Source: https://patents.google.com/patent/US8142495?oq=6246862
Timestamp: 2018-02-24 07:14:48
Document Index: 194209749

Matched Legal Cases: ['art 100', 'art 100', 'art 100', 'art 100', 'art 330', 'art 340', 'art 330', 'art 350', 'art 350', 'art 330']

US8142495B2 - System and a method for altering the geometry of the heart - Google Patents
System and a method for altering the geometry of the heart
US8142495B2
US8142495B2 US12300786 US30078607A US8142495B2 US 8142495 B2 US8142495 B2 US 8142495B2 US 12300786 US12300786 US 12300786 US 30078607 A US30078607 A US 30078607A US 8142495 B2 US8142495 B2 US 8142495B2
US12300786
US20100063586A1 (en )
Morten Smerup
These compartment(s) communicate with an upper (atrial) side 10 a of the ring 10 via a single aperture 11 in the annuloplasty ring 10 as shown in FIG. 2B, through which aperture the first ends 21 a, 22 a, 23 a, 24 a, of said tension members extend to the atrium side 10 a of the annuloplasty ring 10. The first ends 21 a, 22 a, 23 a, 24 a are extendable to the exterior wall 151 of the atrium 150 of the heart 100 (see below), and thus must be adapted to a suitable length for this purpose. The singular aperture 11 may in alternative embodiments be substituted with a number of individual apertures (not shown) for each tension member 21, 22, 23, 24 provided these apertures are situated close to each other on the ring, i.e. within a 30° angle of the ring 10.
The second end 25 b of said inter-papillary tension member 25 is adapted such that the length at least allows an extension of the member 25 from the ring 10 to a first papillary muscle tip 170 and on to the other papillary muscle tip 170 a.
Thus the geometry of the left ventricle can be altered, i.e. partly or entirely restored to its normal geometry, using the device according to the above describe embodiments of the first aspect of the invention, in a way described below. In particular, with this embodiment the interpapillary distance may be very easily adjusted.
In the following, an alternative embodiment of the second aspect of the invention will be described with reference to FIG. 5. The system 201 according to this embodiment of the invention is generally similar to the one described above (with reference to FIG. 4), and with the same variation possibilities as described for that embodiment. However the system 201 in the present embodiment further comprises an additional tension member, namely an inter-papillary tension member 225 for forming a link between the two papillary muscles 170, 171, adjustable from a position exterior to the ventricle wall, upon insertion of the system into the heart 100. The inter-papillary tension member 225 has a first end 225 a and a second end 225 b.
The system 201 further comprises a third papillary anchor 237 for fixing the first end 225 a of said interpapillary tension member 225 to a papillary muscle 171, and fourth papillary anchor 238 through which the second end 225 b of said inter-papillary tension member 225 is extendable, the inter-papillary tension member 225 being configured such that the second end 225 b can be extended to the exterior side of said ventricle wall 111 to be secured to one of the first set of anchors 30 of the system 1, through a papillary muscle 170 of said heart 100, and in such a way that the distance of the inter-papillary link between the papillary muscles 170, 171 is adjustable from a position exterior to the heart 100.
In a first aspect of a method for altering the geometry of a heart using the system 1 shown and described in relation to FIG. 2, where the annuloplasty ring 10 is attached to the atrial side 180 a of the mitral annulus 180, the second ends 21 b, 22 b, 23 b, 24 b of the valve/papillary tension members 21, 22, 23, 24 are brought from the atrial 180 a, to the ventricular 180 b aspect of the annulus 180 by piercing the annulus 180 at positions corresponding to the points of exit of the tension members 21, 22, 23, 24, from the annuloplasty ring 10. This piercing may be provided by a separate surgical tool, or it may be provided by needles/suture needles (26) disposed at the second end of one or more of said tension members, see FIG. 2E. The second ends 21 b, 22 b, 23 b, 24 b are secured/fixated to the papillary muscle tips 170 a (or a place on the ventricular wall 111) by means of suitable anchors 30 of the system 1 or other fixation means. The annulus-papillary tension members 21, 22, 23, 24 are distributed such that a tension member from each point of exit on the annuloplasty ring 10 is connected to each papillary muscle tip 170 a.
Hereafter, the annuloplasty ring 10 is fixated to the atrium side 180 a of the annulus 180 e.g. by means of interrupted sutures following standard surgical techniques. As an alternative to the fixating of the second ends 21 b, 22 b, 23 b, 24 b of the annulus-papillary tension members 21, 22, 23, 24 to the tips 170 a of the papillary muscles 170, they may be passed through the papillary muscles 170 and the left ventricular wall to the epicardial aspect 170 b of the papillary muscle base and fixated to an anchor exterior to the heart wall at this position (not shown).
The valve-papillary tension members 221, 222, 223, 224 are distributed such that each of a pair of tension members from each point of departure on the annuloplasty ring 210 are connected to different ones of the papillary muscle tips 170 a.
At least one passage for each tension member is preferably formed through each papillary muscle 170, through which the tension member is passed. Alternatively, all the tension members through a papillary muscle 170 may be passed through a single passage formed in each papillary muscle 170.
FIG. 16 as mentioned, also illustrates the path of a tension member 21-25 through the annuloplasty ring 10, as could be the situation when the ring 10 is fixed to the annulus, the tension members 21-25 being adjusted and fixed. The tension member 21-25 extends from the atrium side (up in the figure) down through a through hole 341 in the fastening member 340. Then the tension member 21-25 extends back up between the outer surface of the fastening member 340 and surface of the through hole 311 of the hub 310 and on between a flange 314 of the through hole 311 of the hub 310 and a lower surface 334 of the locking part 330. Here the tension member enters the hub 310 of the ring 10 through upper aperture 11 in the ring 10. The tension member is the shown extending through a channel 313 in the vicinity of the hub 310 to aperture 13 and through the tissue surrounding the annulus and into the ventricle. Another tension member 21-25 (not shown in FIG. 16) would extend into channel 312 to extend to a position opposite the hub 310 or on another location on the circle of the annuloplasty ring lower side 10 b.
The tension member is fixated in the desired position by screwing the upper fastening part 340 (the bolt) in such that the tension member is locked or squeezed between the surfaces 314, 334 on the hub 310 and locking part 330, respectively. Thus, it is avoided that the tension member is rotated and/or ruptured during the screwing in of the fastening member. Further, in order to avoid contact between the tension members and the lower fastening part 350 a set of groves 360 is provided on the lower side of the hub 310. Further, a set of grooves 356 are provided on the lower surface of the lower fastening part 350. Thus the tension members can be freely adjusted until there is formed a contact between the surfaces 314, 334 on the hub 310 and locking part 330, respectively.
20. The system of claim 15, wherein at least a portion of the channels are formed on an outer perimeter of the annuloplasty ring and open outward.
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US13396498 Continuation US8591576B2 (en) 2006-05-15 2012-02-14 Method for altering the geometry of the heart
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US14088922 Active US9078752B2 (en) 2006-05-15 2013-11-25 Method for altering the geometry of the heart
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Owner name: ENOVACOR APS,DENMARK
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:HASENKAM, JOHN MICHAEL;SMERUP, MORTEN;NIELSEN, STEN LYAGER;REEL/FRAME:022789/0029
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ENOVACOR APS;REEL/FRAME:022789/0086
Owner name: ENOVACOR APS, DENMARK