Monitoring of percutaneous mitral valvuloplasty

• US 20070027392A1
• Filed: 08/01/2005
• Published: 02/01/2007
• Est. Priority Date: 08/01/2005
• Status: Active Grant

• Current Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Original Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Inventors: Schwartz, Yitzhack
• Granted Patent: US 8,475,524 B2
• Time in Patent Office: Days
• US Class Current: 600/443
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2063 Acoustic tracking systems, e.g. using ultrasound
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 6/541 involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/4488 the transducer being a phased array
• CPC Class Codes: A61B 8/543 involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for

Abstract

During a minimally invasive deployment of a mitral valvuloplasty device into the coronary sinus near realtime tracking of the device is monitored to determine whether the device is compressing the left circumflex coronary artery or is likely to do so. In one embodiment of the invention, one or more position sensors are included in the catheter that is used to deploy the constricting implant and or in the implant itself. The position of the device is determined during deployment, and compared to the location of the left circumflex coronary artery, which may be determined by mapping relative to a pre-acquired image or by simultaneous intracardiac ultrasound imaging.

Claims

1. A method of deforming a mitral valve annulus in a heart of a living subject, comprising the steps of:

constructing an anatomic image of a portion of said heart;

inserting a deployment catheter into a coronary sinus of said heart;

using said deployment catheter positioning an annuloplasty device into an operative location in said coronary sinus;

while performing said step of positioning registering said operative location of said annuloplasty device with said anatomic image;

responsively to said step of registering determining that actuation of said annuloplasty device in said operative location is unlikely to compromise blood flow in a left circumflex coronary artery of said heart; and

thereafter actuating said annuloplasty device to deform said annulus.

2. The method according to claim 1, wherein said step of constructing an anatomic image comprises the steps of:

inserting an ultrasound catheter having ultrasound transducers into said heart;

using said ultrasound catheter to obtain a plurality of 2-dimensional ultrasound images of said heart; and

combining said 2-dimensional ultrasound images into a 3-dimensional ultrasound image.

3. The method according to claim 1, wherein said step of determining comprises ascertaining that said annuloplasty device avoids a crossover of said coronary sinus with said left circumflex coronary artery.

4. The method according to claim 1, wherein said anatomic image is constructed prior to performing said step of inserting a deployment catheter.

5. The method according to claim 1, wherein said anatomic image is constructed concurrently with said step of inserting a deployment catheter.

6. The method according to claim 1, further comprising the step of:

subsequent to said step of actuating, and while said deployment catheter remains in said heart, measuring said blood flow in said left circumflex coronary artery.

7. The method according to claim 6, wherein said step of measuring is performed by Doppler imaging of said left circumflex coronary artery.

8. The method according to claim 1, further comprising the step of:

subsequent to said step of actuating, and while said deployment catheter remains in said heart, measuring mitral valve blood flow.

9. The method according to claim 1, wherein said step of constructing an anatomic image comprises acquiring said anatomic image using said deployment catheter.

10. The method according to claim 1, further comprising the step of directing ablative energy onto a portion of said heart to disrupt electrical conduction therein.

11. An apparatus for performing percutaneous mitral valvuloplasty, comprising:

a deployment catheter adapted to insert an annuloplasty device into a coronary sinus of a heart in a living subject, said deployment catheter being operative for actuating said annuloplasty device in an operative location in said coronary sinus; and

a location positioning system including an image processor and a mapping catheter for acquiring an anatomic image of a portion of said heart, said location positioning system being operative for registering said operative location of said annuloplasty device with said anatomic image while said annuloplasty device is being inserted by said deployment catheter, said location positioning system being operative for locating points of interest on a left circumflex coronary artery of said heart whereby an operator can determine whether actuation of said annuloplasty device in said operative location may comprise blood flow through said left circumflex coronary artery.

12. The apparatus according to claim 11, further comprising an ultrasound driver in said location positioning system, wherein said mapping catheter is an ultrasound catheter having ultrasound transducers, acoustic signals received by said ultrasound transducers being transmitted to said image processor, said image processor being operative for constructing a plurality of 2-dimensional ultrasound images of said heart, and combining said 2-dimensional ultrasound images into a 3-dimensional ultrasound image.

13. The apparatus according to claim 11, wherein said location positioning system is operative for constructing said anatomic image while said deployment catheter is being inserted.

14. An apparatus for performing percutaneous mitral valvuloplasty, comprising:

a catheter adapted to insert an annuloplasty device into a coronary sinus of a heart in a living subject, said catheter being operative for actuating said annuloplasty device in an operative location in said coronary sinus, wherein said catheter has ultrasound transducers adapted for transmitting first acoustic signals toward said heart and receiving second acoustic signals that are echoes of said first acoustic signals,

a location positioning system including an ultrasound driver for driving said transducers and an image processor for receiving electrical signals from said ultrasound transducers of said catheter and processing said signals to construct an anatomic image of a portion of said heart, said location positioning system being operative for registering said operative location of said annuloplasty device with said anatomic image while said annuloplasty device is being inserted by said catheter, said location positioning system being operative for locating points of interest on a left circumflex coronary artery of said heart whereby an operator can determine whether actuation of said annuloplasty device may comprise blood flow through said left circumflex coronary artery.

15. The apparatus according to claim 14, wherein said image processor is operative for processing said electrical signals to construct a plurality of 2-dimensional ultrasound images of said heart, and for combining said 2-dimensional ultrasound images into a 3-dimensional ultrasound image.

16. The apparatus according to claim 14, wherein said image processor is operative for constructing said anatomic image and registering said operative location of said annuloplasty device with said anatomic image concurrently with insertion of said annuloplasty device into said coronary sinus.