Patent Publication Number: US-2007118215-A1

Title: Magnetic engagement of catheter to implantable device

Description:
PRIORITY CLAIM  
      This application claims the benefit of U.S. Provisional Application Ser. No. 60/737,104, filed on Nov. 16, 2005, and titled MAGNETIC ENGAGEMENT OF CATHETER TO IMPLANTABLE DEVICE, the entirety of which is hereby incorporated by reference. 
    
    
     BACKGROUND OF THE INVENTION  
      1. Field of the Invention  
      The present invention relates to methods and devices for reinforcing dysfunctional heart valves and other body structures. More specifically, the present invention relates to annuloplasty rings that can be adjusted within the body of a patient.  
      2. Description of the Related Art  
      The circulatory system of mammals includes the heart and the interconnecting vessels throughout the body that include both veins and arteries. The human heart includes four chambers, which are the left and right atrium and the left and right ventricles. The mitral valve, which allows blood flow in one direction, is positioned between the left ventricle and left atrium. The tricuspid valve is positioned between the right ventricle and the right atrium. The aortic valve is positioned between the left ventricle and the aorta, and the pulmonary valve is positioned between the right ventricle and pulmonary artery. The heart valves function in concert to move blood throughout the circulatory system. The right ventricle pumps oxygen-poor blood from the body to the lungs and then into the left atrium. From the left atrium, the blood is pumped into the left ventricle and then out the aortic valve into the aorta. The blood is then recirculated throughout the tissues and organs of the body and returns once again to the right atrium.  
      If the valves of the heart do not function properly, due either to disease or congenital defects, the circulation of the blood may be compromised. Diseased heart valves may be stenotic, wherein the valve does not open sufficiently to allow adequate forward flow of blood through the valve, and/or incompetent, wherein the valve does not close completely. Incompetent heart valves cause regurgitation or excessive backward flow of blood through the valve when the valve is closed. For example, certain diseases of the heart valves can result in dilation of the heart and one or more heart valves. When a heart valve annulus dilates, the valve leaflet geometry deforms and causes ineffective closure of the valve leaflets. The ineffective closure of the valve can cause regurgitation of the blood, accumulation of blood in the heart, and other problems.  
      Diseased or damaged heart valves can be treated by valve replacement surgery, in which damaged leaflets are excised and the annulus is sculpted to receive a replacement valve. Another repair technique that has been shown to be effective in treating incompetence is annuloplasty, in which the effective size of the valve annulus is contracted by attaching a prosthetic annuloplasty repair segment or ring to an interior wall of the heart around the valve annulus. The annuloplasty ring reinforces the functional changes that occur during the cardiac cycle to improve coaptation and valve integrity. Thus, annuloplasty rings help reduce reverse flow or regurgitation while permitting good hemodynamics during forward flow.  
      Generally, annuloplasty rings comprise an inner substrate of a metal such as stainless steel or titanium, or a flexible material such as silicon rubber or Dacron®. The inner substrate is generally covered with a biocompatible fabric or cloth to allow the ring to be sutured to the heart tissue. Annuloplasty rings may be stiff or flexible, may be open or closed, and may have a variety of shapes including circular, D-shaped, or C-shaped. The configuration of the ring is generally based on the shape of the heart valve being repaired or on the particular application. For example, the tricuspid valve is generally circular and the mitral valve is generally D-shaped. Further, C-shaped rings may be used for tricuspid valve repairs, for example, because it allows a surgeon to position the break in the ring adjacent the atrioventricular node, thus avoiding the need for suturing at that location.  
      Annuloplasty rings support the heart valve annulus and restore the valve geometry and function. Although the implantation of an annuloplasty ring can be effective, the heart of a patient may change geometry over time after implantation. For example, the heart of a child will grow as the child ages. As another example, after implantation of an annuloplasty ring, dilation of the heart caused by accumulation of blood may cease and the heart may begin returning to its normal size. Whether the size of the heart grows or reduces after implantation of an annuloplasty ring, the ring may no longer be the appropriate size for the changed size of the valve annulus.  
     SUMMARY OF THE INVENTION  
      Thus, it would be advantageous to develop systems and methods for reinforcing a heart valve annulus or other body structure using an annuloplasty device that can be adjusted within the body of a patient in a minimally invasive or non-invasive manner.  
      In one embodiment, an annuloplasty device for supporting a heart valve is disclosed. The device comprises a body member having a proximal end, a distal end, and a length extending therebetween, the body member configured to be implanted within a patient&#39;s heart at or near a base of a heart valve; wherein the body member comprises a first portion, comprising a shape memory material and being transformable from a first configuration to a second configuration in response to an activation energy; and a second portion coupled to the first portion, the second portion comprising a magnetic material that is responsive to a magnetic field; and wherein, when in position at or near the base of the heart valve and when the body member transforms from the first configuration to the second configuration, the body member reshapes a tissue of the heart so as to exert a force on the heart valve base.  
      In certain embodiments of the device, the magnetic material is located at the proximal end or the distal end of the body member. In certain embodiments, the magnetic material is located at the proximal end and the distal end of the body member. In certain embodiments, the magnetic material is located between the proximal end and the distal end of the body member. In certain embodiments, the magnetic material is in thermal communication with the first portion of the body member. In certain embodiments, the magnetic material is in thermal communication with the shape memory material. In certain embodiments, the magnetic material comprises at least one of a permanent magnet, a ceramic magnet, an electromagnet, a polymer-bonded magnet, an isotropic material, and an anisotropic material. In certain embodiments, the magnetic material produces a force in a range between 0.2 pounds of force and 2.0 pounds of force at a distance of between one millimeter to ten millimeters, with a magnetic field in a range between 100 Gauss and 10,000 Gauss.  
      In certain embodiments, the annuloplasty device further comprises a conducting element that extends at least partially along the length of the body member; and the first portion of the body member at least partially contacts the conducting element. In certain embodiments, the shape memory material at least partially contacts the conducting element. In certain embodiments, the second portion of the body member comprises at least one of a round wire, a flat wire, a ribbon, a mesh wire, a rod-shaped wire, and a band-shaped wire, or ribbon. In certain embodiments, the conducting element comprises at least one of a round wire, a flat wire, a ribbon, a mesh wire, a rod-shaped wire, and a band-shaped wire.  
      In certain embodiments, the first portion of the body member comprises a tubular structure, and at least part of the second portion of the body member passes through the tubular structure. In certain embodiments, the activation energy comprises a magnetic energy. In certain embodiments, the activation energy comprises acoustic energy. In certain embodiments, the activation energy comprises radio frequency energy. In certain embodiments, the activation energy comprises electrical energy. In certain embodiments, the activation energy comprises thermal energy. In certain embodiments, the shape memory material transforms from the first configuration to the second configuration at or near an activation temperature in response to the activation energy.  
      In another embodiment, an annuloplasty system is disclosed. The system comprises the annuloplasty described above; and an activation device that emanates a magnetic field that is configured magnetically to engage the magnetic material of the second portion of the body member.  
      In yet another embodiment, an annuloplasty activation system for percutaneously activating an adjustable annuloplasty device is disclosed. The system comprises an elongate member having a proximal end and distal end, the distal end configured to be inserted percutaneously into a vein of a patient, further configured to be inserted across a fossa ovalis in an interatrial septum of a patient, and further configured to be inserted into the left atrium of the patient while the proximal end is located outside the patient&#39;s body. The system further comprises a distal element at the distal end of the elongate member, the distal element configured to emanate a magnetic field within the left atrium; wherein the distal element comprises at least one of a permanent magnet and an electromagnet, the electromagnet being activatable from outside the patient&#39;s body.  
      In certain embodiments, the annuloplasty activation system further comprises an annuloplasty device, comprising a body member having a proximal end, a distal end and a length extending therebetween, the body member configured to be implanted within a patient&#39;s heart at or near a base of a heart valve; wherein the body member comprises a first portion, comprising a shape memory material and being transformable from a first configuration to a second configuration in response to an activation energy; and a second portion coupled to the first portion, the second portion comprising a magnetic material that is responsive to a magnetic field. When in position at or near the base of the heart valve and when the body member transforms from the first configuration to the second configuration, the body member reshapes a tissue of the heart so as to exert a force on the heart valve base.  
      In yet further embodiments, a method for changing a dimension of a heart valve annulus is disclosed. The method comprises providing an annuloplasty device comprising a body member having a proximal end, a distal end, and a length extending therebetween, the body member configured to be implanted within a patient&#39;s heart at or near a base of a heart valve. The body member comprises a first portion, comprising a shape memory material and being transformable from a first configuration to a second configuration in response to an activation energy; and a second portion coupled to the first portion, the second portion comprising a magnetic material that is responsive to a magnetic field. When in position at or near the base of the heart valve and when the body member transforms from the first configuration to the second configuration, the body member reshapes a tissue of the heart so as to exert a force on the heart valve base.  
      The method further comprises providing an annuloplasty activation system comprising an elongate member having a proximal end and distal end, the distal end configured to be inserted percutaneously into a vein of a patient, further configured to be inserted across a fossa ovalis in an interatrial septum of a patient, and further configured to be inserted into the left atrium of the patient while the proximal end is located outside the patient&#39;s body. The annuloplasty activation system further comprises a distal element at the distal end of the elongate member, the distal element configured to emanate a magnetic field within the left atrium; wherein the distal element comprises at least one of a permanent magnet and an electromagnet, the electromagnet being activatable from outside the patient&#39;s body. The method further comprises inserting the elongate member into the left atrium of the patient. The method further comprises magnetically engaging the annuloplasty activation system to the annuloplasty device. The method further comprises activating the annuloplasty device such that the body member transforms from the first configuration to the second configuration, thereby reshaping a tissue of the heart so as to exert a force on the heart valve base.  
      In certain embodiments, magnetically engaging the annuloplasty activation system to the annuloplasty device comprises at least a part of the distal element of the annuloplasty activation system contacting at least a part of the second portion of the annuloplasty ring. In certain embodiments, activating the annuloplasty device comprises providing an activation energy to the annuloplasty device. In certain embodiments, the activation energy comprises electric energy, thermal energy, magnetic energy, acoustic energy, and radio frequency energy. In certain embodiments, the heart tissue is reshaped by decreasing a dimension of the heart valve annulus.  
      In another embodiment, a system for reshaping or reforming a heart valve annulus is disclosed. The system comprises a means for magnetically engaging an elongate member to an annuloplasty device while inside a body, the device configured to be implanted at or near the heart valve annulus. The system further comprises a means for changing at least one dimension of the heart valve annulus while transforming the annuloplasty device from a first configuration to a second configuration while the elongate member is engaged to the annuloplasty device.  
      In yet another embodiment, a system for reshaping or reforming a heart valve annulus is disclosed. The system comprises a magnet attached to an elongate member, the magnet configured to engage an annuloplasty device configured to be implanted at or near the heart valve annulus. The system further comprises an energy transfer module configured to change at least one dimension of the heart valve annulus while transforming the annuloplasty device from a first to second configuration and while the elongate member is engaged to the annuloplasty device.  
      For purposes of summarizing the invention, certain aspects, advantages, and novel features of the invention have been described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment of the invention. Thus, the invention may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      Systems and methods which embody the various features of the invention will now be described with reference to the following drawings:  
       FIG. 1A  is a top view in partial section of an adjustable annuloplasty ring according to certain embodiments of the invention;  
       FIG. 1B  is a side view of the annuloplasty ring of  FIG. 1A ;  
       FIG. 1C  is a transverse cross-sectional view of the annuloplasty ring of  FIG. 1A ;  
       FIG. 2  is a graphical representation of the diameter of an annuloplasty ring in relation to the temperature of the annuloplasty ring according to certain embodiments of the invention;  
       FIG. 3A  is a top view in partial section of an adjustable annuloplasty ring having a D-shaped configuration according to certain embodiments of the invention;  
       FIG. 3B  is a side view of the annuloplasty ring of  FIG. 3A ;  
       FIG. 3C  is a transverse cross-sectional view of the annuloplasty ring of  FIG. 3A ;  
       FIG. 4A  is a top view of an annuloplasty ring having a substantially circular configuration according to certain embodiments of the invention;  
       FIG. 4B  is a side view of the annuloplasty ring of  FIG. 4A ;  
       FIG. 4C  is a transverse cross-sectional view of the annuloplasty ring of  FIG. 4A ;  
       FIG. 5  is a top view of an annuloplasty ring having a substantially D-shaped configuration according to certain embodiments of the invention;  
       FIG. 6A  is a schematic diagram of a top view of a shape memory wire having a substantially D-shaped configuration according to certain embodiments of the invention;  
       FIGS. 6B-6E  are schematic diagrams of side views of the shape memory wire of  FIG. 6A  according to certain embodiments of the invention;  
       FIG. 7A  is a perspective view in partial section of an annuloplasty ring comprising the shape memory wire of  FIG. 6A  according to certain embodiments of the invention;  
       FIG. 7B  is a perspective view in partial section of a portion of the annuloplasty ring of  FIG. 7A ;  
       FIG. 8  is a schematic diagram of a shape memory wire having a substantially C-shaped configuration according to certain embodiments of the invention;  
       FIG. 9A  is a perspective view in partial section of an annuloplasty ring comprising the shape memory wire of  FIG. 8  according to certain embodiments of the invention;  
       FIG. 9B  is a perspective view in partial section of a portion of the annuloplasty ring of  FIG. 9A ;  
       FIG. 10A  is a perspective view in partial section an annuloplasty ring comprising a first shape memory wire and a second shape memory wire according to certain embodiments of the invention;  
       FIG. 10B  is a top cross-sectional view of the annuloplasty ring of  FIG. 10A ;  
       FIG. 11A  is a perspective view in partial section of an annuloplasty ring comprising a first shape memory wire and a second shape memory wire according to certain embodiments of the invention;  
       FIG. 11B  is a top cross-sectional view of the annuloplasty ring of  FIG. 11A ;  
       FIG. 12  is a perspective view of a shape memory wire wrapped in a coil according to certain embodiments of the invention;  
       FIGS. 13A and 13B  are schematic diagrams illustrating an annuloplasty ring according to certain embodiments of the invention;  
       FIG. 14  is a schematic diagram illustrating an annuloplasty ring according to certain embodiments of the invention;  
       FIG. 15  is a schematic diagram illustrating an annuloplasty ring according to certain embodiments of the invention;  
       FIGS. 16A and 16B  are schematic diagrams illustrating an annuloplasty ring having a plurality of temperature response zones or sections according to certain embodiments of the invention;  
       FIGS. 17A and 17B  are schematic diagrams illustrating an annuloplasty ring having a plurality of temperature response zones or sections according to certain embodiments of the invention;  
       FIG. 18  is a sectional view of a mitral valve with respect to an exemplary annuloplasty ring according to certain embodiments of the invention;  
       FIG. 19  is a schematic diagram of a substantially C-shaped wire comprising a shape memory material configured to contract in a first direction and expand in a second direction according to certain embodiments of the invention;  
       FIGS. 20A and 20B  are schematic diagrams of a body member usable by an annuloplasty ring according to certain embodiments of the invention;  
       FIGS. 21A and 21B  are schematic diagrams of a body member usable by an annuloplasty ring according to certain embodiments of the invention;  
       FIGS. 22A and 22B  are schematic diagrams of a body member usable by an annuloplasty ring according to certain embodiments of the invention;  
       FIG. 23  is a transverse cross-sectional view of the body member of  FIGS. 21A and 21B ;  
       FIG. 24  is a perspective view of a body member usable by an annuloplasty ring according to certain embodiments comprising a first shape memory band and a second shape memory band;  
       FIG. 25A  is a schematic diagram illustrating the body member of  FIG. 24  in a first configuration or shape according to certain embodiments of the invention;  
       FIG. 25B  is a schematic diagram illustrating the body member of  FIG. 24  in a second configuration or shape according to certain embodiments of the invention;  
       FIG. 25C  is a schematic diagram illustrating the body member of  FIG. 24  in a third configuration or shape according to certain embodiments of the invention;  
       FIG. 26  is a perspective view illustrating an annuloplasty ring comprising one or more thermal conductors according to certain embodiments of the invention;  
       FIGS. 27A-27C  are transverse cross-sectional views of the annuloplasty ring of  FIG. 26  schematically illustrating exemplary embodiments of the invention for conducting thermal energy to an internal shape memory wire;  
       FIG. 28  is a schematic diagram of an annuloplasty ring comprising one or more thermal conductors according to certain embodiments of the invention;  
       FIG. 29A  is a schematic diagram of an annuloplasty ring comprising one or more magnetic devices according to certain embodiments of the invention;  
       FIG. 29B  is a schematic diagram of an annuloplasty ring comprising one or more magnetic bands according to certain embodiments of the invention;  
       FIG. 30  is a schematic diagram of the body member of  FIGS. 20A and 20B  further comprising one or more magnetic devices according to certain embodiments of the invention;  
       FIG. 31  is a partial schematic diagram of a portion of the body member of  FIG. 30  further comprising one or more thermal conductors according to certain embodiments of the invention;  
       FIG. 32  is a schematic diagram of a magnetic tipped catheter according to certain embodiments of the invention;  
       FIG. 33  is a schematic diagram illustrating one embodiment for aligning an internal shape memory element according to certain embodiments of the invention; and  
       FIG. 34  is a schematic diagram illustrating one embodiment for conducting thermal energy to an internal shape memory element according to certain embodiments of the invention. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
      The present invention involves systems and methods for reinforcing dysfunctional heart valves and other body structures with adjustable rings. In certain embodiments, an adjustable annuloplasty ring is implanted into the body of a patient such as a human or other animal. The adjustable annuloplasty ring is implanted through an incision or body opening either thoracically (e.g., open-heart surgery) or percutaneously (e.g., via a femoral artery or vein, or other arteries or veins) as is known to someone skilled in the art. The adjustable annuloplasty ring is attached to the annulus of a heart valve to improve leaflet coaptation and to reduce regurgitation. The annuloplasty ring may be selected from one or more shapes comprising a round or circular shape, an oval shape, a C-shape, a D-shape, a U-shape, an open circle shape, an open oval shape, and other curvilinear shapes.  
      The size of the annuloplasty ring can be adjusted postoperatively to compensate for changes in the size of the heart. As used herein, “postoperatively” refers to a time after implanting the adjustable annuloplasty ring and closing the body opening through which the adjustable annuloplasty ring was introduced into the patient&#39;s body. For example, the annuloplasty ring may be implanted in a child whose heart grows as the child gets older. Thus, the size of the annuloplasty ring may need to be increased. As another example, the size of an enlarged heart may start to return to its normal size after an annuloplasty ring is implanted. Thus, the size of the annuloplasty ring may need to be decreased postoperatively to continue to reinforce the heart valve annulus.  
      In certain embodiments, the annuloplasty ring comprises a shape memory material that is responsive to changes in temperature and/or exposure to a magnetic field. Shape memory is the ability of a material to regain its shape after deformation. Shape memory materials include polymers, metals, metal alloys and ferromagnetic alloys. The annuloplasty ring is adjusted in vivo by applying an energy source to activate the shape memory material and cause it to change to a memorized shape. The energy source may include, for example, thermal energy, radio frequency (RF) energy, x-ray energy, microwave energy, ultrasonic energy such as focused ultrasound, high intensity focused ultrasound (HIFU) energy, light energy, electric field energy, magnetic field energy, combinations of the foregoing, or the like. For example, one embodiment of electromagnetic radiation that is useful is infrared energy having a wavelength in a range between approximately 750 nanometers and approximately 1600 nanometers. This type of infrared radiation may be produced efficiently by a solid state diode laser. In certain embodiments, the annuloplasty ring implant is selectively heated using short pulses of energy having an on and off period between each cycle. The energy pulses provide segmental heating which allows segmental adjustment of portions of the annuloplasty ring without adjusting the entire implant.  
      In certain embodiments, the annuloplasty ring includes an energy absorbing material to increase heating efficiency and localize heating in the area of the shape memory material. Thus, damage to the surrounding tissue is reduced or minimized. Energy absorbing materials for light or laser activation energy may include nanoshells, nanospheres and the like, particularly where infrared laser energy is used to energize the material. Such nanoparticles may be made from a dielectric, such as silica, coated with an ultra thin layer of a conductor, such as gold, and be selectively tuned to absorb a particular frequency of electromagnetic radiation. In certain such embodiments, the nanoparticles range in size between about 5 nanometers and about 20 nanometers and can be suspended in a suitable material or solution, such as saline solution. In certain embodiments, the nanoparticles range in size between about 2 nanometers and about 30 nanometers. In certain embodiments, the nanoparticles range in size between about 5 nanometers and about 20 nanometers. In certain embodiments, the nanoparticles range in size between about 8 nanometers and about 15 nanometers. Coatings comprising nanotubes or nanoparticles can also be used to absorb energy from, for example, HIFU, MRI, inductive heating, or the like.  
      In other embodiments, thin film deposition or other coating techniques such as sputtering, reactive sputtering, metal ion implantation, physical vapor deposition, and chemical deposition can be used to cover portions or all of the annuloplasty ring. Such coatings can be either solid or microporous. When HIFU energy is used, for example, a microporous structure traps and directs the HIFU energy toward the shape memory material. The coating improves thermal conduction and heat removal. In certain embodiments, the coating also enhances radio-opacity of the annuloplasty ring implant. Coating materials can be selected from various groups of biocompatible organic or non-organic, metallic or non-metallic materials such as Titanium Nitride (TiN), Iridium Oxide (Irox), Carbon, Platinum black, Titanium Carbide (TiC) and other materials used for pacemaker electrodes or implantable pacemaker leads. Other materials discussed herein or known in the art can also be used to absorb energy.  
      In addition, or in other embodiments, fine conductive wires such as platinum coated copper, titanium, tantalum, stainless steel, gold, or the like, are wrapped around the shape memory material to allow focused and rapid heating of the shape memory material while reducing undesired heating of surrounding tissues.  
      In certain embodiments, the energy source is applied surgically either during implantation or at a later time. For example, the shape memory material can be heated during implantation of the annuloplasty ring by touching the annuloplasty ring with warm object. As another example, the energy source can be surgically applied after the annuloplasty ring has been implanted by percutaneously inserting a catheter into the patient&#39;s body and applying the energy through the catheter. For example, RF energy, light energy or thermal energy (e.g., from a heating element using resistance heating) can be transferred to the shape memory material through a catheter positioned on or near the shape memory material. Alternatively, thermal energy can be provided to the shape memory material by injecting a heated fluid through a catheter or circulating the heated fluid in a balloon through the catheter placed in close proximity to the shape memory material. As another example, the shape memory material can be coated with a photodynamic absorbing material which is activated to heat the shape memory material when illuminated by light from a laser diode or directed to the coating through fiber optic elements in a catheter. In certain such embodiments, the photodynamic absorbing material includes one or more drugs that are released when illuminated by the laser light.  
      In certain embodiments, a removable subcutaneous electrode or coil couples energy from a dedicated activation unit. In certain such embodiments, the removable subcutaneous electrode provides telemetry and power transmission between the system and the annuloplasty ring. The subcutaneous removable electrode allows more efficient coupling of energy to the implant with minimum or reduced power loss. In certain embodiments, the subcutaneous energy is delivered via inductive coupling.  
      In other embodiments, the energy source is applied in a non-invasive manner from outside the patient&#39;s body. In certain such embodiments, the external energy source is focused to provide directional heating to the shape memory material to reduce or minimize damage to the surrounding tissue. For example, in certain embodiments, a handheld or portable device comprising an electrically conductive coil generates an electromagnetic field that non-invasively penetrates the patient&#39;s body and induces a current in the annuloplasty ring. The current heats the annuloplasty ring and causes the shape memory material to transform to a memorized shape. In certain such embodiments, the annuloplasty ring also comprises an electrically conductive coil wrapped around or embedded in the memory shape material. The externally generated electromagnetic field induces a current in the annuloplasty ring&#39;s coil, causing it to heat and transfer thermal energy to the shape memory material. In certain other embodiments, the annuloplasty ring includes a coating, powder, slurry, paste, or combination of the foregoing, that absorbs energy from the electromagnetic field and transforms the energy into heat to change the temperature of the shape memory material. Such coatings may include, for example, a wide variety of magnetic and non-magnetic mixtures.  
      In certain other embodiments, an external HIFU transducer focuses ultrasound energy onto the implanted annuloplasty ring to heat the shape memory material. In certain such embodiments, the external HIFU transducer is a handheld or portable device. The terms “HIFU,” “high intensity focused ultrasound” or “focused ultrasound” as used herein are broad terms and are used at least in their ordinary sense and include, without limitation, acoustic energy within a wide range of intensities and/or frequencies. For example, HIFU includes acoustic energy focused in a region, or focal zone, having an intensity and/or frequency that is considerably less than what is currently used for ablation in medical procedures. Thus, in certain such embodiments, the focused ultrasound is not destructive to the patient&#39;s cardiac tissue. In certain embodiments, HIFU includes acoustic energy within a frequency range of approximately 0.5 MHz and approximately 30 MHz and a power density within a range of approximately 1 W/cm 2  and approximately 500 W/cm 2 .  
      In certain embodiments, the annuloplasty ring comprises an ultrasound absorbing material or hydro-gel material that allows focused and rapid heating when exposed to the ultrasound energy and transfers thermal energy to the shape memory material. In certain embodiments, a HIFU probe is used with an adaptive lens to compensate for heart and respiration movement. The adaptive lens has multiple focal point adjustments. In certain embodiments, a HIFU probe with adaptive capabilities comprises a phased array or linear configuration. In certain embodiments, an external HIFU probe comprises a lens configured to be placed between a patient&#39;s ribs to improve acoustic window penetration and reduce or minimize issues and challenges regarding passing through bones. In certain embodiments, HIFU energy is synchronized with an ultrasound imaging device to allow visualization of the annuloplasty ring implant during HIFU activation. In addition, or in other embodiments, ultrasound imaging is used to non-invasively monitor the temperature of tissue surrounding the annuloplasty ring by using principles of speed of sound shift and changes to tissue thermal expansion.  
      In certain embodiments, non-invasive energy is applied to the implanted annuloplasty ring using a Magnetic Resonance Imaging (MRI) device. In certain such embodiments, the shape memory material is activated by a constant magnetic field generated by the MRI device. In addition, or in other embodiments, the MRI device generates RF pulses that induce current in the annuloplasty ring and heat the shape memory material. The annuloplasty ring can include one or more coils and/or MRI energy absorbing material to increase the efficiency and directionality of the heating. Suitable energy absorbing materials for magnetic activation energy include particulates of ferromagnetic material. Suitable energy absorbing materials for RF energy include ferrite materials as well as other materials configured to absorb RF energy at resonant frequencies thereof.  
      In certain embodiments, the MRI device is used to determine the size of the implanted annuloplasty ring before, during and/or after the shape memory material is activated. In certain such embodiments, the MRI device generates RF pulses at a first frequency to heat the shape memory material and at a second frequency to image the implanted annuloplasty ring. Thus, the size of the annuloplasty ring can be measured without heating the ring. In certain such embodiments, an MRI energy absorbing material heats sufficiently to activate the shape memory material when exposed to the first frequency and does not substantially heat when exposed to the second frequency. Other imaging techniques known in the art can also be used to determine the size of the implanted ring including, for example, ultrasound imaging, computed tomography (CT) scanning, X-ray imaging, or the like. In certain embodiments, such imaging techniques also provide sufficient energy to activate the shape memory material.  
      In certain embodiments, imaging and resizing of the annuloplasty ring is performed as a separate procedure at some point after the annuloplasty ring as been surgically implanted into the patient&#39;s heart and the patient&#39;s heart, pericardium and chest have been surgically closed. However, in certain other embodiments, it is advantageous to perform the imaging after the heart and/or pericardium have been closed, but before closing the patient&#39;s chest, to check for leakage or the amount of regurgitation. If the amount of regurgitation remains excessive after the annuloplasty ring has been implanted, energy from the imaging device (or from another source as discussed herein) can be applied to the shape memory material so as to at least partially contract the annuloplasty ring and reduce regurgitation to an acceptable level. Thus, the success of the surgery can be checked and corrections can be made, if necessary, before closing the patient&#39;s chest.  
      In certain embodiments, activation of the shape memory material is synchronized with the heart beat during an imaging procedure. For example, an imaging technique can be used to focus HIFU energy onto an annuloplasty ring in a patient&#39;s body during a portion of the cardiac cycle. As the heart beats, the annuloplasty ring may move in and out of this area of focused energy. To reduce damage to the surrounding tissue, the patient&#39;s body is exposed to the HIFU energy only during portions of the cardiac cycle that focus the HIFU energy onto the cardiac ring. In certain embodiments, the energy is gated with a signal that represents the cardiac cycle such as an electrocardiogram signal. In certain such embodiments, the synchronization and gating is configured to allow delivery of energy to the shape memory materials at specific times during the cardiac cycle to avoid or reduce the likelihood of causing arrhythmia or fibrillation during vulnerable periods. For example, the energy can be gated so as to only expose the patient&#39;s heart to the energy during the T wave of the electrocardiogram signal.  
      As discussed above, shape memory materials include, for example, polymers, metals, and metal alloys including ferromagnetic alloys. Exemplary shape memory polymers that are usable for certain embodiments of the present invention are disclosed by Langer, et al. in U.S. Pat. No. 6,720,402, issued Apr. 13, 2004, U.S. Pat. No. 6,388,043, issued May 14, 2002, and U.S. Pat. No. 6,160,084, issued Dec. 12, 2000, each of which are hereby incorporated by reference herein. Shape memory polymers respond to changes in temperature by changing to one or more permanent or memorized shapes. In certain embodiments, the shape memory polymer is heated to a temperature between approximately 38 degrees Celsius and approximately 60 degrees Celsius. In certain other embodiments, the shape memory polymer is heated to a temperature in a range between approximately 40 degrees Celsius and approximately 55 degrees Celsius. In certain embodiments, the shape memory polymer has a two-way shape memory effect wherein the shape memory polymer is heated to change it to a first memorized shape and cooled to change it to a second memorized shape. The shape memory polymer can be cooled, for example, by inserting or circulating a cooled fluid through a catheter.  
      Shape memory polymers implanted in a patient&#39;s body can be heated non-invasively using, for example, external light energy sources such as infrared, near-infrared, ultraviolet, microwave and/or visible light sources. Preferably, the light energy is selected to increase absorption by the shape memory polymer and reduce absorption by the surrounding tissue. Thus, damage to the tissue surrounding the shape memory polymer is reduced when the shape memory polymer is heated to change its shape. In other embodiments, the shape memory polymer comprises gas bubbles or bubble containing liquids such as fluorocarbons and is heated by inducing a cavitation effect in the gas/liquid when exposed to HIFU energy. In other embodiments, the shape memory polymer may be heated using electromagnetic fields and may be coated with a material that absorbs electromagnetic fields.  
      Certain metal alloys have shape memory qualities and respond to changes in temperature and/or exposure to magnetic fields. Exemplary shape memory alloys that respond to changes in temperature include titanium-nickel, copper-zinc-aluminum, copper-aluminum-nickel, iron-manganese-silicon, iron-nickel-aluminum, gold-cadmium, combinations of the foregoing, and the like. In certain embodiments, the shape memory alloy comprises a biocompatible material such as a titanium-nickel alloy.  
      Shape memory alloys exist in two distinct solid phases called martensite and austenite. The martensite phase is relatively soft and easily deformed, whereas the austenite phase is relatively stronger and less easily deformed. For example, shape memory alloys enter the austenite phase at a relatively high temperature and the martensite phase at a relatively low temperature. Shape memory alloys begin transforming to the martensite phase at a start temperature (M s ) and finish transforming to the martensite phase at a finish temperature (M f ). Similarly, such shape memory alloys begin transforming to the austenite phase at a start temperature (A s ) and finish transforming to the austenite phase at a finish temperature (A f ). Both transformations have a hysteresis. Thus, the M s  temperature and the A f  temperature are not coincident with each other, and the M f  temperature and the A s  temperature are not coincident with each other.  
      In certain embodiments, the shape memory alloy is processed to form a memorized shape in the austenite phase in the form of a ring or partial ring. The shape memory alloy is then cooled below the M f  temperature to enter the martensite phase and deformed into a larger or smaller ring. For example, in certain embodiments, the shape memory alloy is formed into a ring or partial ring that is larger than the memorized shape but still small enough to improve leaflet coaptation and reduce regurgitation in a heart valve upon being attached to the heart valve annulus. In certain such embodiments, the shape memory alloy is sufficiently malleable in the martensite phase to allow a user such as a physician to adjust the circumference of the ring in the martensite phase by hand to achieve a desired fit for a particular heart valve annulus. After the ring is attached to the heart valve annulus, the circumference of the ring can be adjusted non-invasively by heating the shape memory alloy to an activation temperature (e.g., temperatures ranging from the A s  temperature to the A f  temperature).  
      Thereafter, when the shape memory alloy is exposed to a temperature elevation and transformed to the austenite phase, the alloy changes in shape from the deformed shape to the memorized shape. Activation temperatures at which the shape memory alloy causes the shape of the annuloplasty ring to change shape can be selected and built into the annuloplasty ring such that collateral damage is reduced or eliminated in tissue adjacent the annuloplasty ring during the activation process. Exemplary A f  temperatures for suitable shape memory alloys range between approximately 45 degrees Celsius and approximately 70 degrees Celsius. Furthermore, exemplary M s  temperatures range between approximately 10 degrees Celsius and approximately 20 degrees Celsius, and exemplary M f  temperatures range between approximately −1 degrees Celsius and approximately 15 degrees Celsius. The size of the annuloplasty ring can be changed all at once or incrementally in small steps at different times in order to achieve the adjustment necessary to produce the desired clinical result.  
      Certain shape memory alloys may further include a rhombohedral phase, having a rhombohedral start temperature (R s ) and a rhombohedral finish temperature (R f ), that exists between the austenite and martensite phases. An example of such a shape memory alloy is a NiTi alloy, which is commercially available from Memry Corporation (Bethel, Conn.). In certain embodiments, an exemplary R s  temperature range is between approximately 30 degrees Celsius and approximately 50 degrees Celsius, and an exemplary R f  temperature range is between approximately 20 degrees Celsius and approximately 35 degrees Celsius. One benefit of using a shape memory material having a rhombohedral phase is that in the rhomobohedral phase the shape memory material may experience a partial physical distortion, as compared to the generally rigid structure of the austenite phase and the generally deformable structure of the martensite phase.  
      Certain shape memory alloys exhibit a ferromagnetic shape memory effect wherein the shape memory alloy transforms from the martensite phase to the austenite phase when exposed to an external magnetic field. The term “ferromagnetic” as used herein is a broad term and is used in its ordinary sense and includes, without limitation, any material that easily magnetizes, such as a material having atoms that orient their electron spins to conform to an external magnetic field. Ferromagnetic materials include permanent magnets, which can be magnetized through a variety of modes, and materials, such as metals, that are attracted to permanent magnets. Ferromagnetic materials also include electromagnetic materials that are capable of being activated by an electromagnetic transmitter, such as one located outside the heart. Furthermore, ferromagnetic materials may include one or more polymer-bonded magnets, wherein magnetic particles are bound within a polymer matrix, such as a biocompatible polymer. The magnetic materials can comprise isotropic and/or anisotropic materials, such as for example NdFeB (Neodynium Iron Boron), SmCo (Samarium Cobalt), ferrite and/or AlNiCo (Aluminum Nickel Cobalt) particles.  
      Thus, an annuloplasty ring comprising a ferromagnetic shape memory alloy can be implanted in a first configuration having a first shape and later changed to a second configuration having a second (e.g., memorized) shape without heating the shape memory material above the A s  temperature. Advantageously, nearby healthy tissue is not exposed to high temperatures that could damage the tissue. Further, since the ferromagnetic shape memory alloy does not need to be heated, the size of the annuloplasty ring can be adjusted more quickly and more uniformly than by heat activation.  
      Exemplary ferromagnetic shape memory alloys include Fe—C, Fe—Pd, Fe—Mn—Si, Co—Mn, Fe—Co—Ni—Ti, Ni—Mn—Ga, Ni 2 MnGa, Co—Ni—Al, and the like. Certain of these shape memory materials may also change shape in response to changes in temperature. Thus, the shape of such materials can be adjusted by exposure to a magnetic field, by changing the temperature of the material, or both.  
      In certain embodiments, combinations of different shape memory materials are used. For example, annuloplasty rings according to certain embodiments comprise a combination of shape memory polymer and shape memory alloy (e.g., NiTi). In certain such embodiments, an annuloplasty ring comprises a shape memory polymer tube and a shape memory alloy (e.g., NiTi) disposed within the tube. Such embodiments are flexible and allow the size and shape of the shape memory to be further reduced without impacting fatigue properties. In addition, or in other embodiments, shape memory polymers are used with shape memory alloys to create a bi-directional (e.g., capable of expanding and contracting) annuloplasty ring. Bi-directional annuloplasty rings can be created with a wide variety of shape memory material combinations having different characteristics.  
      In the following description, reference is made to the accompanying drawings, which form a part hereof, and which show, by way of illustration, specific embodiments or processes in which the invention may be practiced. Where possible, the same reference numbers are used throughout the drawings to refer to the same or like components. In some instances, numerous specific details are set forth in order to provide a thorough understanding of the present disclosure. The present disclosure, however, may be practiced without the specific details or with certain alternative equivalent components and methods to those described herein. In other instances, well-known components and methods have not been described in detail so as not to unnecessarily obscure aspects of the present disclosure.  
       FIGS. 1A-1C  illustrate an adjustable annuloplasty ring  100  according to certain embodiments that can be adjusted in vivo after implantation into a patient&#39;s body. The annuloplasty ring  100  has a substantially annular configuration and comprises a tubular body member  112  that folds back upon itself in a substantial circle having a nominal diameter as indicated by arrow  123 . The tubular body member  112  comprises a receptacle end  114  and an insert end  116 . The insert end  116  of the tubular member  112  is reduced in outer diameter or transverse dimension as compared to the receptacle end  114 . As used herein, “dimension” is a broad term having its ordinary and customary meaning and includes a size or distance from a first point to a second point along a line or arc. For example, a dimension may be a circumference, diameter, radius, arc length, or the like. As another example, a dimension may be a distance between an anterior portion and a posterior portion of an annulus.  
      The receptacle end accepts the insert end  116  of the tubular member  112  to complete the ring-like structure of the annuloplasty ring  100 . The insert end  116  slides freely within the receptacle end  114  of the annuloplasty ring  100  which allows contraction of the overall circumference of the ring  100  as the insert end  116  enters the receptacle end  114  as shown by arrows  118  in  FIG. 1A . In certain embodiments, the nominal diameter or transverse dimension  123  of the annuloplasty ring  100  can be adjusted from approximately 25 mm to approximately 38 mm. However, an artisan will recognize from the disclosure herein that the diameter or transverse dimension  123  of the annuloplasty ring  100  can be adjusted to other sizes depending on the particular application. Indeed, the diameter or transverse dimension  123  of the annuloplasty ring  100  can be configured to reinforce body structures substantially smaller than 25 mm and substantially larger than 38 mm.  
      An artisan will recognize from the disclosure herein that in other embodiments the insert end  116  can couple with the receptacle end  114  without being inserted in the receptacle end  114 . For example, the insert end  116  can overlap the receptacle end  114  such that it slides adjacent thereto. In other embodiments, for example, the ends  114 ,  116  may grooved to guide the movement of the adjacent ends  114 ,  116  relative to one another. Other embodiments within the scope of the invention will occur to those skilled in the art.  
      The annuloplasty ring  100  also comprises a suturable material  128 , shown partially cut away in  FIG. 1A , and not shown in  FIGS. 1B and 1C  for clarity. The suturable material  128  is disposed about the tubular member  112  to facilitate surgical implantation of the annuloplasty ring  100  in a body structure, such as about a heart valve annulus. In certain embodiments, the suturable material  128  comprises a suitable biocompatible material such as Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or the like. In other embodiments, the suturable material  128  comprises a biological material such as bovine or equine pericardium, homograft, patient graft, or cell-seeded tissue. The suturable material  128  may be disposed about the entire circumference of the tubular member  112 , or selected portions thereof. For example, in certain embodiments, the suturable material  128  is disposed so as to enclose substantially the entire tubular member  112  except at the narrowed insert end  116  that slides into the receptacle end  118  of the tubular member  112 .  
      As shown in  FIGS. 1A and 1B , in certain embodiments, the annuloplasty ring  100  also comprises a ratchet member  120  secured to the receptacle end  114  of the tubular member  112 . The ratchet member  120  comprises a pawl  122  configured to engage transverse slots  124  (shown in  FIG. 1B ) on the insert end  116  of the tubular member  112 . The pawl  122  of the ratchet member  120  engages the slots  124  in such a way as to allow contraction of the circumference of the annuloplasty ring  100  and prevent or reduce circumferential expansion of the annuloplasty ring  100 . Thus, the ratchet reduces unwanted circumferential expansion of the annuloplasty ring  100  after implantation due, for example, to dynamic forces on the annuloplasty ring  100  from the heart tissue during systolic contraction of the heart.  
      In certain embodiments, the tubular member  112  comprises a rigid material such as stainless steel, titanium, or the like, or a flexible material such as silicon rubber, Dacron®, or the like. In certain such embodiments, after implantation into a patient&#39;s body, the circumference of the annuloplasty ring  100  is adjusted in vivo by inserting a catheter (not shown) into the body and pulling a wire (not shown) attached to the tubular member  112  through the catheter to manually slide the insert end  116  of the tubular member  112  into the receptacle end  114  of the tubular member  112 . As the insert end  116  slides into the receptacle end  114 , the pawl  122  of the ratchet member  120  engages the slots  124  on the insert end  116  to hold the insert end  116  in the receptacle end  114 . Thus, for example, as the size of a heart valve annulus reduces after implantation of the annuloplasty ring  100 , the size of the annuloplasty ring  100  can also be reduced to provide an appropriate amount of reinforcement to the heart valve.  
      In certain other embodiments, the tubular member  112  comprises a shape memory material that is responsive to changes in temperature and/or exposure to a magnetic field. As discussed above, the shape memory material may include shape memory polymers (e.g., polylactic acid (PLA), polyglycolic acid (PGA)) and/or shape memory alloys (e.g., nickel-titanium) including ferromagnetic shape memory alloys (e.g., Fe—C, Fe—Pd, Fe—Mn—Si, Co—Mn, Fe—Co—Ni—Ti, Ni—Mn—Ga, Ni 2 MnGa, Co—Ni—Al). In certain such embodiments, the annuloplasty ring  100  is adjusted in vivo by applying an energy source such as radio frequency energy, X-ray energy, microwave energy, ultrasonic energy such as high intensity focused ultrasound (HIFU) energy, light energy, electric field energy, magnetic field energy, combinations of the foregoing, or the like. Preferably, the energy source is applied in a non-invasive manner from outside the body. For example, as discussed above, a magnetic field and/or RF pulses can be applied to the annuloplasty ring  100  within a patient&#39;s body with an apparatus external to the patient&#39;s body such as is commonly used for magnetic resonance imaging (MRI). However, in other embodiments, the energy source may be applied surgically such as by inserting a catheter into the body and applying the energy through the catheter.  
      In certain embodiments, the tubular body member  112  comprises a shape memory material that responds to the application of temperature that differs from a nominal ambient temperature, such as the nominal body temperature of 37 degrees Celsius for humans. The tubular member  112  is configured to respond by starting to contract upon heating the tubular member  112  above the As temperature of the shape memory material. In certain such embodiments, the annuloplasty ring  100  has an initial diameter or transverse dimension  123  of approximately 30 mm, and contracts or shrinks to a transverse dimension  123  of approximately 23 mm to approximately 28 mm, or any increment between those values. This produces a contraction percentage in a range between approximately 6 percent and approximately 23 percent, where the percentage of contraction is defined as a ratio of the difference between the starting diameter and finish diameter divided by the starting diameter.  
      The activation temperatures (e.g., temperatures ranging from the A s  temperature to the A f  temperature) at which the tubular member  112  contracts to a reduced circumference may be selected and built into the annuloplasty ring  100  such that collateral damage is reduced or eliminated in tissue adjacent the annuloplasty ring  100  during the activation process. Exemplary A f  temperatures for the shape memory material of the tubular member  112  at which substantially maximum contraction occurs are in a range between approximately 38 degrees Celsius and approximately 75 degrees Celsius. In certain embodiments, the A f  temperature is in a range between approximately 39 degrees Celsius and approximately 75 degrees Celsius. For some embodiments that include shape memory polymers for the tubular member  112 , activation temperatures at which the glass transition of the material or substantially maximum contraction occur range between approximately 38 degrees Celsius and approximately 60 degrees Celsius. In other such embodiments, the activation temperature is in a range between approximately 40 degrees Celsius and approximately 59 degrees Celsius.  
      In certain embodiments, the tubular member  112  is shape set in the austenite phase to a remembered configuration during the manufacturing of the tubular member  112  such that the remembered configuration is that of a relatively small circumferential value with the insert end  116  fully inserted into the receptacle end  114 . After cooling the tubular member  112  below the M f  temperature, the tubular member  112  is manually deformed to a larger circumferential value with the insert end  116  only partially inserted into the receptacle end  114  to achieve a desired starting nominal circumference for the annuloplasty ring  100 . In certain such embodiments, the tubular member  112  is sufficiently malleable in the martensite phase to allow a user such as a physician to adjust the circumferential value by hand to achieve a desired fit with the heart valve annulus. In certain embodiments, the starting nominal circumference for the annuloplasty ring  100  is configured to improve leaflet coaptation and reduce regurgitation in a heart valve.  
      After implantation, the annuloplasty ring  100  is preferably activated non-invasively by the application of energy to the patient&#39;s body to heat the tubular member  112 . In certain embodiments, an MRI device is used as discussed above to heat the tubular member  112 , which then causes the shape memory material of the tubular member  112  to transform to the austenite phase and remember its contracted configuration. Thus, the circumference of the annuloplasty ring  100  is reduced in vivo without the need for surgical intervention. Standard techniques for focusing the magnetic field from the MRI device onto the annuloplasty ring  100  may be used. For example, a conductive coil can be wrapped around the patient in an area corresponding to the annuloplasty ring  100 . In other embodiments, the shape memory material is activated by exposing it other sources of energy, as discussed above.  
      The circumference reduction process, either non-invasively or through a catheter, can be carried out all at once or incrementally in small steps at different times in order to achieve the adjustment necessary to produce the desired clinical result. If heating energy is applied such that the temperature of the tubular member  112  does not reach the A f  temperature for substantially maximum transition contraction, partial shape memory transformation and contraction may occur.  FIG. 2  graphically illustrates the relationship between the temperature of the tubular member  112  and the diameter or transverse dimension  123  of the annuloplasty ring  100  according to certain embodiments. At body temperature of approximately 37 degrees Celsius, the diameter of the tubular member  112  has a first diameter d 0 . The shape memory material is then increased to a first raised temperature T 1 . In response, the diameter of the tubular member  112  reduces to a second diameter d n . The diameter of the tubular member  112  can then be reduced to a third diameter d nm  by raising the temperature to a second temperature T 2 .  
      As graphically illustrated in  FIG. 2 , in certain embodiments, the change in diameter from d 0  to d nm  is substantially continuous as the temperature is increased from body temperature to T 2 . For example, in certain embodiments a magnetic field of about 2.5 Tesla to about 3.0 Tesla is used to raise the temperature of the tubular member  112  above the A f  temperature to complete the austenite phase and return the tubular member  112  to the remembered configuration with the insert end  116  fully inserted into the receptacle end  114 . However, a lower magnetic field (e.g., 0.5 Tesla) can initially be applied and increased (e.g., in 0.5 Tesla increments) until the desired level of heating and desired contraction of the annuloplasty ring  100  is achieved. In other embodiments, the tubular member  112  comprises a plurality of shape memory materials with different activation temperatures and the diameter of the tubular member  112  is reduced in steps as the temperature increases.  
      Whether the shape change is continuous or stepped, the diameter or transverse dimension  123  of the ring  100  can be assessed or monitored during the contraction process to determine the amount of contraction by use of MRI imaging, ultrasound imaging, computed tomography (CT), X-ray or the like. If magnetic energy is being used to activate contraction of the ring  100 , for example, MRI imaging techniques can be used that produce a field strength that is lower than that required for activation of the annuloplasty ring  100 .  
      In certain embodiments, the tubular member  112  comprises an energy absorption enhancement material  126 . As shown in  FIGS. 1A and 1C , the energy absorption enhancement material  126  may be disposed within an inner chamber of the tubular member  112 . As shown in  FIG. 1C  (and not shown in  FIG. 1A  for clarity), the energy absorption enhancement material  126  may also be coated on the outside of the tubular member  112  to enhance energy absorption by the tubular member  112 . For embodiments that use energy absorption enhancement material  126  for enhanced absorption, it may be desirable for the energy absorption enhancement material  126 , a carrier material (not shown) surrounding the energy absorption enhancement material  126 , if there is one, or both to be thermally conductive. Thus, thermal energy from the energy absorption enhancement material  126  is efficiently transferred to the shape memory material of the annuloplasty ring  100 , such as the tubular member  112 .  
      As discussed above, the energy absorption enhancement material  126  may include a material or compound that selectively absorbs a desired heating energy and efficiently converts the non-invasive heating energy to heat which is then transferred by thermal conduction to the tubular member  112 . The energy absorption enhancement material  126  allows the tubular member  112  to be actuated and adjusted by the non-invasive application of lower levels of energy and also allows for the use of non-conducting materials, such as shape memory polymers, for the tubular member  112 . For some embodiments, magnetic flux ranging between about 2.5 Tesla and about 3.0 Tesla may be used for activation. In certain embodiments, magnetic flux ranging between 2.0 Tesla and 3.5 Tesla may be used for activation. By allowing the use of lower energy levels, the energy absorption enhancement material  126  also reduces thermal damage to nearby tissue. Suitable energy absorption enhancement materials  126  are discussed above.  
      In certain embodiments, a circumferential contraction cycle can be reversed to induce an expansion of the annuloplasty ring  100 . Some shape memory alloys, such as NiTi or the like, respond to the application of a temperature below the nominal ambient temperature. After a circumferential contraction cycle has been performed, the tubular member  112  is cooled below the M s  temperature to start expanding the annuloplasty ring  100 . The tubular member  112  can also be cooled below the M f  temperature to finish the transformation to the martensite phase and reverse the contraction cycle. As discussed above, certain polymers also exhibit a two-way shape memory effect and can be used to both expand and contract the annuloplasty ring  100  through heating and cooling processes. Cooling can be achieved, for example, by inserting a cool liquid onto or into the annuloplasty ring  100  through a catheter, or by cycling a cool liquid or gas through a catheter placed near the annuloplasty ring  100 . Exemplary temperatures for a NiTi embodiment for cooling and reversing a contraction cycle range between approximately 20 degrees Celsius and approximately 30 degrees Celsius.  
      In certain embodiments, external stresses are applied to the tubular member  112  during cooling to expand the annuloplasty ring  100 . In certain such embodiments, one or more biasing elements (not shown) are operatively coupled to the tubular member  112  so as to exert a circumferentially expanding force thereon. For example, in certain embodiments a biasing element such as a spring (not shown) is disposed in the receptacle end  114  of the tubular member  112  so as to push the insert end  16  at least partially out of the receptacle end  114  during cooling. In such embodiments, the tubular member  112  does not include the ratchet member  120  such that the insert end  116  can slide freely into or out of the receptacle end  114 .  
      In certain embodiments, the tubular member comprises ferromagnetic shape memory material, as discussed above. In such embodiments, the diameter of the tubular member  112  can be changed by exposing the tubular member  112  to a magnetic field. Advantageously, nearby healthy tissue is not exposed to high temperatures that could damage the tissue. Further, since the shape memory material does not need to be heated, the size of the tubular member  112  can be adjusted more quickly and more uniformly than by heat activation.  
       FIGS. 3A-3C  illustrate an embodiment of an adjustable annuloplasty ring  300  that is similar to the annuloplasty ring  100  discussed above, but having a D-shaped configuration instead of a circular configuration. The annuloplasty ring  300  comprises a tubular body member  311  having a receptacle end  312  and an insert end  314  sized and configured to slide freely in the hollow receptacle end  312  in an axial direction which allows the annuloplasty ring  300  to constrict upon activation to a lesser circumference or transverse dimension as indicated by arrows  316 . The annuloplasty ring  300  has a major transverse dimension indicated by arrow  318  that is reduced upon activation of the annuloplasty ring  300 . The major transverse dimension indicated by arrow  318  can be the same as or similar to the transverse dimension indicated by arrow  123  discussed above. In certain embodiments, the features, dimensions and materials of the annuloplasty ring  300  are the same as or similar to the features, dimensions and materials of annuloplasty ring  100  discussed above. The D-shaped configuration of ring  32  allows a proper fit of the ring  32  with the morphology of some particular heart valves.  
       FIGS. 4A-4C  show an embodiment of an annuloplasty ring  400  that includes a continuous tubular member  410  surrounded by a suturable material  128 . The tubular member  410  has a substantially circular transverse cross section, as shown in  FIG. 4C , and has an absorption enhancing material  126  disposed within an inner chamber of the tubular member  410 . In certain embodiments, the absorption enhancing material  126  is also disposed on the outer surface of the tubular member  410 . The tubular member  410  may be made from a shape memory material such as a shape memory polymer or a shape memory alloy including a ferromagnetic shape memory alloy, as discussed above.  
      For embodiments of the annuloplasty ring  400  with a tubular member  410  made from a continuous piece of shape memory alloy (e.g., NiTi alloy) or shape memory polymer, the annuloplasty ring  400  can be activated by the surgical and/or non-invasive application of heating energy by the methods discussed above with regard to other embodiments. For embodiments of the annuloplasty ring  400  with a tubular member  410  made from a continuous piece of ferromagnetic shape memory alloy, the annuloplasty ring  400  can be activated by the non-invasive application of a suitable magnetic field. The annuloplasty ring  400  has a nominal inner diameter or transverse dimension indicated by arrow  412  in  FIG. 4A  that is set during manufacture of the ring  400 . In certain embodiments, the annuloplasty ring  400  is sufficiently malleable when it is implanted into a patient&#39;s body that it can be adjusted by hand to be fitted to a particular heart valve annulus.  
      In certain embodiments, upon activating the tubular member  410  by the application of energy, the tubular member  410  remembers and assumes a configuration wherein the transverse dimension is less than the nominal transverse dimension  412 . A contraction in a range between approximately 6 percent to approximately 23 percent may be desirable in some embodiments which have continuous hoops of shape memory tubular members  410 . In certain embodiments, the tubular member  410  comprises a shape memory NiTi alloy having an inner transverse dimension in a range between approximately 25 mm and approximately 38 mm. In certain such embodiments, the tubular member  410  can contract or shrink in a range between approximately 6 percent and approximately 23 percent, where the percentage of contraction is defined as a ratio of the difference between the starting diameter and finish diameter divided by the starting diameter. In certain embodiments, the annuloplasty ring  400  has a nominal inner transverse dimension  412  of approximately 30 mm and an inner transverse dimension in a range between approximately 23 mm and approximately 128 mm in a fully contracted state.  
      As discussed above in relation to  FIG. 2 , in certain embodiments, the inner transverse dimension  412  of certain embodiments can be altered as a function of the temperature of the tubular member  410 . As also discussed above, in certain such embodiments, the progress of the size change can be measured or monitored in real-time conventional imaging techniques. Energy from conventional imaging devices can also be used to activate the shape memory material and change the inner transverse dimension  412  of the tubular member  410 . In certain embodiments, the features, dimensions and materials of the annuloplasty ring  400  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  100  discussed above. For example, in certain embodiments, the tubular member  410  comprises a shape memory material that exhibits a two-way shape memory effect when heated and cooled. Thus, the annuloplasty ring  400 , in certain such embodiments, can be contracted and expanded.  
       FIG. 5  illustrates a top view of an annuloplasty ring  500  having a D-shaped configuration according to certain embodiments. The annuloplasty ring  500  includes a continuous tubular member  510  comprising a shape memory material that has a nominal inner transverse dimension indicated by arrow  512  that may contract or shrink upon the activation of the shape memory material by surgically or non-invasive applying energy thereto, as discussed above. The tubular member  510  may comprise a homogeneous shape memory material, such as a shape memory polymer or a shape memory alloy including, for example, a ferromagnetic shape memory alloy.  
      Alternatively, the tubular member  510  may comprise two or more sections or zones of shape memory material having different temperature response curves. The shape memory response zones may be configured in order to achieve a desired configuration of the annuloplasty ring  500  as a whole when in a contracted state, either fully contracted or partially contracted. For example, the tubular member  510  may have a first zone or section  514  that includes the arched portion of the tubular member that terminates at or near the corners  516  and a second zone or section  518  that includes the substantially straight portion of the tubular member  510  disposed directly between the corners  516 .  
      The annuloplasty ring  500  is shown in a contracted state in  FIG. 5  as indicated by the dashed lines  520 ,  522 , which represent contracted states of certain embodiments wherein both the first section  514  and second section  518  of the tubular member  510  have contracted axially. A suturable material (not shown), such as the suturable material  128  shown in  FIG. 1 , may be disposed about the tubular member  510  and the tubular member  510  may comprise or be coated with an energy absorption enhancement material  126 , as discussed above. In certain embodiments, the features, dimensions and materials of the annuloplasty ring  500  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  100  discussed above.  
       FIG. 6A  is a schematic diagram of a top view of a substantially D-shaped wire  600  comprising a shape memory material according to certain embodiments of the invention. The term “wire” is a broad term having its normal and customary meaning and includes, for example, mesh, flat, round, rod-shaped, or band-shaped members. Suitable shape memory materials include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above. The wire  600  comprises a substantially linear portion  608 , two corner portions  610 , and a substantially semi-circular portion  612 .  
      For purposes of discussion, the wire  600  is shown relative to a first reference point  614 , a second reference point  616  and a third reference point  618 . The radius of the substantially semi-circular portion  612  is defined with respect to the first reference point  614  and the corner portions  610  are respectively defined with respect to the second reference point  616  and the third reference point  618 . Also for purposes of discussion,  FIG. 6A  shows a first transverse dimension A, a second transverse dimension B.  
      In certain embodiments, the first transverse dimension A is in a range between approximately 20.0 mm and approximately 40.0 mm, the second transverse dimension B is in a range between approximately 10.0 mm and approximately 25.0 mm. In certain such embodiments, the wire  600  comprises a rod having a diameter in a range between approximately 0.45 mm and approximately 0.55 mm, the radius of each corner portion  610  is in a range between approximately 5.8 mm and 7.2 mm, and the radius of the substantially semi-circular portion  612  is in a range between approximately 11.5 mm and approximately 14.0 mm. In certain other such embodiments, the wire  600  comprises a rod having a diameter in a range between approximately 0.90 mm and approximately 1.10 mm, the radius of each corner portion  610  is in a range between approximately 6.1 mm and 7.4 mm, and the radius of the substantially semi-circular portion  612  is in a range between approximately 11.7 mm and approximately 14.3 mm.  
      In certain other embodiments, the first transverse dimension A is in a range between approximately 26.1 mm and approximately 31.9 mm, the second transverse dimension B is in a range between approximately 20.3 mm and approximately 24.9 mm. In certain such embodiments, the wire  600  comprises a rod having a diameter in a range between approximately 0.4 mm and approximately 0.6 mm, the radius of each corner portion  610  is in a range between approximately 6.7 mm and 8.3 mm, and the radius of the substantially semi-circular portion  612  is in a range between approximately 13.3 mm and approximately 16.2 mm. In certain other such embodiments, the wire  600  comprises a rod having a diameter in a range between approximately 0.90 mm and approximately 1.10 mm, the radius of each corner portion  610  is in a range between approximately 6.9 mm and 8.5 mm, and the radius of the substantially semi-circular portion  612  is in a range between approximately 13.5 mm and approximately 16.5 mm.  
      In certain embodiments, the wire  600  comprises a NiTi alloy configured to transition to its austenite phase when heated so as to transform to a memorized shape, as discussed above. In certain such embodiments, the first transverse dimension A of the wire  600  is configured to be reduced by approximately 10% to 25% when transitioning to the austenite phase. In certain such embodiments, the austenite start temperature A s  is in a range between approximately 33 degrees Celsius and approximately 43 degrees Celsius, the austenite finish temperature A f  is in a range between approximately 45 degrees Celsius and approximately 55 degrees Celsius, the martensite start temperature M s  is less than approximately 30 degrees Celsius, and the martensite finish temperature M f  is greater than approximately 20 degrees Celsius. In other embodiments, the austenite finish temperature A f  is in a range between approximately 48.75 degrees Celsius and approximately 51.25 degrees Celsius. Other embodiments can include other start and finish temperatures for martensite, rhombohedral and austenite phases as described herein.  
       FIGS. 6B-6E  are schematic diagrams of side views of the shape memory wire  600  of  FIG. 6A  according to certain embodiments. In addition to expanding and/or contracting the first transverse dimension A and/or the second transverse dimension B when transitioning to the austenite phase, in certain embodiments the shape memory wire  600  is configured to change shape in a third dimension perpendicular to the first transverse dimension A and the second transverse dimension B. For example, in certain embodiments, the shape memory wire  600  is substantially planar or flat in the third dimension, as shown in  FIG. 6B , when implanted into a patient&#39;s body. Then, after implantation, the shape memory wire  600  is activated such that it expands or contracts in the first transverse dimension A and/or the second transverse dimension B and flexes or bows in the third dimension such that it is no longer planar, as shown in  FIG. 6C . Such bowing may be symmetrical as shown in  FIG. 6C  or asymmetrical as shown in  FIG. 6D  to accommodate the natural shape of the annulus.  
      In certain embodiments, the shape memory wire  600  is configured to bow in the third dimension a distance in a range between approximately 2 millimeters and approximately 10 millimeters. In certain embodiments, the shape memory wire  600  is implanted to bow towards the atrium when implanted around a cardiac valve annulus to accommodate the natural shape of the annulus. In other embodiments, the shape memory wire  600  is configured to bow towards the ventricle when implanted around a cardiac valve to accommodate the natural shape of the annulus.  
      In certain embodiments, the shape memory wire  600  is bowed in the third dimension, as shown in  FIG. 6C , when implanted into the patient&#39;s body. Then, after implantation, the shape memory wire  600  is activated such that it expands or contracts in the first transverse dimension A and/or the second transverse dimension B and further flexes or bows in the third dimension, as shown in  FIG. 6E . In certain other embodiments, the shape memory wire  600  is bowed in the third dimension, as shown in  FIG. 6C , when implanted into the patient&#39;s body. Then, after implantation, the shape memory wire  600  is activated such that it expands or contracts in the first transverse dimension A and/or the second transverse dimension B and changes shape in the third dimension so as to become substantially flat, as shown in  FIG. 6B . An artisan will recognize from the disclosure herein that other annuloplasty rings disclosed herein can also be configured to bow or change shape in a third dimension so as to accommodate or further reinforce a valve annulus.  
       FIG. 7A  is a perspective view illustrating portions of an annuloplasty ring  700  comprising the wire  600  shown in  FIG. 6A  according to certain embodiments of the invention. The wire  600  is covered by a flexible material  712  such as silicone rubber and a suturable material  714  such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material. In other embodiments, the suturable material  714  comprises a biological material such as bovine or equine pericardium, homograft, patient graft, or cell-seeded tissue. For illustrative purposes, portions of the flexible material  712  and the suturable material  714  are not shown in  FIG. 7A  to show the wire  600 . However, in certain embodiments, the flexible material  712  and the suturable material  714  are continuous and cover substantially the entire wire  600 . Although not shown, in certain embodiments, the wire  600  is coated with an energy absorption enhancement material, as discussed above.  
       FIG. 7B  is an enlarged perspective view of a portion of the annuloplasty ring  700  shown in  FIG. 7A . For illustrative purposes, portions of the flexible material  712  are not shown to expose the wire  600  and portions of the suturable material  714  are shown peeled back to expose the flexible material  712 . In certain embodiments, the diameter of the flexible material  712  is in a range between approximately 0.10 inches and approximately 0.15 inches.  FIG. 7B  shows the wire  600  substantially centered within the circumference of the flexible material  712 . However, in certain embodiments, the wire  600  is offset within the circumference of the flexible material  712  to allow more space for sutures.  
       FIG. 8  is a schematic diagram of a substantially C-shaped wire  800  comprising a shape memory material according to certain embodiments of the invention. Suitable shape memory materials include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above. The wire  800  comprises two corner portions  810 , and a substantially semi-circular portion  812 .  
      For purposes of discussion, the wire  800  is shown relative to a first reference point  814 , a second reference point  816  and a third reference point  818 . The radius of the substantially semi-circular portion  812  is defined with respect to the first reference point  814  and the corner portions  810  are respectively defined with respect to the second reference point  816  and the third reference point  818 . Also for purposes of discussion,  FIG. 8  shows a first transverse dimension A and a second transverse dimension B. In certain embodiments, the wire  800  comprises a rod having a diameter and dimensions A and B as discussed above in relation to  FIG. 6A .  
      In certain embodiments, the wire  800  comprises a NiTi alloy configured to transition to its austenite phase when heated so as to transform to a memorized shape, as discussed above. In certain such embodiments, the first transverse dimension A of the wire  800  is configured to be reduced by approximately 10% to 25% when transitioning to the austenite phase. In certain such embodiments, the austenite start temperature A s  is in a range between approximately 33 degrees Celsius and approximately 43 degrees Celsius, the austenite finish temperature A f  is in a range between approximately 45 degrees Celsius and approximately 55 degrees Celsius, the martensite start temperature M s  is less than approximately 30 degrees Celsius, and the martensite finish temperature M f  is greater than approximately 20 degrees Celsius. In other embodiments, the austenite finish temperature A f  is in a range between approximately 48.75 degrees Celsius and approximately 51.25 degrees Celsius.  
       FIG. 9A  is a perspective view illustrating portions of an annuloplasty ring  900  comprising the wire  800  shown in  FIG. 8  according to certain embodiments of the invention. The wire  800  is covered by a flexible material  912  such as silicone rubber and a suturable material  914  such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material. In other embodiments, the suturable material  914  comprises a biological material such as bovine or equine pericardium, homograft, patient graft, or cell-seeded tissue. For illustrative purposes, portions of the flexible material  912  and the suturable material  914  are not shown in  FIG. 9A  to show the wire  800 . However, in certain embodiments, the flexible material  912  and the suturable material  914  cover substantially the entire wire  800 . Although not shown, in certain embodiments, the wire  800  is coated with an energy absorption enhancement material, as discussed above.  
       FIG. 9B  is an enlarged perspective view of a portion of the annuloplasty ring  900  shown in  FIG. 9A . For illustrative purposes, portions of the flexible material  912  are not shown to expose the wire  800  and portions of the suturable material  914  are shown peeled back to expose the flexible material  912 . In certain embodiments, the diameter of the flexible material  912  is in a range between approximately 0.10 inches and approximately 0.15 inches.  FIG. 9B  shows the wire  800  substantially centered within the circumference of the flexible material  912 . However, in certain embodiments, the wire  800  is offset within the circumference of the flexible material  912  to allow more space for sutures.  
       FIG. 10A  is a perspective view illustrating portions of an annuloplasty ring  1000  configured to contract and expand according to certain embodiments of the invention.  FIG. 10B  is a top cross-sectional view of the annuloplasty ring  1000 . As discussed above, after the annuloplasty ring  1000  has been contracted, it may become necessary to expand the annuloplasty ring  1000 . For example, the annuloplasty ring  1000  may be implanted in a child with an enlarged heart. When the size of the heart begins to recover to its natural size, the annuloplasty ring  1000  can be contracted. Then, as the child gets older and the heart begins to grow, the annuloplasty ring  1000  can be enlarged as needed.  
      The annuloplasty ring  1000  comprises a first shape memory wire  1010  for contracting the annuloplasty ring  1000  and a second shape memory wire  1012  for expanding the annuloplasty ring  1000 . The first and second shape memory wires,  1010 ,  1012  are covered by the flexible material  912  and the suturable material  914  shown in  FIGS. 9A-9B . For illustrative purposes, portions of the flexible material  912  and the suturable material  914  are not shown in  FIG. 10A  to show the shape memory wires  1010 ,  1012 . However, as schematically illustrated in  FIG. 10B , in certain embodiments, the flexible material  912  and the suturable material  914  substantially cover the first and second shape memory wires  1010 ,  1012 . As discussed below, the flexible material  912  operatively couples the first shape memory wire  1010  and the second shape memory wire  1012  such that a shape change in one will mechanically effect the shape of the other. The first and second shape memory wires  1010 ,  1012  each comprise a shape memory material, such as the shape memory materials discussed above. However, the first and second shape memory wires  1010 ,  1012  are activated at different temperatures.  
      In certain embodiments, the annuloplasty ring  1000  is heated to a first temperature that causes the first shape memory wire  1010  to transition to its austenite phase and contract to its memorized shape. At the first temperature, the second shape memory wire  1012  is in its martensite phase and is substantially flexible as compared the contracted first shape memory wire  1010 . Thus, when the first shape memory wire  1010  transitions to its austenite phase, it exerts a sufficient force on the second shape memory wire  1012  through the flexible material  912  to deform the second shape memory wire  1012  and cause the annuloplasty ring  1000  to contract.  
      The annuloplasty ring  1000  can be expanded by heating the annuloplasty ring to a second temperature that causes the second shape memory wire  1012  to transition to its austenite phase and expand to its memorized shape. In certain embodiments, the second temperature is higher than the first temperature. Thus, at the second temperature, both the first and second shape memory wires  1010 ,  1012  are in their respective austenite phases. In certain such embodiments, the diameter of the second shape memory wire  1012  is sufficiently larger than the diameter of the first shape memory wire  1010  such that the second memory shape wire  1012  exerts a greater force to maintain its memorized shape in the austenite phase than the first shape memory wire  1010 . Thus, the first shape memory wire  1010  is mechanically deformed by the force of the second memory shape wire  1012  and the annuloplasty ring  1000  expands.  
      In certain embodiments, the first memory shape wire  1010  is configured to contract by approximately 10% to 25% when transitioning to its austenite phase. In certain such embodiments, the first memory shape wire  1010  has an austenite start temperature A s  in a range between approximately 33 degrees Celsius and approximately 43 degrees Celsius, an austenite finish temperature A f  in a range between approximately 45 degrees Celsius and approximately 55 degrees Celsius, a martensite start temperature M s  less than approximately 30 degrees Celsius, and a martensite finish temperature M f  greater than approximately 20 degrees Celsius. In other embodiments, the austenite finish temperature A f  of the first memory shape wire  1010  is in a range between approximately 48.75 degrees Celsius and approximately 51.25 degrees Celsius.  
      In certain embodiments, the second memory shape wire  1012  is configured to expand by approximately 10% to 25% when transitioning to its austenite phase. In certain such embodiments, the second memory shape wire  1010  has an austenite start temperature A s  in a range between approximately 60 degrees Celsius and approximately 70 degrees Celsius, an austenite finish temperature A f  in a range between approximately 65 degrees Celsius and approximately 75 degrees Celsius, a martensite start temperature M s  less than approximately 30 degrees Celsius, and a martensite finish temperature M f  greater than approximately 20 degrees Celsius. In other embodiments, the austenite finish temperature A f  of the first memory shape wire  1010  is in a range between approximately 68.75 degrees Celsius and approximately 71.25 degrees Celsius.  
       FIG. 11A  is a perspective view illustrating portions of an annuloplasty ring  1100  according to certain embodiments comprising the first shape memory wire  1010  for contraction, the second shape memory wire  1012  for expansion, the flexible material  912  and the suturable material  914  shown in  FIGS. 10A-10B . For illustrative purposes, portions of the flexible material  912  and the suturable material  914  are not shown in  FIG. 11A  to show the shape memory wires  1010 ,  1012 . However, in certain embodiments, the flexible material  912  and the suturable material  914  substantially cover the first and second shape memory wires  1010 ,  1012 .  FIG. 11B  is an enlarged perspective view of a portion of the annuloplasty ring  1100  shown in  FIG. 11A . For illustrative purposes, portions of the flexible material  912  are not shown to expose the first and second shape memory wires  1010 ,  1012  and portions of the suturable material  914  are shown peeled back to expose the flexible material  912 .  
      The first shape memory wire  1010  comprises a first coating  1120  and the second shape memory wire  1012  comprises a second coating  1122 . In certain embodiments, the first coating  1120  and the second coating  1122  each comprise silicone tubing configured to provide suture attachment to a heart valve annulus. In certain other embodiments, the first coating  1120  and the second coating  1122  each comprise an energy absorption material, such as the energy absorption materials discussed above. In certain such embodiments, the first coating  1120  heats when exposed to a first form of energy and the second coating  1122  heats when exposed to a second form of energy. For example, the first coating  1120  may heat when exposed to MRI energy and the second coating  1122  may heat when exposed to HIFU energy. As another example, the first coating  1120  may heat when exposed to RF energy at a first frequency and the second coating  1122  may heat when exposed to RF energy at a second frequency. Thus, the first shape memory wire  1010  and the second shape memory wire  1012  can be activated independently such that one transitions to its austenite phase while the other remains in its martensite phase, resulting in contraction or expansion of the annuloplasty ring  1100 .  
       FIG. 12  is a perspective view of a shape memory wire  800 , such as the wire  800  shown in  FIG. 8 , wrapped in an electrically conductive coil  1210  according to certain embodiments of the invention. The coil  1210  is wrapped around a portion of the wire  800  where it is desired to focus energy and heat the wire  800 . In certain embodiments, the coil  1210  is wrapped around approximately 5% to approximately 15% of the wire  800 . In other embodiments, the coil  1210  is wrapped around approximately 15% to approximately 70% of the wire  800 . In other embodiments, the coil  1210  is wrapped around substantially the entire wire  800 . Although not shown, in certain embodiments, the wire  800  also comprises a coating comprising an energy absorption material, such as the energy absorption materials discussed above. The coating may or may not be covered by the coil  1210 .  
      As discussed above, an electrical current can be non-invasively induced in the coil  1210  using electromagnetic energy. For example, in certain embodiments, a handheld or portable device (not shown) comprising an electrically conductive coil generates an electromagnetic field that non-invasively penetrates the patient&#39;s body and induces a current in the coil  1210 . The electrical current causes the coil  1210  to heat. The coil  1210 , the wire  800  and the coating (if any) are thermally conductive so as to transfer the heat or thermal energy from the coil  1210  to the wire  800 . Thus, thermal energy can be directed to the wire  800 , or portions thereof, while reducing thermal damage to surrounding tissue.  
       FIGS. 13A and 13B  show an embodiment of an annuloplasty ring  1310  having a nominal inner diameter or transverse dimension indicated by arrow  1312  and a nominal outer diameter or transverse dimension indicated by arrows  1314 . The ring  1310  includes a tubular member  1316  having a substantially round transverse cross section with an internal shape memory member  1318  disposed within an inner chamber  1319  of the tubular member  1316 . The internal shape memory member  1318  is a ribbon or wire bent into a series of interconnected segments  1320 . Upon heating of the tubular member  1316  and the internal shape memory member  1318 , the inner transverse dimension  1312  becomes smaller due to axial shortening of the tubular member  1316  and an inward radial force applied to an inner chamber surface  1322  of the tubular member  1316  by the internal shape memory member  1318 . The internal shape memory member  1318  is expanded upon heating such that the ends of segments  1320  push against the inner chamber surface  1322  and outer chamber surface  1324 , as shown by arrow  1326  in  FIG. 13B , and facilitate radial contraction of the inner transverse dimension  1312 . Thus, activation of the internal shape memory member  1318  changes the relative distance between the against the inner chamber surface  1322  and outer chamber surface  1324 .  
      Although not shown in  FIG. 13A  or  13 B, The inner shape memory member  1318  may also have a heating energy absorption enhancement material, such as one or more of the energy absorption enhancement materials discussed above, disposed about it within the inner chamber  1319 . The energy absorption material may also be coated on an outer surface and/or an inner surface of the tubular member  1316 . The inner transverse dimension  1312  of the ring  1310  in  FIG. 13B  is less than the inner transverse dimension  1312  of the ring  1310  shown in  FIG. 13A . However, according to certain embodiments, the outer transverse dimension  1314  is substantially constant in both  FIGS. 13A and 13B .  
      For some indications, it may be desirable for an adjustable annuloplasty ring to have some compliance in order to allow for expansion and contraction of the ring in concert with the expansion and contraction of the heart during the beating cycle or with the hydrodynamics of the pulsatile flow through the valve during the cycle. As such, it may be desirable for an entire annuloplasty ring, or a section or sections thereof, to have some axial flexibility to allow for some limited and controlled expansion and contraction under clinical conditions.  FIGS. 14 and 15  illustrate embodiments of adjustable annuloplasty rings that allow some expansion and contraction in a deployed state.  
       FIG. 14  shows an annuloplasty ring  1400  that is constructed in such a way that it allows mechanical expansion and compression of the ring  1400  under clinical conditions. The ring  1400  includes a coil  1412  made of a shape memory material, such as one or more of the shape memory materials discussed above. The shape memory material or other portion of the ring  1400  may be coated with an energy absorption material, such as the energy absorption materials discussed above. The coil  1412  may have a typical helical structure of a normal spring wire coil, or alternatively, may have another structure such as a ribbon coil. In certain embodiments, the coil  1412  is surrounded by a suturable material  128 , such as Dacron® or the other suturable materials discussed herein. The coiled structure or configuration of the coil  1412  allows the ring  1400  to expand and contract slightly when under physiological pressures and forces from heart dynamics or hydrodynamics of blood flow through a host heart valve.  
      For embodiments where the coil  1412  is made of NiTi alloy or other shape memory material, the ring  1400  is responsive to temperature changes which may be induced by the application of heating energy on the coil  1412 . In certain embodiments, if the temperature is raised, the coil  1412  will contract axially or circumferentially such that an inner transverse dimension of the ring  1400  decreases, as shown by the dashed lines in  FIG. 14 . In  FIG. 14 , reference  1412 ′ represents the coil  1412  in its contracted state and reference  128 ′ represents the suturable material  128  in its contracted state around the contracted coil  1412 ′. In addition, or in other embodiments, the coil  1412  expands axially or circumferentially such that the inner transverse dimension of the ring  1400  increases. Thus, in certain embodiments, the ring  1400  can be expanded and contracted by applying invasive or non-invasive energy thereto.  
       FIG. 15  illustrates another embodiment of an adjustable annuloplasty ring  1500  that has dynamic compliance with dimensions, features and materials that may be the same as or similar to those of ring  1400 . However, the ring  1500  has a zig-zag ribbon member  1510  in place of the coil  1412  in the embodiment of  FIG. 14 . In certain embodiments, if the temperature is raised, the ribbon member  1510  will contract axially or circumferentially such that an inner transverse dimension of the ring  1500  decreases, as shown by the dashed lines in  FIG. 15 . In  FIG. 15 , reference  1510 ′ represents the ribbon member  1510  in its contracted state and reference  128 ′ represents the suturable material  128  in its contracted state around the contracted ribbon member  1510 ′. In addition, or in other embodiments, the ribbon member  1510  expands axially or circumferentially such that the inner transverse dimension of the ring  1500  increases. Thus, in certain embodiments, the ring  1500  can be expanded and contracted by applying invasive or non-invasive energy thereto.  
      The embodiments of  FIGS. 14 and 15  may have a substantially circular configuration as shown in the figures, or may have D-shaped or C-shaped configurations as shown with regard to other embodiments discussed above. In certain embodiments, the features, dimensions and materials of rings  1400  and  1500  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  400  discussed above.  
       FIGS. 16A and 16B  illustrate an annuloplasty ring  1600  according to certain embodiments that has a substantially circular shape or configuration when in the non-activated state shown in  FIG. 16A . The ring  1600  comprises shape memory material or materials which are separated into a first temperature response zone  1602 , a second temperature response zone  1604 , a third temperature response zone  1606  and a fourth temperature response zone  1608 . The zones are axially separated by boundaries  1610 . Although the ring  1600  is shown with four zones  1602 ,  1604 ,  1606 ,  1608 , an artisan will recognize from the disclosure herein that other embodiments may include two or more zones of the same or differing lengths. For example, one embodiment of an annuloplasty ring  1600  includes approximately three to approximately eight temperature response zones.  
      In certain embodiments, the shape memory materials of the various temperature response zones  1602 ,  1604 ,  1606 ,  1608  are selected to have temperature responses and reaction characteristics such that a desired shape and configuration can be achieved in vivo by the application of invasive or non-invasive energy, as discussed above. In addition to general contraction and expansion changes, more subtle changes in shape and configuration for improvement or optimization of valve function or hemodynamics may be achieved with such embodiments.  
      According to certain embodiments, the first zone  1602  and second zone  1604  of the ring  1600  are made from a shape memory material having a first shape memory temperature response. The third zone  1606  and fourth zone  1608  are made from a shape memory material having a second shape memory temperature response. In certain embodiments, the four zones comprise the same shape memory material, such as NiTi alloy or other shape memory material as discussed above, processed to produce the varied temperature response in the respective zones. In other embodiments, two or more of the zones may comprise different shape memory materials. Certain embodiments include a combination of shape memory alloys and shape memory polymers in order to achieve the desired results.  
      According to certain embodiments,  FIG. 16B  shows the ring  1600  after heat activation such that it comprises expanded zones  1606 ′,  1608 ′ corresponding to the zones  1606 ,  1608  shown in  FIG. 16A . As schematically shown in  FIG. 16A , activation has expanded the zones  1606 ′,  1608 ′ so as to increase the axial lengths of the segments of the ring  1600  corresponding to those zones. In addition, or in other embodiments, the zones  1606  and  1608  are configured to contract by a similar percentage instead of expand. In other embodiments, the zones  1602 ,  1604 ,  1606 ,  1608  are configured to each have a different shape memory temperature response such that each segment corresponding to each zone  1602 ,  1604 ,  1606 ,  1608  could be activated sequentially.  
       FIG. 16B  schematically illustrates that the zones  1606 ′,  1608 ′ have expanded axially (i.e., from their initial configuration as shown by the zones  1606 ,  1608  in  FIG. 16A ). In certain embodiments, the zones  1602 ,  1604  are configured to be thermally activated to remember a shape memory dimension or size upon reaching a temperature in a range between approximately 51 degrees Celsius and approximately 60 degrees Celsius. In certain such embodiments, the zones  1606  and  1608  are configured to respond at temperatures in a range between approximately 41 degrees Celsius and approximately 48 degrees Celsius. Thus, for example, by applying invasive or non-invasive energy, as discussed above, to the ring  1600  until the ring  1600  reaches a temperature of approximately 41 degrees Celsius to approximately 48 degrees Celsius, the zones  1606 ,  1608  will respond by expanding or contracting by virtue of the shape memory mechanism, and the zones  1602 ,  1604  will not.  
      In certain other embodiments, the zones  1602 ,  1604  are configured to expand or contract by virtue of the shape memory mechanism at a temperature in a range between approximately 50 degrees Celsius and approximately 60 degrees Celsius. In certain such embodiments, the zones  1606 ,  1608  are configured to respond at a temperature in a range between approximately 39 degrees Celsius and approximately 45 degrees Celsius.  
      In certain embodiments, the materials, dimensions and features of the annuloplasty ring  1600  and the corresponding zones  1602 ,  1604 ,  1606 ,  1608  have the same or similar features, dimensions or materials as those of the other ring embodiments discussed above. In certain embodiments, the features of the annuloplasty ring  1600  are added to the embodiments discussed above.  
       FIGS. 17A and 17B  illustrate an annuloplasty ring  1700  according to certain embodiments that is similar to the annuloplasty ring  1600  discussed above, but having a “D-shaped” configuration. The ring  1700  comprises shape memory material or materials which are separated into a first temperature response zone  1714 , a second temperature response zone  1716 , a third temperature response zone  1718  and a fourth temperature response zone  1720 . The segments defined by the zones  1714 ,  1716 ,  1718 ,  1720  are separated by boundaries  1722 . Other than the D-shaped configuration, the ring  1700  according to certain embodiments has the same or similar features, dimensions and materials as the features, dimension and materials of the ring  1600  discussed above.  
      According to certain embodiments,  FIG. 17B  shows the ring  1700  after heat activation such that it comprises expanded zones  1718 ′,  1720 ′ corresponding to the zones  1718 ,  1720  shown in  FIG. 17A . As schematically shown in  FIG. 17B , activation has expanded the zones  1718 ′,  1720 ′ by virtue of the shape memory mechanism. The zones  1718 ,  1720  could also be selectively shrunk or contracted axially by virtue of the same shape memory mechanism for an embodiment having a remembered shape smaller than the nominal shape shown in  FIG. 17A . The transverse cross sections of the rings  1600  and  1700  are substantially round, but can also have any other suitable transverse cross sectional configuration, such as oval, square, rectangular or the like.  
      In certain situations, it is advantageous to reshape a heart valve annulus in one dimension while leaving another dimension substantially unchanged or reshaped in a different direction. For example,  FIG. 18  is a sectional view of a mitral valve  1810  having an anterior (aortic) leaflet  1812 , a posterior leaflet  1814  and an annulus  1816 . The anterior leaflet  1812  and the posterior leaflet  1814  meet at a first commissure  1818  and a second commissure  1820 . When healthy, the annulus  1816  encircles the leaflets  1812 ,  1814  and maintains their spacing to provide closure of a gap  1822  during left ventricular contraction. When the heart is not healthy, the leaflets  1812 ,  1814  do not achieve sufficient coaptation to close the gap  1822 , resulting in regurgitation. In certain embodiments, the annulus  1816  is reinforced so as to push the anterior leaflet  1812  and the posterior leaflet  1814  closer together without substantially pushing the first commissure  1818  and the second commissure  1820  toward one another.  
       FIG. 18  schematically illustrates an exemplary annuloplasty ring  1826  comprising shape memory material configured to reinforce the annulus  1816  according to certain embodiments of the invention. For illustrative purposes, the annuloplasty ring  1826  is shown in an activated state wherein it has transformed to a memorized configuration upon application of invasive or non-invasive energy, as described herein. While the annuloplasty ring  1826  is substantially C-shaped, an artisan will recognize from the disclosure herein that other shapes are possible including, for example, a continuous circular, oval or D-shaped ring.  
      In certain embodiments, the annuloplasty ring  1826  comprises a first marker  1830  and a second marker  1832  that are aligned with the first commissure  1818  and the second commissure  1820 , respectively, when the annuloplasty ring  1826  is implanted around the mitral valve  1810 . In certain embodiments, the first marker  1830  and the second marker  1832  comprise materials that can be imaged in-vivo using standard imaging techniques. For example, in certain embodiments, the markers  1830  comprise radiopaque markers or other imaging materials, as is known in the art. Thus, the markers  1830 ,  1832  can be used for subsequent procedures for alignment with the annuloplasty ring  1826  and/or the commissures  1818 ,  1820 . For example, the markers  1830 ,  1832  can be used to align a percutaneous energy source, such as a heated balloon inserted through a catheter, with the annuloplasty ring  1826 .  
      When the shape memory material is activated, the annuloplasty ring  1826  contracts in the direction of the arrow  1824  to push the anterior leaflet  1812  toward the posterior leaflet  1814 . Such anterior/posterior contraction improves the coaptation of the leaflets  1812 ,  1814  such that the gap  1824  between the leaflets  1812 ,  1814  sufficiently closes during left ventricular contraction. In certain embodiments, the annuloplasty ring  1826  also expands in the direction of arrows  1834 . Thus, the first commissure  1818  and the second commissure  1820  are pulled away from each other, which draws the leaflets  1812 ,  1814  closer together and further improves their coaptation. However, in certain other embodiments, the annuloplasty ring does not expand in the direction of the arrows  1834 . In certain such embodiments, the distance between the lateral portions of the annuloplasty ring  1826  between the anterior portion and the posterior portion (e.g., the lateral portions approximately correspond to the locations of the markers  1830 ,  1832  in the embodiment shown in  FIG. 18 ) remains substantially the same after the shape memory material is activated.  
       FIG. 19  is a schematic diagram of a substantially C-shaped wire comprising a shape memory material configured to contract in a first direction and expand in a second direction according to certain embodiments of the invention. Suitable shape memory materials include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above.  FIG. 19  schematically illustrates the wire  800  in its activated configuration or memorized shape. For illustrative purposes, the wire  800  is shown relative to dashed lines representing its deformed shape or configuration when implanted into a body before activation.  
      When the shape memory material is activated, the wire  800  is configured to respond by contracting in a first direction as indicated by arrow  1824 . In certain embodiments, the wire  800  also expands in a second direction as indicated by arrows  1834 . Thus, the wire  800  is usable by the annuloplasty ring  1826  shown in  FIG. 18  to improve the coaptation of the leaflets  1812 ,  1814  by contracting the annulus  1816  in the anterior/posterior direction. In certain embodiments, the anterior/posterior contraction is in a range between approximately 10% and approximately 20%. In certain embodiments, only a first portion  1910  and a second portion  1912  of the wire  800  comprise the shape memory material. When the shape memory material is activated, the first portion  1910  and the second portion  1912  of the wire  800  are configured to respond by transforming to their memorized configurations and reshaping the wire  800  as shown.  
       FIGS. 20A and 20B  are schematic diagrams of a body member  2000  according to certain embodiments usable by an annuloplasty ring, such as the annuloplasty ring  1826  shown in  FIG. 18 . Although not shown, in certain embodiments, the body member  2000  is covered by a flexible material such as silicone rubber and a suturable material such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material, as discussed above.  
      The body member  2000  comprises a wire  2010  and a shape memory tube  2012 . As used herein, the terms “tube,” “tubular member” and “tubular structure” are broad terms having at least their ordinary and customary meaning and include, for example, hollow elongated structures that may in cross-section be cylindrical, elliptical, polygonal, or any other shape. Further, the hollow portion of the elongated structure may be filled with one or more materials that may be the same as and/or different than the material of the elongated structure. In certain embodiments, the wire  2010  comprises a metal or metal alloy such as stainless steel, titanium, platinum, combinations of the foregoing, or the like. As used herein, the term “wire” is a broad term having at least its ordinary and customary meaning and includes, for example, solid, hollow or tubular elongated structures that may in cross-section be cylindrical, elliptical, polygonal, or any other shape, including a substantially flat ribbon shape. In certain embodiments, the shape memory tube  2012  comprises shape memory materials formed in a tubular structure through which the wire  2010  is inserted. In certain other embodiments, the shape memory tube  2012  comprises a shape memory material coated over the wire  2010 . Suitable shape memory materials include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above. Although not shown, in certain embodiments, the body member  2000  comprises an energy absorption enhancement material, as discussed above.  
       FIG. 20A  schematically illustrates the body member  2000  in a first configuration or shape and  FIG. 20B  schematically illustrates the body member  2000  in a second configuration or shape after the shape memory tube has been activated. For illustrative purposes, dashed lines in  FIG. 20B  also show the first configuration of the body member  2000 . When the shape memory material is activated, the shape memory tube  2012  is configured to respond by contracting in a first direction as indicated by arrow  1824 . In certain embodiments, the shape memory tube  2012  is also configured to expand in a second direction as indicated by arrows  1834 . The transformation of the shape memory tube  2012  exerts a force on the wire  2010  to change its shape. Thus, the body member  2000  is usable by the annuloplasty ring  1826  shown in  FIG. 18  to pull the commissures  1818 ,  1820  further apart and push the leaflets  1812 ,  1814  closer together to improve coaptation.  
       FIGS. 21A and 21B  are schematic diagrams of a body member  2100  according to certain embodiments usable by an annuloplasty ring, such as the annuloplasty ring  1826  shown in  FIG. 18 . Although not shown, in certain embodiments, the body member  2100  is covered by a flexible material such as silicone rubber and a suturable material such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material, as discussed above.  
      The body member  2100  comprises a wire  2010 , such as the wire  2010  shown in  FIGS. 20A and 20B  and a shape memory tube  2112 . As schematically illustrated in  FIGS. 21A and 21B , the shape memory tube  2112  is sized and configured to cover a certain percentage of the wire  2010 . However, an artisan will recognize from the disclosure herein that in other embodiments the shape memory tube  2112  may cover other percentages of the wire  2010 . Indeed,  FIGS. 22A and 22B  schematically illustrate another embodiment of a body member  2200  comprising a shape memory tube  2112  covering a substantial portion of a wire  2010 . The amount of coverage depends on such factors as the particular application, the desired shape change, the shape memory materials used, the amount of force to be exerted by the shape memory tube  2112  when changing shape, combinations of the foregoing, and the like. For example, in certain embodiments where, as in  FIGS. 22A and 22B , the shape memory tube  2112  covers a substantial portion of a wire  2010 , portions of the shape memory tube  2112  are selectively heated to reshape the wire  2010  at a particular location. In certain such embodiments, HIFU energy is directed towards, for example, the left side of the shape memory tube  2112 , the right side of the shape memory tube  2112 , the bottom side of the shape memory tube  2112 , or a combination of the foregoing to activate only a portion of the shape memory tube  2112 . Thus, the body member  2200  can be reshaped one or more portions at a time to allow selective adjustments.  
      In certain embodiments, the shape memory tube  2112  comprises a first shape memory material  2114  and a second shape memory material  2116  formed in a tubular structure through which the wire  2010  is inserted. In certain such embodiments, the first shape memory material  2114  and the second shape memory material  2116  are each configured as a semi-circular portion of the tubular structure. For example,  FIG. 23  is a transverse cross-sectional view of the body member  2100 . As schematically illustrated in  FIG. 23 , the first shape memory material  2114  and the second shape memory material  2116  are joined at a first boundary  2310  and a second boundary  2312 . In certain embodiments, silicone tubing (not shown) holds the first shape memory material  2114  and the second shape memory material  2116  together. In certain other embodiments, the first shape memory material  2114  and the second shape memory material  2116  each comprise a shape memory coating covering opposite sides of the wire  2010 . Suitable shape memory materials include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above. Although not shown, in certain embodiments the body member  2100  comprises an energy absorption enhancement material, as discussed above.  
       FIG. 21A  schematically illustrates the body member  2100  in a first configuration or shape before the first shape memory material  2114  and the second shape memory material  2116  are activated. In certain embodiments, the first shape memory material  2114  and the second shape memory material  2116  are configured to be activated or return to their respective memorized shapes at different temperatures. Thus, the first shape memory material  2114  and the second shape memory material  2116  can be activated at different times to selectively expand and/or contract the body member  2100 . For example, in certain embodiments, the second shape memory material  2116  is configured to be activated at a lower temperature than the first shape memory material  2114 .  
       FIG. 21B  schematically illustrates the body member  2100  in a second configuration or shape after the second shape memory material  2116  has been activated. For illustrative purposes, dashed lines in  FIG. 21B  also show the first configuration of the body member  2100 . When the second shape memory material  2116  is activated, it responds by bending the body member  2100  in a first direction as indicated by arrow  1824 . In certain embodiments, activation also expands the body member  2100  in a second direction as indicated by arrows  1834 . Thus, the body member  2100  is usable by the annuloplasty ring  1826  shown in  FIG. 18  to pull the commissures  1818 ,  1820  further apart and push the leaflets  1812 ,  1814  closer together to improve coaptation.  
      In certain embodiments, the first shape memory material  2114  can then be activated to bend the body member  2100  opposite to the first direction as indicated by arrow  2118 . In certain such embodiments, the body member  2100  is reshaped to the first configuration as shown in  FIG. 21A  (or the dashed lines in  FIG. 21B ). Thus, for example, if the size of the patient&#39;s heart begins to grow again (e.g., due to age or illness), the body member  2100  can be enlarged to accommodate the growth. In certain other embodiments, activation of the first shape memory material  2114  further contracts the body member  2100  in the direction of the arrow  1824 . In certain embodiments, the first shape memory material  2114  has an austenite start temperature A s  in a range between approximately 42 degrees Celsius and approximately 50 degrees Celsius and the second shape memory material  2116  has an austenite start temperature A s  in a range between approximately 38 degrees Celsius and 41 degrees Celsius.  
       FIG. 24  is a perspective view of a body member  2400  usable by an annuloplasty ring according to certain embodiments comprising a first shape memory band  2410  and a second shape memory band  2412 . Suitable shape memory materials for the bands  2410 ,  2412  include shape memory polymers or shape memory alloys including, for example, ferromagnetic shape memory alloys, as discussed above. Although not shown, in certain embodiments the body member  2100  comprises an energy absorption enhancement material, as discussed above. Although not shown, in certain embodiments, the body member  2100  is covered by a flexible material such as silicone rubber and a suturable material such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material, as discussed above.  
      The first shape memory band  2410  is configured to loop back on itself to form a substantially C-shaped configuration. However, an artisan will recognize from the disclosure herein that the first shape memory band  2410  can be configured to loop back on itself in other configurations including, for example, circular, D-shaped, or other curvilinear configurations. When activated, the first shape memory band  2410  expands or contracts such that overlapping portions of the band  2410  slide with respect to one another, changing the overall shape of the body member  2400 . The second shape memory band  2412  is disposed along a surface of the first shape memory band  2410  such that the second shape memory band  2412  is physically deformed when the first shape memory band  2410  is activated, and the first shape memory band  2410  is physically deformed when the second shape memory band  2412  is activated.  
      As shown in  FIG. 24 , in certain embodiments at least a portion of the second shape memory band  2412  is disposed between overlapping portions of the first shape memory band  2410 . An artisan will recognize from the disclosure herein, however, that the second shape memory band  2412  may be disposed adjacent to an outer surface or an inner surface of the first shape memory band  2410  rather than between overlapping portions of the first shape memory band  2410 . When the second shape memory band  2412  is activated, it expands or contracts so as to slide with respect to the first shape memory band  2410 . In certain embodiments, the first shape memory band  2410  and the second shape memory band  2412  are held in relative position to one another by the flexible material and/or suturable material discussed above.  
      While the first shape memory band  2410  and the second shape memory band  2412  shown in  FIG. 24  are substantially flat, an artisan will recognize from the disclosure herein that other shapes are possible including, for example, rod-shaped wire. However, in certain embodiments the first shape memory band  2410  and the second shape memory band  2412  advantageously comprise substantially flat surfaces configured to guide one another during expansion and/or contraction. Thus, the surface area of overlapping portions of the first shape memory band  2410  and/or the second shape memory band  2412  guide the movement of the body member  2400  in a single plane and reduce misalignment (e.g., twisting or moving in a vertical plane) during shape changes. The surface area of overlapping portions also advantageously increases support to a heart valve by reducing misalignment during beating of the heart.  
      An artisan will recognize from the disclosure herein that certain embodiments of the body member  2400  may not comprise either the first shape memory band  2410  or the second shape memory band  2412 . For example, in certain embodiments the body member  2400  does not include the second shape memory band  2412  and is configured to expand and/or contract by only activating the first shape memory band  2410 . Further, an artisan will recognize from the disclosure herein that either the first band  2410  or the second band  2412  may not comprise a shape memory material. For example, the first band  2410  may titanium, platinum, stainless steel, combinations of the foregoing, or the like and may be used with or without the second band  2412  to support a coronary valve annulus.  
      As schematically illustrated in  FIGS. 25A-25C , in certain embodiments the body member  2400  is configured to change shape at least twice by activating both the first shape memory band  2410  and the second shape memory band  2412 .  FIG. 25A  schematically illustrates the body member  2400  in a first configuration or shape before the first shape memory band  2410  or the second shape memory band  2412  are activated. In certain embodiments, the first shape memory band  2410  and the second shape memory band  2412  are configured to be activated or return to their respective memorized shapes at different temperatures. Thus, the first shape memory band  2410  and the second shape memory band  2412  can be activated at different times to selectively expand and/or contract the body member  2400 . For example (and for purposes of discussing  FIGS. 25A-25C ), in certain embodiments, the first shape memory band  2410  is configured to be activated at a lower temperature than the second shape memory band  2412 . However, an artisan will recognize from the disclosure herein that in other embodiments the second shape memory band  2412  may be configured to be activated at a lower temperature than the first shape memory band  2410 .  
       FIG. 25B  schematically illustrates the body member  2400  in a second configuration or shape after the first shape memory band  2410  has been activated. When the first shape memory band  2410  is activated, it responds by bending the body member  2400  in a first direction as indicated by arrow  1824 . In certain embodiments, the activation also expands the body member  2400  in a second direction as indicated by arrows  1834 . Thus, the body member  2400  is usable by the annuloplasty ring  1826  shown in  FIG. 18  to pull the commissures  1818 ,  1820  further apart and push the leaflets  1812 ,  1814  closer together to improve coaptation.  
      In certain embodiments, the second shape memory band  2412  can then be activated to further contract the body member  2400  in the direction of the arrow  1824  and, in certain embodiments, further expand the body member  2400  in the direction of arrows  1834 . In certain such embodiments, activating the second shape memory band  2412  reshapes the body member  2400  to a third configuration as shown in  FIG. 25C . Thus, for example, as the patient&#39;s heart progressively heals and reduces in size, the body member  2400  can be re-sized to provide continued support and improved leaflet coaptation. In certain other embodiments, activation of the second shape memory band  2412  bends the body member  2400  opposite to the first direction as indicated by arrow  2118 . In certain such embodiments, activating the second shape memory band  2412  reshapes the body member  2400  to the first configuration as shown in  FIG. 25A . Thus, for example, if the size of the patient&#39;s heart begins to grow again (e.g., due to age or illness), the body member  2400  can be re-sized to accommodate the growth.  
      In certain annuloplasty ring embodiments, flexible materials and/or suturable materials used to cover shape memory materials also thermally insulate the shape memory materials so as to increase the time required to activate the shape memory materials through application of thermal energy. Thus, surrounding tissue is exposed to the thermal energy for longer periods of time, which may result in damage to the surrounding tissue. Therefore, in certain embodiments of the invention, thermally conductive materials are configured to penetrate the flexible materials and/or suturable materials so as to deliver thermal energy to the shape memory materials such that the time required to activate the shape memory materials is decreased.  
      For example,  FIG. 26  is a perspective view illustrating an annuloplasty ring  2600  comprising one or more thermal conductors  2610 ,  2612 ,  2614  according to certain embodiments of the invention. The annuloplasty ring  2600  further comprises a shape memory wire  800  covered by a flexible material  912  and a suturable material  914 , such as the wire  800 , the flexible material  912  and the suturable material  914  shown in  FIG. 9A . As shown in  FIG. 26 , in certain embodiments, the shape memory wire  800  is offset from the center of the flexible material  912  to allow more room for sutures to pass through the flexible material  912  and suturable material  914  to attach the annuloplasty ring  2600  to a cardiac valve. In certain embodiments, the flexible material  912  and/or the suturable material  914  are thermally insulative. In certain such embodiments, the flexible material  912  comprises a thermally insulative material. Although the annuloplasty ring  2600  is shown in  FIG. 26  as substantially C-shaped, an artisan will recognize from the disclosure herein that the one or more thermal conductors  2610 ,  2612 ,  2614  can also be used with other configurations including, for example, circular, D-shaped, or other curvilinear configurations.  
      In certain embodiments, the thermal conductors  2610 ,  2612 ,  2614  comprise a thin (e.g., having a thickness in a range between approximately 0.002 inches and approximately 0.015 inches) wire wrapped around the outside of the suturable material  914  and penetrating the suturable material  914  and the flexible material  912  at one or more locations  2618  so as to transfer externally applied heat energy to the shape memory wire  800 . For example,  FIGS. 27A-27C  are transverse cross-sectional views of the annuloplasty ring  2600  schematically illustrating exemplary embodiments for conducting thermal energy to the shape memory wire  800 . In the exemplary embodiment shown in  FIG. 27A , the thermal conductor  2614  wraps around the suturable material  914  one or more times, penetrates the suturable material  914  and the flexible material  912 , passes around the shape memory wire  800 , and exits the flexible material  912  and the suturable material  914 . In certain embodiments, the thermal conductor  2614  physically contacts the shape memory wire  800 . However, in other embodiments, the thermal conductor  2614  does not physically contact the shape memory wire  800  but passes sufficiently close to the shape memory wire  800  so as to decrease the time required to activate the shape memory wire  800 . Thus, the potential for thermal damage to surrounding tissue is reduced.  
      In the exemplary embodiment shown in  FIG. 27B , the thermal conductor  2614  wraps around the suturable material  914  one or more times, penetrates the suturable material  914  and the flexible material  912 , passes around the shape memory wire  800  two or more times, and exits the flexible material  912  and the suturable material  914 . By passing around the shape memory wire  800  two or more times, the thermal conductor  2614  concentrates more energy in the area of the shape memory wire  800  as compared to the exemplary embodiment shown in  FIG. 27A . Again, the thermal conductor  2614  may or may not physically contact the shape memory wire  800 .  
      In the exemplary embodiment shown in  FIG. 27C , the thermal conductor  2614  wraps around the suturable material  914  one or more times and passes through the suturable material  914  and the flexible material  912  two or more times. Thus, portions of the thermal conductor  2614  are disposed proximate the shape memory wire  800  to transfer heat energy thereto. Again, the thermal conductor  2614  may or may not physically contact the shape memory wire  800 . An artisan will recognize from the disclosure herein that one or more of the exemplary embodiments shown in  FIGS. 27A-27C  can be combined and that the thermal conductor  2614  can be configured to penetrate the suturable material  914  and the flexible material  912  in other ways in accordance with the invention so as to transfer heat to the shape memory wire  800 .  
      Referring again to  FIG. 26 , in certain embodiments the locations of the thermal conductors  2610 ,  2612 ,  2614  are selected based at least in part on areas where energy will be applied to activate the shape memory wire  800 . For example, in certain embodiments heat energy is applied percutaneously through a balloon catheter and the thermal conductors  2610 ,  2612 ,  2614  are disposed on the surface of the suturable material  914  in locations likely to make contact with the inflated balloon.  
      In addition, or in other embodiments, the thermal conductors  2610 ,  2612 ,  2614  are located to mark desired positions on the annuloplasty ring  2600 . For example, the thermal conductors  2610 ,  2612 ,  2614  may be disposed at locations on the annuloplasty ring  2600  corresponding to commissures of heart valve leaflets, as discussed above with respect to  FIG. 18 . As another example, the thermal conductors  2610 ,  2612 ,  2614  can be used to align a percutaneous energy source, such as a heated balloon inserted through a catheter, with the annuloplasty ring  2600 . In certain such embodiments the thermal conductors  2610 ,  2612 ,  2614  comprise radiopaque materials such as gold, copper or other imaging materials, as is known in the art.  
       FIG. 28  is a schematic diagram of an annuloplasty ring  2800  according to certain embodiments of the invention comprising one or more thermal conductors  2810 ,  2812 ,  2814 ,  2816 ,  2818 , such as the thermal conductors  2610 ,  2612 ,  2614  shown in  FIG. 26 . As schematically illustrated in  FIG. 28 , the annuloplasty ring  2800  further comprises a shape memory wire  800  covered by a flexible material  912  and a suturable material  914 , such as the wire  800 , the flexible material  912  and the suturable material  914  shown in  FIG. 9A .  
      In certain embodiments, the shape memory wire  800  is not sufficiently thermally conductive so as to quickly transfer heat applied in the areas of the thermal conductors  2810 ,  2812 ,  2814 ,  2816 ,  2818 . Thus, in certain such embodiments, the annuloplasty ring  2800  comprises a thermal conductor  2820  that runs along the length of the shape memory wire  800  so as to transfer heat to points of the shape memory wire  800  extending beyond or between the thermal conductors  2810 ,  2812 ,  2814 ,  2816 ,  2818 . In certain embodiments, each of the thermal conductors  2810 ,  2812 ,  2814 ,  2816 ,  2818 , comprise a separate thermally conductive wire configured to transfer heat to the thermal conductive wire  2820 . However, in certain other embodiments, at least two of the thermal conductors  2810 ,  2812 ,  2814 ,  2816 ,  2818  and the thermal conductor  2820  comprise one continuous thermally conductive wire.  
      Thus, thermal energy can be quickly transferred to the annuloplasty ring  2600  or the annuloplasty ring  2800  to reduce the amount of energy required to activate the shape memory wire  800  and to reduce thermal damage to the patient&#39;s surrounding tissue.  
      Magnetically Engageable Embodiments  
       FIG. 29A  schematically illustrates a top view of an annuloplasty ring  2900  having a C-shaped configuration according to certain embodiments. The annuloplasty ring  2900  includes a continuous tubular member  2910  comprising a shape memory material that has a nominal inner transverse dimension that may contract or shrink upon the activation of the shape memory material by surgically or non-invasive applying energy thereto, as discussed above. The annuloplasty ring further comprises magnetic devices  2914  and  2916 .  
      In certain embodiments, the annuloplasty ring  2900  comprises a shape memory wire covered by a flexible material and a suturable material, such as the wire  800 , the flexible material  912  and the suturable material  914  shown in  FIG. 9A .  
      The tubular member  2910  may comprise a homogeneous shape memory material, such as a shape memory polymer or a shape memory alloy including, for example, a ferromagnetic shape memory alloy. Alternatively, the tubular member  2910  may comprise two or more sections or zones of shape memory material having different temperature response curves, as discussed above with reference to  FIG. 5 . The shape memory response zones may be configured in order to achieve a desired configuration of the annuloplasty ring  2900  as a whole when in a contracted state, either fully contracted or partially contracted. In certain embodiments, the tubular member  2910  may enclose shape memory material. In certain embodiments, the tubular member  2910  may be made of at least a portion of shape memory material.  
      A suturable material (not shown), such as the suturable material  128  shown in  FIG. 1 , may be disposed about the annuloplasty ring  2900  and the annuloplasty ring  2900  may comprise or be coated with an energy absorption enhancement material  126 , as discussed above.  
      The annuloplasty ring  2900  comprises one or more magnetic devices  2914  and  2916 . In certain embodiments (not illustrated), the annuloplasty ring  2900  comprises one magnetic device, while in other embodiments, the annuloplasty ring  2900  comprises a plurality of magnetic devices. In certain embodiments, a magnetic device is located at only one end of the annuloplasty ring  2900 , while in other embodiments, magnetic devices are located at both ends of the annuloplasty ring  2900 . In certain embodiments, a magnetic device defines an end of the annuloplasty ring  2900 , as shown in  FIG. 29A . In certain embodiments, a magnetic device may be located between the ends of the annuloplasty ring  2900 , as shown in  FIG. 29B . In certain embodiments, the magnetic devices  2914  and  2916  may be disposed about the tubular member  2910 . In certain embodiments, the magnetic devices  2914  and  2916  may be adjacent to an end of the tubular member  2910 . In certain embodiments of the annuloplasty ring  2900  comprising more than one tubular member, magnetic devices may axially separate adjacent tubular members.  
      The term “magnetic” as used herein is a broad term and is used in its ordinary sense and includes, without limitation, any material that easily magnetizes, such as a material having atoms that orient their electron spins to conform to an external magnetic field. The magnetic devices  2914  and  2916  comprise materials exhibiting magnetic behavior or that may be magnetized by another magnet, including, but not limited to, ferromagnetism (including ferrimagnetism), diamagnetism and paramagnetism. Ferromagnetic materials include permanent magnets, ceramic magnets, electromagnetic materials, one or more polymer-bonded magnets, and isotropic and/or anisotropic materials, as discussed above. The magnetic devices  2914  and  2916  may also conduct thermal energy.  
      In certain embodiments, at least one of the magnetic devices  2914  and  2916  comprises a magnetic material. In certain embodiments, at least one of the magnetic devices  2914  or  2916  comprises an electromagnet that can be turned on or off. For example, the electromagnet may be turned on by providing an electric current to the magnet, and the electromagnet may be turned off by ceasing the flow of electric current.  
      In certain embodiments, one or more of the magnetic devices  2914  and  2916  can produce a force in a range between approximately 0.2 pounds of force and approximately 2.0 pounds of force at a distance of between one millimeter to ten millimeters, with a magnetic field in a range between approximately 100 Gauss and approximately 10,000 Gauss. In certain embodiments, a magnetic device may produce a force in a range between 0.1 pounds of force and 3.0 pounds of force at a distance between 0.5 millimeters and twenty millimeters. In certain embodiments, a magnetic device may produce a force in a range between 0.05 pounds of force and 5.0 pounds of force. In certain embodiments, the magnetic field may have a range between approximately 100 gauss and approximately 700 gauss. In certain embodiments, the magnetic field may have a range between approximately 50 gauss and approximately 15,000 gauss.  
      The magnetic devices  2914  and  2916  may have any suitable configuration provided they are suitably biocompatible or covered with a biocompatible material for implantation in the human body, as discussed above.  
      In certain embodiments, the magnetic devices  2914  and  2916  are cylindrical shaped magnets having a positive pole and a negative pole. In certain such embodiments, one or more of the magnetic devices  2914  and  2916  has a diameter in a range between approximately 0.2 mm and approximately 0.4 mm, and a height in a range between approximately 0.2 mm and approximately 0.4 mm, which facilitates attachment of the magnetic devices  2914  and  2916  to the annuloplasty ring  2900 . In other embodiments, the magnetic devices  2914  and  2916  may have other shapes. For example, in certain embodiments, one or more of the magnetic devices  2914  and  2916  can be in the shape of a rod, a sphere, a disk, a cube, a band, or the like. In certain embodiments, the magnets may have a different number of poles. In certain embodiments where the magnetic devices as disposed about the tubular member  2910 , the magnetic devices may take the shape of a band around the tubular member.  
      In certain embodiments, the features, dimensions and materials of the annuloplasty ring  2900  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  100  discussed above.  
       FIG. 29B  schematically illustrates a top view of an annuloplasty ring  2902  having a C-shaped configuration according to certain embodiments. The annuloplasty ring  2902  includes a continuous tubular member  2910  comprising a shape memory material that has a nominal inner transverse dimension that may contract or shrink upon the activation of the shape memory material by surgically or non-invasive applying energy thereto, as discussed above. The annuloplasty ring further comprises magnetic devices  2914  and  2916  located between the ends of the annuloplasty ring  2902 .  
      The tubular member  2910  may comprise a homogeneous shape memory material, such as a shape memory polymer or a shape memory alloy including, for example, a ferromagnetic shape memory alloy. Alternatively, the tubular member  2910  may comprise two or more sections or zones of shape memory material having different temperature response curves, as discussed above with reference to  FIG. 5 . The shape memory response zones may be configured in order to achieve a desired configuration of the annuloplasty ring  2902  as a whole when in a contracted state, either fully contracted or partially contracted. In certain embodiments, the tubular member  2910  may enclose shape memory material. In certain embodiments, the tubular member  2910  may be made of at least a portion of shape memory material.  
      A suturable material (not shown), such as the suturable material  128  shown in  FIG. 1 , may be disposed about the annuloplasty ring  2900  and the annuloplasty ring  2902  may comprise or be coated with an energy absorption enhancement material  126 , as discussed above.  
      The annuloplasty ring  2902  comprises one or more magnetic devices  2914  and  2916  located between the ends of the annuloplasty ring  2902 . The magnetic devices  2914  and  2916  of the annuloplasty ring  2902  comprise one or more magnetic bands disposed about the tubular member  2910 . In certain embodiments, In certain embodiments, the annuloplasty ring  2902  may comprise more than one tubular member axially separated by magnetic devices. In certain embodiments, the magnetic bands  2914  and  2916  are located at or near the ends of the annuloplasty ring  2902 . In certain embodiments, the magnetic bands  2914  and  2916  are located substantially near the midpoint between the both ends of the annuloplasty ring  2902 . In certain embodiments, the one or more magnetic bands  2914  and  2916  are located at various points along the annuloplasty ring  2902 . In certain embodiments (not illustrated), the annuloplasty ring  2902  comprises one magnetic device, while in other embodiments, the annuloplasty ring  2902  comprises a plurality of magnetic devices  2914  and  2916 .  
      In certain embodiments, the outside surface of the magnetic devices  2914  and  2916  is coated with a thin coating of biocompatible material as discussed above, including fluorinated ethylene propylene (FEP), polyether ether kythane (PEEK®), polycarbonate, polypropylene, high density polyethylene (HDPE), modified ethylene-tetrafluoroethylene copolymer (ETFE), polyethylene terephthalate polyester (PET-P), polyimide, nylon 6/12, and acrylonitrile/butadiene/styrene resin (ABS). In other embodiments, the suturable material comprises a biological material such as bovine or equine pericardium, homograft, patient graft, or cell-seeded tissue. An outer layer of rigid material, as described above, can also be used.  
      In certain embodiments, the features, dimensions and materials of the annuloplasty ring  2902  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  100  discussed above.  
       FIG. 30  schematically illustrates one embodiment of the body member  2000  shown in  FIG. 20 . The body member  2000  comprises a wire  2010 , a shape memory tube  2012 , and magnetic devices  2914  and  2916 . Although not shown, in certain embodiments, the body member  2000  is covered by a flexible material such as silicone rubber and a suturable material such as woven polyester cloth, Dacron®, woven velour, polyurethane, polytetrafluoroethylene (PTFE), heparin-coated fabric, or other biocompatible material, as discussed above. Although also not shown, in certain embodiments, the body member  2000  comprises an energy absorption enhancement material, as discussed above.  
      In certain embodiments, the body member  2000  is configured to enter multiple configurations when activated, as discussed above with reference to  FIGS. 20A and 20B .  
      The body member  2000  comprises one or more magnetic devices  2914  and  2916 . In certain embodiments (not illustrated), the body member  2000  comprises one magnetic device, while in other embodiments, the body member  2000  comprises a plurality of magnetic devices.  
      In certain embodiments, the wire  2010  attaches the magnetic devices  2914 ,  2916  to the first and second ends, respectively, of the body member  2000 . In certain embodiments, the wire  2010  wraps around the magnetic devices  2914  and  2916  in a semicircular, or hook-shaped fashion. In other embodiments, the wire  2010  wraps around the magnetic devices  2914  and  2916  in a loop, as illustrated in  FIG. 30 . For example, each end of the wire  2010  may form a circle shape around the magnetic devices  2914  and  2916 . In certain embodiments, the wire  2010  wraps around the magnetic devices  2914  and  2916  in a series of loops. For example, the wire  2010  may form a spiral or helical shape around the magnetic devices  2914  and  2916 . In other embodiments, the wire  2010  may form other shapes when coupling with the magnetic devices  2914  and  2916 . In certain embodiments, the wire  2010  may couple to the magnetic devices  2914  and  2916  using other methods.  
      Although the embodiments  2900 ,  2902 , and  2000  of  FIGS. 29A, 29B , and  30 , respectively, are illustrated in a substantially C-shaped configuration, in other embodiments the body member can be selected from a variety of shapes including, for example, ring shaped or D-shaped, as shown with regard to other embodiments discussed above. In certain embodiments, the features, dimensions and materials of embodiments  2900  and  2902  are the same as or similar to the features, dimensions and materials of the annuloplasty ring  2000  discussed above.  
       FIG. 31  schematically illustrates in more detail the first and second ends of the body member  2000  as illustrated in  FIG. 30 . As shown in  FIG. 31 , the body member  2000  comprises the wire  2010 , the shape memory tube  2012 , and the magnetic devices  2914  and  2916 . As discussed above, in certain embodiments the magnetic devices  2914  and  2916  each comprise a positive pole and a negative pole. In the embodiment illustrated in  FIG. 31 , the first magnetic device  2914  is orientated such that its negative pole is on a top surface of the magnetic device  2914 , and the second magnetic device  2916  is oriented such that its positive pole is on a top surface of the magnetic device  2916 . As discussed below, in certain embodiments, opposite poles of the respective magnetic devices facing one direction advantageously improves alignment with one or more catheters. Thus, the body member  2000  can engage the annuloplasty ring  1826  in a desired orientation and with improved contact to increase contact surface area and contact holding force.  
      In other embodiments, the magnetic devices can have different orientations. In certain other embodiments, the first magnetic device  2914  can be orientated such that its positive pole is on its top surface, and the second magnetic device  2916  can be oriented such that its negative pole is on its top surface. In certain other embodiments, the first and second magnetic devices  2914  and  2916  can be orientated such that their positive poles are on their respective top surfaces. In certain other embodiments, the first and second magnetic devices  2914  and  2916  can be orientated such that their negative poles are on their respective top surfaces.  
      The body member  2000  further comprises one or more energy conductors  3110 , according to certain embodiments of the invention. In certain embodiments, the conductors  3110  comprise thermal conductors. In certain embodiments, the conductors are configured to conduct other forms of energy, such as radio frequency (RF) energy, x-ray energy, microwave energy, ultrasonic energy such as focused ultrasound, high intensity focused ultrasound (HIFU) energy, light energy, electric field energy, magnetic field energy, combinations of the foregoing, or the like.  
      In certain embodiments, the conductors  3110  comprise a thin wire wrapped around the outside of the shape memory tube  2012  to transfer externally applied heat energy to the shape memory tube  2012 . For example, the wire may have a thickness in a range between approximately 0.002 inches and approximately 0.015 inches. In certain embodiments, the wire may have a thickness in a range between approximately 0.001 inches and approximately 0.080 inches. In certain embodiments, the wire may have a thickness in a range between approximately 0.0005 inches and approximately 0.1 inches. In certain embodiments, the conductors  3110  are attached to one or both of the magnetic devices  2914  and  2916 . In certain embodiments, the conductors  3110  may comprise a casing wrapped around the outside of the shape memory tube  2012 . In certain embodiments, the conductors  3110  may comprise platinum coated copper, titanium, tantalum, stainless steel, gold, their combinations, or the like, as discussed above.  
      In certain embodiments, the conductors  3110  comprise heating wire  3110 , which that generate heat when activated by an electrically conductive element, such as an electrical source or a heat source. For example, the heating wire  3110  may be activated by a catheter comprising a contact portion that may be heated, as discussed below.  
      In certain embodiments, the heating wire  3110  comprises a thin wire, such as a nickel-chromium resistance wire or iron-chrome-aluminum wire, wrapped around the outside of the shape memory tube  2012 . In certain embodiments, the wire may have a thickness in a range between approximately 0.002 inches and approximately 0.015 inches. In certain embodiments, the wire may have a thickness in a range between approximately 0.001 inches and approximately 0.080 inches. In certain embodiments, the wire may have a thickness in a range between approximately 0.0005 inches and approximately 0.1 inches. In certain embodiments, the heating wire  3110  is encased in a biocompatible material as described above.  
      In certain embodiments, the heating wire  3110  is attached to one or both of the magnetic devices  2914  and  2916 . The wire  3110  transfers heat energy generated or conducted by the wire  3110  to the shape memory tube  2012 . For example, if the wire  3110  is heated using an external device, a quantity of the heat from the wire  3110  may pass to the shape memory tube  2012  through a contact point between the two objects in order to heat the shape memory tube  2012  to an austensite temperature.  
      In certain embodiments, the conductor  3110 , such as the heating wire, may not physically contact with the shape memory tube  2012 . In certain embodiments, the conductor  3110  can pass around and/or through the covering of an annuloplasty ring, such as annuloplasty rings  1826  or  2600 , to transfer heat or electric current to the shape memory tube  2012 . In certain embodiments, the conductor  3110  passes sufficiently close to the shape memory tube  2012  so as to decrease the time required to activate the shape memory tube  2012 . Thus, the potential for damage to surrounding tissue is reduced.  
       FIG. 32  is a perspective view of a magnetic tipped catheter  3200  configured to deliver energy to an implant according to certain embodiments. The energy source may include, for example, radio frequency (RF) energy, x-ray energy, microwave energy, ultrasonic energy such as focused ultrasound, high intensity focused ultrasound (HIFU) energy, light energy, electric field energy, magnetic field energy, combinations of the foregoing, or the like.  
      The catheter  3200  comprises a catheter body portion  3210  at a proximal end of the catheter  3200  and a distal portion  3208  at a distal end of the catheter  3200 . The distal portion  3208  comprises a flexible tip portion  3212 , which itself comprises a magnetic tip  3214  configured to emanate a magnetic field. For example, the magnetic tip illustrated has a positive pole and a negative pole. In certain embodiments, the flexible tip portion  3212  may be made using flexible material, as described above.  
      In certain embodiments, the magnetic tip  3214  comprises a ferromagnetic material, as described above. In certain embodiments, the positive pole of the magnetic tip  3214  is at the distal end of the catheter  3200 . In certain other embodiments, the negative pole of the magnetic tip  3214  is at the distal end of the catheter  3200 . The magnetic tip  3214  can be adhered, welded, soldered, glued, or otherwise incorporated into the distal portion  3208  as desired. In certain embodiments, the magnetic tip  3214  may comprise a plurality of magnetic bands. The magnetic bands can be evenly or unevenly spaced along the length of the distal portion  3208 . The magnetic devices  2914  and  2916  of the implantable device  2000  can be positioned at any suitable location to aid in the positioning of the distal portion  3208  of the catheter  3200  relative to the implant  2000 .  
      The body portion  3210  includes a side arm  3204  through which catheter ports  3260  may be accessed. In certain embodiments, the catheter  3200  may contain one port, while in other embodiments the catheter  3200  may contain more than one port. In certain embodiments, the catheter  3200  may not contain any ports. A catheter port  3260  may be used to facilitate the insertion and pushing of instruments or objects, such as heated fluid or a heated fluid balloon, or fiber optic elements through the catheter body  2604  so as to deliver them to heart tissue.  
      Heart tissue may be accessed during an operation by various techniques and procedures so that the implantable device  2000  can be activated. For example, minimal invasive surgery techniques, laparoscopic procedures, and/or open surgical procedures can provide a convenient access path to the chambers of the heart for delivering energy using the magnetic tipped catheter  3200 . In some embodiments, access to the heart can be provided through the chest of a patient, and may include, without limitation, conventional transthoracic surgical approaches, open and semi-open heart procedures, and port access techniques. Such surgical access and procedures preferably can utilize conventional surgical instruments for access and performing surgical procedures on the heart, for example, retractors, rib spreaders, trocars, laparoscopic instruments, forceps, cannulas, staplers, and the like. The implant  2000  can be activated in conjunction with another surgical procedure that provides access (e.g., mitral valve repair, bypass surgical procedures, etc.).  
      Generally, in an embodiment intended for access through the femoral vein and delivery to the left atrium, the catheter  3200  can have a length within the range of from about 50 cm to about 150 cm, and a diameter of generally no more than about 5 French, 10 French, or 15 French. Those skilled in the art recognize that the catheter system can be configured and sized for various methods of activating the implantable device, as described below. The catheter  3200  can be sized and configured so that it can be delivered using, for example, conventional transthoracic surgical, minimally invasive, or port access approaches. In view of the present disclosure, further dimensions and physical characteristics of catheters for navigation to particular sites within the body are well understood in the art.  
      In embodiments where the catheter  3200  is delivered percutaneously into the heart, a guiding sheath can be placed in the vasculature system of the patient and used to guide the catheter  3200  to a desired deployment site.  
      In some embodiments, a guide wire is used to gain access through the superior or inferior vena cava, for example, through groin access for delivery through the inferior vena cava. The guiding sheath can be advanced over the guide wire and into the inferior vena cava. The distal end of the guiding sheath can be passed through the right atrium and towards the septum. Once the distal end of the guiding sheath is positioned proximate to the septum, a needle or piercing member is preferably advanced through the guiding sheath and used to puncture the fossa ovalis or other portion of the septum. In some embodiments, the guiding sheath is dimensioned and sized to pass through the fossa ovalis without requiring a puncturing device. That is, the guiding sheath can pass through the natural anatomical structure of the fossa ovalis into the left atrium.  
      The guiding sheath can be positioned through the inferior vena cava through the right atrium and a septal hole. When the guiding sheath is positioned within the heart, the catheter  3200  can be advanced distally through the guiding sheath. As the catheter  3200  is advanced through the guiding sheath, the distal portion  3208  is somewhat straight. Thus, the distal portion  3208  can be delivered through a low profile delivery sheath and can flex as it is advanced distally.  
      The catheter system  3200  can be advanced until the distal portion  3208  passes out of an opening of the guiding sheath. Preferably, the distal portion  3208  is in a generally collapsed state (e.g., a deflated state) as it is delivered through the guiding sheath for a low profile configuration.  
      As the distal portion  3208  passes out of the opening of the guiding sheath, the distal portion can assume its at-rest configuration. The distal portion  3208  assumes a somewhat curved configuration as it extends out of the opening. Of course, the catheter system  3200  can be twisted and rotated within the guiding sheath to position the distal portion  3208  comprising the magnetic tip  3214 .  
      In some embodiments, the magnetic tip  3214  of the distal portion  3208  can be an atraumatic tip that is configured to slide through the lumen of the delivery sheath. The atraumatic tip  3214  can limit or prevent significant damage to the inner tissue of the heart.  
       FIG. 33  schematically illustrates one exemplary embodiment of aligning one or more catheters with an implant, such as body member  2000  of  FIG. 30 , within the human body. Although the embodiment of body member  2000  is illustrated, other implants, including annuloplasty rings  2900  and  2902 , may also be used.  
      The body member  2000  comprises the first magnetic device  2914  attached to the first end of the body member  2000 , the second magnetic device  2916  attached to the second end of the body member  2000 , and the conductor  3110 .  FIG. 33  also illustrates a two catheters  3200   a  and  3200   b , such as the catheter  3200  of  FIG. 32 . The first catheter  3200   a  comprises a first flexible tip portion  3212   a  and a first magnetic tip  3214   a , and a second catheter  3200   b  comprising a second flexible tip portion  3212   b  and a second magnetic tip  3214   b.    
      After the body member  2000  has been implanted into a patient, a first catheter  3200   a  is inserted into the patient and guided to the annuloplasty implant area, as discussed above. The pole on the outer surface of the first magnetic tip  3214   a  and pole on the top surface of the first magnet device  2914  are of opposite polarities such that the magnetic tip  3214   a  and the first magnetic device  2914  produce a mutually attractive force. In certain embodiments, the magnetic tip  3214   a  and the first magnet device  2914  magnetically attach to each other, thus allowing the catheter  3200   a  to align with and attach to the implanted body member.  
      The illustrated embodiment shows the first magnetic tip  3214   a  having a positive pole on its outer surface and the first magnetic device  2914  having a negative pole on its top surface. In certain other embodiments, the first magnetic tip  3214   a  has a negative pole on its outer surface and the first magnetic device  2914  has a positive pole on its top surface such that the magnetic tip  3214   a  and the first magnetic device  2914  produce a mutually attractive force.  
      In certain other embodiments, a second catheter  3200   b  is also inserted into the patient and guided to the annuloplasty implant area. The poles of the magnetic tip  3214   b  and the second magnetic device  2916  are of opposite polarities such that the magnetic tip  3214   b  and the first magnetic device  2916  produce a mutually attractive force. In certain embodiments, the magnetic tip  3214   b  and the second magnet device  2914  magnetically attach to each other. Thus, both catheters  3200   a  and  3200   b  can be aligned with and attached to the implanted annuloplasty ring.  
      The illustrated embodiment shows the second magnetic tip  3214   b  having a negative pole on its outer surface and the second magnetic device  2916  having a positive pole on its top surface. In certain other embodiments, the second magnetic tip  3214   b  has a positive pole on its outer surface and the second magnetic device  2916  has a negative pole on its top surface such that the magnetic tip  3214   b  and the second magnetic device  2916  produce a mutually attractive force.  
      After the magnetic tip  3214   a  magnetically attaches to the magnetic device  2914 , as shown in  FIG. 34 , the distal portion  3208  of the catheter  3200   a  can deliver energy to the conductor  3110 . The delivered energy may include, for example, thermal energy, radio frequency (RF) energy, x-ray energy, microwave energy, ultrasonic energy such as focused ultrasound, high intensity focused ultrasound (HIFU) energy, light energy, electric field energy, magnetic field energy, combinations of the foregoing, or the like. In certain embodiments, energy may be delivered to the implant using an energy transfer module, such as a magnet, a conductor, a wire, or a needle-type “pointer” or any other suitable structure in thermal or electrical communication with the implant. In certain embodiments, thermal energy may be delivered to the implant via the conductor  3110 . In certain embodiments, thermal energy may be delivered to the implant via the implant&#39;s magnetic devices  2914  and  2916 . In certain embodiments, the energy may be delivered to the implant via another surface of the implant.  
      In certain embodiments, thermal energy may be delivered. In the embodiment illustrated in  FIG. 34 , thermal energy may be delivered to the conductor  3110  via the catheter  3200  using a needle type of pointer  3410  inserted through the catheter  3200   a  to contact the conductor  3110 . In certain embodiments, the pointer  3410  may be inserted through a port  3260  of the catheter  3200 . In certain embodiments not illustrated, the pointer  3410  may be external to and/or travel alongside an exterior surface of the catheter  3200   a . In certain embodiments, the pointer  3410  conducts thermal energy from an external source to the conductor  3110 . The conductor  3110  in turn, transfers the thermal energy to the shape memory tube  2012 , which causes the annuloplasty ring to alter its shape. In certain embodiments, the pointer  3410  heats the magnetic tip  3214  of the catheter  3200 , which, when in contact with the conductor  3110 , heats the conductor  3110 .  
      In embodiments where catheter  3200  activates an implant by sending activation energy to a magnetic device of the implant, energy may be delivered to either one or several magnetic devices simultaneously. In embodiments where the implant is composed of a plurality of shape memory segments, the catheter  3200  may activate the implant by sending activation energy to one or several shape memory segments simultaneously.  
      In certain other embodiments, after the first and second catheters  3200   a ,  3200   b  are magnetically attached to the first and the second magnetic devices  2914 ,  2916 , respectively, a first pointer  3410  can be inserted through the catheter  3200   a , and a second pointer  3410  can be inserted through the catheter  3200   b . The first pointer  3410  contacts the heating wire  3110  at the first magnetic device  2914 , and the second pointer  3420  contacts the heating wire  3110  at the second magnetic device  2916 . In certain embodiments, a current passing from the first pointer  3410  to the second pointer  3410  can provide a circuit through the heating wire  3110 , which causes the heating wire  3110  to generate heat. Thus, the heating wire  3110  transfers thermal energy to the shape memory tube  2012 , which causes the annuloplasty ring to alter its shape.  
      In certain embodiments, an electric current may pass through the catheter  2900  which heats the end portion  3280  of the flexible tip  3212 . In certain embodiments, the electric current may heat the magnetic tip  3214 . The catheter.  3200  may thus be used to apply energy to an implant as described above, such as implants  2000 ,  2900  and  2902  comprising magnetic devices described above.  
      In certain embodiments of the catheter  3200 , media, such as a fluid like water or saline, can be injected through the catheter port  3260  and through the body portion  3210  to the distal portion&#39;s flexible tip  3212 . The media may or may not be heated. Preferably, the media is heated to a threshold or target temperature before being delivered to the distal portion  3208 . The media can flow through the a port  3260  of the catheter and heat the flexible tip portion  3212  of the catheter  3200 . For example, the flexible tip portion  3212  may contain a balloon member (not illustrated) that is inflated by the media and heated as the heated media fills the distal portion  3208 . The heat from the distal portion  3208  can be transferred to the body member  2000 , preferably being transferred at least until the body member  2000  is activated, thereby changing the shape of the implantable device  2900 .  
      After the body member  2000  has been activated, the catheter  3200  can be retracted or moved proximally relative to the guide sheath. As the catheter system  3200  is pulled proximally through the guide sheath, the distal portion is straightened and slid through the opening and into the guide sheath. The catheter  3200  and the guide sheath can be withdrawn from the vasculature, preferably withdrawn without damaging the vasculature tissue.  
      While certain embodiments of the inventions have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of the inventions. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the form of the methods and systems described herein may be made without departing from the spirit of the inventions. For example, certain annuloplasty rings discussed herein can be flexible, semi-rigid, or rigid. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the invention.