; 
         FIG. 10  is a longitudinal section through the sheath and the valve forming part of the assembly according to the invention, in a second embodiment, with the catheter used for introducing the valve into this sheath; 
         FIG. 11  is a perspective view of the valve according to the second embodiment; 
         FIG. 12  is a view similar to  FIG. 10 , after placement of the valve; 
         FIG. 13  is a view, similar to  FIG. 9 , of the assembly according to a third embodiment; 
         FIG. 14  is a perspective view of the valve that can be placed in the stent shown in  FIG. 13 , and 
         FIGS. 15 through 17  are views of the assembly according to the third embodiment, in cross section on lines XV-XV, XVI-XVI and XVII-XVII, respectively, in  FIG. 13 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     In embodiments described herein, those elements or parts that are identical or similar and are found again from one embodiment to another are designated by the same reference numbers. 
       FIGS. 1 through 3  show, respectively, an expandable framework  2  called a stent, a sheath  3 , and a prosthetic valve  4 . This stent  2 , this sheath  3  and this valve  4  form an assembly  1 , which can be seen in  FIG. 9 , allowing the valve  4  to be placed in an aorta  100 , showing the location of the coronary ostia  101  and the origin of the coronary vessels  104 . 
     Referring to  FIG. 1 , it will be seen that the stent  2  comprises in succession, from one axial end to the other, in the proximal to distal direction, a frustoconical proximal portion  10 , a proximal cylindrical portion  11 , a distal frustoconical portion  12 , several connection rods  13 , and a distal cylindrical portion  14 . 
     This stent  2  is made of a metal, steel or alloy with shape memory. This shape-memory material can in particular be the one known by the brand name Nitinol. 
     The portions  10  through  12  and  14  are made up of a network of filaments forming juxtaposed meshes of diamond shape or, for portion  10 , of triangle shape. The material from which the stent  2  is made is such that these meshes can pass from a contracted configuration, in which the filaments are near one another, giving the meshes an elongate shape, to an expanded configuration, shown in  FIG. 1  and in detail in  FIG. 7 , in which the filaments are spaced apart from one another. 
     In the contracted configuration, the assembly  1  can be introduced into the aorta  100  by means of a catheter, as far as the zone in which the prosthetic valve  4  is to be implanted; in the expanded configuration, the stent  2  bears against the aorta  100 , the wall  102  of the ventricle and the natural valvular ring  103  in the manner shown in  FIG. 9 , such that it permits implantation of the valve  4  in place of the natural valve, the latter having been removed beforehand if necessary. 
     Referring to  FIGS. 1 and 9 , it will be seen that the portion  10  has a diameter decreasing in the distal direction, this portion  10  being configured so that, in the expanded state, it bears against the wall  102  of the ventricle of the heart. 
     In the expanded state, the portion  11  has a diameter such that it is able to bear against the natural valvular ring  103  and a radial force such that it can push the natural valve (or its remnants after partial exeresis) against the ring  103  in order to ensure leaktightness at this site. This portion  11  has deployable hooks  15 , shown more particularly in  FIGS. 5 through 8 . These hooks  15  permit anchoring of the stent  2  in the aorta  100  via the sheath  3 . 
     As is shown in  FIGS. 5 and 6 , each hook  15  extends in the longitudinal direction of a mesh, being connected in a pivotable manner to a proximal zone  16  of connection of two proximal filaments  17 . This hook  15  has a curved and tapered free end  15   a , and a face  15   b  directed to the inside of the stent  2  and of rounded shape. The distal zone  18  of connection of the two other filaments  19  that is situated opposite the base of the hook  15  is able to bear, during expansion of the stent  2 , on this face  15   b , as will be inferred from comparison of  FIGS. 6 and 8 . The fact that this zone  18  bears along this face  15   b  makes it possible to deploy the hook  15  radially outward of the stent  2  and maintain this hook  15  in the deployed position in which its tapered end  15   a  is inserted into the wall of the ring  103 . The hooks can have a fishhook shape in order to prevent their removal. 
     The portion  12  is directly connected to the portion  11  and has a diameter decreasing in the distal direction. This portion  12  is intended to extend to the area of the coronary ostia  101  and to receive the valve  4 . Its frustoconical shape means it is possible to keep the sheath  3  at a distance from the coronary ostia  101  and thus prevent any risk of covering the apertures  104  of the coronary vessels that open out in these. 
     The portion  12  additionally comprises a series of internal arms  25 , shown more particularly in  FIG. 4 . Each arm  25  is connected via its proximal end to a junction zone  16  of two proximal filaments  17  of a mesh, in proximity to the portion  11 , and has a curved distal end  25   a . These arms  25  are inclined toward the inside of the portion  12  before placement of the valve  4  on the stent  2 , and  FIG. 4  shows that in this position they can receive the valve  4 . The latter actually comprises a peripheral wall  30  in which there are longitudinal tunnels  31  for receiving the arms  25 ; these can then be folded back against the wall of the portion  12 , either by deformation of the material constituting the arms  25  and/or the portion  12 , or by shape memory when use is made of a material with shape memory. These arms  25  thus allow the valve  4  to be mounted in the portion  12 , as is shown in  FIG. 9 . 
     The connection rods  13  connect the distal edge of the portion  12  to the proximal edge of the portion  14 . They are arranged uniformly on the periphery of the stent  2  and, as is shown in  FIG. 9 , they have a length that is sufficient to ensure that the portion  14  is placed, after implantation, beyond the coronary ostia  101 . The spacing of these rods  13  can be curbed by an annular element making it possible to limit the upper diameter of the valve  4  to a predefined size. 
     The portion  14  for its part has, in the expanded state, a slightly greater diameter than the internal diameter of the aorta  100 , and it bears against the wall of the latter once the stent  2  has been put in place. This portion  14  can be equipped with hooks  15 . 
     The sheath  3  is made of an impermeable biocompatible material, such as pericardial tissue, material known under the name Dacron, or a polymer such as polyurethane, and it has portions  35 ,  36  and  37 . These portions  35 ,  36  and  37  can be connected, respectively, to the portions  10 ,  11  and  12  and can closely match these portions  10  through  12  when the latter are in the expanded state. The connection between the sheath  3  and the portions  10  through  12  is formed by seams when the assembly  1  is assembled. The connection can also be effected by molding of a polymer material. 
     At the proximal end, the sheath  3  has a flap  40  extending on the outer face of the portion  35 . This flap  40  has, near its free edge, an inflatable peripheral chamber  41 . This chamber  41  can be inflated so as to form a seal ensuring leaktightness between the sheath  3  and the wall of the ventricle  102 , on the proximal side of the natural valvular ring  103 . 
     At the distal end, the sheath  3  has a flap  42  extending on the outer face of the portion  12 . Near its free edge, this flap  42  comprises an inflatable peripheral chamber  43 , similar to the chamber  41  and able to be inflated in the same way as the latter. This chamber  43  ensures leaktightness between the sheath  3  and the ring  103 , on the distal side of the latter. 
     It will be seen from  FIG. 2  that the flap  42  forms a distal sleeve  45  extending beyond the distal edge of the portion  12 , and it is clear from  FIG. 9  that this sleeve  45  can be folded back inside the portion  12 . This sleeve  45  includes a metal wire  46  extending over the entire circumference, this wire  46  having an undulated shape and being elastically deformable. The deformability of this wire  46  allows the sleeve  45  to pass from its extended position shown in  FIG. 2  to its folded position shown in  FIG. 9 , in which it is maintained by elastic return of the wire  46 . In this folded position, the sleeve  45  is placed against the inner face of the peripheral wall  30  of the valve  4  and traps this wall  30  between it and said portion  12 . 
     The valve  4  can be made of a biological material or of a synthetic material, or of a combination of these two types of materials. Its peripheral wall  30  has a frustoconical shape adapted to its tight engagement in the portion  12  when the arms  25  are folded back against this portion  12 , which ensures complete immobilization of the valve  4  in the stent  2 . 
     The assembly  1  is assembled by placing the sheath  3  on the stent  2  and placing the valve  4  on the arms  25 , the stent  2  being in the contracted state. The assembly  1  is then placed in a catheter permitting its introduction into the patient&#39;s body, this catheter including one or more inflatable balloons able to deploy the portions  10 ,  11  and  14 . This catheter is then brought into position in the aorta  100 . The balloons are then inflated in order to deploy the portions  10 ,  11  and  14 ; the forced deployment of the portion  11  by the balloons ensures the deployment of the hooks  15  and triggers deployment of the portion  12 , and consequently of the valve  4 . The chambers  41 ,  43  are then inflated to ensure leaktightness of the sheath  3  with respect to the ring  103 , and the sleeve  45  is folded back inside the portion  12  in order to clamp the peripheral wall  30  of the valve  4  against this portion  12 . 
     As will be apparent from the above, the valve  4  and the stent  2  of the assembly  1  are designed in such a way that the valve  4  is situated outside the zone or zones  10 ,  11 ,  14  to be expanded. The stent  2  can be expanded with a force of expansion adapted for perfect anchoring of this stent  2  in the receiving walls  100 ,  102 ,  103 , and without any risk to the valve  4 . The hooks  15  ensure complete immobilization of the assembly  1  in the aorta  100 , and the chambers  41 ,  43 , and also the sleeve  45 , ensure complete leaktightness of the assembly  1  with respect to the aorta  100 . 
     In the second embodiment of the assembly  1 , the valve  4  is not mounted in advance inside the stent  2  but is placed in it once the stent  2  has been expanded. As is shown in  FIG. 10 , the sheath  3  then has internal tubes  50  formed in such a way as to protrude inside the stent  2  once this sheath  3  is engaged on the stent  2 . These tubes  50  can in particular be sewn or fixed by any other means to the sheath  3  after the latter has been placed on the stent  2 . 
     Referring to  FIG. 11 , it will be seen that the peripheral wall  30  of the valve  4  has, in place of the tunnels  31 , a series of pin-shaped clips  51 . Each clip  51  has an inner arm  52  engaged longitudinally in the wall  30 , and a rectilinear outer arm  53  extending along the outer face of the wall  30 . The arms  53  terminate in curved ends and are connected to wires  55  engaged and able to slide in the tubes  50 . 
     As is shown in  FIG. 10 , a catheter  80  is used to bring the valve  4  into position in the sheath  3 . The valve  4  is engaged with sliding on the catheter  80 , and the wires  55 , after passing through the tubes  50 , are engaged in the catheter  80  from the direction of the distal opening thereof and pass through this catheter  80  in order to be actuated from the outside. The valve  4  is put into place and deployed by pulling on the different wires  55  so as to engage the different arms  53  in the tubes  50 . The inner arms  52  can comprise (see  FIG. 12 ) proximal hooks that complete the deployment of the valve  4  by being fastened to the wall of the sheath  3 , for example by means of inflation of a balloon. 
     In the third embodiment of the assembly  1  shown in  FIG. 13 , the stent  2  forms a median cage delimited by a ring  60  and by longitudinal wires  61 , in which cage the valve  4  is tightly inserted. As is shown in  FIG. 14 , the valve  4  has a lateral wall  30  of tubular shape in which three lateral openings  65  are formed. These openings  65  are positioned opposite the coronary ostia  101  and permit a natural flow of blood, without risk of stagnation in the area of these coronary ostia  101 . 
     The invention provides an assembly  1  for placing a valve  4  in a body duct  100 , said assembly having the following advantages over similar assemblies in the prior art: elimination of the risk of damage to the valve  4  by the balloon or balloons used to expand the stent  2 ; possibility of applying a considerable force of expansion to the stent  2 , that ensures the anchoring of the assembly  1 ; this considerable force of expansion additionally permits this anchoring by means of the deployable hooks  15 ; elimination of the risk of dilation of the valve  4  beyond a diameter no longer permitting its optimal functioning, in particular through loss of coaptation of the valvules; possibility of obtaining perfect leaktightness of the assembly  1  in the area of the valvular ring  103  and of the valve  4 ; elimination of the risk of blocking of the coronary ostia  101 ; and maintenance of a flow of body fluid all around said assembly  1  once the latter is implanted. 
     It goes without saying that the invention is not limited to the embodiment described above by way of example, and that instead it encompasses all alternative embodiments thereof coming within the scope of protection defined by the attached claims. 
     It is to be appreciated that the Detailed Description section, and not the Summary and Abstract sections, is intended to be used to interpret the claims. The Summary and Abstract sections may set forth one or more but not all exemplary embodiments of the present invention as contemplated by the inventor(s), and thus, are not intended to limit the present invention and the appended claims in any way. 
     The present invention has been described above with the aid of functional building blocks illustrating the implementation of specified functions and relationships thereof. The boundaries of these functional building blocks have been arbitrarily defined herein for the convenience of the description. Alternate boundaries can be defined so long as the specified functions and relationships thereof are appropriately performed. 
     The foregoing description of the specific embodiments will so fully reveal the general nature of the invention that others can, by applying knowledge within the skill of the art, readily modify and/or adapt for various applications such specific embodiments, without undue experimentation, without departing from the general concept of the present invention. Therefore, such adaptations and modifications are intended to be within the meaning and range of equivalents of the disclosed embodiments, based on the teaching and guidance presented herein. It is to be understood that the phraseology or terminology herein is for the purpose of description and not of limitation, such that the terminology or phraseology of the present specification is to be interpreted by the skilled artisan in light of the teachings and guidance. 
     The breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims and their equivalents. 
     The claims in the instant application are different than those of the parent application or other related applications. The Applicant therefore rescinds any disclaimer of claim scope made in the parent application or any predecessor application in relation to the instant application. The Examiner is therefore advised that any such previous disclaimer and the cited references that it was made to avoid, may need to be revisited. Further, the Examiner is also reminded that any disclaimer made in the instant application should not be read into or against the parent application.