Patent Publication Number: US-2022211361-A1

Title: Crossable interseptal occluder device

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a National Phase Application of PCT International Application No. PCT/IB2020/054195, having an International Filing Date of May 4, 2020 which claims the benefit of priority to Italian Patent Application No. 102019000006534, filed May 3, 2019, each of which is hereby incorporated by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     In the most general aspect thereof, the present invention is directed to an occluder device. In particular, the present invention relates to an interseptal occluder device. Even more particularly, the present invention relates to an interseptal occluder device of the crossable type, or crossable interseptal occluder device. 
     In particular, the present invention is directed to a device for closing a defect of a partition or an opening obtained in a partition, not necessarily of the heart. 
     Even more particularly, the present invention is directed to a device for closing a defect present in a partition, for example a defect in an atrial partition, so that the defect, even if occluded, may be used for a medical device to pass through said defect. 
     Moreover, the device of the present invention is intended to occlude defects (typically congenital defects, but not only) or interatrial partition holes/openings created following percutaneous interventions with trans-septal puncture techniques (for example for the mitral valve repair or the occlusion of the Left Atrial Appendage). 
     BACKGROUND OF THE INVENTION 
     A partition is for example a thin wall dividing a cavity into two smaller cavities or chambers or compartments. The term “partition” is intended to define both a heart wall which divides two atria, as well as a wall which divides the right or left atrium and ventricle. 
     With reference to  FIG. 1 , an atrial partition  100  is a tissue wall which separates the right atrium  101  from the left atrium  102  of the heart  103 . 
     A ventricular partition  104  is a tissue wall which separates the right  105  and left  106  ventricles of the heart  103 . 
     A defect  107  of the partition  100 ,  104  may include a perforation or a hole in the partition. A defect  107  of the partition  100 ,  104  can occur congenitally or by piercing the partition with a medical device to access a position within the heart. 
     The femoral vein is an access point for many laboratory catheterization procedures, with a smaller percentage of procedures using the access to arteries. 
     The atrial partition  100  is a percutaneous access point, for example for atrial fibrillation therapy, closure of the left atrial appendage, percutaneous repair of the mitral valve, and percutaneous replacement of the mitral valve. In these and other procedures, the devices need to cross the atrial partition  100  and, in doing so, can leave an orifice in the atrial partition which cannot close or heal on its own. 
     Therefore, these defects are often closed using devices, such as clips or occluders. However, these devices do not allow re-crossing through the partition. 
     Therefore, there is a need for improved occlusion devices for closing a defect or an opening of the partition, and for re-crossing it in (possible) subsequent procedures. 
     Crossable occluding devices are known from the prior art. These have an anchoring structure and a diaphragm or valve connected thereto. 
     For example, documents WO2017136287A1, US2014074155 show crossable occluder solutions. 
     Document US20070073337 shows devices and methods for occluding the defects of internal tissues, such as the defects of the partition, with clip-based devices. A device having a clip structure is shown, which includes a tubular body having at least a first and a second deflectable element coupled thereto. The first and second elements are coupled at the opposite ends of the tubular body and configured to switch from a non-deployed configuration to a deployed configuration. In the deployed configuration, each element extends outwardly away from the tubular body in a position configured to rest on a tissue surface. The first and second elements of the clip are preferably configured to support a tissue wall therebetween and close any opening in the tissue wall. This solution does not allow to re-cross the device once implanted. 
     Document US20140012368 shows devices and methods for improving the implantation, retractability, or repositioning of a device for positioning a valve in a partition. The embodiments of the devices include pivotable sections which provide the ability to maintain the engagement of the device with a release system during implantation, in which the release system approaches an opening of the partition. The embodiments of the devices include configurations which allow for better recovery in a delivery system if a malfunction or problem with the patient&#39;s physiology is detected. This device is used to implant a flow control valve. These solutions are devices for treating heart failure. In particular, it is intended to create interatrial pressure outlets, shunts, and the like, which reduce the high pressure on one side of the heart, thus mitigating the resulting symptoms. Therefore, this solution aims to create an opening in the partition. This flow control element is a tissue valve such as a tricuspid valve, a bicuspid valve or a single-leaflet valve made of pericardial tissue from cattle, pigs, sheep or other animals, and therefore it has cusp-like foils made of preferably natural tissue and cusp-shaped. 
     Document US20160296684 shows endoluminal devices for the treatment of heart failure, which include a central body adapted to allow the passage of interatrial blood, an anchor fixed to the central body adapted to keep the endoluminal device in place inside a defect present in the atrial partition of a patient&#39;s heart, and a control element rotationally engaged with the central body. The rotation of the control element in relation to the central body creates a bidirectional flow of interatrial blood which allows to reduce high pressure in the right and left parts of the heart. This solution has a valve which, depending on the rotating position of a diaphragm, which position has been previously fixed, allows a flow of blood. This valve is made with a central body shutter, the rigidity of which allows the central body to maintain a certain radial force outward, against the walls of the partition, thus reducing the risk of displacement or migration of the endoluminal device. 
     These solutions, although being advantageous in some aspects, are very complex to implement, and especially do not allow to substantially completely occlude the partition defect while choosing freely the crossing point or re-crossing point in different positions of the diaphragm, thus facilitating the approach of the surgical device to the surgery area which can be located very differently from patient to patient and from disease to disease. 
     Therefore, the need for an occluding device which is simple to manufacture, easy to apply, and flexible to use after implantation for crossing the defect or the now-occluded opening of the partition in case of subsequent surgery is still strongly felt. 
     SUMMARY OF THE INVENTION 
     Therefore, it is the object of the present invention to provide a crossable interseptal occluder device, having structural and functional features that meet the aforementioned needs and overcome the drawbacks mentioned with reference to the devices of the prior art. 
     Some advantageous embodiments are also described. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Further features and advantages of the present invention will become apparent from the description provided hereinafter of preferred exemplary embodiments thereof, given by way of non-limiting example, with reference to the accompanying drawings, in which: 
         FIG. 1  is a diagrammatic sectional view of a heart in which defects or openings are present in the atrial and ventricular partitions; 
         FIG. 2  shows an axonometric view of a crossable interseptal occluding device according to the present invention; 
         FIG. 3  is a cross-sectional view of a crossable interseptal occluding device applied to close a defect or opening of a partition; 
         FIG. 4A  is a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment with parallel fringes; 
         FIG. 4B  is a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment with radial fringes; 
         FIG. 5  is a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment where two diaphragms at least partially overlap with each other and the fringes thereof, arranged parallel in the same diaphragm, are oriented orthogonal to the facing diaphragm; 
         FIG. 6  is a perspective view of only the part of the diaphragm of a crossable interseptal occluding device crossed by a medical device, here depicted as a tubular body only, by moving away and extending the fringes of said diaphragm; 
         FIGS. 7A to 7E  depict only the part of the diaphragm of a crossable interseptal occluding device, in a front view and in a local cross section of the fringes alone in order to show the shape of the sections of the fringes according to four different embodiments; 
         FIGS. 8A and 8B  show only the part of the diaphragm of a crossable interseptal occluding device, in a front view and in a local cross section of the fringes alone according to an embodiment with tapered fringes; 
         FIG. 9  depicts only the local cross sections of two diaphragms with tapered fringes, in a facing phase, in which one diaphragm is rotated and offset from the second one, so as to arrange the tapered fringes thereof between the tapered fringes of the facing diaphragm and mutually partially interpenetrated; 
         FIG. 10  is a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment with radial fringes and annular path interrupted by small bridges; 
         FIG. 11  is a diagrammatic front view of an operation for connecting a diaphragm to a support structure to obtain a crossable interseptal occluding device; 
         FIG. 12  depicts a diaphragm of a crossable interseptal occluding device made with a single wire folded and forming wire stretches which are mutually substantially parallel; 
         FIG. 13  is a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment where two diaphragms at least partially overlap with each other and the fringes thereof, shaped as wires, are arranged parallel in the same diaphragm, but are oriented orthogonal to the facing diaphragm; 
         FIG. 14  depicts a diaphragm of a crossable interseptal occluding device made with wires folded and forming first wire stretches which are mutually substantially parallel and second stretches which are substantially parallel but transverse to the first stretches; 
         FIG. 15  is a cross-sectional view of a crossable interseptal occluding device applied to close a defect or opening of a partition, in which the diaphragm is dome-shaped with concavity facing the cavity or compartment where a higher pressure is expected; 
         FIG. 16  is an axonometric view of a diaphragm of a crossable interseptal occluding device, in which the diaphragm is dome-shaped with concavity facing the cavity or compartment where a higher pressure is expected and is crossed by a medical device, here depicted in a tubular shape only, which moves and extends the fringes; 
         FIG. 17  shows a cross-sectional views of a crossable interseptal occluding device applied to close a defect or opening of a partition, in which the diaphragm is in one piece with the support structure anchored to the partition; 
         FIGS. 18 to 21  show cross-sectional views of different embodiments of the anchoring portions of a support structure applied to a defect or opening of a partition and made in a single piece with the diaphragm; 
         FIGS. 22 to 24  show a front view of different embodiments of anchoring portions of support structures of crossable interseptal occluding devices, in particular disc-shaped, three-lobed and angularly offset, six-lobed and angularly offset; 
         FIG. 25  is a front view of a crossable interseptal occluding device in which at least one of the anchoring portions of a support structure has circumferentially distributed openings; 
         FIG. 26  shows a diagrammatic front view of only the part of the diaphragm of a crossable interseptal occluding device, made according to an embodiment with fringes and wavy fringe edges or fringes with wavy fringe body, which is suitable for a greater elastic extension in case of re-crossing by a medical device; 
         FIG. 27  is a diagrammatic axonometric view of only the diaphragm of the crossable interseptal occluding device, in which the occluding bridges are according to a further embodiment; 
         FIG. 28  shows an axonometric sectional view according to line XXVII-XXVII in  FIG. 27  in which the shapes of the cross sections of the occluding bridges are highlighted, showing a meshing or geometric coupling between the different elongated bodies of the occluding bridges, thus creating slits or cuts for separating the bodies of the bridges with a winding shape; 
         FIG. 29  is a front view of a diaphragm of a crossable interseptal occluding device, according to a further embodiment, where the occluding bridges have independent leaves in the central body portion thereof and inclined with respect to the plane of the diaphragm or lumen, so as to create winding path separation slits, for example by partially overlapping a bridge with the adjacent one; 
         FIG. 30  shows a section according to line XXX-XXX in  FIG. 29  of the diaphragm in  FIG. 29 ; 
         FIG. 31  is a front view of a diaphragm of a crossable interseptal occluding device, according to a further embodiment, where the occluding bridges have independent leaves in the central body portion thereof, which are arranged so as to be offset on two planes, alternatively on a first plane and on a second plane which is offset from and parallel to the first one, so as to create winding path separation slits, for example by partially overlapping a bridge with the adjacent one; 
         FIG. 32  shows a section according to line XXXII-XXXII in  FIG. 31  of the diaphragm in  FIG. 31 ; and 
         FIG. 33  is a diagrammatic view of a crossable interseptal occluding device in which the diaphragm is made from elements or a single thread-like element wrapped around the support structure, such as a tube, or an elastic thread, arranged so as to causally cross the area of the lumen and create a substantial occlusion in the majority of the lumen. 
     
    
    
     DETAILED DESCRIPTION 
     In accordance with a general embodiment, there is provided a crossable interseptal occluder device  1  comprising a support structure  2  in which the support structure  2  comprises a central support structure portion  3  which delimits a lumen  4 . 
     The support structure  2  comprises a first anchoring portion  5  and an opposite second anchoring portion  6 . 
     The support structure  2  is configured to expand and contract between a compressed tubular configuration for insertion through a patient&#39;s vasculature and an expanded or extended configuration in which the first and second anchoring portions  5 ,  6  extend radially outwards from the central support structure portion  3  to compress a partition  7  therebetween by arranging the support structure  2  astride the partition  7  through a defect or hole or opening present in the partition  7 . 
     The crossable interseptal occluder device  1  further comprises at least one diaphragm  8 . 
     The diaphragm  8  is supported by the support structure  2  and arranged to close the majority of the lumen  4 , when the diaphragm  8  is in a relaxed configuration with the supporting structure  2  being extended. 
     The diaphragm  8  is configured to allow a medical device inserted into a first compartment  9  or  10  delimited by the partition  7  to pass through the diaphragm  8  and then through the lumen  4  entering a second compartment  10  or  9  delimited by the partition  7 . 
     The diaphragm  8  comprises a diaphragm edge  11  placed close to the central support structure portion  3  of the support structure  2 . 
     The diaphragm  8  comprises a plurality of elongated membrane occluding fringes or bridges  21  or occluding bridges  21 . 
     Each of said occluding bridges  21  comprises an elongated body  50  having opposite elongated body ends or ends  51 ,  52  and opposite longitudinal edges or sides  22 . 
     In a relaxed configuration of the diaphragm  8 , each occluding bridge  21  of said plurality of occluding bridges  21  is arranged close to at least a further occluding bridge  21  of said plurality of occluding bridges  21 . 
     At least one portion of the longitudinal sides  22  of each occluding bridge  21  and at least one portion of the longitudinal sides  22  of said at least a further occluding bridge  21  delimit at least one slit or cut  27  into said diaphragm  8 . 
     Both opposite ends  51 ,  52  of each occluding bridge  21  are directly or indirectly connected to or supported by the support structure  2 . 
     The term “occlude” means the possibility of minimizing or completely avoiding the flow of blood passing through the diaphragm. This definition is to describe an occlusion created by a plurality of occluding elements which, arranged to cover the lumen, create barriers while remaining at least partially independent of each other to be movable when necessary, but which tend to return, when not urged, to the occlusion position. 
     The term “relaxed position or configuration of the diaphragm” means a configuration both unimplanted and implanted in the patient in which the support structure is expanded or deployed or extended in which the diaphragm is not urged by external forces, but not necessarily without internal actions, such as a tension which tends to keep the occluding bridges in the occlusion position. For example, this position coincides with that of the support structure in an extended position, adapted to grasp the edges of the partition close to the edge of the lumen to be occluded. For example, but not necessarily, the relaxed position of the diaphragm coincides with an arrangement of the occluding bridges which is planar as a whole or on planes. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each of the longitudinal sides  22  delimits, with the side of an adjacent occluding bridge  21 , an elongated and narrow opening or elongated slit  27 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each bridge of said plurality of occluding bridges  21  of each diaphragm  8  of said at least one diaphragm  8  lies in a single plane. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the plurality of occluding bridges  21  is arranged with the bridges placed side by side. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each occluding bridge  21  is arranged close to at least a further occluding bridge  21  facing at least one portion of a longitudinal side  22  thereof to at least one portion of a longitudinal side  22  of said further occluding bridge  21 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the slit or cut  27  is one elongated slit  27  or a long and narrow opening  11  delimited by occluding bridges  21 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each occluding bridge  21  is placed adjacent to said at least a further occluding bridge  21 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each of said opposite longitudinal sides  22  lies so that the sum of the elongated bodies  50  of the occluding bridges  21  occludes the majority of the lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each occluding bridge  21  is arranged parallel to said at least a further occluding bridge  21 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the slit or cut  27  has a longitudinal extension equal to the entire longitudinal extension of the elongated body  50  of each occluding bridge  21  which delimits the slit or cut  27 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , all slits or cuts  27  are arranged parallel to one another. 
     In accordance with an embodiment, except for the opposite elongated body ends  51 ,  52 , each elongated body  50  of each occluding bridge  21  is independent of other elongated bodies  50  of other occluding bridges  21 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  of said plurality of occluding bridges  21  are randomly distributed in order to occlude the majority of said lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  of said plurality of occluding bridges  21  are arranged so as to avoid from intertwining or interlacing with one another. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , each of said bridges of said plurality of occluding bridges  21  lies in a plane arranged orthogonal to an axis of the lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , all bridges of said plurality of occluding bridges  21  of each diaphragm  8  lie in the same plane. 
     In accordance with an embodiment, both opposite ends  51 ,  52  of each occluding bridge  21  are directly or indirectly connected to or supported by said central support structure portion  3  of said support structure  2 . 
     In accordance with an embodiment, the opposite longitudinal sides  22  of said plurality of occluding bridges  21  are parallel to one another. 
     In accordance with an embodiment, said plurality of occluding bridges  21  comprises opposite longitudinal sides  22  and said opposite longitudinal sides  22  of adjacent occluding bridges  21  are arranged side by side and in contact with one another. 
     In accordance with an embodiment, the diaphragm  8  is made of an elastic material, for example silicone or medical elastomer or polyurethane or bioerodible or bioabsorbable material. 
     In accordance with an embodiment, the diaphragm  8  is made of an elastic material capable of deformation at least between 10% and 20%. 
     In accordance with an embodiment, the diaphragm  8  is made of an elastic material, for example silicone or medical elastomer or polyurethane or bioerodible or bioabsorbable material; and the diaphragm  8  is made of an elastic material capable of deformation of at least 150%. 
     In accordance with an embodiment, the diaphragm  8  is an elastic membrane. 
     In accordance with an embodiment, the occluding bridges  21  of the diaphragm  8  are separated from one another in the extension thereof or central occluding bridge portion  29  but joined together in a single piece. 
     In accordance with an embodiment, the diaphragm edge  11  and the occluding bridges  21  are in a single piece. 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of circular shape. 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of square or rectangular shape. 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from the center of said section to a section end  24  thereof. 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from a first section base side  25  to a section end  24  thereof. 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from a first section base side  25  to smaller section side  26 . 
     In accordance with an embodiment, at least one of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of oval or triangular or rhomboidal or trapezoidal shape. 
     In accordance with an embodiment, at least one pair of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of concave shape, in the first occluding bridge  21  of said pair, facing a convex shape, in the second occluding bridge  21  of said pair, and said concave and convex shapes are at least partially meshed with each other. 
     In accordance with an embodiment, at least one pair of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of concave shape, in the first occluding bridge  21  of said pair, facing a convex shape, in the second occluding bridge  21  of said pair, and said concave and convex shapes are at least partially meshed with each other and said shapes are arched shapes. 
     In accordance with an embodiment, at least one pair of said occluding bridges  21  has a longitudinal extension and comprises an occluding bridge section  23  evaluated in a transverse direction to said longitudinal direction of concave shape, in the first occluding bridge  21  of said pair, facing a convex shape, in the second occluding bridge  21  of said pair, and said concave and convex shapes are at least partially meshed with each other and said shapes are triangular or trapezoidal shapes. 
     In accordance with an embodiment, a pair of diaphragms is included, each of the diaphragms  8  of said pair of diaphragms  28  comprising a plurality of occluding bridges  21 . 
     The diaphragms  8  of said pair of diaphragms  28  are arranged facing each other and with the plurality of occluding bridges  21  of the first diaphragm  8  of said pair of diaphragms  28  being offset with respect to the plurality of diaphragm occluding bridges  21  of the second diaphragm  8  of said pair of diaphragms  28  by overlapping at least partially said plurality of occluding bridges  21  of the first diaphragm  8  to said plurality of elongated slits or cuts  27  of said second diaphragm  8 . 
     In accordance with an embodiment, said plurality of occluding bridges  21  of the first diaphragm  8  has tapered occluding bridge sections  23 , for example triangular or rhomboidal in shape. 
     The tapering of the occluding bridge sections  23  of said plurality of occluding bridges  21  of the first diaphragm  8  tapers towards said second diaphragm  8 . 
     In accordance with an embodiment, said plurality of occluding bridges  21  of the first diaphragm  8  interpenetrates at least partially between the occluding bridges  21  of said plurality of occluding bridges  21  of the second diaphragm  8 . 
     In accordance with an embodiment, the diaphragm  8  has a concave body or concavity facing one of the first or second compartment  9 ,  10 . 
     In accordance with an embodiment, the diaphragm  8  is dome-shaped. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises diaphragm ribs adapted to create a support scaffold. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises diaphragm ribs in a single piece with the diaphragm  8 . 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises at least one diametrical rib extending along a diameter of the diaphragm  8 . 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises at least one circumferentially extending rib. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises at least one radially extending rib. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises at least one rib extending along a circle chord. 
     In accordance with an embodiment, the diaphragm  8  comprises a diaphragm stiffening structure, the diaphragm stiffening structure comprises diaphragm ribs adapted to create a support frame and said at least one rib is of elastic and/or extensible shape or material. 
     In accordance with an embodiment, the diaphragm  8  comprises a first diaphragm portion  12  having an external continuous annular portion directly or indirectly connected to the support structure  2 . 
     Each occluding bridge end  51 ,  52  is connected to the external annular diaphragm portion  12 . 
     In accordance with an embodiment, the diaphragm  8  comprises an external annular diaphragm portion  12  directly or indirectly connected to the support structure  2 . 
     Each occluding bridge end  51 ,  52  is in a single piece with the external annular diaphragm portion  12 . 
     In accordance with an embodiment, the diaphragm  8  comprises an external annular diaphragm portion  12  directly or indirectly connected to the support structure  2 . 
     The diaphragm  8  comprises a central disc-shaped diaphragm portion  20 . 
     Said plurality of occluding bridges  21  is arranged radially with an external end  51  connected to the external annular diaphragm portion  12  and the internal end  52  connected to the central diaphragm disc  20 . 
     In accordance with an embodiment, the diaphragm  8  comprises an external annular diaphragm portion  12  directly or indirectly connected to the support structure  2 . 
     The diaphragm  8  comprises a central disc-shaped diaphragm portion  20 . 
     Said plurality of occluding bridges  21  is arranged radially with an external end  51  connected to the external annular diaphragm portion  12  and the internal end  52  connected to the central diaphragm disc  20 . 
     The opposite occluding bridge edges or sides  22  converge towards the central diaphragm disc  20 ; and each occluding bridge edge or side  22  is arranged parallel to the adjacent occluding bridge edge or side  22  of the adjacent occluding bridge  21 . 
     In accordance with an embodiment, the diaphragm  8  comprises a plurality of hollow tubes or wires or elastic threads  42  comprising hollow tube or elastic thread stretches  41  which form the diaphragm  8 . 
     In accordance with an embodiment, the diaphragm  8  comprises a single hollow tube or wire or elastic thread  40  folded to form hollow tube or wire or elastic thread stretches  41  which form the diaphragm  8 . 
     In accordance with an embodiment, said plurality of hollow tubes or wires or elastic threads  42  or said single folded hollow tube or wire or elastic thread  40  is connected or folded around the support structure  2 . 
     In accordance with an embodiment, said plurality of hollow tubes or wires or elastic threads  42  or said single folded hollow tube or wire or elastic thread  40  is connected or folded around the central support structure portion  3 . 
     In accordance with an embodiment, the diaphragm  8  comprises a plurality of hollow tube or wire or elastic thread stretches  41  which are parallel to one another. 
     In accordance with an embodiment, the diaphragm  8  comprises a plurality of hollow tube or wire or elastic thread stretches  41  which are mutually arranged side by side. 
     In accordance with an embodiment, the diaphragm  8  comprises a plurality of hollow tube or wire or elastic thread stretches  41  which are arranged adjacent to one another. 
     In accordance with an embodiment, the diaphragm  8  comprises a plurality of radially arranged hollow tube or wire or elastic thread stretches  41 . 
     In accordance with an embodiment, the diaphragm  8  comprises a first plurality of hollow tube or wire or elastic thread stretches  41  which are parallel to one another and a second plurality of hollow tube or wire or elastic thread stretches  41  which, in said second plurality, are parallel to one another but orthogonal to said first plurality of hollow tube or wire or elastic thread stretches  41 . 
     In accordance with an embodiment, the diaphragm  8  comprises a first plurality of hollow tube or wire or elastic thread stretches  41  which are parallel to one another and at least a second plurality of hollow tube or wire or elastic thread stretches  41  which, in said at least a second plurality, are parallel to one another but inclined with respect to said first plurality of hollow tube or wire or elastic thread stretches  41 . 
     In accordance with an embodiment, said plurality of hollow tubes or wires or elastic threads  42  or said single hollow tube or wire or elastic thread  40  is made of a superelastic material, preferably Nitinol, or silicone, or polyurethane or medical elastomer or of a bioerodable material. 
     In accordance with an embodiment, the crossable interseptal occluder device comprises at least two diaphragms  8 . 
     Said at least two diaphragms  8  at least partially overlap with each other. 
     In accordance with an embodiment, the crossable interseptal occluder device comprises at least two diaphragms  8 . 
     Said at least two diaphragms  8  at least partially overlap with each other so as to at least partially face at least one occluding bridge  21  of a first diaphragm  8  to at least one elongated and narrow opening or slit or cut  27  of a second diaphragm  8 . 
     In accordance with an embodiment, the crossable interseptal occluder device comprises at least two diaphragms  8 . 
     Said at least two diaphragms  8  at least partially overlap with each other so as to at least partially enter an elongated and narrow opening or slit or cut  27  of a second diaphragm  8  with at least one occluding bridge  21  of a first diaphragm  8 , by arranging itself between two adjacent occluding bridges  21  of said second diaphragm  8 . 
     In accordance with an embodiment, the support structure  2  is in a single piece. In accordance with an embodiment, the support structure  2  and the diaphragm  8  are in a single piece. 
     In accordance with an embodiment, the support structure  2  is made of medical elastomer. 
     In accordance with an embodiment, two diaphragms  8  are included, and the two diaphragms  8  angularly overlap with each other by arranging the occluding bridges  21  of a first diaphragm  8  crossed with respect to the occluding bridges  21  of the other diaphragm  8 . 
     In accordance with an embodiment, two diaphragms  8  are included; and the two diaphragms  8  overlap with each other, the occluding bridges  21  of a first diaphragm  8  are arranged inclined with respect to the occluding bridges  21  of the second diaphragm  8 . 
     In accordance with an embodiment, two diaphragms  8  are included; and the two diaphragms  8  angularly overlap with each other by arranging the occluding bridges  21  of a first diaphragm  8  so as to be orthogonal to the occluding bridges  21  of the other diaphragm  8 . 
     In accordance with an embodiment, two diaphragms  8  are included; and the two diaphragms  8  angularly overlap with each other by arranging the occluding bridges  21  of a first diaphragm  8  at an angle between  20  degrees and  90  degrees with respect to the occluding bridges  21  of the other diaphragm  8 . 
     In accordance with an embodiment, the crossable interseptal occluder device  1  comprises a diaphragm  8  with occluding bridges  21  in a thread; said occluding bridges  21  are mounted to a frame fixed to the support structure  2 . 
     In accordance with an embodiment, the crossable interseptal occluder device  1  comprises a diaphragm  8  with occluding bridges  21  having a wavy occluding bridge body  50 . 
     In accordance with an embodiment, the crossable interseptal occluder device  1  comprises a diaphragm  8  with occluding bridges  21  having a wavy occluding bridge body  50 , thus allowing each wavy bridge  21  urged by a possible crossing of the diaphragm, for example by a medical device, to elongate, and then return to a closed position of the diaphragm  8 . 
     In accordance with an embodiment, the crossable interseptal occluder device  1  comprises a diaphragm  8  with occluding bridges  21  having wavy occluding bridge edges  22 , the wavy bridge edge being the side portion of the occluding bridge  21  which delimits the elongated and narrow opening or slit or cut  27 , thus allowing each occluding bridge urged by a possible crossing of the diaphragm by a medical device, to elongate, and facilitating, once the device has been removed, the re-closing of the wavy bridge  21  and therefore of the diaphragm  8 . 
     In accordance with an embodiment, in a relaxed configuration, the diaphragm  8  is planar in shape and the occluding bridges  21  are tensioned on the support structure  2 . 
     In accordance with an embodiment, the occluding bridges  21  are slats or strips or foils or wires or hollow tubes. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  are separated by slits or cuts  27  in order to avoid material continuity between one bridge and the other. 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8  and when the device is not implanted in a human body, the occluding bridges  21  close the majority of the lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  cover 70-100% of the lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  are uniformly distributed over the lumen  4 . 
     In accordance with an embodiment, in a relaxed configuration of the diaphragm  8 , the occluding bridges  21  delimit slits or cuts  27  which leave free passages among the occluding bridges  21  of no more than 25% of the lumen  4 . 
     In accordance with an embodiment, the diaphragm  8  is obtained from a single sheet where the elongated slits  27  are made by laser cutting. 
     In accordance with an embodiment, the diaphragm  8  is obtained from a single sheet  53  in which the elongated slits  27  are made by cuts. 
     Said sheet  53  is fixed to the support structure  2  crossing the lumen  4  twice. 
     In accordance with an embodiment, the occluding bridges  21  are concentric rings which extend along an annular path  16 . 
     Adjacent concentric occluding bridges  21  are connected by means of radial small bridges or cut interruptions  17 ,  18 ,  19 . 
     Said radial small bridges or cut interruptions  17 ,  18 ,  19  are circumferentially offset between three near concentric occluding bridges  21  so as to avoid a radial alignment of a plurality of radial small bridges or cut interruptions. 
     The sides  22  of adjacent concentric occluding bridges  21  delimit arched slits or cuts  27  aligned along a circumferential path interrupted by said radial small bridges or cut interruptions  17 ,  18 ,  19 . 
     In accordance with an embodiment, the diaphragm  8  comprises an external continuous annular diaphragm portion  12  directly or indirectly connected to the support structure  2 . 
     The radially outermost occluding bridge  21  is connected to the external continuous annular diaphragm portion  12  via said radial small bridges or cut interruptions  17 ,  18 ,  19 . 
     In accordance with a general embodiment, a crossable interseptal occluder device  1  comprises a support structure  2 . 
     Said support structure  2  comprises a central support structure portion  3  which delimits a lumen  4 . 
     Said support structure  2  comprises a first anchoring portion  5  and an opposite second anchoring portion  6 . 
     Said support structure  2  is configured to expand and contract between a compressed tubular configuration for insertion through the patient&#39;s vasculature and an expanded configuration in which the first and second anchoring portions  5 ,  6  extend radially outwards from the central support structure portion  3  to compress a partition  7  therebetween by arranging said support structure  2  astride the partition  7  through a defect or hole or opening present in the partition  7 . 
     Said crossable interseptal occluder device  1  further comprises a diaphragm  8 . 
     Said diaphragm  8  is supported by the support structure  2  and arranged to close at least partially the lumen  4 . 
     Said diaphragm  8  is configured to allow a medical device inserted into a first compartment  9  or  10  delimited by the partition  7  to pass through the diaphragm  8  and then through said lumen  4  entering a second compartment  10  or  9  delimited by the partition  7 . 
     Said diaphragm  8  comprises a diaphragm edge  11  placed close to the central support structure portion  3  of the support structure  2 . 
     Advantageously, the diaphragm  8  comprises at least one elongated and narrow opening  27 . 
     The term “elongated and narrow opening” means a longitudinally extending opening, predominantly with respect to the extension thereof which is transverse to said longitudinal direction. 
     Alternatively, the elongated and narrow opening  27  comprises one of the following embodiments: 
     it extends from a first diaphragm portion  12  of the diaphragm  8  placed close to a first edge stretch  13  of the diaphragm edge  11 , to a second diaphragm portion  14  of the diaphragm  8  placed close to a second edge stretch  15  of the diaphragm edge  11 ; 
     or 
     it extends from a first diaphragm portion  12  of the diaphragm  8  placed close to a first edge stretch  13  of the diaphragm edge  11 , to a second diaphragm portion  14  of the diaphragm  8  placed close to a diaphragm center of the diaphragm  8 ; 
     or 
     it extends close to the diaphragm edge  11  to cover an annular path  16  interrupted by small diaphragm bridges  17 ,  18 ,  19  which connect a central diaphragm portion  20  to the diaphragm edge  11  by forming a plurality of elongated and narrow openings  11  placed one after the other. 
     In accordance with an alternative embodiment, said at least one elongated and narrow opening  27  is a plurality of long and narrow openings  11  delimited by a plurality of elongated membrane fringes  21 , or membrane fringes  21  or occluding bridges  21 . 
     In accordance with an alternative embodiment, in the diaphragm  8  the multiple membrane fringes  21  are parallel to one another. 
     In accordance with an alternative embodiment, in the diaphragm  8  the multiple membrane fringes  21  are mutually placed side by side and spaced apart from said plurality of long and narrow openings  11 . 
     In accordance with an alternative embodiment, said plurality of membrane fringes  21  comprises membrane fringe edges  22  and the membrane fringe edges  22  of adjacent membrane fringes  21  are mutually placed side by side and in contact with one other so that said elongated and narrow opening  27  is a slit. 
     In accordance with an alternative embodiment, said plurality of membrane fringes  21  comprises membrane fringe edges  22  and the membrane fringe edges  22  of adjacent membrane fringes  21  are separated from one another so that said elongated and narrow opening  27  is a free opening. 
     In accordance with an alternative embodiment, the diaphragm  8  is made of an elastic material, for example silicone or medical elastomer or polyurethane or of a bioerodable material. 
     In accordance with an alternative embodiment, the diaphragm  8  is a membrane. 
     In accordance with an alternative embodiment, the diaphragm  8  is an elastic membrane. 
     In accordance with an alternative embodiment, the membrane fringes  21  of the diaphragm  8  are separated from one another in the extension thereof or central fringe portion  29  but joined together in a single piece. 
     In accordance with an alternative embodiment, the diaphragm edge  11  and the membrane fringes  21  are in a single piece. 
     In accordance with an alternative embodiment, each of said membrane fringes  21  has a longitudinal extension and comprises a fringe section  23  evaluated in a transverse direction to said longitudinal direction of square or rectangular shape. 
     In accordance with an alternative embodiment, each of said membrane fringes  21  has a longitudinal extension and comprises a fringe section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from the center of said section to a section end  24  thereof. 
     In accordance with an alternative embodiment, each of said membrane fringes  21  has a longitudinal extension and comprises a fringe section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from a first section base side  25  to a section end  24 . 
     In accordance with an alternative embodiment, each of said membrane fringes  21  has a longitudinal extension and comprises a fringe section  23  evaluated in a transverse direction to said longitudinal direction of tapered shape passing from a first section base side  25  to a smaller section side  26 . 
     In accordance with an alternative embodiment, each of said membrane fringes  21  has a longitudinal extension and comprises a fringe section  23  evaluated in a transverse direction to said longitudinal direction of oval or triangular or rhomboidal or trapezoidal shape. 
     In accordance with an alternative embodiment, a pair of diaphragms  28  is included, each of said diaphragms  8  of said pair of diaphragms  28  comprising a plurality of membrane fringes  21  which delimit a plurality of elongated and narrow openings  27 . 
     The diaphragms  8  of said pair of diaphragms  28  are arranged facing each other and with the plurality of membrane fringes  21  of the first diaphragm  8  of said pair of diaphragms being offset with respect to the plurality of membrane fringes  21  of the second diaphragm  8  of said pair of diaphragms  28  by overlapping at least partially said plurality of membrane fringes  21  of the first diaphragm  8  to said plurality of elongated and narrow openings  27  of said second diaphragm  8 . 
     In accordance with an alternative embodiment, said plurality of membrane fringes  21  of the first diaphragm  8  has tapered fringe sections  23 . 
     In accordance with an alternative embodiment, said plurality of membrane fringes  21  of the first diaphragm  8  has tapered fringe sections  23 , for example with rhomboid- or triangle-shaped section. 
     In accordance with an alternative embodiment, the tapering of the fringe sections  23  of said plurality of membrane fringes  21  of the first diaphragm  8  tapers towards said second diaphragm  8 . 
     In accordance with an alternative embodiment, said plurality of membrane fringes  21  of the first diaphragm  8  interpenetrates at least partially between said membrane fringes of said plurality of membrane fringes  21  of the second diaphragm  8 . 
     In accordance with an alternative embodiment, the diaphragm  8  has a concave body or concavity facing one of the first or second compartment  9 ,  10 . 
     In accordance with an alternative embodiment, the diaphragm  8  is dome-shaped. 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a diaphragm stiffening structure. 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises diaphragm ribs adapted to create a support scaffold. 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises diaphragm ribs in a single piece with the diaphragm  8 . 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises at least one diametrical rib extending along a diameter of the diaphragm  8 . 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises at least one circumferentially extending rib. 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises at least one radially extending rib. 
     In accordance with an embodiment, said at least one radially extending rib is made of an extendable, i.e. stretchable, elastic material. 
     In accordance with an alternative embodiment, the diaphragm stiffening structure comprises at least one rib extending along a circle chord. 
     In accordance with an embodiment, said at least one rib extending along a circle chord is made of an extendable, i.e. stretchable, elastic material. 
     In accordance with an alternative embodiment, the diaphragm  8  comprises at least one diaphragm portion shaped as a diaphragm half-dome, where said diaphragm half-dome is separated from one diametrical rib of one diaphragm stiffening structure by an elongated and narrow opening  27  shaped as an arch. 
     In accordance with an alternative embodiment, said elongated and narrow opening  27  shaped as an arch extends from a first diaphragm portion  12  of said diaphragm  8  placed close to a first edge stretch  13  of said diaphragm edge  11 , to a second diaphragm portion  14  of said diaphragm  8  placed close to a second edge stretch  15  of said diaphragm edge  11 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises two diaphragm portions shaped as a diaphragm half-dome, where said diaphragm half-domes are mutually placed side by side to form a diaphragm dome  39  and each of said diaphragm half-domes is separated from a diametrical rib of a diaphragm stiffening structure by an elongated and narrow opening  27  shaped as an arch. 
     In accordance with an alternative embodiment, said elongated and narrow opening  27  shaped as an arch of each of said two diaphragm half-domes extends from a first diaphragm portion  12  of said diaphragm  8  placed close to a first edge stretch  13  of said diaphragm edge  11 , to a second diaphragm portion  14  of said diaphragm  8  placed close to a second edge stretch  15  of said diaphragm edge  11 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a plurality of elastic threads  42  comprising elastic thread stretches  41  which form the diaphragm  8 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a single elastic thread  40  folded to form elastic thread stretches  41  which form the diaphragm  8 . 
     In accordance with an alternative embodiment, said plurality of elastic threads  42  or said single folded elastic thread  40  is connected or folded around the support structure  2 . 
     In accordance with an alternative embodiment, said plurality of elastic threads  42  or said single folded elastic thread  40  is connected or folded around the central support structure portion  3 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a plurality of elastic thread stretches  41  which are parallel to one another. 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a plurality of elastic thread stretches  41  which are mutually arranged side by side. 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a plurality of elastic thread stretches  41  which are arranged adjacent to one another. 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a plurality of radially arranged elastic thread stretches  41 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a first plurality of elastic thread stretches  41  which are parallel to one another and a second plurality of elastic thread stretches  41  which, in said second plurality, are parallel to one another but orthogonal to said first plurality of elastic thread stretches  41 . 
     In accordance with an alternative embodiment, the diaphragm  8  comprises a first plurality of elastic thread stretches  41  which are parallel to one another and at least a second plurality of elastic thread stretches  41  which, in said at least a second plurality, are parallel to one another but inclined with respect to said first plurality of elastic thread stretches  41 . 
     In accordance with an alternative embodiment, said plurality of elastic threads  42  or said single elastic thread  40  is made of a superelastic material, preferably Nitinol, or silicone, or polyurethane or medical elastomer or of a bioerodable material. 
     In accordance with an alternative embodiment, the crossable interseptal occluder device comprises at least two diaphragms  8 . 
     In accordance with an alternative embodiment, said at least two diaphragms  8  at least partially overlap with each other. 
     In accordance with an alternative embodiment, said at least two diaphragms  8  at least partially overlap with each other so as to at least partially face a membrane fringe  21  of a first diaphragm  8  to an elongated and narrow opening  27  of a second diaphragm  8 . 
     In accordance with an alternative embodiment, said at least two diaphragms  8  at least partially overlap with each other so as to at least partially enter an elongated and narrow opening  27  of a second diaphragm  8  with at least one membrane fringe  21  of a first diaphragm  8 , by arranging itself between two adjacent membrane fringes  21  of said second diaphragm  8 . 
     In accordance with an alternative embodiment, the support structure  2  is in a single piece. 
     In accordance with an alternative embodiment, the support structure  2  and said diaphragm  8  are in a single piece. 
     In accordance with an alternative embodiment, the support structure  2  is made of medical elastomer. 
     Those skilled in the art can make several changes and adaptations to the embodiments described above, and replace elements with others which are functionally equivalent, in order to meet contingent and specific needs, without however departing from the scope of the following claims. 
     Some exemplary embodiments of the present invention will be described below. 
     In accordance with an embodiment, the crossable interseptal occluder device  1  is made to be implanted by means of minimally invasive or percutaneous techniques. 
     One of the peculiarities of the crossable interseptal occluder device  1  consists in the possibility of being crossed again after some time from its implantation, in order to start new interseptal procedures. 
     In accordance with an embodiment, the architecture of the crossable interseptal occluder device  1  is based on two components or parts:
         a frame, or support structure  2 , dedicated to the positioning and anchoring in situ of the device, generally toroidal in shape with opposing “umbrellas” or “donuts”, positioned astride the defect or hole or opening, with the umbrellas or donuts arranged on opposite sides of the partition  100 ;   a diaphragm  8 , for example a central diaphragm, dedicated to the occlusion of the defect/hole, for example an iatrogenic or congenital defect/hole  107 , with the possibility of being crossed again after some time.       

     The support structure  2  can be identified among those currently used or in any case described in the prior art, or it can be conceived and implemented according to an embodiment as previously described here. 
     From the construction point of view, for example, two main types of solutions can be referred to:
         support structure  2  obtained by means of techniques of braiding metal wires made of superelastic alloy (e.g. Nitinol; CoCr);   support structure  2  obtained from a laser-cut and then shaped metal tube made of superelastic alloy.       

     For the diaphragm  8 , or occluding diaphragm, some exemplary embodiments are described below. 
     1) Diaphragm  8  with Occluding Bridges in an “Elastic Fringe Curtain” 
     This diaphragm  8  consists of thin strips (fringes  21 ) of elastic and highly extendable material. The fringes  21  are parallel and adjacent to one another, or with a small gap to space them apart, or arranged in a sunburst pattern, or according to other construction schemes. The diaphragm  8  can also consist of one or more layers of variously crossed fringes  21 . Upon crossing by the catheter, the fringes  21  move apart and elongate, thus allowing the re-crossing. The re-crossing point can be freely decided by the operator at any point of the diaphragm  8 . Advantageously, the suggested solution for diaphragm and fringes, after the removal of the device, allows to re-close the fringes  21  and therefore the diaphragm  8  itself. 
     1-a) Diaphragm with Occluding Bridges in an “Elastic Fringe Curtain” in the Shape of a Thin Disc 
     Depending on the technology adopted for the manufacture, the elastic fringes  21 , and in particular the cross sections thereof, can be made in various shapes, as in the example in  FIGS. 7B to 7E, 8A and 8B, and 9 . 
     The distance “d”, shown in  FIG. 7E , between the fringes  21  can vary between zero (for example in diaphragms obtained from cut membranes) and a distance of the order of one millimeter. Distances of such an extent, indeed, are destined to be soon occluded by natural tissue regrowth. 
     The individual fringes  21  can have different shapes and orientation, and the distance therebetween may also be non-homogeneous. 
     In terms of materials, thin-disc diaphragms  8  can typically be made of silicone or polyurethane, choosing the types the physical-mechanical features of which are most suitable for the intended use. 
     In technological terms, the diaphragms  8  with elastic fringes  21  can be obtained:
         from membranes then incised in the form of a fringe;   by molding;   by means of 3-D printing processes;   by means of subsequent operations of gluing various components.       

     The diaphragm  8  in the shape of a thin disc can also be made from bioabsorbable polymers. In this case, the possibility of re-crossing will typically be obtained at the end of the bio-absorption process, due to the substantial replacement of the diaphragm  8  with the patient&#39;s natural tissue. By adopting particularly elastic bio-absorbable polymers, re-crossability will be ensured, immediately after implantation, by an operating mechanism which is similar to that of the silicone or polyurethane diaphragms (offset+elongation of fringes). 
     As regards fixing of the diaphragm  8 , for example in the center of the support structure  2 , this can be done according to one of the techniques listed here:
         gluing   heat sealing   stitching   co-molding   crimping   interlocking   a mixed solution among the previous ones       

     1-b) Diaphragm with Occluding Bridges in an “Elastic Fringe Curtain” Obtained with Elastic Threads 
     A second embodiment for diaphragms  8  with elastic fringes  21  is that which can be obtained from elastic and highly extendable threads  40 . Such a solution can be implemented ac-cording to various approaches. For example, in a first solution, the threads  40  may be applied directly to the structures of the support structure. Or, in a second example, the threads  40  may be applied to a frame, in turn mounted to the support structure. 
     The threads  40  may be applied so as to create different patterns: parallel, crossed, radial threads. 
     In terms of materials, the same materials listed for the thin diss solution, including bioerodible polymers, are suitable for the threads  40 . 
     The threads  40  can be obtained by extrusion or other known techniques and applied to the frames or directly to the support structure  2  by:
         winding   binding   heat sealing   gluing   pinching   other known techniques   mixed solutions among those listed       

     1-c) Diaphragm with Occluding Bridges in a “Dome of Elastic Fringes” 
     Physiologically, pressure differences exist between the two sides of the atrial partition, which vary within the cardiac cycle. In particular, the pressure in left atrium  102  is higher than that in the right atrium  101 . A constructional solution aimed at minimizing the passage of blood from the chamber, or compartment, at a higher pressure to that at a lower pressure can be that of the “dome of elastic fringes”. 
     The solution essentially follows that of the disc of elastic fringes described in item 1-a but, instead of developing flat, it precisely develops in the shape of a dome. The dome will be mounted to the support structure with the convexity facing the higher pressure chamber. Thereby, the blood itself, at a higher pressure, will tend to compact the adjacent fringes  21  together, thus increasing the tightness of the occlusion. 
     As for the materials, the technologies for making the dome, and how to fix it to the frame, the same related to the disc solution described above applies. 
     Some exemplary embodiment of an occluding device  1  according to the present invention will be described below. 
     In particular, the solution described herein has an “integral solution”, or in a single piece, (support structure  2 +diaphragm  8 ) made of medical elastomer, for example silicone or polyurethane. 
     In general terms, the description of the device coincides with that given in the previous embodiments, taking into account that in this embodiment the support structure does not derive from known solutions made of metal alloy, but is made of medical elastomer. 
     The advantages of this solution compared to those already described mainly lie in the high simplicity and cost-effectiveness of the construction, as well as in a greater lightness compared to the traditional occluders obtained from metal alloys. 
     In  FIGS. 22 to 30 , the diaphragm  8  is depicted in its shape of a “curtain of elastic fringes”, but it will be able to be made according to any of the solutions described above. 
     The general structure of the device reflects that already described, which includes:
         a support structure  2  dedicated to the positioning and anchoring in situ of the device  1 , generally toroidal in shape with opposing “umbrellas” or “donuts”, positioned astride the defect or hole, with the umbrellas or donuts arranged on opposite sides of the interatrial partition;   a diaphragm  8  or central diaphragm dedicated to the occlusion of the iatrogenic or congenital defect/hole, with the possibility of being crossed again after some time.       

     In this case, the support structure  2  is made of medical elastomer, and is characterized by a specific design, adapted to utilize the features of that family of materials and to optimize the functionality of the device: 
     compression along the ridge; 
     convexity facing the atrial chamber. 
     The support structure  2 , in accordance with an embodiment, has a convexity facing the atrial chambers. This peculiarity offers a range of advantages:
         a gap is created between the support structure and the interatrial partition. In this gap, the tissue of the atrial partition comes out during the expansion and in-situ release of the device. In fact, it must be considered that the iatrogenic or congenital defect or hole to be occluded will have a typically smaller diameter than that of the occluder, and an irregular shape. Under the radial thrust of the occluder, the excess tissue will widen and deform, and will be accommodated in the gap provided between the anchoring portions. In the absence of this gap, the excess tissue could hinder the regular expansion of the occluder device  1 ;   due to the shape provided, the support structure  2  rests on the interatrial partition mainly along the external edge only, concentrating along such an edge the compression force which stabilizes the device  1  in place. Thereby, the contact pressure is high, and the adhesion of the support structure  2  to the partition is optimal.       

     The above effects can be modulated by acting on dimensions and other measures as shown in  FIGS. 23 to 26 . 
     In particular, the thickening of the edge ( FIG. 24 ), or the inclusion of a reinforcing material ( FIG. 25 ), can strongly increase the resistance to displacement. 
     Even in terms of the general shape of the support structure, it is possible to manufacture the device according to various solutions, according to the desired performance. For example, lobed forms for the frame umbrellas, with lobes staggered between the two sides of the partition, can facilitate the anchoring and the ease of “crimping” the device on a delivery catheter ( FIGS. 28 and 29 ). 
     It is also possible to vary the design of the umbrellas by making cuts or openings in appropriate shapes and positions. Thereby, the device  1  is lightened, the creation of massive thrombotic formations between the umbrella and the interatrial partition is avoided, and the “crimping” of the device on the delivery catheter is facilitated ( FIG. 30 ). 
     In terms of materials, the whole device  1  is made of medical elastomer, typically silicone or polyurethane. Alternatively, the whole device  1  is made of bio-erodible polymers. 
     The preferred solution is obtained by molding, according to known techniques, the component in a single piece. 
     In accordance with an embodiment, the device can also be obtained by assembling, typically by gluing, parts obtained with elastomers which are different in hardness or elasticity. For example, the support structure  2  could be made of a single piece of more rigid elastomer, by applying a more pliable elastomer diaphragm  8  in the center. 
     There is also the possibility of co-molding, inserting, applying other local reinforcement components, or intended for other functions, made of different materials: metallic alloys, polymer threads, fabrics, and the like. 
     In accordance with an alternative embodiment, two fringed diaphragms  8  are provided, the fringes  21  of which have a tapered cross section, for example triangular or trapezoidal. Said two diaphragms  8  overlap with each other and are slightly staggered, so as to intercalate the respective fringes  21  and arrange the triangular or rhomboidal sections of either diaphragm at least partially interpenetrated to improve the fluid tightness, as shown in  FIGS. 8A, 8B, 9 , for example. 
     In accordance with an alternative embodiment, two fringed diaphragms  8  are provided. Said two fringed diaphragms  8  overlap with each other by angularly arranging the fringes  21  of a diaphragm  8  crossed with respect to the fringes  21  of the other diaphragm  8 . For example, the fringes  21  of a first diaphragm  8  are arranged orthogonal to the fringes  21  of the second diaphragm  8 , as shown in  FIG. 5  or in  FIG. 13 , for example, where the fringes are in a thread. 
     In accordance with an alternative embodiment, a diaphragm  8  with fringes  21  in a thread is provided. Said thread-like fringes  21  are mounted to frame and said frame is fixed to said support structure  2 . 
     In accordance with an alternative embodiment, a diaphragm  8  with fringes  21  having a wavy fringe body is provided, thus allowing each fringe urged by a possible crossing of the diaphragm, to elongate, and then return to a closed position of the diaphragm  8 . 
     In accordance with an alternative embodiment, a diaphragm  8  with fringes  21  having wavy fringe edges is provided, the fringe edge being the lateral portion of the fringe which delimits said elongated and narrow opening  27 , thus allowing each fringe urged by a possible crossing of the diaphragm by a medical device, to elongate, but facilitating, once the device has been removed, the re-closing of the fringes  21  and therefore of the diaphragm  8 . 
     All different embodiments of diaphragm  8  and fringes  21  thereof described above advantageously allow the re-crossing of the diaphragm  8 , after its implantation, and equally advantageously, after the removal of the medical device, allow the re-closing of the fringes  21  and therefore the re-closing of the diaphragm  8 . 
     LIST OF REFERENCE NUMERALS 
     
         
           1  crossable interseptal occluder device 
           2  support structure 
           3  central support structure portion 
           4  lumen 
           5  first anchoring portion 
           6  second anchoring portion 
           7  partition 
           8  diaphragm 
           9  first compartment 
           10  second compartment 
           11  diaphragm edge 
           12  first diaphragm portion or external continuous annular diaphragm portion 
           13  first edge stretch 
           14  second diaphragm portion 
           15  second edge stretch 
           16  annular path 
           17  small diaphragm bridges 
           18  small diaphragm bridges 
           19  small diaphragm bridges 
           20  central diaphragm portion 
           21  elongated membrane fringes or occluding bridges 
           22  membrane fringe edges or occluding bridge edges or occluding bridge sides 
           23  fringe section or bridge section 
           24  section end 
           25  first section base side 
           26  smaller section side 
           27  elongated and narrow opening or cut 
           28  pair of diaphragms 
           29  central fringe portion or central occluding bridge portion 
           39  diaphragm dome 
           40  elastic threads or single elastic thread 
           41  elastic thread stretches 
           42  plurality of elastic threads 
           50  occluding bridge body 
           51  occluding bridge body end 
           52  occluding bridge body end 
           53  single sheet forming said diaphragm 
           100  atrial partition 
           101  right atrium 
           102  left atrium 
           103  heart 
           104  ventricular partition 
           105  right ventricle 
           106  left ventricle 
           107  defect or opening