Patent Publication Number: US-2022218482-A1

Title: Device and a Method for Improving the Function of a Heart Valve

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/231,337 filed Dec. 21, 2018, which is a continuation of U.S. patent application Ser. No. 14/357,760 filed May 12, 2014 entitled A Device And A Method For Improving The Function Of A Heart Valve, which is the U.S. National Phase of and claims priority to International Patent Application No. PCT/EP2012/072272, International Filing Date Nov. 9, 2012, entitled A Device And A Method For Improving The Function Of A Heart Valve, which claims benefit of European Patent Application No. EP11188656.0 filed Nov. 10, 2011 entitled A Device And a Method For Improving The Function Of A Heart Valve, and of U.S. Provisional Application Ser. No. 61/558,787, filed Nov. 11, 2011 entitled A Device And a Method For Improving The Function Of A Heart Valve, all of which are incorporated herein by reference in their entireties. 
    
    
     FIELD OF THE INVENTION 
     This disclosure pertains in general to the field of medical devices and methods. More particularly, the disclosure relates to a medical device for improving the function of a heart valve, and in particular to improving leaflets thereof. 
     BACKGROUND OF THE INVENTION 
       FIG. 1  illustrates a portion of the heart  12 , the mitral valve  18 , and the left ventricle  14 . The mitral valve is at its boundary circumferenced by an annulus  20 . The valve has two cusps or leaflets  22 ,  24 . Each of these cusps or leaflets  22 ,  24  are connected to a respective papillary muscle  27 ,  29  via their respective connecting chordae  26 ,  28 . In normal healthy individuals the free edges of the opposing leaflets will close the valve. However, for some individuals the closure is not complete, which results in a regurgitation, also called valvular insufficiency, i.e. back flow of blood to the left atrium making the heart less effective and with potentially severe consequences for the patient.  FIG. 2  illustrates a mitral valve  18 , in which the leaflets  22 ,  24  do not close properly. This commonly occurs when the annulus  20  becomes dilated. One surgical procedure to correct this is to remove a portion of the leaflet  24  and stitch the cut edges together with one another. The procedure will pull back the annulus  20  to a more normal position. However the strength of the leaflet  24  is altered. Similar problems with a less effective heart function occur if one or both leaflets are perforated to such an extent that blood is flowing towards the left atrium, although the leaflets close properly. 
     In some conditions of degenerated heart function, the leaflets do not present a solid surface, as in a degenerative valve disease. The leaflet could also be perforated, with one or several holes, where the blood can flow backwards into the atrium. 
     Another possibility is that the leaflet is ruptured, most commonly at an edge of a leaflet, resulting in an incomplete coaptation. In some conditions of degenerated heart function, the leaflets do not present a solid surface, e.g. degenerative valve disease. The leaflet could be perforated, with one or several holes, where the blood can flow backwards into the atrium. Another possibility is that the leaflet is ruptured, most commonly at an edge of a leaflet, resulting in an incomplete coaptation. 
     US2005/0107871 discloses a valve implant or prosthesis which includes a skirt or prosthetic valve leaflet configured to cover one of the leaflets of the valve to be repaired in a patient&#39;s heart. In one embodiment, a heart valve prosthesis Includes a curved member and a skirt. The curved member can have first and second ends and be adapted to form a partial ring along a portion of one of the valve annulae in the patient&#39;s heart. Alternatively, the curved member can form a full ring that is adapted to extend along the entire valve annulus. The skirt extends along the curved member and depends therefrom. This prosthesis Is especially useful in treating mitral valve insufficiency. In this case, the skirt can be configured so that when the prosthesis Is secured to the mitral valve along the mitral valve annulus, the skirt covers the posterior leaflet and the opposed edges of the skirt and the anterior leaflet coapt. In addition, when the curved member is secured to the posterior portion of the mitral valve annulus, further annulus dilation can be minimized or eliminated. 
     Hence, a medical device and method would be advantageous, and in particular such a device and method allowing for repair of one or more leaflets of a heart valve, or other related anatomical structures, such as the chordae attached to the ventricular side of leaflets. 
     From US2004/106989 a support for providing additional strength to existing regurgitant or prolapsed valve leaflets is known. The support restores an otherwise non-functioning, or poorly functioning, native valve to a functioning condition, obviating the need for a complete valve removal or replacement. The support may also be applied to a functioning valve leaflet as a prophylactic measure against future failure. The delivery method includes a delivery mechanism for attaching the support to the native valve leaflet. 
     However, the support disclosed in this document may not be rigid enough. Furthermore, the support may not be easy to handle by the surgeon during surgery. 
     SUMMARY OF THE INVENTION 
     Accordingly, embodiments of the present disclosure preferably seeks to mitigate, alleviate or eliminate one or more deficiencies, disadvantages or issues in the art, such as the above-identified, singly or in any combination by providing a device and a method, that improves the function of a heart valve comprised of valve tissue including an annulus at an outer section of the valve tissue and a plurality of leaflets at an inner section of the valve tissue, according to the appended patent claims. 
     According to a first aspect of the disclosure, a medical device is provided for improving the function of a heart valve. The medical device has a flexible leaflet reinforcement patch, which has at least partly an extension between an inner portion and an outer portion thereof. The outer portion of the flexible leaflet reinforcement patch is during use oriented towards the annulus of a cardiac valve, away from one or more of a plurality of leaflets thereof. The inner portion is oriented towards the inner section of leaflet tissue of the cardiac valve. The inner portion of the leaflet is oriented towards the centre of the valve. At least a part of the inner portion of the flexible leaflet reinforcement patch is in juxtaposition to at least one leaflet. The inner part of the flexible leaflet reinforcement patch, which is in juxtaposition to at least one of the leaflets is positioned in such a manner that it provides reinforcement to at least a portion of one of the plurality of leaflets. 
     According to a second aspect of the disclosure, a method for improving the function of a heart valve is provided. By placing the flexible leaflet reinforcement patch in such a manner as to orient its outer section towards the annulus and to orient the inner section towards an inner section of the valve tissue a circumferential proportion of the heart valve and leaflets are engaged with the flexible leaflet reinforcement patch. The flexible leaflet reinforcement patch is placed so that it has at least a portion of one of the plurality of leaflets in juxtaposition, so as to provide reinforcement to the leaflet portion or portions. 
     According to a third aspect of the disclosure, a medical device for improving the function of a heart valve, comprising valve tissue including an annulus and a plurality of leaflets is provided. The medical device comprises a tissue anchoring unit, such as a first loop-shaped support, configured to abut a first side of the heart valve. The medical device further comprises a first flexible leaflet reinforcement patch, being connected by a connection portion to the abutted tissue anchoring unit, and at least a portion of the leaflet reinforcement patch is in juxtaposition with at least one leaflet. The flexible leaflet reinforcement patch is configured to provide reinforcement to the at least one leaflet. 
     Further embodiments are defined in the dependent claims, wherein features for the second and subsequent aspects of the disclosure are as for the first aspect mutatis mutandis. 
     Some embodiments have a tissue anchoring unit that is connected to the outer surface of the flexible leaflet reinforcement patch. The tissue anchoring unit, when in use, secures the flexible leaflet reinforcement patch to the adjacent tissue and/or annulus, in such a manner that the flexible leaflet reinforcement patch is prevented from dislocating itself, without loss of the desired reinforcement function. Hence, the flexible leaflet reinforcement patch will be less affected by the forces of the pulsatile blood flow and the dynamics of the beating heart, which would dislocate the flexible leaflet reinforcement patch otherwise. 
     The tissue anchoring unit for some embodiments is a loop-shaped support. This gives a more rigid construction that abuts against the whole extension of adjacent valve tissue, e.g. the annulus. The medical device is easier to handle by the surgeon during surgery. 
     Some embodiments have a tissue anchoring unit which has fastening units as glue, spikes, prongs, points, hooks, clasps or hasps. These fastenings units further secure attachment of the medical device to adjacent valve tissue, e.g. annulus. The fastening units are in some embodiments made of a biocompatible material. In other embodiments these fastening units are made of biodegradable material or bioabsorbable material. The latter embodiments act to reinforce the leaflets during a restricted period of time, as and when required. 
     Some embodiments have portions of the flexible leaflet reinforcement patch at least partly extending from the outer section of the valve tissue to a free edge of a leaflet. These embodiments will reinforce the whole radial extension of the leaflet, e.g. by patching over the sewing line where a leaflet section has been removed and the opposing cut edges have been surgically attached together. 
     Some embodiments have the thickness of the flexible leaflet reinforcement patch thinner than the extension of flexible leaflet reinforcement patch. The thickness of the flexible leaflet reinforcement patch is for some embodiments at least partly uniform. This does not restrain and affect the natural movement of the leaflet during heart movements. Having the flexible leaflet reinforcement patch at least uniform in thickness allows for individual patient configuration to facilitate that the flexible leaflet reinforcement patch&#39;s thickness reinforces weakened or degenerated areas of at least a portion of a leaflet. 
     Some embodiments have the inner portion of the flexible leaflet reinforcement patch that will grow into a leaflet where the flexible leaflet reinforcement patch is in juxtaposition against the leaflet. This gives a permanent reinforcement of the leaflet area. Furthermore, some embodiments have its inner portion made of a biocompatible material. As such the medical device will not interfere with the valve tissue, avoiding rejection reactions, and/or avoids causing of blood clotting, embolies, blood cavitations, or turbulences in the blood flow passing the heart valve. 
     Some embodiments have the inner portion of the flexible leaflet reinforcement patch made of a biodegradable material and/or a bio absorbable material. These embodiments will give a temporary reinforcement of the leaflet area until the leaflet is restored to a healthy condition. The time span of the temporary reinforcement is controlled upon specification of the biodegradable material and/or a bio absorbable material. 
     Some embodiments have fastening units at the inner portion of the flexible leaflet reinforcement patch in juxtaposition to the leaflet. These fastening units are e.g. glue, spikes, prongs, points, hooks, clasps or hasps. In use these fastening units prevent the leaflet reinforcement patch from vertically dislocating until the leaflet has firmly grown into the leaflet or the leaflet reinforcement patch is absorbed or degraded. 
     Some embodiments have an inner portion of the flexible leaflet reinforcement patch for attaching a first end of a string. The other end of the string is to be connected to a cardiac structure other than a leaflet. These embodiments preserve the natural leaflet if securing in the free edge of the leaflet is prevented due to e.g. degeneration of the leaflet. In some embodiments the cardiac structure is a papillary muscle and the string is a chordae replacement unit. In use, these embodiments maintain the natural dynamics of the heart, while replacing one or several chordae with one or several replacement units. These strings are made of biocompatible material, such as artificial or biological material. 
     Some embodiments have at least one string extending from the inner portion of the flexible leaflet reinforcement patch. The free end of the string is in use connected to a cardiac structure other than a leaflet. These embodiments preserve the natural leaflet if securing in the free edge of the leaflet is prevented due to e.g. degeneration of the leaflet. In some embodiments the free end of the string is connected to the papillary muscle. Moreover, in use these embodiments maintain the natural dynamics of the heart while adding one or several artificial chordae as replacement units. 
     Some embodiments provide a method for anchoring the flexible leaflet reinforcement patch in the heart valve tissue including a tissue anchoring unit. The flexible leaflet reinforcement patch will thus be securely attached to the adjacent heart tissue and also make the flexible leaflet reinforcement patch less affected by the dynamic forces of pulsatile blood flow and dynamic movements of the beating heart. 
     Some embodiments provide for a method for placing the flexible leaflet reinforcement patch&#39;s inner section in juxtaposition against at least a portion of at least one of the leaflets. The placement includes connecting at least one string to a cardiac structure other than a leaflet. 
     Some embodiments have a first loop-shaped support which in use abuts a first side of the heart valve. Connected to the first loop-shaped support is a first flexible leaflet reinforcement patch at a connecting surface. When first loop-shaped support is abutting the heart valve, the first flexible leaflet reinforcement patch is arranged so that in use, the patch is in juxtaposition to at least a portion of one of the leaflets. The connected flexible leaflet reinforcement patch is configured to provide reinforcement to at least one of the leaflets. 
     Some embodiments have a tissue anchoring unit, which in use anchor the medical device to a first side of the heart valve. To the anchoring unit a flexible leaflet reinforcement patch is attached, and the flexible leaflet reinforcement patch has a leaflet in juxtaposition to the inner section. When in use, the section in juxtaposition is arranged against at least a portion of at least one leaflet, when the anchoring unit is fixed in the heart valve. The flexible leaflet reinforcement patch reinforces at least one of the leaflets when in juxtaposition to the leaflet. 
     Some embodiments have a first loop-shaped support as the tissue anchoring unit. The first loop-shaped support gives enhanced rigidity to the medical device and furthermore makes the device more manageable at implantation. Moreover, the medical device will be juxtaposed with valve tissue throughout the circumferential extension of the anchoring unit. 
     In some embodiments, the flexible leaflet reinforcement patch has a plurality of separate flexible leaflet reinforcement patch units. In use these individual extending flexible leaflet reinforcement patch units independently extend towards the centre of the valve. An induced dislocation of a single leaflet reinforcement patch unit is effectively isolated and thus will not pull and dislocate adjacent leaflet reinforcement patch units. 
     For some embodiments, the thickness of the leaflet reinforcement patch is at least partly uniform. The leaflet reinforcement patch does not affect the natural movement of the leaflet by adding extra weight or rigidity at portion of the leaflet, where it is not needed. 
     In some embodiments the leaflet reinforcement patch extends at least partly to the free edge of at least one of the plurality of leaflets. 
     In some embodiments, the whole extension of the leaflet will be covered and reinforced by the leaflet reinforcement patch. 
     Some embodiments provide for a catheter-based delivery without leakage or regurgitation. 
     Some embodiments provide for sealing of the area between a stent and a replacement heart valve. 
     Some embodiments provide good adherence between two metal parts and sealing of the area between the two metal parts, at a target site, such as a mitral valve. 
     Embodiments provide for advantageous medical devices and/or methods for facilitating and/or providing treatment of regurgitation of mitral and tricuspid valves. 
     It should be emphasized that the term “comprises/comprising” when used in this specification is taken to specify the presence of stated features, integers, steps or components but does not preclude the presence or addition of one or more other features, integers, steps, components or groups thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other aspects, features and advantages of the embodiments that the disclosure is capable of will be apparent and elucidated from the following description of embodiments of the present disclosure, reference being made to the accompanying drawings, in which 
         FIG. 1  is a cross-sectional view of the left ventricle of the heart including the mitral valve, corresponding papillary muscles and the connecting chordae; 
         FIG. 2  is a plan view of the mitral valve; 
         FIG. 3A  illustrates the flexible leaflet reinforcement patch;  FIG. 3B  illustrates the flexible leaflet reinforcement patch with an anchor unit attached;  FIG. 3C  illustrates example of extensions of the inner section of the flexible leaflet reinforcement patch;  FIG. 3D  illustrates a flexible leaflet reinforcement patch with adaptations matching the commissures; 
         FIG. 4  is a plan view of the mitral valve, illustrating surgical intervention and resulting stitches; 
         FIG. 5 ; is a plan view of the mitral valve, illustrating a flexible leaflet reinforcement patch in juxtaposition to surgical intervention areas of the leaflet; 
         FIG. 6  is a cross-sectional view of half of a heart valve, illustrating the anatomic structures of heart wall, leaflet, chordae and papillary muscle; 
         FIG. 7  is another cross-sectional view of half of a heart valve, illustrating the anatomic structures of heart wall, leaflet, chordae and papillary muscle; 
         FIG. 8  is yet another cross-sectional view of half of a heart valve, illustrating the anatomic structures of heart wall, leaflet, chordae and papillary muscle; 
         FIG. 9  is a further cross-sectional view of half of a heart valve, illustrating the anatomic structures of heart wall, leaflet, chordae and papillary muscle; 
         FIG. 10  is a flow chart of an embodiment of a method  100  comprising steps  110 - 170 ; and 
         FIG. 11  is a cross-sectional view through a heart valve, illustrating placement of a flexible leaflet reinforcement patch. 
     
    
    
     DESCRIPTION OF EMBODIMENTS 
     Specific embodiments of the disclosure now will be described with reference to the accompanying drawings. This disclosure may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the disclosure to those skilled in the art. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to be limiting of the disclosure. In the drawings, like numbers refer to like elements. 
     The description is illustrated with reasoning using the mitral valve as a starting point. However it should be understood that the methods and devices of this disclosure could be applied also to e.g. the tricuspid valve, the aortic valve or the pulmonary valve. 
       FIG. 1  illustrates a portion of the heart  12 , the mitral valve  18 , and the left ventricle  14 . The mitral valve is at its boundary encompassed by an annulus  20 . The valve has two cusps or leaflets  22 ,  24 . Each of these cusps or leaflets  22 ,  24  are connected to its respective papillary muscle,  27 ,  29  via respectively connecting chordae  26 ,  28 . In healthy individuals, the free edges of the opposing leaflets will close the valve. However, for some individuals, the closure is not complete which results in a regurgitation, also called valvular insufficiency, i.e. a back flow of blood to the left atrium making the heart less effective and potentially with severe consequences for the patient. 
       FIG. 2  illustrates the mitral valve  18  having the leaflets not closing properly. This commonly occurs when the annulus becomes dilated. One surgical procedure to correct this is to remove a portion of the leaflet and stitch the cut edges together with one another. The procedure will pull back the annulus to a more normal position. However the strength of the leaflet is altered. Similar problems, with a less effective heart function, occur if one or both leaflets are perforated to such an extent that blood is flowing towards the left atrium, although the leaflets close properly. 
     In an embodiment of the disclosure according to  FIG. 3A , a flexible leaflet reinforcement patch  30  is illustrated with an extension between an inner section  34  and an outer section  32 . The outer section of the flexible leaflet reinforcement patch  30  is configured to be oriented towards the annulus, and the inner portion of the flexible leaflet reinforcement patch  30  is configured to be oriented towards the inner section of the valve tissue, i.e. towards the centre of the valve. The flexible leaflet reinforcement patch has at least a portion of the inner section  34  of the flexible leaflet reinforcement patch in juxtaposition to a portion of a leaflet. When in use, the portion of the flexible leaflet reinforcement patch  30 , which is in juxtaposition to at least one portion of the plurality of leaflets, is arranged in a manner so as to provide reinforcement to the leaflet portions. Thus, the flexible leaflet reinforcement patch  30  provides reinforcement for a leaflet portion which either has become degenerated or damaged or provides reinforcement for a leaflet portion where a portion has been surgically removed, i.e. the flexible leaflet reinforcement patch  30  is used for repair and/or replacement of a leaflet or a portion thereof. 
     Some embodiments have a tissue anchoring unit  35 , shown in  FIG. 3B , configured to anchor the medical device to a first side of the heart valve. These embodiments have a leaflet reinforcement patch, which is connected to the tissue anchoring unit  35 . The leaflet reinforcement patch  30  has a leaflet in juxtaposition to a portion of the leaflet reinforcement patch  30 , which is configured to be arranged in juxtaposition against at least a portion of at least one of the leaflets, when the anchoring unit is fixed to the heart valve. The connected leaflet reinforcement patch  30  is configured to provide reinforcement to at least one of the leaflets, when at least a portion is in juxtaposition against the leaflet. In the embodiment of the disclosure illustrated in  FIG. 3B , a tissue anchoring unit  35  is connected at the outer section  32  of the flexible leaflet reinforcement patch  30 . The tissue anchoring unit  35  provides for an opportunity to secure or anchor the flexible leaflet reinforcement patch  30  to adjacent heart tissue and/or annulus. Thus the flexible leaflet reinforcement patch  30  is prevented from dislocating itself, with loss of the desired reinforcement function. Moreover, the flexible leaflet reinforcement patch  30  will be less affected by the force of the pulsatile blood flow and the dynamics of the beating heart. 
     The tissue anchoring unit  35  for some of the embodiments is a first loop-shaped support. The loop-shaped support presents a more rigid construction and also provides an abutment against the whole extension of the annulus, which further contributes to the rigidity of the construction. The rigidity of the loop-shaped support can be soft or very firm depending on the material, e.g. plastic, shape memory polymer, cloth or fabric, multilayered stitched and reinforced, and metal, such as titanium, stainless steel or nitinol. The gained rigidity may potentially yield the medical device to be easier to handle in the surgical situation with regards to implantation of the medical device. 
     The tissue anchoring unit  35  has fastening units in some embodiments. The fastening units are glue, spikes, prongs, points, hooks, clasps or hasps. The fastening units will further firmly secure attachment of the medical device to adjacent valve tissue and are in some embodiments made of a biocompatible material. In other embodiments these fastening units are made of biodegradable material or bioabsorbable material. By having fastening units of biodegradable material or bioabsorbable material, a time dependent attachment of the flexible leaflet reinforcement patch  30  due to the speed of degradation and/or absorption is possible. Until the inner portion is securely incorporated into the leaflets, the fastening units hold the outer sections of the leaflet reinforcement patch, adjacent to the annulus. The desired position of the inner portion is preserved and will be incorporated into the surrounding tissue. 
     In one embodiment depicted in  FIG. 3C , the extension of the flexible leaflet reinforcement patch  30  is at least partly configured for extending from the outer section of the valve tissue to a free edge of the at least one of the plurality of leaflets, with an extension, such as a wave-shaped extension  36 . Alternatively, the flexible leaflet reinforcement patch  30  has a rectangular-shaped extension  37 . However, it should be understood that any other suitable shape of the extension may be used. The extension of the flexible leaflet reinforcement patch  30  can be along the whole extension of the leaflet towards the free-edge of the leaflet. This minimizes unwanted force concentrations at the transition edge between the flexible leaflet reinforcement patch  30  and the leaflet. Adjacent to the edge of the flexible leaflet reinforcement patch  30  is where the leaflet is exposed to the highest force. By extending the flexible leaflet reinforcement patch  30 , this force concentration is eliminated and potential rupture of the leaflet is avoided. Patching over the sewing line is advantageous, especially in those instances where a leaflet section has been removed and the opposing cut edges has been surgically attached together strengthening the leaflet area. 
     Shown in  FIG. 3D  is a flexible leaflet reinforcement patch  30  having a more anatomic configuration, shaped for a better fit with parts of the heart. The indentation  39  corresponds to a commissure of the heart valve, and the flexible leaflet reinforcement patch  30  does not extend beyond the commissure. The blood flow pattern from the left atrium to the left ventricle is kept as natural as possible and as such does not cause turbulent or constricted blood flow. When a flexible leaflet reinforcement patch  30  extends over the commissure, a free edge of the flexible leaflet reinforcement patch  30  is exposed so that the dynamics of the beating heart, i.e. movements and pulsatile blood flow, can pull and tear the flexible leaflet reinforcement patch  30 . 
     The surgical procedure is illustrated in  FIG. 4 , where a leaflet-ectomy may be surgically removing a piece of the leaflet resembling a sector of a circle  40  and stitching the radial edges of the leaflet together with one another  42 . A different procedure, so called sliding, involves making cuts in the leaflet along and adjacent to the annulus and one cut in the leaflet towards the centre of the valve. Next a radial piece of the leaflet is removed, in such a manner as to reduce the circumference of the outer section of the leaflet. The procedure yields commonly L- or T-shaped formations of stitches and sewing lines, one line of stitches along the annulus  46  and one line of stitches inwardly towards the centre of the valve  44 . 
     In an embodiment according to  FIG. 5 , the flexible leaflet reinforcement patch  30  is in position at the heart valve with the outer section  32  towards the annulus and the inner section  34  towards the centre of the heart valve. As shown in  FIG. 5 , the inner section  34  of the flexible leaflet reinforcement patch  30  extends, with an extension, such as the wave-shaped extension  36 , radially inwards over the stitched areas of the leaflet to reinforce the leaflet. Thus, the flexible leaflet reinforcement patch  30  reinforces the leaflet. In addition, the outer section  32  of the flexible leaflet reinforcement patch  30  is during use oriented towards the annulus of the cardiac valve, in this case a mitral valve, and since the flexible leaflet reinforcement patch  30  is in close contact with the annulus, the area between the annulus and the outer section  32  of the flexible leaflet reinforcement patch  30  is sealed. 
     The material of the flexible leaflet reinforcement patch  30  is flexible in at least two aspects; firstly not to negatively affect the natural movement of the leaflet during the cycle of a heart beat, secondly to allow, at implantation of the medical device, adjustment of the medical device to properly match the anatomic structure of the implantation site. This latter flexibility of the leaflet reinforcement patch is due to expected anatomic variations between different patients. 
     In some embodiments, the flexible leaflet reinforcement patch  30  also has a thickness, which is thinner than the extension of the flexible leaflet reinforcement patch  30 . The thickness of the flexible leaflet reinforcement patch  30  is at least partly non-uniform, such that the flexible leaflet reinforcement patch  30  is e.g. thicker at certain areas in juxtaposition to the flexible leaflet reinforcement patch  30 , i.e. where a larger force is anticipated or another higher demand is likely. Thus, the leaflet reinforcement patch can be devised with a variation in thickness so as to be precisely tailored to the specific need required. With similar reasoning, a thinner proportion of a segment of the flexible leaflet reinforcement patch  30  may be advantageous, e.g. to not prevent the natural movement of the leaflet where no reinforcement is required. The thickness of the flexible leaflet reinforcement patch  30  is configured at least partly to be appositioned with weakened or degenerated areas of at least a portion the leaflets. 
     Some embodiments have an inner section  34  of the flexible leaflet reinforcement patch  30 , which is incorporated into at least one of the plurality of leaflets. These embodiments give a permanent reinforcement of the leaflet area where the flexible leaflet reinforcement patch  30  has been integrated. Furthermore, some embodiments have the inner section  34  made of a biocompatible material. As such the medical device will not inflict with and/or cause blood clotting. In addition, in some embodiments the inner section  34  of the flexible leaflet reinforcement patch  30  is made of a biodegradable material and/or a bioabsorbable material. These choices of material provide a temporary reinforcement of the leaflet area until the leaflet is restored to a healthy condition, which may be beneficial in some circumstances, e.g. for young patients, whose hearts are still growing, since in young patients, with growing hearts, a non-degradable or non-absorbable leaflet reinforcement patch may disturb the growth of the heart valve. The time span of the temporary reinforcement may be controlled upon choice of specification of the biodegradable material and/or the bio absorbable material. 
     Some embodiments provide for a leaflet in juxtaposition to a portion of the flexible leaflet reinforcement patch&#39;s inner section  34  by comprising fastening means, e.g. glue, spikes, prongs, points, hooks, clasps or hasps. By having such fastening means for portions of the flexible leaflet reinforcement patches  30  in juxtaposition to the leaflet, the leaflet reinforcement patch is prevented from vertically dislocating until the leaflet reinforcement patch is firmly integrated into the leaflet or the flexible leaflet reinforcement patch  30  is absorbed or degraded properly. 
     In an embodiment shown in  FIG. 6 , which is a cross-sectional view of half of a heart valve, the anatomic structures of the heart; the annulus  20 , the leaflet  24 , the chordae tendinae  28  and the papillary muscle  29  are shown. The flexible leaflet reinforcement patch  30  is in juxtaposition to the leaflet  24 . The inner section  34  of the flexible leaflet reinforcement patch  30 , the outer section  32  of the flexible leaflet reinforcement patch  30  and the anchoring unit  35  are also shown in  FIG. 6 . The inner section  34  of the flexible leaflet reinforcement patch  30  has an extension that optionally reaches and contacts the free edge  60  of the leaflet  24 . Furthermore, in some embodiments there is a variation in thickness along the extension of the flexible leaflet reinforcement patch  30 , towards the centre of the heart valve. Alternatively, the thickness of the flexible leaflet reinforcement patch  30  is circumferentially non-uniform, radially non-uniform or non-uniform in both circumferential and radial directions, i.e. the thickness of a first portion of the flexible leaflet reinforcement patch  30  can be non-uniform with a second portion of the flexible leaflet reinforcement patch  30 , with the second portion of the flexible leaflet reinforcement patch  30  being positioned apart from the first portion of the flexible reinforcement patch  30  in any direction.  FIGS. 6-9  illustrate variations of the extension and thickness of the flexible leaflet reinforcement patch  30  discussed in the description above. As can be seen in  FIG. 6 , the flexible leaflet reinforcement patch  30  can be short, and only extend from the anchoring unit  35  slightly further than halfway to the free edge  60  of the leaflet  24 . In an embodiment according to  FIG. 7 , the flexible leaflet reinforcement patch  30  is long, and extends from the anchoring unit  35  considerably further than halfway to the free edge  60  of the leaflet  24 , and almost to the free edge  60  of the leaflet  24 . In some embodiments, such as the embodiment depicted in  FIG. 9 , the flexible leaflet reinforcement patch  30  extends from the anchoring unit  35  all the way to the free edge  60  of the leaflet  24 . 
     In some embodiments, the anchoring unit  35  is a first loop-shaped support, which is configured to abut a first side of the heart valve, and a first leaflet reinforcement patch  30  is connected at a connection surface to the first loop-shaped support. The first leaflet reinforcement patch  30  has a leaflet in juxtaposition to a section of the leaflet reinforcement patch which is configured to be arranged in juxtaposition against at least a portion of at least one of the leaflets when the first loop-shaped support is abutting the heart valve. The connected leaflet reinforcement patch is configured to provide reinforcement to at least one of the leaflets. 
     It should be understood that the cross-section of the first loop-shaped support is not limited to a circular shape.  FIGS. 6-9  illustrate variations of the anchoring unit  35 . In  FIG. 6 , the anchoring unit  35  has an oval or conical shape. In  FIG. 7 , the anchoring unit  35  is substantially flat, with a square or rectangular cross-section and with rounded edges.  FIG. 8  illustrates an anchoring unit with hooks positioned at the annulus  20 . In  FIG. 9 , the anchoring unit  35  is substantially flat, with a square or rectangular cross-section. The anchoring unit  35  may also be of a different shape, such as spherical or conical. It should also be understood that the disclosure is not limited to the embodiments in the figures. As an example, the various shapes of the anchoring unit  35  given above can be used together with any of the flexible leaflet reinforcement patches, depicted in  FIGS. 6-9 , and being defined by their thickness and length. 
     In another embodiment according to  FIG. 8  the flexible leaflet reinforcement patch  30  is configured for attaching a first end of at least one string  82  to the inner section  34 . The inner section  34  is not required to fully extend to the free edge  60  of the leaflet  24  for connecting the first end of the string  82 . In some embodiments the extension of the inner section  34  is proportional to the leaflet  24 . The first end of the string  82  is either connected transversally through the leaflet  24  at the edge of the flexible leaflet reinforcement patch  30  or connected in such a manner that the string is positioned on the leaflet towards the free edge  60  of the leaflet  80 . The other end of the string  82 , the second end of at least one string  82 , is in use to be connected to a cardiac structure other than a leaflet. The second end of the string  82  beneficially is connected to a cardiac structure within the left ventricle to preserve the natural movement of the leaflet as the heart beats. The structure may be the papillary muscle  29  or the lower parts of the corresponding chordae  28 . This is advantageous, especially if the string  82  is secured with the free edge  60  of the leaflet  24 , since then the natural leaflet can be preserved. The string  82  is important also when the chordae  28  has been damaged or degenerated, since the string can also function as a support for the chordae  28 . In some embodiments the string  82  is made of a biocompatible material; however the string may also be of artificial and/or biological material. Some embodiments maintain the natural dynamics of the heart while replacing one or several chordae with one or several replacement units or strings  82  without substantial replacement of anatomic structures of the heart. 
     In another embodiment according to  FIG. 9 , the flexible leaflet reinforcement patch  30  has at least one string  90  extending from the inner section  34 . The free end of the at least one string  90  is in use to be connected to a cardiac structure other than a leaflet  24 , which may be a papillary muscle  29  or the lower parts of the corresponding chordae  28 . This embodiment is beneficial, especially when the leaflet  24  is degenerated and/or damaged so that securing a string to the free edge  60  of the leaflet  24  is not possible. The embodiment also maintains the natural dynamics of the heart while adding one or several artificial chordae  28  or at least one string  90 , as replacement or support, without substantial replacement of anatomic structures of the heart. 
     In  FIG. 10 , a method is illustrated for improving the function of a heart valve in sequential steps  100 , although it should be apparent for a skilled person in the art when reading the present disclosure that same steps could be performed overlapping each other. It should also be understood that some steps may be performed simultaneously. The method begins with a leaflet-ectomy according to standard procedures or a sliding procedure  110 . These procedures will alter the strength of the leaflet, since stitches, clamps and/or other connecting units are used to align the cut edges of the leaflets together with one another and/or with the annulus. The flexible leaflet reinforcement patch  30  is then placed and positioned  120  at the mitral valve with the outer section towards the annulus and the inner section  34  towards the centre of the valve. The flexible leaflet reinforcement patch  30  is rotated and adjusted to align  130  the portion in juxtaposition with the flexible leaflet reinforcement patch  30  to the desired position on the leaflet  24 . If an anchoring unit  35  is connected to the flexible leaflet reinforcement patch  30 , the anchoring unit  35  is secured  140  into the heart tissue in or adjacent to the annulus. If the portion in juxtaposition to the flexible leaflet reinforcement patch  30  has anchoring units  35 , the anchoring units are secured  150  into the leaflet  24 . Some procedures require replacement of one or several chordae  28  for the leaflet  24  to gain a more natural behaviour of the leaflet  24 . Optionally, in step  160 , one end of a string  80 ,  90  is attached to the inner section  34  of the flexible leaflet reinforcement patch  30 , while the other end of the string  80 ,  90  is attached to a cardiac structure, such as a chordae  28  or a papillary muscle  29 , within the left ventricle. Alternatively several strings, such as string  80  or string  90  can be attached. As another alternative, at least one string  80  is attached to a chordae  28  and at least one string  90  is attached to a papillary muscle  90 . When the procedure is completed the heart is sealed or closed in step  170 . 
     In the embodiments disclosed above, the anchoring unit  35  has only one loop-shaped support. However, it should be understood that the anchoring unit  35  in some embodiments also may have further loop-shaped supports. 
       FIG. 11  illustrates an embodiment; wherein a second flexible leaflet reinforcement patch  114  is put in juxtaposition with the leaflet  24  on the opposite side of the annulus  20  with respect to the first flexible leaflet reinforcement patch  30  and the first loop-shaped support  116 . The second flexible leaflet reinforcement patch  114  is connected to a second tissue anchoring unit  112 , such as a second loop-shaped support. The second loop-shaped support  112  and the second flexible leaflet reinforcement patch  114  are commonly positioned within the left ventricle. In other embodiments, any number of flexible leaflet reinforcement patches can be used. 
     The method above is not limited to open surgery; it should be clear for the skilled person in the art that a catheter-based procedure is within the scope of the method. 
     In one embodiment of this disclosure, a second flexible leaflet reinforcement patch  114  is positioned at a target site at an inside of a cardiac valve, preferably with an opposing first flexible leaflet reinforcement patch  30 . The first flexible leaflet reinforcement patch  30  may be omitted in some embodiments. Due to the second flexible leaflet reinforcement patch  114 , it will be possible to improve tightness of the valve and reduce or avoid leakage or regurgitation of the valve, since the second flexible leaflet reinforcement patch  114  will seal the valve area from the cardiac chamber towards the atrial side of the valve. The leaflet reinforcement is improved by the second flexible leaflet reinforcement patch  114 , in particular during systolic high pressure in the cardiac chamber. 
     Regarding ways of entering the heart valve of interest both transapical, as well as through the arterial venous system are potential procedures for the method. 
     Another approach that can be taken is the epicardial access approach, which is an approach in which a device can be inserted via the left internal mammary puncture from the left arm, i.e. there is no need for any sub-xiphoid incision. Thus, the epicardial access approach is a minimally invasive approach. 
     The present disclosure has been described above with reference to specific embodiments. However, other embodiments than the above described are equally possible within the scope of the disclosure. Different method steps than those described above, may be provided within the scope of the disclosure. A radially outwardly oriented sealing flange may be added to an anchoring unit, in order to further improve sealing efficiency. 
     The different features and steps of the disclosure may be combined in other combinations than those described. The scope of the disclosure is only limited by the appended patent claims. 
     More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and/or configurations will depend upon the specific application or applications for which the teachings of the present disclosure is/are used.