Percutaneous cardiac valve repair with adjustable artificial chordae
First Claim
39. A method of adjusting the geometry of a patient'"'"'s heart, comprising:
- a) introducing a catheter through a patient'"'"'s vasculature into the patient'"'"'s heart;
b) advancing a distal end of the catheter proximate a first portion of the interior of the patient'"'"'s heart;
c) using the catheter to attach a first portion of a filament to the first portion;
d) using the catheter to attach a second portion of the filament to a second portion of the interior of the patient'"'"'s heart; and
e) applying tension to the filament to adjust the geometry of the patient'"'"'s heart.
2 Assignments
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Accused Products
Abstract
The invention includes a novel method and system to achieve leaflet coaptation in a cardiac valve percutaneously by creation of neochordae to prolapsing valve segments. This technique is especially useful in cases of ruptured chordae, but may be utilized in any segment of prolapsing leaflet. The technique described herein has the additional advantage of being adjustable in the beating heart. This allows tailoring of leaflet coaptation height under various loading conditions using image-guidance, such as echocardiography. This offers an additional distinct advantage over conventional open-surgery placement of artificial chordae. In traditional open surgical valve repair, chord length must be estimated in the arrested heart and may or may not be correct once the patient is weaned from cardiopulmonary bypass. The technique described below also allows for placement of multiple artificial chordae, as dictated by the patient'"'"'s pathophysiology.
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Citations
114 Claims
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39. A method of adjusting the geometry of a patient'"'"'s heart, comprising:
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a) introducing a catheter through a patient'"'"'s vasculature into the patient'"'"'s heart;
b) advancing a distal end of the catheter proximate a first portion of the interior of the patient'"'"'s heart;
c) using the catheter to attach a first portion of a filament to the first portion;
d) using the catheter to attach a second portion of the filament to a second portion of the interior of the patient'"'"'s heart; and
e) applying tension to the filament to adjust the geometry of the patient'"'"'s heart. - View Dependent Claims (40, 41, 42, 43, 44)
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45. A catheter adapted and configured to deliver a filament through a patient'"'"'s vasculature into the patient'"'"'s heart proximate a leaflet of a cardiac valve of the patient, the catheter comprising:
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a) an elongate body having a proximal end and a distal end;
b) a filament in operable association with the elongate body; and
c) a deployable penetrator in operable association with the elongate body, the deployable penetrator being adapted and configured to be deployed through a portion of a patient'"'"'s valve leaflet to facilitate capture of the leaflet by the filament. - View Dependent Claims (46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60)
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61. A catheter for applying an anchor into cardiac tissue of a patient, comprising:
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a) an elongate outer body having a proximal end, a distal end and defining a lumen therethrough;
b) an torquable elongate inner body movably disposed within the lumen of the outer body, the inner body having a fitting for receiving an anchor therein. - View Dependent Claims (62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77)
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78. A catheter for fastening together a plurality of filaments, comprising:
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a) an elongate body having a proximal end and a distal end;
b) a guide passage for receiving a plurality of filaments to be fastened together;
c) a fastener applicator disposed proximate the distal end of the elongate body for applying a fastener to the plurality of filaments received by the guide passage; and
d) an actuator disposed proximate the proximal end of the elongate body operably coupled to the fastener applicator to facilitate fastening the plurality of filaments. - View Dependent Claims (79, 80)
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81. A catheter for positioning a lock on a filament comprising:
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a) an inner member having a proximal end, a distal end and defining a lumen at least partially therethrough, the lumen being adapted and configured to receive a filament therethrough;
b) a filament lock biased to change from a first, relatively open state to a second, relatively closed state, the filament lock being disposed on a substantially rigid portion of the inner member, the inner member being sufficiently rigid to prevent the filament lock from changing from the first state to the second state; and
c) an outer member having a proximal end, a distal end and defining a lumen at least partially therethrough;
the lumen of the outer member being adapted and configured to movably receive the inner member, the lumen being sufficiently small to prevent the filament lock from entering the lumen when positioned on the inner member. - View Dependent Claims (82, 83, 84, 85, 86, 87, 88)
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89. An anchor adapted and configured to be anchored in cardiac tissue of a patient, comprising:
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a) an anchoring portion having a proximal end and a distal end, the anchoring portion being adapted and configured to be anchored into cardiac tissue of a patient; and
b) a filament lock disposed at the proximal end of the anchoring portion, the filament lock being biased to change from a first, relatively open state to a second, relatively closed state when disposed about a filament, the filament lock defining a lumen therethrough for receiving an locking onto a filament. - View Dependent Claims (91)
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90-1. The anchor of claim 90, wherein the shape memory material includes nitinol.
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92. A catheter for severing a filament inside of a patient'"'"'s vasculature, comprising:
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a) an inner member having a proximal end, a distal end, and defining a lumen therethrough, the lumen being adapted and configured to receive a filament therethrough;
b) an outer member having a proximal end, a distal end and defining a lumen therethrough, the lumen of the outer member being adapted and configured to receive the inner member; and
c) a pair of substantially arcuate cutting jaws pivotally mounted inside the lumen of the outer member in a wall of the outer member;
the jaws being biased to close about and sever the filament;
the jaws being held apart by the inner member when the inner member is positioned between the jaws, wherein the filament is severed when the inner member is moved out of alignment with the cutting jaws.
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93. A method of treating a cardiac valve, comprising:
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a) introducing a catheter through a patient'"'"'s vasculature into the patient'"'"'s heart;
b) advancing a distal end of the catheter proximate a leaflet of a cardiac valve of the patient;
c) using the catheter to direct a first portion of a filament through the leaflet to capture the leaflet;
d) attaching a second end of the filament to cardiac tissue proximate an annulus of the cardiac valve;
e) applying tension to the filament to cause the leaflet of the cardiac valve to fold over onto itself until coaptation of the leaflet is established with an adjoining valve leaflet. - View Dependent Claims (94)
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95. A system for treating a cardiac valve of a patient, comprising:
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a) a first catheter for directing a first portion of a filament through a leaflet of a patient'"'"'s cardiac valve to capture the leaflet; and
b) a second catheter for implanting an anchor into cardiac tissue of the patient displaced from the leaflet. - View Dependent Claims (96, 97, 98, 99, 100)
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101. A method of implanting a filament in a lumenal system of a patient;
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a) introducing a catheter through a lumenal system of a patient to a location in the patient to be treated;
b) advancing a distal region of the catheter proximate a first location;
c) attaching a first portion of a filament to the first location using the catheter;
d) advancing the distal region of the catheter proximate a second location; and
e) attaching a second portion of the filament to the second location using the catheter. - View Dependent Claims (102, 103, 104, 105, 106, 107, 108, 109)
- comprising;
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110. A system for implanting a filament in a lumenal system of a patient;
- comprising;
a) a catheter having an elongate body, the elongate body having a proximal end and a distal end;
b) an elongate filament having a predetermined length, the elongate filament having a first means for attachment to tissue at a first portion thereof and a second means for attachment to tissue at a second portion thereof - View Dependent Claims (111, 112, 113, 114)
- comprising;
Specification