ELONGATED BODY FOR DEPLOYMENT IN A CORONARY SINUS

• US 20110029071A1
• Filed: 12/21/2009
• Published: 02/03/2011
• Est. Priority Date: 12/20/2007
• Status: Active Grant

• Current Assignee: Mor Research Applications Ltd. (Clalit Health Services)
• Original Assignee: Mor Research Applications Ltd. (Clalit Health Services)
• Inventors: Israel, Henry M., Zlotnick, Amnon, Harari, Boaz
• Granted Patent: US 9,131,928 B2
• Time in Patent Office: Days
• US Class Current: 623/2.11
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0448 Additional elements on or within the anchor
• CPC Class Codes: A61B 2017/0488 Instruments for applying suture clamps, clips or locks for applying suture anchors A61B2017/0409; for applying wound clamps A61B17/10; for applying ligaturing clamps or clips A61B17/128
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61F 2/2451 Inserts in the coronary sinus for correcting the valve shape
• CPC Class Codes: A61F 2/2466 Delivery devices therefor
• CPC Class Codes: A61F 2/2487 Devices within the heart chamber, e.g. splints

Abstract

Coronary sinus ring apparatus, including an elongated body for deployment in a coronary sinus, an aperture in a long side of the body, at least a partial lumen extending from one end of the elongated body to at least the aperture, and a guide within the elongated body positioned and shaped to guide an element inserted along the lumen to the aperture. Apparatus for treating a heart, including a delivery tube sized for and adapted for insertion into a body, a sharp tip adapted to be pushed through cardiac muscle, an elongate tensioning element, and a foldable anchor adapted to couple the elongate tension element to cardiac muscle tissue, wherein the delivery tube encloses one or both of the elongate tensioning element and the foldable anchor. Related apparatus is also described.

Claims

1-53. -53. (canceled)

54. Cardiac tensioning apparatus, comprising:

(a) an elongate tensioning element;

(b) at least one anchor adapted to couple said elongate tensioning element to cardiac tissue, at a first position along said elongate tensioning element; and

(c) a hook adapted to engage a rod like element, at a second position along said elongate tensioning element.

55. Apparatus for treating a heart, comprising:

a delivery tube sized for and adapted for insertion into a body;

a sharp tip adapted to be pushed through cardiac muscle;

an elongate tensioning element; and

at least one anchor on said elongate tensioning element and adapted to couple said elongate tension element to cardiac muscle tissue,

wherein said delivery tube encloses one or both of said element and said at least one anchor.

56. Apparatus according to claim 55, wherein said at least one anchor is a hook adapted to engage a rod-like element.

57. Apparatus according to claim 55, wherein said at least one anchor is a rod-like element.

58. Apparatus according to claim 55, comprising a second anchor, mounted on said elongate tensioning element and configured to anchor said elongate tensioning element to different cardiac muscle tissue at a spaced apart position from said at least one anchor.

59. Apparatus according to claim 58, wherein said at least one anchor and said second anchor are configured to be urged against opposite parts of said hearts by said elongate tensioning element.

60. Apparatus according to claim 59, wherein said at least one anchor and said second anchor are adapted to not engage said heart absent tension from said elongate tensioning element.

61. Coronary sinus guide apparatus, comprising:

(a) an elongate body adapted to conform to the shape of a coronary sinus;

(b) an aperture in a long side of said body, having a diameter of at least 1 mm;

(c) a partial lumen extending from one end of said body at least to said aperture; and

(d) a guide within said body positioned and shaped to guide an element inserted along said pathways to said aperture.

62. Apparatus according to claim 61, comprising an anchoring element at least one end of said body.

63. Apparatus according to claim 61, wherein said body is long enough and stiff enough to modify a shape of a Mitral valve annulus.

64. Apparatus according to claim 61, configured for permanent implantation in a coronary sinus.

65. Apparatus according to claim 61, comprising a catheter adapted to fit through said aperture and including a tip for penetrating cardiac muscle tissue.

66. A method of treating a heart, comprising:

(a) accessing a heart through a hole in the body with a diameter of less than 3 cm;

(b) penetrating a first wall of the heart;

(c) second penetrating a second wall of the heart;

(d) coupling an elongate tensioning element to said second wall; and

(e) second coupling said elongate tensioning element to said first wall.

67. A method according to claim 66, wherein said coupling and said second coupling comprise:

releasing an anchor distal to said second wall; and

releasing a second anchor proximal to said first wall.

68. A method according to claim 66, comprising adjusting a length of said elongate tensioning element inside said heart.

69. A method according to claim 66, comprising selecting a desired effect on said heart of said elongate tensioning element and selecting the locations of said penetrations in accordance with said selecting.

70. A method according to claim 66, comprising repeating at least one of said coupling and said second coupling for a plurality of elongate tensioning elements.

71. A method according to claim 66, wherein said coupling and said second coupling are selected so that said elongate tensioning element is not tensioned by said walls over the entire cycle of the heart.

72. A method of having a beneficial effect on a heart, comprising:

(a) identifying that a heart suffers from one or more of Heart failure, Mitral valve insufficiency and Dilated Cardiomyopathy;

(b) selecting a desired limit on a geometry of the heart; and

(c) implanting at least one elongate tensioning element at a position and length which provide one or both of a desired limit on geometry and desired assistance to cardiac muscle wall movement.

73. A method according to claim 72, wherein said at least one elongate tensioning element comprises a plurality of elongate tensioning elements.

74. A method according to claim 72, wherein said at least one elongate tensioning element is not implanted at a papillary muscle or an apex of the heart.

75. Coronary sinus ring apparatus, comprising:

(a) an elongated body for deployment in a coronary sinus;

(b) an aperture in a long side of the body;

(c) at least a partial lumen extending from one end of the elongated body to at least the aperture; and

(d) a guide within the elongated body positioned and shaped to guide an element inserted along the lumen to the aperture.

76. A method of puncturing a coronary sinus wall, comprising:

(a) placing a coronary sinus ring in the coronary sinus;

(b) inserting a puncturing device guided by the coronary sinus ring up to a puncturing device guide;

(c) having the puncturing device guide aim the puncturing device against the coronary sinus wall; and

(d) using the puncturing device to puncture the coronary sinus wall.

77. Apparatus for treating a heart, comprising:

a delivery tube sized for and adapted for insertion into a body;

a sharp tip adapted to be pushed through cardiac muscle;

an elongate tensioning element; and

a foldable anchor adapted to couple the elongate tension element to cardiac muscle tissue,

wherein the delivery tube encloses one or both of the elongate tensioning element and the foldable anchor.