Patent Description:
Hypertrophic obstructive cardiomyopathy is a myocardium morphological abnormal disease, the cause of which may be related to gene mutation, abnormal myocardial calcium dynamics and increased secretion of catecholamine. The pathology manifestation of the disease is asymmetric septal hypertrophy, hypertrophic myocardium projects into the left ventricle, which decreases the volume of the left ventricle, significantly increases the pressure step difference of the left ventricular outflow, results in systolic anterior motion and further exacerbates the obstruction of the left ventricular outflow. In turns, it results in obstruction of left ventricular bleeding and progressive deterioration of cardiac function. The disease clinical signs and symptoms mainly manifested as symptoms of heart failure such as chest pain, difficulty in breathing and syncope, untreated years fatality rate <NUM> %~<NUM>%, mostly sudden death due to malignant arrhythmia, poor natural prognosis.

At present, the treatment methods of hypertrophic obstructive cardiomyopathy mainly include drug therapy, double-cavity pacing therapy, coronary septal alcohol ablation and open septal myocardium resection (Morrow surgical method and improved Morrow surgical method). Drug and double-cavity pacing therapy can only reduce myocardial oxygen consumption and alleviate heart failure symptoms to a certain extent, enhance patients' exercise tolerance, and cannot fundamentally remove the etiology, so the treatment effect is limited. Alcohol ablation results in partial myocardial infarction by injecting anhydrous alcohol into the first septal branch of the anterior left descending branch of the coronary artery, thinning the basal section of the hypertrophic septum, reducing hypertrophic obstruction and reducing the pressure step. However, this method still has great limitations: (<NUM>) it may cause non-target myocardial infarction to e abnormal myocardial motion and aggravate the condition. (<NUM>) it may cause high incidence of complications (about <NUM>%) such as atrioventricular block and ventricular arrhythmia due to myocardial scarring. (<NUM>) about <NUM> %~<NUM>% of patients are not subjected to alcohol ablation due to the variation of the first septal branch. (<NUM>) the short-term and long-term curative effects are inferior to open septal myocardium resection. (<NUM>) the malformation of mitral papillary muscle and abnormal valve structure could not be treated. In addition, although the septal radiofrequency ablation via percutaneous catheters has been attempted, it has not yet been widely used due to these complications. Therefore, septal myocardium resection is still the best treatment for hypertrophic obstructive cardiomyopathy.

However, traditional septal myocardium resection still has many challenges and problems: (<NUM>) Since the heart is removed in the stopped state, the thickness and texture of the heart are different from the heart in the beat state, and the scope of removal is difficult to evaluate preoperative. It is completely dependent on the experience of the operator. Therefore, only a few experienced centers can complete the operation well, which is difficult to promote. (<NUM>) It is impossible to evaluate the removal effect in real time after removing. If the scope of removal is too wide, it may lead to perforation of ventricular septum and injury of conduction beam. (<NUM>) The surgical trauma caused by cardiac surgery and extracorporeal circulation leads to myocardial injury and systemic inflammatory. Therefore, the surgical method of septal myocardium resection still needs improvement.

A method and device for the treatment of hypertrophic cardiomyopathy is disclosed in <CIT>. The device includes a cutting device for resection of a thickened myocardium. The operator positions the cutting device adjacent to the myocardium that is to be resected and then slides a tubular blade within an outer shell of the cutting device to resect the septum.

An electric intracardiac myocardium cutter is shown in <CIT>, which includes a shell, a puncture needle assembly, a cutter assembly, an outer tube assembly, and a negative pressure suction assembly. The puncture needle assembly, the cutter assembly and the outer tube assembly are coaxially arranged from inside to outside; one end of the outer tube assembly is fixedly connected with the shell, and the other end of the outer tube assembly is sealed.

To solve at least one of the above technical solutions, the present application provides a bendable cutting apparatus for myocardium. The cutting apparatus comprises a cutting portion, a bendable portion, and a driving portion, the bendable portion is connected between the cutting portion and the bendable portion; wherein the cutting portion is driven by the driving portion to cut down a target portion of the myocardium, and the bendable portion is configured to bend in response to being tensioned and loosen by the driving portion. The cutting portion further has a cavity, a cutter configured to cut down the target portion of the myocardium, and a puncture needle; the cutter and the puncture needle are provided in the cavity; and a groove is provided on a wall of the cutting portion to receive the target portion of the myocardium. The cutter is connected to the driving portion by a first shaft; and the driving portion is further configured to drive the cutter to move linearly and rotate along a long axis of the cutting apparatus. the puncture needle is connected to the driving portion by a second shaft and is driven by the driving portion to move along the long axis of the cutting apparatus; the second shaft is extendable in the first shaft; and a connecting block is provided at a front end of the second shaft, the puncture needle is provided at a lower position on the connecting block relative to an axis of the second shaft to puncture through the groove; and the puncture needle is provided inclined downward relative to the axis of the second shaft.

In some embodiments of the present application, the bendable portion comprises a joint member having a plurality of joints, each of the plurality of joints is in a loose fit with an adjoining one of the plurality of joints, a front one of the plurality of joints is connected to the cutting portion, and a rear one of the plurality of joints is connected to the driving portion; wherein the plurality of joints is further connected together by a first rope and a second rope, the driving portion is configured to tension and loose the first rope and the second rope to bend the joint member.

In some embodiments of the present application, t in a case that the joint member is bent from a horizontal position to an upward vertical position, a bending angle ranges from <NUM>° to <NUM>°, and in a case that the joint member is bent from a horizontal position to a downward vertical position, the bending angle ranges from <NUM>° to -<NUM>°.

In some embodiments of the present application, the driving portion comprises a bending button, a first screw rod, a second screw rod, a first screw plate, and a second screw plate; wherein the first screw rod is connected with the bending button, the second screw rod is connected to the first screw rod, the second screw rod has a screw direction different with a screw direction of the first screw rod, and the bending button is configured to rotate the first screw rod and the second first screw rod; wherein the first screw plate is threadedly connected with the first screw rod and is connected to the first rope, and the second screw plate is threadedly connected with the second screw rod and is connected to the second rope, so that the first rope and the second rope are tensioned and loosen in response to rotation of the first screw rod and the second first screw rod.

In some embodiments of the present application, the cutter is further configured to extend through the groove and return back to the cavity in response to being moved linearly by the driving portion, and the cutter has an arc surface corresponding to an inner surface of the cavity.

In some embodiments of the present application, a plurality of holes is provided in the groove, and a suction tube is connected to the cavity to suck air in the cavity by a negative pressure, so that the target portion of the myocardium is firmly absorbed in the groove.

In some embodiments of the present application, the driving portion further comprises a cutting button connected with the first shaft, and the cutting button is configured to drive the cutter to move linearly and rotate along the long axis of the cutting apparatus.

In some embodiments of the present application, the cutting button is operated manually or driven by a motor.

In some embodiments of the present application, the driving portion further comprises a slider connected with the second shaft, and the slider is configured to move the second shaft linearly in the first shaft, so that the puncture needle is extended through the groove to puncture the target portion of the myocardium.

In some embodiments of the present application, the slider is operated manually or driven by a motor.

The present disclosure further provides a system with bendable cutting apparatus for myocardium, wherein the system includes the bendable cutting apparatus for myocardium of above, a sheath and a traction wire.

Compared with the prior art, the device has the functions of removing septal hypertrophy from multiple angles and modifying abnormal papillary muscles, and can be applicable to the part of hypertrophy that is difficult to remove due to the change of angle position during the removal of septal hypertrophy, as well as the cutting part of the root of abnormal papillary muscles, so that the left ventricular outflow channel is more completely cleared, the difficulty of surgery is reduced, and the surgical effect is optimized.

The above and/or additional aspects and advantages of the disclosed apparatus will become apparent and readily understood from the following description of embodiments taken in conjunction with the accompanying drawings.

In order to facilitate understanding of this disclosure, the apparatus is more fully described below with reference to the related drawings. The embodiments of the present invention are shown in the drawings. However, this disclosure can be implemented in many different forms and is not limited to the embodiments described herein. Conversely, the purpose of providing these embodiments is to make the disclosure more thorough and comprehensive. The embodiments described below by reference to the accompanying drawings are exemplary and are merely illustrative of the present disclosure and are not to be construed as limiting the scope of the invention.

In the description and claims, it should be understood that the azimuth or positional relationship indicated by the terms "center", "central portion", "longitudinal", "transverse", "length", "width", "thickness", "upper", "lower", "front", "rear", "left", "right", "vertical", "horizontal", "top", "bottom", "inner", "outer", "axial", "radial", "circumferential", and the like, is based on the azimuth or positional relationship shown in the drawings, merely for ease of description of this disclosure and simplification of the description, and is not intended to indicate or imply that the device or element referred to must have a particular azimuth, be constructed and operated in a particular azimuth, and therefore is not to be construed as limiting the present disclosure. Further, features defining by "first" and "second" may explicitly or implicitly include one or more these features. In the description, unless otherwise stated, "plurality" means two or more.

In the description, it should be understood that, unless expressly stated and defined otherwise, the terms "mount", "conduct", "connect" are to be understood in a broad sense, for example, as a fixed connection, as a detachable connection, or as an integrated connection. It may be a mechanical connection or an electrical connection. It may be directly connected or indirectly connected by means of an intermediate medium, and it may be internal communication of the two elements. The specific meaning of the above terms in the present disclosure can be understood in a specific way to those of ordinary skill in the art.

When used here, singular forms of "a", "one" and "the" can also include plural forms unless the context clearly indicates another way. It should also be understood that the terms "comprise/include" or "have" indicate the existence of the stated features, whole, steps, operations, components, parts, or combinations thereof, but not rule out the possibility of the existence or addition of one or more other features, whole, steps, operations, components, parts, or combinations thereof.

In addition, the expressions "proximal" and "distal" of the feature in the embodiment are relative expressions of the feature's proximity or distance to the human body or the operator. For example, the part of the instrument that interferes with the human body is regarded as distant from the operator. The part placed outside the body near the operator is considered to be proximal.

A bendable cutting apparatus for myocardium is provided according to the present disclosure. As shown in <FIG>, the bendable cutting apparatus <NUM> for myocardium may be a minimally invasive cardiac surgical instrument. The bendable cutting apparatus <NUM> for myocardium includes a cutting portion <NUM>, a bendable portion <NUM>, and a driving portion <NUM>, wherein the bendable portion <NUM> is connected between the cutting portion <NUM> and the driving portion <NUM>. The cutting portion <NUM> is driven by the driving portion <NUM> to cut down a target, wherein the target may be a target tissue, for example a hypertrophy tissues on the myocardium. The hypertrophy tissues is taken as the target for description below. The bendable portion <NUM> is configured to bend in response to being tensioned and loosen by the driving portion <NUM>. Specifically, in use, the driving portion <NUM> is held and controlled by the operator. The cutting portion <NUM> is moved to the hypertrophy tissues by the operator via the driving portion <NUM>, and then, the driving portion <NUM> is operated to tension and loose the bendable portion <NUM> to bend, as such, the cutting portion <NUM> is adjusted to a proper angle or position relative to the hypertrophy tissues. The operator can use the driving portion <NUM> to control and adjust the bending angle of the bendable portion <NUM> until a final angle or position of the cutting portion <NUM> relative to the hypertrophy tissues is obtained. Meanwhile, the operator controls the driving portion <NUM> to drive the cutting portion <NUM> to cut down the hypertrophy tissues.

By providing the bendable portion <NUM>, the angle or position of the cutting portion <NUM> relative to the hypertrophy tissues is advanced adjusted, and the cutting apparatus <NUM> can be applied for cutting the hypertrophy tissues from multiple angles. As such, the cutting apparatus <NUM> has the functions of removing septal hypertrophy tissues from multiple angles and modifying abnormal papillary muscles, and can be applied to some hypertrophic tissues that are difficult to be removed due to changes in angle position during the removal of septal hypertrophy, as well as the cutting part of the root of abnormal papillary muscles, so that the left ventricular outflow channel is more completely cleared, the difficulty of surgery is reduced, and the surgical effect is optimized.

In an embodiment, as shown in <FIG>, the bendable portion <NUM> comprises a joint member <NUM>, wherein the joint member <NUM> is disposed between the cutting portion <NUM> and the driving portion <NUM>, and has a plurality of joints <NUM>. Exemplarily, a front one <NUM> of the plurality of joints is connected to the cutting portion <NUM>, and a rear one <NUM> of the plurality of joints is connected to the driving portion <NUM>.

Each of the plurality of joints <NUM> is in a loose fit with an adjoining one. Further, the plurality of joints <NUM> is further connected together by a first rope <NUM> and a second rope <NUM>, and the first rope <NUM> and the second rope <NUM> are connected to the driving portion <NUM>. As such, the driving portion <NUM> may apply a tension force and a loose force to the first rope <NUM> and the second rope <NUM>, respectively, and the first rope <NUM> and the second rope <NUM> further to tension and loose the plurality of joints <NUM>. The plurality of joints <NUM> may connect closely with each other when a tension force is applied, and the plurality of joints <NUM> may connect loosely when a loose force is applied. Further, the joint member <NUM> is presented in bending as the plurality of joints <NUM> connects closely and loosely with each other, and the details are described below.

Combined with <FIG>, the driving portion <NUM> comprises a bending button <NUM>, a first screw rod <NUM>, a second screw rod <NUM>, a first screw plate <NUM>, and a second screw plate <NUM>. The first screw rod <NUM> is connected with the bending button <NUM>, the second screw rod <NUM> is connected to the first screw rod <NUM>, the second screw rod <NUM> has a screw direction different with a screw direction of the first screw rod <NUM>. The first screw plate <NUM> is threadedly connected with the first screw rod <NUM> and is moveable along the first screw rod <NUM>. The first crew plate <NUM> is further connected to the first rope <NUM>. The second screw plate <NUM> is threadedly connected with the second screw rod <NUM> and is moveable along the second screw rod <NUM>. The second screw plate <NUM> is further connected to the second rope <NUM>. The bending button <NUM> is configured to rotate the first screw rod <NUM> and the second first screw rod <NUM>. A first window (not shown) may be provided on the cutting apparatus <NUM> for operating the bending button <NUM>.

When the first screw rod <NUM> is rotated clockwise, the first screw plate <NUM> moves forward along the first screw rod <NUM> to loosen the first rope <NUM>. Since the second screw rod <NUM> has different screw direction with the first screw rod <NUM>, the second screw plate <NUM> moves backward along the second screw rod <NUM> to tension the second rope <NUM>. The parts of the plurality of the joints <NUM> connected to the first rope <NUM> are connected loosely, and parts of the plurality of the joints <NUM> connected to the second rope <NUM> are connected closely. At this time, the joint member <NUM> is bent downward. When the first screw rod <NUM> is rotated counterclockwise, the first screw plate <NUM> moves backward along the first screw rod <NUM> to tension the first rope <NUM> and the second screw plate <NUM> moves forward along the second screw rod <NUM> to loosen the second rope <NUM>. The parts of the plurality of the joints <NUM> connected to the first rope <NUM> are connected closely, and parts of the plurality of the joints <NUM> connected to the second rope <NUM> are connected loosely. Thus, the joint member <NUM> is bent upward.

During the joint member <NUM> is bent from a horizontal position to an upward vertical position, the bending angle can be adjusted from <NUM>° to <NUM>°. During the joint member <NUM> is bent from a horizontal position to a downward vertical position, the bending angle can be adjusted from <NUM>° to -<NUM>°. This is, the bending angle of the joint member ranges from -<NUM>° to <NUM>°.

In an embodiment, a first rail and a second rail (not shown) are provided in the driving portion <NUM>. The first rail is disposed corresponding to the first rope <NUM>, and is slidably connected with corresponding sides of the first screw plate <NUM> and the second screw plate <NUM>. The second rail is disposed corresponding to the second rope <NUM>, and is slidably connected with another corresponding sides of the first screw plate <NUM> and the second screw plate <NUM>.

Combined with <FIG>, the cutting portion <NUM> has a cutter <NUM> configured to cut down the hypertrophy tissues, and the cutter <NUM> is connected to the driving portion <NUM> by a first shaft <NUM>. The driving portion <NUM> is further configured to drive the cutter <NUM> to move linearly and rotate along a long axis of the cutting apparatus <NUM>. The cutter <NUM> is moved linearly to close to or away from the hypertrophy tissues for a primary position, and then a secondary position is provided by the bendable portion <NUM>. After an accurately position is ensured, the cutter <NUM> is rotated to cut down the hypertrophy tissues.

In an embodiment, a groove <NUM> is provided on a wall of the cutting portion <NUM>, the groove <NUM> can receive the hypertrophy tissues while forcing on the cutting portion <NUM> and/or the hypertrophy tissues. The cutting portion <NUM> further has a cavity <NUM>, the cutter <NUM> is provided in the cavity <NUM>. The cutter <NUM> is driven by the driving portion <NUM> to extend through the groove <NUM> to the hypertrophy tissues, and then to rotate to cut down the hypertrophy tissues.

In an embodiment, before performing the operation, the cutter <NUM> is operated to move linearly to and close the groove <NUM>, and the heparin saline is injected into the cavity <NUM> (the way of injection will be discussed below), so that the cavity <NUM> and the groove <NUM> are filled with heparin saline to realize liquid seal and vent the air. Then, the cutting portion <NUM> is operated to close to the hypertrophy tissues, and the cutter <NUM> is moved to return back to the cavity <NUM> by the driving portion <NUM> to expose the groove <NUM>. The hypertrophy tissues are forced into the groove <NUM>. The cutter <NUM> is driven by the driving portion <NUM> to extend through the groove <NUM> to the hypertrophy tissues, and then to rotate to cut down the hypertrophy tissues.

In an embodiment, the cutter <NUM> has an arc surface corresponding to an inner surface of the cavity <NUM>. As such, the cutter <NUM> functions more effectively on closing the groove <NUM> and cutting the hypertrophy tissues in the groove <NUM>.

In an embodiment, as shown in <FIG>, a plurality of holes <NUM> is provided in the groove <NUM>, and a suction tube <NUM> (referring to <FIG>) is connected to the cavity <NUM>. The suction tube <NUM> is provided with a negative pressure source (not shown). The negative pressure source provides a negative pressure to suck the air in the cavity <NUM>, and the air between the hypertrophy tissues and the groove <NUM>, through the plurality of holes <NUM> and the suction tube <NUM>. As such, the hypertrophy tissues can be firmly absorbed in the groove <NUM>. In another embodiment, the heparin saline is injected into the cavity <NUM> by the suction tube <NUM>.

In an embodiment, combined with <FIG>, the driving portion <NUM> further comprises a cutting button <NUM> connected with the first shaft <NUM>, and the cutting button <NUM> is configured to drive the cutter <NUM> to move linearly and rotate along the long axis of the cutting apparatus <NUM>.

In an embodiment, the cutting button <NUM> is operated manually. Exemplarily, a second window (not shown) may be provided on the cutting apparatus <NUM> for operating the cutting button <NUM>. The operator may slide the cutting button <NUM> from the second window to move the cutter <NUM> linearly, and may rotate the cutting button <NUM> from the second window to rotate the cutter <NUM>. In another embodiment, the cutting button <NUM> may be driven by a motor to slide linearly and rotate along the long axis of the cutting apparatus.

In an embodiment, back to <FIG>, the cutting portion <NUM> further comprises a puncture needle <NUM> provided in the cavity <NUM>, the puncture needle <NUM> is connected to the driving portion <NUM> by a second shaft <NUM> and is driven by the driving portion <NUM> to move along the long axis of the cutting apparatus <NUM>. Exemplarily, the puncture needle <NUM> is moved toward to the groove <NUM> and to puncture the hypertrophy tissues in the groove <NUM>. As such, the hypertrophy tissues are firmly positioned in the groove <NUM> by puncturing, thereby facilitating for cutting the hypertrophy tissues. Moreover, the cut hypertrophy tissues are held in the groove <NUM> by the puncture needle <NUM> for an easy removal.

In an embodiment, the second shaft <NUM> is extended in the first shaft <NUM>, a connecting block <NUM> is provided at a front end of the second shaft <NUM>, and the puncture needle <NUM> is provided at a lower position on the connecting block <NUM>. In an embodiment, the puncture needle <NUM> is provided inclined downward for puncturing the groove <NUM> easily and holding the hypertrophy tissues at a greater extent.

In an embodiment, back to <FIG>, the driving portion <NUM> further comprises a slider <NUM> connected with the second shaft <NUM>, and the slider <NUM> is configured to move the second shaft <NUM> linearly in the first shaft <NUM>. A third window (not shown) may be provided on the cutting apparatus <NUM>. The operator may slide the slider <NUM> from the third window, to extend the puncture needle <NUM> through the groove <NUM>, to puncture the hypertrophy tissues.

A system with bendable cutting apparatus for myocardium is provided according to the present disclosure. The system includes the bendable cutting apparatus <NUM> for myocardium of above, a sheath and a traction wire.

According to the present disclosure, the cutting apparatus has the functions of removing septal hypertrophy tissues from multiple angles and modifying abnormal papillary muscles, and can be applied to some hypertrophic tissues that are difficult to be removed due to changes in angle position during the removal of septal hypertrophy, as well as the cutting part of the root of abnormal papillary muscles, so that the left ventricular outflow channel is more completely cleared, the difficulty of surgery is reduced, and the surgical effect is optimized.

The bendable cutting apparatus <NUM> for myocardium disclosed in the present disclosure is applied to a new minimally invasive operation for the treatment of hypertrophic obstructive cardiomyopathy. The operation is described in combination with the cutting apparatus in the present disclosure.

S100, before performing the operation, the operator pushes the cutting button <NUM> to move the cutter <NUM> along the long axis of the cutting apparatus <NUM> to close the grove <NUM>; and then the operator injects the heparin saline into the suction tube <NUM> through the syringe, so that the cavity <NUM> and the groove <NUM> is filled with the heparin saline to realize liquid seal and vent the gas.

S200, the operator treats the gap between the fourth and fifth ribs of the patient's left front chest wall with an incision to enter the pericardium and expose the apex of the heart. A suture purse is formed at the apex, and an opening is formed by puncture at the central position of the suture purse. After performing the puncture, the operator uses a dilator to enlarge the opening of the apical puncture and fasten the dilator at the opening.

S300, the operator moves the cutting portion <NUM> and bendable portion <NUM> to the left ventricular chamber along the dilated opening at the apex, and localizes the target area, that is, the basal section of the septal hypertrophic that needs to be removed, under the guidance of esophagus ultrasound and three-dimensional esophagus ultrasound.

S400, the operator aligns the cutter <NUM> and the groove <NUM> to the target area, and then the operator rotates the bending button <NUM> to apply tension and loosen force on the first rope <NUM> and the second rope <NUM> to bend the joint member <NUM> of the bendable portion <NUM>, to adjust the angle between the groove <NUM> (the cutter <NUM>) and the target area.

S500, the operator pulls the cutting button <NUM> back to keep the cutter <NUM> away from the groove <NUM> so that the groove <NUM> is exposed/open completely. Then the operator forces on the cutting apparatus <NUM> to make the hypertrophy tissues into the groove <NUM>. The operator starts the negative pressure source to suck the air in the cavity <NUM> and the air between the hypertrophy tissues and the groove <NUM> through suction tube <NUM> and the plurality of holes <NUM>, thereby absorbing and holding the hypertrophic tissue in the target area in the groove <NUM>.

S600, after the hypertrophic tissue is absorbed and held in the groove <NUM>, the operator pulls the slider <NUM> to move the second shaft <NUM> linearly in the first shaft <NUM>, so that the puncture needle <NUM> punctures the groove <NUM> and positions the hypertrophic tissue in the groove <NUM>.

S700, the operator needs to judge whether chords and papillary muscle injury will occur or not by three-dimensional ultrasound when cutting hypertrophic tissue. If not, the operator pushes the cutting button <NUM> to move the cutter <NUM> to hypertrophic tissue, and then turns the cutting button <NUM> to rotate the cutter <NUM> to cut down the hypertrophic tissue in the groove <NUM>.

S800, after cutting the hypertrophic tissue, the operator removes the cutting portion <NUM> and the bendable portion <NUM> from the opening along the dilator, removes the cut the hypertrophic tissues, and flushes the cutting apparatus <NUM> with heparin saline.

S900, the operator observes the effect of the removal of the hypertrophic tissues through the esophagus ultrasound.

If it is judged that the effect of cutting the hypertrophic tissues is not as expected, S100 to S800 are repeated until it is judged that the effect is as expected.

Preferably, doppler ultrasound is used to measure the pressure difference of the left ventricular outflow to value the effect of cutting the hypertrophic tissues.

Preferably, and when S400 is re-executed, the angle of the groove <NUM> relative to the hypertrophy tissues is continuously adjusted to adapt to the hypertrophy tissues of different parts. If necessary, the operator can connect the suction tube <NUM> to the pressure catheter, and measure the pressure difference of the left ventricular outflow in real time before the cutting portion <NUM> and the bendable portion <NUM> are removed, so as to observe the cutting effect in real time.

S1000, if the effect of cutting the hypertrophy tissues are as expected, the operator sutures the opening at the apex and closed the incision of the chest wall layer by layer.

A method of hypertrophic obstructive cardiomyopathy using the cutting apparatus according to the present application is provided. On one hand, it avoids the problem of excessive myocardial resection that may be caused by static cardiac resection, and avoids the risk of iatrogenic septal perforation. On the other hand, it avoids the problem that the scope of surgical resection is not good enough, and it reduces over-dependence on the experience of the surgeon. It significantly improves the surgical efficacy. The cutting apparatus integrates cutting and removal of hypertrophic tissues to prevent peripheral artery embolization caused by falling of hypertrophic tissue.

Further, the cutting apparatus is made of a good material of ultrasonic compatibility, which is convenient to guide the esophagus ultrasound. Through the small incision of the left front chest wall, the operation wound caused by opening the chest in the middle is avoided, and the patient recovers quickly. Cardiac beating operation avoids the application of cardiopulmonary bypass in conventional thoracic surgery, thus avoids myocardial ischemia reperfusion injury and cardiopulmonary bypass related complications. If there are unpredictable complications during the operation, it can be transferred to conventional thoracic surgery in time to avoid fatal complications caused by alcohol ablation and radiofrequency ablation.

In the description of this specification, reference to the terms "one embodiment," "some examples," "some embodiments," "illustrative embodiments," "examples," "specific examples," or "some examples," etc., means that a particular feature, structure, material, or characteristic described in connection with the embodiment or example is included in at least one embodiment or example of the present disclosure. In the present specification, the schematic representation of the above references does not necessarily refer to the same embodiments or examples. Moreover, the specific features, structures, materials, or characteristics described may be combined in any one or more embodiments or examples in a suitable manner.

Claim 1:
A bendable cutting apparatus for myocardium, comprising a cutting portion (<NUM>), a bendable portion (<NUM>), and a driving portion (<NUM>); the bendable portion (<NUM>) being connected between the cutting portion (<NUM>) and the driving portion (<NUM>); the cutting portion (<NUM>) being driven by the driving portion (<NUM>) to cut down a target portion of the myocardium; wherein the bendable portion (<NUM>) is configured to bend in response to being tensioned and loosen by the driving portion (<NUM>);
wherein the cutting portion (<NUM>) further has a cavity (<NUM>), a cutter (<NUM>) configured to cut down the target portion of the myocardium, and a puncture needle (<NUM>); the cutter (<NUM>) and the puncture needle (<NUM>) are provided in the cavity (<NUM>); and a groove (<NUM>) is provided on a wall of the cutting portion (<NUM>) to receive the target portion of the myocardium;
wherein the cutter (<NUM>) is connected to the driving portion (<NUM>) by a first shaft (<NUM>); and the driving portion (<NUM>) is further configured to drive the cutter (<NUM>) to move linearly and rotate along a long axis of the cutting apparatus (<NUM>);
wherein the puncture needle (<NUM>) is connected to the driving portion (<NUM>) by a second shaft (<NUM>) and is driven by the driving portion (<NUM>) to move along the long axis of the cutting apparatus (<NUM>); the second shaft (<NUM>) is extendable in the first shaft (<NUM>); and a connecting block (<NUM>) is provided at a front end of the second shaft (<NUM>),
wherein the puncture needle (<NUM>) is provided at a lower position on the connecting block (<NUM>) relative to an axis of the second shaft (<NUM>) to puncture through the groove (<NUM>); and the puncture needle (<NUM>) is provided inclined downward relative to the axis of the second shaft (<NUM>).