Percutaneous mitral annuloplasty and cardiac reinforcement
First Claim
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1. A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising:
- an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions dimensioned to reside completely within the vascular system, the elongate body being movable from a first configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus proximate the coronary sinus;
a forming element attached to the elongate body for manipulating the elongate body from the first transluminal configuration to the second remodeling configuration; and
a lock for retaining the elongate body in the second configuration at least in part within the coronary sinus.
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Abstract
A mitral annuloplasty and LV restriction device is designed to be transvenously advanced and deployed within the coronary sinus and in some embodiments other coronary veins. The device places tension on adjacent structures, reducing the diameter and/or limiting expansion of the mitral annulus and/or limiting diastolic expansion of the left ventricle. These effects may be beneficial for patients with dilated cardiomyopathy.
895 Citations
46 Claims
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1. A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising:
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an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions dimensioned to reside completely within the vascular system, the elongate body being movable from a first configuration for transluminal delivery to at least a portion of the coronary sinus to a second configuration for remodeling the mitral valve annulus proximate the coronary sinus;
a forming element attached to the elongate body for manipulating the elongate body from the first transluminal configuration to the second remodeling configuration; and
a lock for retaining the elongate body in the second configuration at least in part within the coronary sinus. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
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30. A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising:
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an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions dimensioned to reside completely within the vascular system, the elongate body being movable from a first configuration for transluminal delivery to at least a portion of the coronary sinus and a second configuration for remodeling the mitral valve annulus proximate the coronary sinus;
a forming element attached to the elongate body for manipulating the elongate body from the first transluminal configuration to the second remodeling configuration, the forming element secured to the elongate body at a point of attachment and moveable relative to the elongate body in order to adjust the elongate body within the coronary sinus between the first and second configurations, the forming element adapted to be severed while the elongate body is positioned at least in part within the coronary sinus in the second configuration; and
a cutting tool which is adapted to sever the forming element while the elongate body is positioned at least in part within the coronary sinus;
wherein the elongate body maintains a substantially constant length when manipulated by the forming element between the first and second configurations.
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31. A medical apparatus for remodeling a mitral valve annulus adacent to the coronary sinus, comprising:
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an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions dimensioned to reside completely within the vascular system, the elongate body being movable from a first configuration for transluminal delivery to at least a portion of the coronary sinus and a second configuration for remodeling the mitral valve annulus proximate the coronary sinus;
a forming element attached to the elongate body for manipulating the elongate body from the first transluminal configuration to the second remodeling configuration, the forming element secured to the elongate body at a point of attachment and movable relative to the elongate body in order to adjust the elongate body within the coronary sinus between the first and second configurations, the forming element adapted to be severed while the elongate body is positioned at least in part within the coronary sinus in the second configuration; and
a cutting tool adapted to sever the forming element while the elongate body is positioned at least in part within the coronary sinus;
wherein the elongate body is relatively non-compressible while the elongate body is adjusted between the first and second configurations.
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32. A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising:
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an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions dimensioned to reside completely within the vascular system, the elongate body being movable from a first configuration for transluminal delivery to at least a portion of the coronary sinus and a second configuration for remodeling the mitral valve annulus proximate the coronary sinus;
a forming element attached to the elongate body for manipulating the elongate body from the first transluminal configuration to the second remodeling configuration, the forming element secured to the elongate body at a point of attachment and movable relative to the elongate body in order to adjust the elongate body within the coronary sinus between the first and second configurations, the forming element adapted to be severed while the elongate body is positioned at least in part within the coronary sinus in the second configuration; and
a cutting tool adapted to sever the forming element while the elongate body is positioned at least in part within the coronary sinus;
wherein the elongate body is interchangeably adjustable between the first and second configurations within the coronary sinus.
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33. A method of performing transluminal mitral annuloplasty, comprising the steps of:
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selecting a prosthesis having a proximal end and a distal end;
providing a deployment system cooperating with the prosthesis and which is adapted to at least in part deliver the prosthesis into the coronary sinus;
inserting the deployment system and prosthesis into the venous system;
transluminally advancing the prosthesis into at least a portion of the coronary sinus;
tightening the prosthesis to generate a compressive force on the adjacent cardiac musculature and influence the size of the mitral valve annulus, the tightening step achieved by proximally retracting a forming element while resisting proximal movement of the prosthesis; and
locking the prosthesis after the step of tightening;
wherein the prosthesis is interchangeably adjustable between tightening to generate the compressive force, and untightening to relieve the compressive force while the prosthesis is positioned within the coronary sinus. - View Dependent Claims (34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45)
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46. A method of performing trasluminaI mitral annuloplasty, comprising the step of:
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selecting a prosthesis having a proximal end and a distal end;
providing a deployment system cooperating with the prosthesis and which is adapted to at least in part deliver the prosthesis into the coronary sinus;
inserting the deployment system and prosthesis into the venous system;
transluminally advancing the prosthesis into at least a portion of the coronary sinus;
tightening the prosthesis to generate a compressive force on the adjacent cardiac musculature and influence the size of the mitral valve annulus, the tightening step achieved by proximally retracting a forming element while resisting proximal movement of the prosthesis; and
locking the prosthesis after the step of tightening;
wherein the prosthesis maintains a substantially constant length when tightened to generate the compressive force.
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Specification