CA2128338C - Septal defect closure device - Google Patents
Septal defect closure device Download PDFInfo
- Publication number
- CA2128338C CA2128338C CA002128338A CA2128338A CA2128338C CA 2128338 C CA2128338 C CA 2128338C CA 002128338 A CA002128338 A CA 002128338A CA 2128338 A CA2128338 A CA 2128338A CA 2128338 C CA2128338 C CA 2128338C
- Authority
- CA
- Canada
- Prior art keywords
- closure device
- disk
- membrane
- catheter
- septal defect
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
- A61B2017/00592—Elastic or resilient implements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
- A61B2017/00597—Implements comprising a membrane
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
- A61B2017/00606—Implements H-shaped in cross-section, i.e. with occluders on both sides of the opening
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
- A61B2017/00623—Introducing or retrieving devices therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
Abstract
The present invention provides a system and a method for closing septal defects and the like. The system includes a closure device (10) having a pair of occluding disks (20, 30) each disk being formed of membrane (22, 32) and an elastically deformable frame (24, 34) carried about the periphery of the membrane (22, 32). The frame (24, 34) which may be formed of a superelastic material is capable of being collapsed for passage through a catheter and elastically returning to predetermined shape for faulty holding the membrane. A central portion of the membrane (22, 32) of each disk (20, 30) is attached to a central portion of the other membrane to define a conjoint disk (40). The method of the invention involves collapsing the frames (24, 34) of the disk (20, 30) inserting the closure device (10) into a catheter and positioning the distal end of the catheter adjacent a septal defect. The disk (70) is then urged out of the distal end of the catheter to permit its frame (24) to elastically return to a predetermined shape, pulling the membrane (22) taut on one side of the defect. The second disk (30) is then similarly deployed on another side of the defect, automatically positioning the conjoint disk (40) within the defect to occlude it.
Description
4'V~ 93!13712 PC'I'/US93/004~9 ._.. ~~2~33~
~EPTAL I)EFEE~I' LGS ZItE DIE~ICE
BAGI~GRG~UhTD OF THE INVVIr11~1'1'I_ Q'I~T
W'he present invention generally relates to devices and methods for occluding ~eptal defects or shunts in the-heart or the vascular system. In particular, the present invention provides a device for closing such defects which may be delivered through a catheter and a method for delivering and deploying that device to close off the defect.
A septum is generally defined as a thin wall ~f muscle or other tissue which divides taw~ or more chambers ~r other areas within the body. The term "septa!
defect"
generally refers to a perforation or other hole which passes through a septum.
Ventricular ~eptal defeats, atrxal septa! defects and patent ductus ariosus are the three most common congenital ~dia~ malf~rcnations. ~f these three malf~rmations, ataial septa!
defects are ,i the easiest tee approach 'through a transcatheter apprcfach and the defects themselves are locate av~ray from the atric~ventricular ~ralve apparaatus. These defects have been surgically ctyrr~ted for d~cad~s.
Initially, atria! septa! defects were cor~ted by open heart surgery. In such an ~perataon, 'the surg~n would have to open the chest s~f a patient and bypass the heart temgdrarily; e.g:; by means of ~ mechanical he.~t or a "heart-long machine."
The surg~n would then physically cut into the heard and suture small defects closed. In the Vie' ~f largea° defects, a patch of a biol~gically c~mpatible material would be sewn onto .
the septum t~ cover the defect. An atria! septa! defect makes the heart muscles work _:
.:; .
considerably harder because of shunting of blood through the defect ~d, if left untreated, leads to high pulanona~y arterial pressures, and this additi~nal strain placed on the heart muscles can cause fatal heart failure.
in order to a~r~id the morbidity and mortality associated with open heart surgery, a variety of transcatheter closure techniques have been attempted. In such techniques, an ,1 ;:,:3 occluding devict is delivered through a catheter. Once the closure device is positioned adjacent the defect, it must be attached to the rest of the septum in a manner which permits it to effectively block the passage of blood through the defect.
The first such closure device was proposed by King and Mills nearly 20 years ago and is described in U.S. patent 3,874,388 (1975).
The King closure device comprises a pair of complex mechanical umbrellas, with each umbrella having a plurality of arms extending radially from a central hub. The hubs of the two umbrellas are mechanically connected to one another and each umbrella includes a fabric covering over the arms, much like a common umbrella. The ends of each arm are provided with barbs which are anchored into the septum to hold the occluder in place. Although this device represents a significant improvement over open heart surgery, the complex mechanical umbrellas pmve rather difficult to unfold after passage through a catheter, requiring an array of cables to deploy the arms.
This makes proper placement of the device difficult, and the barbs on the arms prevent retraction or repositioning of the device once it is in place. Use of this device has been limited to adult patients because the device requires a large catheter, such as about 23 French (7.3mm), for delivery.
Rashland proposod a single-umbrella closure device which was capable of delivery through a Smm system, which permitted use in children weighing at least about 20kg.
Similar to the King device, this umbrella utilizes barbed hooks on the ends of umbrella arms to ensure attachment to the septum, and the single umbrella is placed on the left side of the atrial septal defect. The barbs once again prevented disengagement of the device, and poorly centered devices were common. This device had limited acceptance in the field due to the positioning difficulties because malpositioned or improperly seated devices frequently required open heart surgery for correction.
Due to the low success rate of these devices, Lock and others developed a "modified double-umbrella Rashkind occluder" in which the arms of the device are hinged to permit them to fold back against themselves. Lock's "clamshell" occluder did not include barbs at the end of the radial arms of the umbrella, allowing its position to be 'readjusted or retrieved. Furthermore, the structure of this umbrella was somewhat more compact than the earlier King or Rashkind umbrellas, allowing delivery through an 11 'V~~ 93/13712 PC.'T/US93A00489 _ 3 _ 2128~~~', . : . .
French (3.7mm~ catheter, enabling the device to be used to treat children weighing 8kg or more.
More recently, Sideris has proposed an occlusion device which combines a single umbrella with a separate anchoring device. This accluder is shown ira U~.S.
patent 4,917,089. Like the previous defect occlusion devices, Sideris' invention utilizes an umbrella with a plurality of radially extending arms. A string connects the arms of this umbrella to a generally rhomboidally shaped anchor which includes an internal wire skeleton and a central, rhomboidally shaped piece of rubber. The string.attached to the struts of the umbrella is affixed to the central rubber element of the anchor.
The anchor is placed on the opposite side of the septum from the umbrella and the length of the string limits movement of the occlusion device with respect to the septum.
All of the prior art devices deseribed above share two defects in common.
Firstly, all of these systems are rather mechanically complex and require a great deal of remote manipulation for deployrracnt, such as by applying tension to one or more cables in order to deploy the arms ~f an umbrella or to anchor the device in place. This extensive remote manipulation hot only increases the difficulty ~f the prb~ure, but tends to increase the likelih~od that the device will be improperly deployed and require either retrieval or ._ reposWonmg.
S~r~dly, all of these devices are essentially two separate members which are y joint to each ~ther at a singic point or pivot. i~hen the left atrial member is opened, the centraD point would teed to ride to ttae lower margin of the deft; proper centering of the device is Quite difficult. The Ieock device does form a 'cone' when traction is applied to hdlp: centering: In order for this to effectively occur, though, the device has to be pulled per~psndic~lar to the plane ~f the atrial septum. In a beating human heart, this is rather daf~eult to achieve.
It would therefore be desirable to provide a simple, compact closure device which gay ~ delivered through 'a small catheter to permit the treatment of younger children.
It would also be highly advantageous to have such an anchoring device which can be readily deployed with a minimum of remote manipulation. In addition, a device which is truly self centering and self occluding would be superior to these prior art devices.
Wo 93!13712 P~'I'/US93/OO~i~9 21~~~3~ ~. _4_ The present invention provides a simple, reliable device for effectively occluding a septa! defect. 'The instant closure device includes first and second occluding disks which ' are attached to one another. Fach disk comprises a membrane having an elastically deformable frame carried about its periphery. The frame is capable of being collapsed so that the device may be delivered through a catheter, but should be flexible enough to permit it to elastically return to its initial shape upon exiting the catheter to pull the membrane taut. A central portion of the membrane of each disk is affixed to a corresponding portion of the membrane of the other disk, thereby attaching the two disks directly to one another at their centers. The affixed central portions of the two membranes defines a central "conjoint disk" of the device, and this conjoint disk is sized to be received within a septa! defect.
The present invention also contemplates a method of delivering this septa!
defect closure device. The frames of the two disks are collapsed and the device is inserted into the distal end of a delivery catheter. This is dally through an outer guiding catheter which is positioned within a patient's vascular system across the septa! defect being treated, and the first of he fwo disks is urged out of the catheter on one side of the defect. The fle~cible frame of he disk elastically returns to its initial shape; expanding the disk and pulling the membrane taut. The second disk may then be urged out of the distal er~d of the catheter on the other side of the def t. The frame of this second disk pulls E the attach membrane taut; leavipag the central conjoint disk of the device within the defect.
A septa! defect closure device of the invention is simple in construction, greatly enhancing the mech~eal durability of the device and therefore reducing the risks associated with its use. AdditiopaUy, because the closure device relies upon elastically .
deforinable fr~atn~s whack automatically assume their initial shape upon exiting a catheter, it can be deployed to occleade a defect without complex remote manipulati~n by the operator.
,, ~a~F ~~scoN of ~ oRAwlrIGs Figure 1 is a partially broken-away view of a heart having an atria! septa!
defect, Figure 2 is the heart of Figure 1 showing a septa! closure device of the invention W4 93113°~t2 fGTlUS93/ti0489 2~.~~'~~~
- 5 - ._ occluding the atrial septal defect;
Figure 3 is a partially expanded side view of a preferred embodiment of a septal closure device of the invention;
Figure 4 is a front view of the closure device of Figure 3;
Figures 5A-F depict alternative embodiments of a closure device of the invention;
Figure 6 is a front view of a flame for use in the closure device of Figure 3;
Figure 6A is an enlarged isolation view of the encircled portion of Figure 6;
Figure 7 is a front view of the frame of Figure 6 in its unassembled form;
Figure 8 schematically depicts a closure device of the invention collapsed inside a catheter for delivery to a septal defect;
Figure 9 schematically depicts the closure device of Figure 8 with the first disk expanded on one side of the septal defect;
Figure 10 schematically depicts the closure device of Figures 8 and 9 with the second disk expanded on the other side of the septal defect;
Figure ll is a view similar to Figure 9, but depicts an alternative embodiment wherein a coaxial catheter delivery is employed;
.1r Figure 12 is a cross-sectional view of an arternati~e embodiment of a septal closure ., device of the invention; .
Figure I3 is a perspective view of a handle of a delivery system for delivering a device of the invention; , ~t~ Figure 14 is a schematic view of the handle for the delivery system shown in Figure 13; .
Figure IS is a schematic; cross-sectional view of the clistal end of a delivery ..system for delivering a device of the invention; and Figure l;6 is a perspective: view of the distal portion of the delivery system shown in Figuxe l5.
j r~ji RIPTION OF THE PREFERRED EMBOI?IMENTS
Figure 1 represents a heart H having a septum S dividing the two atria A,A. A
defect D is shown as a port extending through the atrial septum. A normal atrial septum serves'to effectively divide the two chambers A,A and separate the blood passing through the heart: As shown in Figure l, though, the septal defect prevents the septum from ,~'~
fulfilling its function in that it permits blood to pass from one chamber to the other as the heart pumps. The presence of a significantly large atrial septal defect causes blood to shunt across the defect from the left atrium to the right atrium and hence on to the right ventricle and pulmonary arteries to the lungs. This increases the blood flow to the lung.
If the defect is not closed, over a period of time this leads to an increase in the pressures in the pulmonary arteries and right side of the heart, and shunting of unoxygenated blood from the right to the left side, leading to death due to cardiac failure, hemoptysis or cerebral stroke due to blood clots passing from the veins thmugh the atrial defect into the cerebral circulation. In patients with significant sized ventricular septal defecu or patent ductus arteriosus, there is shunting of blood from the high pressure left ventricle or aorta, into the right sided chambers and pulmonary arteries which normally have much lower pressures. The torrential increase in flow at a high pressure can lead to cardiac failure and death, apart from the serious long-term complication of high pulmonary pressures causing a reversal of the direction of the shunt.
As shown generally in Figure 2, a septal defect closure device 10 of the invention may be attached to the septum to effectively block the defect. As described in detail below, once the closure device is in place it will become anchored to the septum and prevent the flow of blood through the septum to the adjoining chambers of the heart. This will permit the heart to operate normally.
One preferred embodiment of the invention is shown in Figures 3 and 4. As best seen in Figure 3, the closure device includes two disks 20,30. Each disk generally comprises a membrane 22,32 which may be of any desired shape. In the embodiment shown in Figures 3-8, the membrane is preferably formed of a thin, flexible material, such as a fabric which may be folded and pulled taut without being damaged.
Elastic polymeric materials such as nylon, polyester, polypropylene, polytetrafluoroethylene (Teflon), and expanded polytetrafluoroethylene (GoreTeX), as well as natural fabrics such as silk, have been found to work quite well, with elastic nylon appearing to be the best material for the present purposes. Alternatively, the membrane may be formed of a thin piece of a superelastic material, such as a thin sheet of NiTi alloy or a superelastic polymeric composite.
A frame 24,34 is attached to and desirably extends substantially around the * trade-mark dV0 93113712 ~ ~ ~ ~ ~ ~ ~ PC'f/US93/00489 periphery of the membrane. When the frame is in its natural, non-deformed state, as shown in Figures 3 and 4, it serves to hold the membrane 22,32 taut. In Figure 3, the frames of the two disks 20,30 are shown as being spaced from one another for purposes of the present explanation, but this is not the normal configuration of the disks.
Normally, the frames 24,34 of the device pull their respective membranes 22,32 into a taut, generally planar shape, and the two frames will generally abut against one another.
The membranes 22,32 may be attached to their respective frames 24,34 by any suitable means. For instance, the membrane may be directly attached to the frame by means of an adhesive or the like. Preferably, though, the periphery of the membrane is wrapped about the frame and the peripheral edge (not shown) is attached to the rest of the membrane, essentially defining a sleeve about the frame. The sleeve may fit the frame relatively loosely so that the frame may move within the sleeve with respect to the membrane. The peripheral edge of the membrane may be affixed to the rest of the membrane in any suitable fashion, such as by sewing in the case of a fabric membrane.
If a thermosetting polymeric material, e.g., nylon, is used; the peripheral edge may be fused to the rest of the membrane by means of heat sealing or the Like.
Alternatively, if the membranes are themselves formed of a superelastic material, they will tend to return to their original shape even without a frame, so the frame may be omitted if so desired.
The frame desirably comprises a plurality of elongate legs 26, with each leg being flexibly connected to another leg at each ends Any suitable number of Legs may be employed; and the legs may be shaped as desired. For instance, in Figures 3 and 4, the fraume has five substantially straight legs and is therefore generally pentagonal in shape.
Figures SA-F illustrate a number'~f alternative embodiments of frames of the invention which utilize a variety of different numbers and shapes of legs. The reference numerals used in Figure 5 correspond to those :used in Figures 3 and 4 with respect to the first frame 20; but bear an additional alpha suffix ranging from A to F.
In Figures SA-C; the legs are all generally straight and range in number from three to six. obviously, if the legs are straight, at least three legs must be provided to ~equa~ly extend about the periphery of the membrane. In Figures SD-F, the legs are not straight, but rather are more complex irt shape. Legs 2bD (Figure SD) are generally arcuate in shape, with four legs defining a generally circular frame 24D.
Although one WO 93/13712 PGT/US93/00~189 _g_ such curved Leg could extend about the entire periphery of the membrane 22D to provide a frame 24D consisting of a single leg, for reasons set forth below it is preferred that the frame include at Least two interconnected legs. In Figures SE and F, each leg is bent at an obtuse angle at approximately the middle of its length. When inserting the frame into a catheter as detailed below, these bends in the Legs permit the frame to be collapsed more readily. The angle of the bends in the legs may be adjusted as desired to achieve the desired frame configuration. Although the frames shown in Figure 5 all have legs which are substantially equal in Length, the legs of any given frame may vary in length if so desired.
The legs of a frame may be connected to each other in any useful fashion.
Figures 3 and 4, however, show a preferred way of connecting the legs. As noted above, the legs ~, 26,36 of a frame 20,30 are flexibly connected to another leg at each end. A
resilient lnnn '752 aft ie e~ic~nnep~ ~r~taara~:n a~lianPnt Pft(jC of tWn IP~C alfit~
dnE End Of the lOOt3 is attached to each leg. 'These loops desia~ably lie generally ~n the same plane as the legs and :r may e~ctend generally outwardly of the periphery of the disk (as shown in Figures 3, 4, F), or may extend generally inwardly of the periphery of the disk (as shown SA, and SE
in Figures 58-D). As shown in Figure 5; each of he loops may be of substantially the same size, for instance in the range of about lmm to about 3mm in length.
Alternatively, as shown in Figure SE; the frame may be provided with a plurality of relatively small loops 28E and a plurality of relatively long loops 28E', which may desirably range from about 5 to about: l5 mm in length: These longer loops 28E' are desirably spaced about ,,;, the periphery of the closure device and extend - generally radially outwardly of the periphery of the disk. When' the disk is deployed to block a septal defect or the like, these Ion~er Loops can serve as bracing struts which will effectively engage the tissue E .surrounding the defect being closed without requiring any significant increase in the size of the disks employed or the catheter used to deliver to device.
The loops 28,38 are desirably formed to function as tension springs, biasing the legs to which they are attached outwardly into the position shown in Figures 3 and 4.
;j This will help ensure' that the frame will elastically return substantially to its initial configuration even after it has been collapsed and delivered through a catheter, as set forth below.
w0 93/1371 PGT/1.JS93/00~9 -9- , , .
yn a particularly preferred embodiment, each frame 20,30 is formed integrally of a single elongate strand of wire dV. As best seen in Figures 6-7, each of the legs 26 may simply comprise a length of the wire and the wire may be twisted between adjacent legs to define the loops 28. The ends pf the wire may be attached to each other in any secure fashion, such as by means of a weldment or a suitable biocompatible cementitious mateYial.
In the embodiment shown, however, one leg 26' comprises two overlapping lengths of wire. ~tlhen the wire 'W is formed into the shape of the frame, one more leg-like length than is otherwise necessaay is formed. The two end lengths 26"
of the wire are then laid over and affixed to one another, yielding a frame having tlae desired number of legs. Desirably, both of the end lengths 26" are approximately the same length and end loops 28" are provided at the ends of the wire. As shown in detail in 'i Figure 6A, these end loops 28" may be interlocked with the loop 28 between the opposite end length 26" and its adjacent leg 26. By so interlocking these loops to form an overlapping loop 28' at each end of the overlapped leg 26', the two end lengths 26" of ~e wire may be effectively joined to one another to define the overlapped leg.
If so desired, the end lengths 26" fraa~ be further secured to one another by means of a weldment or a suitable adhesive; as noted above; or a suture (not shown) may be tied y~
about ~eh overlapping loop 28' to hold that loop together: In order to provide further security, gather than siynply using two short, separate sutures to secure the two end loops, ~ s~gle,1~nger suture may be used: The suture may be tied at one end to ~ne loop and ~t its other egad to the other loop, witch an intermediate length of the suture being helically wound about the overlapping leg 26' to ensure that the two end lengths 26" are firmly attached to ~ne another:
~e a 20 should be formed of a flexible, elastically deformable material,: such as a metal. ~ ~ particularly preferred embbdiment, the wire comprising the frame is firmed of a super~lastic W aterial. ~ne such material currently laaown in the art is a near-stoichiometric nickelJtitanium alloy, commonly referred to as Ieiitinol or lotiTi. Such superelastie (also referred t~ as "pseudoelastic°') materials may be elastically deformed to a much grehter extent than most other materials yet substantially fully recover their original shape when released. This permits the frame 20 to be deformed sufficiently for WO 93/13712 ~'CT/US93/00489 . - 10-. ._ . .
insertion into and passage through a small-diameter catheter yet automatically elastically return to its initial shape upon exiting the catheter. In an alternative embodiment, the preferred shape of the frame may be cut out from a sheet of such superelastic material as a single block, by chemical etching, punching with a suitable punch and die, or any other , appropriate forming method.
In order to enhance radiopacity so that the frame can be viewed remotely during deployment, the frame may be provided with a radiopaque coating, such as gold or platinum. For instance, the wire W may be plated with a thin layer of gold or platinum.
In one particularly useful embodiment, a helically wound length of a thin radiopaque wire (not shown) is placed over the wire Wy such corelcoil structures are well known in the art and need not be discussed at length here. In order to ensure that the frame can be collapsed into the smallest possible configuration for delivery through small catheters, the diameter of the wire comprising the frame should be kept small. For instance, the wire W may be about 9 mils; (O.OQ9") in diameter and the radiopaque outer wire may about 1-3 mils (0:001-0.003") thick, for a total outer diameter of about 11-15 mils (0.011-0.0I5"). Although the outer wise may extend along the entare length of the frame, it is preferred that it be-provided only along the legs 26, living the loops 28 as short ~a~
lengths of the bare wire W.
Alternativel , radio ue markin bands (not shown), which are commercially 'y p~
available, may be employed. By placing one such band on each leg 26 of the frame, the surgeon can remotely visualize the frame as a plurality of small bands; when the bands are appropriately spaced from one' another on a monitor; he surgeon will know that the ", frame is properly deployed.
;.
a ~ Referring back to Figures 3 and 4, a septal defect closure device of the invention includes a central conjoint disk 40A central portion of~each membrane 22,32 is attached to a corresponding central portion of the membrane of the other disk. The central conjoint disk 40 may be of any desired shape; but the generally circular shape shown in Figures 3-5 is' prefera~ed:
The membranes 22,32 may be affixed to one another by any desired means, such ;as a biocompatibae adhesive. The adhesion between the two central membrane portions should be strong enough to ensure that the two disks will not become separated from one WO 93/13712 PGT/U~93/00489 - ll - 21~~c~~~
another during handling and deployment of the closure device. in one preferred embodiment, the membranes are sewn to one another, with the stitching defining the shape and size of the conjoint disk 40. If the membranes are farmed of an appropriate polymeric material their central portions may instead be fused to one another ~by means of heat sealing or the like. As another alternative embodiment, the membranes 22,32 may be formed of a thin, highly fleycible material such as a nylon. and the conjoint disk may include another piece of material (not shown), such as polyurethane, nylon, a superelastic material such as nitinol; or the like. This additional material is desirably disposed between the two membranes and sewn or otherwise bonded to the membranes in defining the conjoint disk. The additional material may be of any size, but is desirably apgrooimately the same size as the conjoint disk, or slightly larger.
If so desired, the central conjoint disk may include an internal frame 50 as shown in Figure SB. This internal frame is desirably constructed in substantially the same manner as the frames 20;30 described above: However; the internal frame 50 is desirably smaller in size than the frames 20,30 and is sized to be attached directly to the peripheral edge of the conjoint disk 40. The internal frame 50 is desirably bonded to and generally positioned within the conjoint disk such that when the devace is deployed, this small, internal' frame will assist in the immediate; taut deployment of the conjoint disk within the defect.
In order to facilitate relatively quick closure, the conjoint disk is desirably sized to substantially fill the defect being occluded, but- should not be substantially larger than the defect. Although the size of septal defects tend to vary, most atrial septal defects are smaller than 25mm in diameter. Accordingly, it is contemplated that a variety of closure devices having central conjoint disks ranging in sine from about 5 to about 30mm will be provided. A surgeon may treasure the size of the defect by known means, e.g., using a balloon catheter filled with a contrast medium, and select a closure device having a 'conjoint disk' of the appropriate size:
For reasons set forth more fully below, it is also desirable that the disks 20,30 be at least l.6 times the size of the defect; and preferably range from about 1.6 to about 2.5 times the size of the defect. The difference between the stretched diameter of the septal ' defect, as determined by measurement with a.balloon catheter or by other known means, WO~ 93/13712 PCT/US9310~489 ._ .. ~ - 12 -and the size of the frame is optimally approximately l5mm. Since the central conjoint disk 40 is chosen to approximate the size of the deft, the maximum dimension of the frame may be at least 1.6-2.5 rimes the size of the conjoint disk. As an example, to patch a lOmm defect, a closure device having a central conjoint disk about lOmm in diameter .
and a frame of about 25mm in maximum dimension rnay be selected.
tern alternative embodiment of the present invention is shown in cross-section in Figure 12, wherein like numbers have bin used, but differ from the numbers in Figures 3-10 by 100. As shown in Figure 12, the first disk 120 comprises a membrane supported by a frame 124. However, unlike the embodiment described above, the membrane I22 of the present invention is not a single layer of fabric, but is rather a flexible, collapsible balloon-type member which can be inflated to define an internal cavity I21. Similarly, the second disk 130 is supported by a frame 134 and the membrane 132 may be inflate to define an internal cavity I31. The membranes 122,132 may be formed of any suitable material, such as a thin, flexible latex or the like.
Inflatable, detachable balloon-type structures are known in the art and may be delivered by known transcatheter techniques. The membranes 122,132 ir~ay be attached to the frames 124,134 by any suitable pneans, such as by a weldrnent 127 internally formed with the membranes which substantially encases the frame 124; as shown.
7Che conjoint disk 40 of the embodiment described above simply comprises central porn~ns of e,~ch of the membranes 122;132 which are b~nded td one another, as described above. In the embodiment shown in Figure 12, though; the conjoint disk 140 is somewhat more complex in structure. 'fhe merxtbrane 122 of the first disk 120 includes an inflation port 123 which is operatively connoted go a check valve 125. In the preferred embodiment shown, the check valve 125 ~ is disposed on the second disk 130 at a location disposed away from the first disk' 120.
This check ~ralve 125 is desirably disposed immediately adjacent a similar check valve 135 associated with the sec~nd disk 130. 'These check valves may in turn be connected to a detachable, dual lumen itaflation catheter (not shown) as is known in the art for such teehniques as balloon etnbolization and the like. 7Chis catheter permits an operator to selectively deliver a fluid through a check valve to inflate the associated disk. °The inflation catheter should be detachable from the check valves after the device is deployed.
''W~ 93/13712 PCT/U~93/1304$9 In the embodiment shown wherein the check valve is disposed away from the first disk 120, the inflation port 123 desirably extends through the conjoint disk 140 and may be centrally located therein. The rest of the conjoint disk may be defined by a short, generally tubular segment 133 of the second disk and the inflation port 123 of the farst disk may extend through this tubular section. The diameter of the conjoint disk is desirably sued to substantially fill the defect being blocked, as described above in connection with the previous embodiment.
Figure 12 depicts the present embodiment once it has ali°eady been inflated. In deploying the closure device 110, though; the membranes 122,132 preferably are not inflated, but are desirably substantially empty so that they will remain flexible. Thus, the structure of this deflated closure device substantially corresponds to the overall structure of the previous embodiment and may be delivered to the defect and deployed in a similar manner: However, once the first disk 120 is opened on the distal side of the defect by the action of the frame, it nnay then be inflated. 'this may be accomplished by delivering a suitable fluid through the check valve 125 and inflation port 123 to inflate the membrane 122. The fluid owill then expand the membrane to defied and fill the cavity 121.
Although any suitable fluid may be used; it is preferred that a biologically compatible, 'self-curing cementitious material; such as an epoxy or a cyanoacrylate, be used. In this ;' manner; the cavity 121 may be filled aNith this material and permitted to substantially harden, creating a stable, gene~ly rigid structural member from the membrane 122.
A~ in the previous embodiment; the closure device may then be retracted until the first disk 120 engages the septum and the second disk 130 may then be deployed. The frame 134 will then tend t~ cause the membrane 132 to engage the septum as in the ': previ~us emb~diment. Although this would serge to effectively close the defect, the s~;ond membrane may also be inflated in a like manner to fill the cavity 131 with a suitable fluid, such as that described above. This wfll serve to provaoe relauveiy ng~a structural supp~rt, as with the fiat disk 120; but it will also serve to inflate the tubular segment 133 of the conjoint disk 140; more effectively closing the defect by expanding the disk 140.
Figure 10 depicts a closure device 10 of the invention deployed to occlude a defect in a septum S. The first disk 20 of the device is positioned on one side of the defect w0 93/13712 PGT/US93/004~9 ' 14' while the second disk 30 is generally disposed on the other side. The frames 24,34 of the disks are elastically biased taward the position shown in Figure 4, pulling their respective membranes 22,32 taut. The central conjoint disk 40 is positioned within and substantially closes off the defect. As explained above, the taut membranes are generally planar and the frames 24,34 generally abut against one another when the device is unconstrained.
Because the frames are elastically biased toward their constrained configuration, they are biased generally toward one another and engage opposing sides of the septum about the defect, Since there are no compressive forces acting on the frames which might cause them to collapse, this serves to effectively hold the device in place with the conjoint disk 40 positioned within the defect, as shown.
The membranes are formed of a relatively porous material. At farst glance this may seem to contradict the purpose of the device, i.e., to block the flow of blood across the device, and hence ~e ~p~m. However; blood will tend to coagulate in the conjoint disk after it has been in place for some time; blood flow across the conjoint disk is usually substantially blocked after about 1Or20 minutes. If so desired, the conjoint disk (or the entire device) ~y ~ ~ ~~ a thrombogenic agent to speed this natural process or may be impregnated with a biocompatible polymeric compound or ttae like to make it relatively impervious to fluids:
The primary purpose of using a porous material for the membranes is to accelerate the process of permanently, anchoring the device in place. The frames 24,34 hold the membranes taiutly and in intimate contact with he outer surface of the septum S, as shown in Figure 10. This intimate contact between tht septum and the porous membranes permits ingrowth of collagen and fibrous tissue frem the septum into the membranes.
C?ver time, the membrane resting against the septum will become securely anchored to the ~p~ wall and be covered by a layer of endothelial cells.
The design of this device is in stark contrast to the septal defect closure devices known in the art. As explained in some detail above, all of the prior art devices employ a mechanical umbrella of one design or another. The radially extending arms of the umbrella contact the septum and sere to space all but the peripheral edge of the umbrella away from the septum. Endothelial cells, collagen and fibrous tissue are therefore permitted to grow into only the very periphery of the umbrella. Thus, while a closure 1~VV~ 93/13712 PCTlLl~93/004~9 device of the invention essentially becomes an integral part of the septum, the complex mechanical structure of prior art devices does not yield as complete integration as the present invention. . . .
The mechanical complexity of prior art devices also tends to markedly affect their durability. In the case of atrial or ventricular septal defects, for example, the heart obviously continues to beat after the device is in place. Since beating of the heart is accomplished by flexure of the heart muscles, the septum will flex to some degree with every beat of the heart. The radial arms must therefore flex with the sepxum each and every time the heart beats. The number of cycles of this stress-inducing movement produces repeated stresses on the arms, which can eventually lead to mechanical failure and fracture of the arms.
When a closure device of the invention is deployed, the centrifugal tension of the outer frame opens the disk to occlude-the defect. Since there are no radial arms to prop open the dedrice; the occurrence of repeated flexion does not occur due to the beating of the heart or pressure differences betw~n the cardiac chamber during the phase of contractiop of the heart: To the contrary, 'any pressure difference would drive the frame and disk against the septum; more fimtly occluding the defect, in much the same manner as a bathtub stopper. In addition; the superelastic anaterial of the frame tolerates flexural stresses much better than the algid steel arms of the prior art devices. The present device therefore will continue to flex .wvith the septum without any significant effect on its structural integrit~ra ..:'s, As stated above; the present indention also contemplates a method of delivering and deploying the closure device 10 described above. According to this method, the device is delivered to the site of the septum by a transratheter procedure, eliminating the rw,~
need for open' heart surgery and hll of its' attendant risks.
The device is inserted into the distal end of a catheter ~ by collapsing the frames '3 ~ og ghe disks. The frame 24 of the first disk 20 is collapsed and inserted into the end of r ~o catheter first. M"his array be accomplished in any suitable manner, such as by manually :a folding the frame and placing it into the s;atheter: In a preferred embodiment, however, the lops 2g are used as eyelets to assist in collapsing the frame. A thread, such as a ~ length of a suture thread, is passed through all of the loops of the frame and is drawn ::~_, .<
WO 93/137t2 PCT/US93/00489 - 16 - ._ tight. Similar to a conventional purse string. This will cause the ends of the legs 26 to generally converge upon a single point spaced axially outwardly of the central conjoint disk 40. These converging ends may be inserted into the distal end of the catheter, and the thread passing through the loops may be removed by simply pulling on one of its ends. The rest of the first disk 20 can then be urged into the catheter and the walls of the catheter will further collapse the frame 24 upon itself, folding each of the legs. As noted above in connection with Figures SE and F, if the legs are already bent, .this insertion will tend to be easier, The second disk 30 may be folded in the same manner if so desired. This can also be accomplished by simply continuing to urge the device into the catheter, though. The walls of the catheter will act against the legs 36, generally folding them such that their ends will generally converge on a point spaced axially outwardly of the central conjoint disk 40, much Like the first frame 24. Obviously, the ends of the legs 26 of the first disk will converge on a point spaced distally of the conjoint disk while the ends of the legs 36 of the second conjoint disk will converge on a point spaced proximally of the conjoint disk. The device will therefore be configured within the catheter generally as schematically shown in Figure 8; though the ends of the legs will tend to be closer to one another than is depicted' in that drawing:
~~er before orpreferably, after insertion of the closure device into the catheter C; the distal tip of the catheter is positioned adjacent the septal defect D
to be occluded.
A distal portion of the catheter should extend hrough the defect to position the distal tip of the catheter on the distal side of the defect, as shown in Figure 8. The closure device is urged through substantially the entire length of the catheter such that it is positioned n~ ~e distal tip of the catheter; also as shown in Figure 8. Once again this may be done either before or after positioning of 'the catheter, 'but it is desirably done before' so ~t ~e distal tip of the catheter will not be inadvertently moved out of position as the device is advanced.
Once the catheter is properly positioned, the first disk 20 of the device is urged out of the distal end ~f the catheter. With the constraint of the catheter walls removed, the frame 24 will elastically substantially return to its initial, non-deformed shape (Fig.
~EPTAL I)EFEE~I' LGS ZItE DIE~ICE
BAGI~GRG~UhTD OF THE INVVIr11~1'1'I_ Q'I~T
W'he present invention generally relates to devices and methods for occluding ~eptal defects or shunts in the-heart or the vascular system. In particular, the present invention provides a device for closing such defects which may be delivered through a catheter and a method for delivering and deploying that device to close off the defect.
A septum is generally defined as a thin wall ~f muscle or other tissue which divides taw~ or more chambers ~r other areas within the body. The term "septa!
defect"
generally refers to a perforation or other hole which passes through a septum.
Ventricular ~eptal defeats, atrxal septa! defects and patent ductus ariosus are the three most common congenital ~dia~ malf~rcnations. ~f these three malf~rmations, ataial septa!
defects are ,i the easiest tee approach 'through a transcatheter apprcfach and the defects themselves are locate av~ray from the atric~ventricular ~ralve apparaatus. These defects have been surgically ctyrr~ted for d~cad~s.
Initially, atria! septa! defects were cor~ted by open heart surgery. In such an ~perataon, 'the surg~n would have to open the chest s~f a patient and bypass the heart temgdrarily; e.g:; by means of ~ mechanical he.~t or a "heart-long machine."
The surg~n would then physically cut into the heard and suture small defects closed. In the Vie' ~f largea° defects, a patch of a biol~gically c~mpatible material would be sewn onto .
the septum t~ cover the defect. An atria! septa! defect makes the heart muscles work _:
.:; .
considerably harder because of shunting of blood through the defect ~d, if left untreated, leads to high pulanona~y arterial pressures, and this additi~nal strain placed on the heart muscles can cause fatal heart failure.
in order to a~r~id the morbidity and mortality associated with open heart surgery, a variety of transcatheter closure techniques have been attempted. In such techniques, an ,1 ;:,:3 occluding devict is delivered through a catheter. Once the closure device is positioned adjacent the defect, it must be attached to the rest of the septum in a manner which permits it to effectively block the passage of blood through the defect.
The first such closure device was proposed by King and Mills nearly 20 years ago and is described in U.S. patent 3,874,388 (1975).
The King closure device comprises a pair of complex mechanical umbrellas, with each umbrella having a plurality of arms extending radially from a central hub. The hubs of the two umbrellas are mechanically connected to one another and each umbrella includes a fabric covering over the arms, much like a common umbrella. The ends of each arm are provided with barbs which are anchored into the septum to hold the occluder in place. Although this device represents a significant improvement over open heart surgery, the complex mechanical umbrellas pmve rather difficult to unfold after passage through a catheter, requiring an array of cables to deploy the arms.
This makes proper placement of the device difficult, and the barbs on the arms prevent retraction or repositioning of the device once it is in place. Use of this device has been limited to adult patients because the device requires a large catheter, such as about 23 French (7.3mm), for delivery.
Rashland proposod a single-umbrella closure device which was capable of delivery through a Smm system, which permitted use in children weighing at least about 20kg.
Similar to the King device, this umbrella utilizes barbed hooks on the ends of umbrella arms to ensure attachment to the septum, and the single umbrella is placed on the left side of the atrial septal defect. The barbs once again prevented disengagement of the device, and poorly centered devices were common. This device had limited acceptance in the field due to the positioning difficulties because malpositioned or improperly seated devices frequently required open heart surgery for correction.
Due to the low success rate of these devices, Lock and others developed a "modified double-umbrella Rashkind occluder" in which the arms of the device are hinged to permit them to fold back against themselves. Lock's "clamshell" occluder did not include barbs at the end of the radial arms of the umbrella, allowing its position to be 'readjusted or retrieved. Furthermore, the structure of this umbrella was somewhat more compact than the earlier King or Rashkind umbrellas, allowing delivery through an 11 'V~~ 93/13712 PC.'T/US93A00489 _ 3 _ 2128~~~', . : . .
French (3.7mm~ catheter, enabling the device to be used to treat children weighing 8kg or more.
More recently, Sideris has proposed an occlusion device which combines a single umbrella with a separate anchoring device. This accluder is shown ira U~.S.
patent 4,917,089. Like the previous defect occlusion devices, Sideris' invention utilizes an umbrella with a plurality of radially extending arms. A string connects the arms of this umbrella to a generally rhomboidally shaped anchor which includes an internal wire skeleton and a central, rhomboidally shaped piece of rubber. The string.attached to the struts of the umbrella is affixed to the central rubber element of the anchor.
The anchor is placed on the opposite side of the septum from the umbrella and the length of the string limits movement of the occlusion device with respect to the septum.
All of the prior art devices deseribed above share two defects in common.
Firstly, all of these systems are rather mechanically complex and require a great deal of remote manipulation for deployrracnt, such as by applying tension to one or more cables in order to deploy the arms ~f an umbrella or to anchor the device in place. This extensive remote manipulation hot only increases the difficulty ~f the prb~ure, but tends to increase the likelih~od that the device will be improperly deployed and require either retrieval or ._ reposWonmg.
S~r~dly, all of these devices are essentially two separate members which are y joint to each ~ther at a singic point or pivot. i~hen the left atrial member is opened, the centraD point would teed to ride to ttae lower margin of the deft; proper centering of the device is Quite difficult. The Ieock device does form a 'cone' when traction is applied to hdlp: centering: In order for this to effectively occur, though, the device has to be pulled per~psndic~lar to the plane ~f the atrial septum. In a beating human heart, this is rather daf~eult to achieve.
It would therefore be desirable to provide a simple, compact closure device which gay ~ delivered through 'a small catheter to permit the treatment of younger children.
It would also be highly advantageous to have such an anchoring device which can be readily deployed with a minimum of remote manipulation. In addition, a device which is truly self centering and self occluding would be superior to these prior art devices.
Wo 93!13712 P~'I'/US93/OO~i~9 21~~~3~ ~. _4_ The present invention provides a simple, reliable device for effectively occluding a septa! defect. 'The instant closure device includes first and second occluding disks which ' are attached to one another. Fach disk comprises a membrane having an elastically deformable frame carried about its periphery. The frame is capable of being collapsed so that the device may be delivered through a catheter, but should be flexible enough to permit it to elastically return to its initial shape upon exiting the catheter to pull the membrane taut. A central portion of the membrane of each disk is affixed to a corresponding portion of the membrane of the other disk, thereby attaching the two disks directly to one another at their centers. The affixed central portions of the two membranes defines a central "conjoint disk" of the device, and this conjoint disk is sized to be received within a septa! defect.
The present invention also contemplates a method of delivering this septa!
defect closure device. The frames of the two disks are collapsed and the device is inserted into the distal end of a delivery catheter. This is dally through an outer guiding catheter which is positioned within a patient's vascular system across the septa! defect being treated, and the first of he fwo disks is urged out of the catheter on one side of the defect. The fle~cible frame of he disk elastically returns to its initial shape; expanding the disk and pulling the membrane taut. The second disk may then be urged out of the distal er~d of the catheter on the other side of the def t. The frame of this second disk pulls E the attach membrane taut; leavipag the central conjoint disk of the device within the defect.
A septa! defect closure device of the invention is simple in construction, greatly enhancing the mech~eal durability of the device and therefore reducing the risks associated with its use. AdditiopaUy, because the closure device relies upon elastically .
deforinable fr~atn~s whack automatically assume their initial shape upon exiting a catheter, it can be deployed to occleade a defect without complex remote manipulati~n by the operator.
,, ~a~F ~~scoN of ~ oRAwlrIGs Figure 1 is a partially broken-away view of a heart having an atria! septa!
defect, Figure 2 is the heart of Figure 1 showing a septa! closure device of the invention W4 93113°~t2 fGTlUS93/ti0489 2~.~~'~~~
- 5 - ._ occluding the atrial septal defect;
Figure 3 is a partially expanded side view of a preferred embodiment of a septal closure device of the invention;
Figure 4 is a front view of the closure device of Figure 3;
Figures 5A-F depict alternative embodiments of a closure device of the invention;
Figure 6 is a front view of a flame for use in the closure device of Figure 3;
Figure 6A is an enlarged isolation view of the encircled portion of Figure 6;
Figure 7 is a front view of the frame of Figure 6 in its unassembled form;
Figure 8 schematically depicts a closure device of the invention collapsed inside a catheter for delivery to a septal defect;
Figure 9 schematically depicts the closure device of Figure 8 with the first disk expanded on one side of the septal defect;
Figure 10 schematically depicts the closure device of Figures 8 and 9 with the second disk expanded on the other side of the septal defect;
Figure ll is a view similar to Figure 9, but depicts an alternative embodiment wherein a coaxial catheter delivery is employed;
.1r Figure 12 is a cross-sectional view of an arternati~e embodiment of a septal closure ., device of the invention; .
Figure I3 is a perspective view of a handle of a delivery system for delivering a device of the invention; , ~t~ Figure 14 is a schematic view of the handle for the delivery system shown in Figure 13; .
Figure IS is a schematic; cross-sectional view of the clistal end of a delivery ..system for delivering a device of the invention; and Figure l;6 is a perspective: view of the distal portion of the delivery system shown in Figuxe l5.
j r~ji RIPTION OF THE PREFERRED EMBOI?IMENTS
Figure 1 represents a heart H having a septum S dividing the two atria A,A. A
defect D is shown as a port extending through the atrial septum. A normal atrial septum serves'to effectively divide the two chambers A,A and separate the blood passing through the heart: As shown in Figure l, though, the septal defect prevents the septum from ,~'~
fulfilling its function in that it permits blood to pass from one chamber to the other as the heart pumps. The presence of a significantly large atrial septal defect causes blood to shunt across the defect from the left atrium to the right atrium and hence on to the right ventricle and pulmonary arteries to the lungs. This increases the blood flow to the lung.
If the defect is not closed, over a period of time this leads to an increase in the pressures in the pulmonary arteries and right side of the heart, and shunting of unoxygenated blood from the right to the left side, leading to death due to cardiac failure, hemoptysis or cerebral stroke due to blood clots passing from the veins thmugh the atrial defect into the cerebral circulation. In patients with significant sized ventricular septal defecu or patent ductus arteriosus, there is shunting of blood from the high pressure left ventricle or aorta, into the right sided chambers and pulmonary arteries which normally have much lower pressures. The torrential increase in flow at a high pressure can lead to cardiac failure and death, apart from the serious long-term complication of high pulmonary pressures causing a reversal of the direction of the shunt.
As shown generally in Figure 2, a septal defect closure device 10 of the invention may be attached to the septum to effectively block the defect. As described in detail below, once the closure device is in place it will become anchored to the septum and prevent the flow of blood through the septum to the adjoining chambers of the heart. This will permit the heart to operate normally.
One preferred embodiment of the invention is shown in Figures 3 and 4. As best seen in Figure 3, the closure device includes two disks 20,30. Each disk generally comprises a membrane 22,32 which may be of any desired shape. In the embodiment shown in Figures 3-8, the membrane is preferably formed of a thin, flexible material, such as a fabric which may be folded and pulled taut without being damaged.
Elastic polymeric materials such as nylon, polyester, polypropylene, polytetrafluoroethylene (Teflon), and expanded polytetrafluoroethylene (GoreTeX), as well as natural fabrics such as silk, have been found to work quite well, with elastic nylon appearing to be the best material for the present purposes. Alternatively, the membrane may be formed of a thin piece of a superelastic material, such as a thin sheet of NiTi alloy or a superelastic polymeric composite.
A frame 24,34 is attached to and desirably extends substantially around the * trade-mark dV0 93113712 ~ ~ ~ ~ ~ ~ ~ PC'f/US93/00489 periphery of the membrane. When the frame is in its natural, non-deformed state, as shown in Figures 3 and 4, it serves to hold the membrane 22,32 taut. In Figure 3, the frames of the two disks 20,30 are shown as being spaced from one another for purposes of the present explanation, but this is not the normal configuration of the disks.
Normally, the frames 24,34 of the device pull their respective membranes 22,32 into a taut, generally planar shape, and the two frames will generally abut against one another.
The membranes 22,32 may be attached to their respective frames 24,34 by any suitable means. For instance, the membrane may be directly attached to the frame by means of an adhesive or the like. Preferably, though, the periphery of the membrane is wrapped about the frame and the peripheral edge (not shown) is attached to the rest of the membrane, essentially defining a sleeve about the frame. The sleeve may fit the frame relatively loosely so that the frame may move within the sleeve with respect to the membrane. The peripheral edge of the membrane may be affixed to the rest of the membrane in any suitable fashion, such as by sewing in the case of a fabric membrane.
If a thermosetting polymeric material, e.g., nylon, is used; the peripheral edge may be fused to the rest of the membrane by means of heat sealing or the Like.
Alternatively, if the membranes are themselves formed of a superelastic material, they will tend to return to their original shape even without a frame, so the frame may be omitted if so desired.
The frame desirably comprises a plurality of elongate legs 26, with each leg being flexibly connected to another leg at each ends Any suitable number of Legs may be employed; and the legs may be shaped as desired. For instance, in Figures 3 and 4, the fraume has five substantially straight legs and is therefore generally pentagonal in shape.
Figures SA-F illustrate a number'~f alternative embodiments of frames of the invention which utilize a variety of different numbers and shapes of legs. The reference numerals used in Figure 5 correspond to those :used in Figures 3 and 4 with respect to the first frame 20; but bear an additional alpha suffix ranging from A to F.
In Figures SA-C; the legs are all generally straight and range in number from three to six. obviously, if the legs are straight, at least three legs must be provided to ~equa~ly extend about the periphery of the membrane. In Figures SD-F, the legs are not straight, but rather are more complex irt shape. Legs 2bD (Figure SD) are generally arcuate in shape, with four legs defining a generally circular frame 24D.
Although one WO 93/13712 PGT/US93/00~189 _g_ such curved Leg could extend about the entire periphery of the membrane 22D to provide a frame 24D consisting of a single leg, for reasons set forth below it is preferred that the frame include at Least two interconnected legs. In Figures SE and F, each leg is bent at an obtuse angle at approximately the middle of its length. When inserting the frame into a catheter as detailed below, these bends in the Legs permit the frame to be collapsed more readily. The angle of the bends in the legs may be adjusted as desired to achieve the desired frame configuration. Although the frames shown in Figure 5 all have legs which are substantially equal in Length, the legs of any given frame may vary in length if so desired.
The legs of a frame may be connected to each other in any useful fashion.
Figures 3 and 4, however, show a preferred way of connecting the legs. As noted above, the legs ~, 26,36 of a frame 20,30 are flexibly connected to another leg at each end. A
resilient lnnn '752 aft ie e~ic~nnep~ ~r~taara~:n a~lianPnt Pft(jC of tWn IP~C alfit~
dnE End Of the lOOt3 is attached to each leg. 'These loops desia~ably lie generally ~n the same plane as the legs and :r may e~ctend generally outwardly of the periphery of the disk (as shown in Figures 3, 4, F), or may extend generally inwardly of the periphery of the disk (as shown SA, and SE
in Figures 58-D). As shown in Figure 5; each of he loops may be of substantially the same size, for instance in the range of about lmm to about 3mm in length.
Alternatively, as shown in Figure SE; the frame may be provided with a plurality of relatively small loops 28E and a plurality of relatively long loops 28E', which may desirably range from about 5 to about: l5 mm in length: These longer loops 28E' are desirably spaced about ,,;, the periphery of the closure device and extend - generally radially outwardly of the periphery of the disk. When' the disk is deployed to block a septal defect or the like, these Ion~er Loops can serve as bracing struts which will effectively engage the tissue E .surrounding the defect being closed without requiring any significant increase in the size of the disks employed or the catheter used to deliver to device.
The loops 28,38 are desirably formed to function as tension springs, biasing the legs to which they are attached outwardly into the position shown in Figures 3 and 4.
;j This will help ensure' that the frame will elastically return substantially to its initial configuration even after it has been collapsed and delivered through a catheter, as set forth below.
w0 93/1371 PGT/1.JS93/00~9 -9- , , .
yn a particularly preferred embodiment, each frame 20,30 is formed integrally of a single elongate strand of wire dV. As best seen in Figures 6-7, each of the legs 26 may simply comprise a length of the wire and the wire may be twisted between adjacent legs to define the loops 28. The ends pf the wire may be attached to each other in any secure fashion, such as by means of a weldment or a suitable biocompatible cementitious mateYial.
In the embodiment shown, however, one leg 26' comprises two overlapping lengths of wire. ~tlhen the wire 'W is formed into the shape of the frame, one more leg-like length than is otherwise necessaay is formed. The two end lengths 26"
of the wire are then laid over and affixed to one another, yielding a frame having tlae desired number of legs. Desirably, both of the end lengths 26" are approximately the same length and end loops 28" are provided at the ends of the wire. As shown in detail in 'i Figure 6A, these end loops 28" may be interlocked with the loop 28 between the opposite end length 26" and its adjacent leg 26. By so interlocking these loops to form an overlapping loop 28' at each end of the overlapped leg 26', the two end lengths 26" of ~e wire may be effectively joined to one another to define the overlapped leg.
If so desired, the end lengths 26" fraa~ be further secured to one another by means of a weldment or a suitable adhesive; as noted above; or a suture (not shown) may be tied y~
about ~eh overlapping loop 28' to hold that loop together: In order to provide further security, gather than siynply using two short, separate sutures to secure the two end loops, ~ s~gle,1~nger suture may be used: The suture may be tied at one end to ~ne loop and ~t its other egad to the other loop, witch an intermediate length of the suture being helically wound about the overlapping leg 26' to ensure that the two end lengths 26" are firmly attached to ~ne another:
~e a 20 should be formed of a flexible, elastically deformable material,: such as a metal. ~ ~ particularly preferred embbdiment, the wire comprising the frame is firmed of a super~lastic W aterial. ~ne such material currently laaown in the art is a near-stoichiometric nickelJtitanium alloy, commonly referred to as Ieiitinol or lotiTi. Such superelastie (also referred t~ as "pseudoelastic°') materials may be elastically deformed to a much grehter extent than most other materials yet substantially fully recover their original shape when released. This permits the frame 20 to be deformed sufficiently for WO 93/13712 ~'CT/US93/00489 . - 10-. ._ . .
insertion into and passage through a small-diameter catheter yet automatically elastically return to its initial shape upon exiting the catheter. In an alternative embodiment, the preferred shape of the frame may be cut out from a sheet of such superelastic material as a single block, by chemical etching, punching with a suitable punch and die, or any other , appropriate forming method.
In order to enhance radiopacity so that the frame can be viewed remotely during deployment, the frame may be provided with a radiopaque coating, such as gold or platinum. For instance, the wire W may be plated with a thin layer of gold or platinum.
In one particularly useful embodiment, a helically wound length of a thin radiopaque wire (not shown) is placed over the wire Wy such corelcoil structures are well known in the art and need not be discussed at length here. In order to ensure that the frame can be collapsed into the smallest possible configuration for delivery through small catheters, the diameter of the wire comprising the frame should be kept small. For instance, the wire W may be about 9 mils; (O.OQ9") in diameter and the radiopaque outer wire may about 1-3 mils (0:001-0.003") thick, for a total outer diameter of about 11-15 mils (0.011-0.0I5"). Although the outer wise may extend along the entare length of the frame, it is preferred that it be-provided only along the legs 26, living the loops 28 as short ~a~
lengths of the bare wire W.
Alternativel , radio ue markin bands (not shown), which are commercially 'y p~
available, may be employed. By placing one such band on each leg 26 of the frame, the surgeon can remotely visualize the frame as a plurality of small bands; when the bands are appropriately spaced from one' another on a monitor; he surgeon will know that the ", frame is properly deployed.
;.
a ~ Referring back to Figures 3 and 4, a septal defect closure device of the invention includes a central conjoint disk 40A central portion of~each membrane 22,32 is attached to a corresponding central portion of the membrane of the other disk. The central conjoint disk 40 may be of any desired shape; but the generally circular shape shown in Figures 3-5 is' prefera~ed:
The membranes 22,32 may be affixed to one another by any desired means, such ;as a biocompatibae adhesive. The adhesion between the two central membrane portions should be strong enough to ensure that the two disks will not become separated from one WO 93/13712 PGT/U~93/00489 - ll - 21~~c~~~
another during handling and deployment of the closure device. in one preferred embodiment, the membranes are sewn to one another, with the stitching defining the shape and size of the conjoint disk 40. If the membranes are farmed of an appropriate polymeric material their central portions may instead be fused to one another ~by means of heat sealing or the like. As another alternative embodiment, the membranes 22,32 may be formed of a thin, highly fleycible material such as a nylon. and the conjoint disk may include another piece of material (not shown), such as polyurethane, nylon, a superelastic material such as nitinol; or the like. This additional material is desirably disposed between the two membranes and sewn or otherwise bonded to the membranes in defining the conjoint disk. The additional material may be of any size, but is desirably apgrooimately the same size as the conjoint disk, or slightly larger.
If so desired, the central conjoint disk may include an internal frame 50 as shown in Figure SB. This internal frame is desirably constructed in substantially the same manner as the frames 20;30 described above: However; the internal frame 50 is desirably smaller in size than the frames 20,30 and is sized to be attached directly to the peripheral edge of the conjoint disk 40. The internal frame 50 is desirably bonded to and generally positioned within the conjoint disk such that when the devace is deployed, this small, internal' frame will assist in the immediate; taut deployment of the conjoint disk within the defect.
In order to facilitate relatively quick closure, the conjoint disk is desirably sized to substantially fill the defect being occluded, but- should not be substantially larger than the defect. Although the size of septal defects tend to vary, most atrial septal defects are smaller than 25mm in diameter. Accordingly, it is contemplated that a variety of closure devices having central conjoint disks ranging in sine from about 5 to about 30mm will be provided. A surgeon may treasure the size of the defect by known means, e.g., using a balloon catheter filled with a contrast medium, and select a closure device having a 'conjoint disk' of the appropriate size:
For reasons set forth more fully below, it is also desirable that the disks 20,30 be at least l.6 times the size of the defect; and preferably range from about 1.6 to about 2.5 times the size of the defect. The difference between the stretched diameter of the septal ' defect, as determined by measurement with a.balloon catheter or by other known means, WO~ 93/13712 PCT/US9310~489 ._ .. ~ - 12 -and the size of the frame is optimally approximately l5mm. Since the central conjoint disk 40 is chosen to approximate the size of the deft, the maximum dimension of the frame may be at least 1.6-2.5 rimes the size of the conjoint disk. As an example, to patch a lOmm defect, a closure device having a central conjoint disk about lOmm in diameter .
and a frame of about 25mm in maximum dimension rnay be selected.
tern alternative embodiment of the present invention is shown in cross-section in Figure 12, wherein like numbers have bin used, but differ from the numbers in Figures 3-10 by 100. As shown in Figure 12, the first disk 120 comprises a membrane supported by a frame 124. However, unlike the embodiment described above, the membrane I22 of the present invention is not a single layer of fabric, but is rather a flexible, collapsible balloon-type member which can be inflated to define an internal cavity I21. Similarly, the second disk 130 is supported by a frame 134 and the membrane 132 may be inflate to define an internal cavity I31. The membranes 122,132 may be formed of any suitable material, such as a thin, flexible latex or the like.
Inflatable, detachable balloon-type structures are known in the art and may be delivered by known transcatheter techniques. The membranes 122,132 ir~ay be attached to the frames 124,134 by any suitable pneans, such as by a weldrnent 127 internally formed with the membranes which substantially encases the frame 124; as shown.
7Che conjoint disk 40 of the embodiment described above simply comprises central porn~ns of e,~ch of the membranes 122;132 which are b~nded td one another, as described above. In the embodiment shown in Figure 12, though; the conjoint disk 140 is somewhat more complex in structure. 'fhe merxtbrane 122 of the first disk 120 includes an inflation port 123 which is operatively connoted go a check valve 125. In the preferred embodiment shown, the check valve 125 ~ is disposed on the second disk 130 at a location disposed away from the first disk' 120.
This check ~ralve 125 is desirably disposed immediately adjacent a similar check valve 135 associated with the sec~nd disk 130. 'These check valves may in turn be connected to a detachable, dual lumen itaflation catheter (not shown) as is known in the art for such teehniques as balloon etnbolization and the like. 7Chis catheter permits an operator to selectively deliver a fluid through a check valve to inflate the associated disk. °The inflation catheter should be detachable from the check valves after the device is deployed.
''W~ 93/13712 PCT/U~93/1304$9 In the embodiment shown wherein the check valve is disposed away from the first disk 120, the inflation port 123 desirably extends through the conjoint disk 140 and may be centrally located therein. The rest of the conjoint disk may be defined by a short, generally tubular segment 133 of the second disk and the inflation port 123 of the farst disk may extend through this tubular section. The diameter of the conjoint disk is desirably sued to substantially fill the defect being blocked, as described above in connection with the previous embodiment.
Figure 12 depicts the present embodiment once it has ali°eady been inflated. In deploying the closure device 110, though; the membranes 122,132 preferably are not inflated, but are desirably substantially empty so that they will remain flexible. Thus, the structure of this deflated closure device substantially corresponds to the overall structure of the previous embodiment and may be delivered to the defect and deployed in a similar manner: However, once the first disk 120 is opened on the distal side of the defect by the action of the frame, it nnay then be inflated. 'this may be accomplished by delivering a suitable fluid through the check valve 125 and inflation port 123 to inflate the membrane 122. The fluid owill then expand the membrane to defied and fill the cavity 121.
Although any suitable fluid may be used; it is preferred that a biologically compatible, 'self-curing cementitious material; such as an epoxy or a cyanoacrylate, be used. In this ;' manner; the cavity 121 may be filled aNith this material and permitted to substantially harden, creating a stable, gene~ly rigid structural member from the membrane 122.
A~ in the previous embodiment; the closure device may then be retracted until the first disk 120 engages the septum and the second disk 130 may then be deployed. The frame 134 will then tend t~ cause the membrane 132 to engage the septum as in the ': previ~us emb~diment. Although this would serge to effectively close the defect, the s~;ond membrane may also be inflated in a like manner to fill the cavity 131 with a suitable fluid, such as that described above. This wfll serve to provaoe relauveiy ng~a structural supp~rt, as with the fiat disk 120; but it will also serve to inflate the tubular segment 133 of the conjoint disk 140; more effectively closing the defect by expanding the disk 140.
Figure 10 depicts a closure device 10 of the invention deployed to occlude a defect in a septum S. The first disk 20 of the device is positioned on one side of the defect w0 93/13712 PGT/US93/004~9 ' 14' while the second disk 30 is generally disposed on the other side. The frames 24,34 of the disks are elastically biased taward the position shown in Figure 4, pulling their respective membranes 22,32 taut. The central conjoint disk 40 is positioned within and substantially closes off the defect. As explained above, the taut membranes are generally planar and the frames 24,34 generally abut against one another when the device is unconstrained.
Because the frames are elastically biased toward their constrained configuration, they are biased generally toward one another and engage opposing sides of the septum about the defect, Since there are no compressive forces acting on the frames which might cause them to collapse, this serves to effectively hold the device in place with the conjoint disk 40 positioned within the defect, as shown.
The membranes are formed of a relatively porous material. At farst glance this may seem to contradict the purpose of the device, i.e., to block the flow of blood across the device, and hence ~e ~p~m. However; blood will tend to coagulate in the conjoint disk after it has been in place for some time; blood flow across the conjoint disk is usually substantially blocked after about 1Or20 minutes. If so desired, the conjoint disk (or the entire device) ~y ~ ~ ~~ a thrombogenic agent to speed this natural process or may be impregnated with a biocompatible polymeric compound or ttae like to make it relatively impervious to fluids:
The primary purpose of using a porous material for the membranes is to accelerate the process of permanently, anchoring the device in place. The frames 24,34 hold the membranes taiutly and in intimate contact with he outer surface of the septum S, as shown in Figure 10. This intimate contact between tht septum and the porous membranes permits ingrowth of collagen and fibrous tissue frem the septum into the membranes.
C?ver time, the membrane resting against the septum will become securely anchored to the ~p~ wall and be covered by a layer of endothelial cells.
The design of this device is in stark contrast to the septal defect closure devices known in the art. As explained in some detail above, all of the prior art devices employ a mechanical umbrella of one design or another. The radially extending arms of the umbrella contact the septum and sere to space all but the peripheral edge of the umbrella away from the septum. Endothelial cells, collagen and fibrous tissue are therefore permitted to grow into only the very periphery of the umbrella. Thus, while a closure 1~VV~ 93/13712 PCTlLl~93/004~9 device of the invention essentially becomes an integral part of the septum, the complex mechanical structure of prior art devices does not yield as complete integration as the present invention. . . .
The mechanical complexity of prior art devices also tends to markedly affect their durability. In the case of atrial or ventricular septal defects, for example, the heart obviously continues to beat after the device is in place. Since beating of the heart is accomplished by flexure of the heart muscles, the septum will flex to some degree with every beat of the heart. The radial arms must therefore flex with the sepxum each and every time the heart beats. The number of cycles of this stress-inducing movement produces repeated stresses on the arms, which can eventually lead to mechanical failure and fracture of the arms.
When a closure device of the invention is deployed, the centrifugal tension of the outer frame opens the disk to occlude-the defect. Since there are no radial arms to prop open the dedrice; the occurrence of repeated flexion does not occur due to the beating of the heart or pressure differences betw~n the cardiac chamber during the phase of contractiop of the heart: To the contrary, 'any pressure difference would drive the frame and disk against the septum; more fimtly occluding the defect, in much the same manner as a bathtub stopper. In addition; the superelastic anaterial of the frame tolerates flexural stresses much better than the algid steel arms of the prior art devices. The present device therefore will continue to flex .wvith the septum without any significant effect on its structural integrit~ra ..:'s, As stated above; the present indention also contemplates a method of delivering and deploying the closure device 10 described above. According to this method, the device is delivered to the site of the septum by a transratheter procedure, eliminating the rw,~
need for open' heart surgery and hll of its' attendant risks.
The device is inserted into the distal end of a catheter ~ by collapsing the frames '3 ~ og ghe disks. The frame 24 of the first disk 20 is collapsed and inserted into the end of r ~o catheter first. M"his array be accomplished in any suitable manner, such as by manually :a folding the frame and placing it into the s;atheter: In a preferred embodiment, however, the lops 2g are used as eyelets to assist in collapsing the frame. A thread, such as a ~ length of a suture thread, is passed through all of the loops of the frame and is drawn ::~_, .<
WO 93/137t2 PCT/US93/00489 - 16 - ._ tight. Similar to a conventional purse string. This will cause the ends of the legs 26 to generally converge upon a single point spaced axially outwardly of the central conjoint disk 40. These converging ends may be inserted into the distal end of the catheter, and the thread passing through the loops may be removed by simply pulling on one of its ends. The rest of the first disk 20 can then be urged into the catheter and the walls of the catheter will further collapse the frame 24 upon itself, folding each of the legs. As noted above in connection with Figures SE and F, if the legs are already bent, .this insertion will tend to be easier, The second disk 30 may be folded in the same manner if so desired. This can also be accomplished by simply continuing to urge the device into the catheter, though. The walls of the catheter will act against the legs 36, generally folding them such that their ends will generally converge on a point spaced axially outwardly of the central conjoint disk 40, much Like the first frame 24. Obviously, the ends of the legs 26 of the first disk will converge on a point spaced distally of the conjoint disk while the ends of the legs 36 of the second conjoint disk will converge on a point spaced proximally of the conjoint disk. The device will therefore be configured within the catheter generally as schematically shown in Figure 8; though the ends of the legs will tend to be closer to one another than is depicted' in that drawing:
~~er before orpreferably, after insertion of the closure device into the catheter C; the distal tip of the catheter is positioned adjacent the septal defect D
to be occluded.
A distal portion of the catheter should extend hrough the defect to position the distal tip of the catheter on the distal side of the defect, as shown in Figure 8. The closure device is urged through substantially the entire length of the catheter such that it is positioned n~ ~e distal tip of the catheter; also as shown in Figure 8. Once again this may be done either before or after positioning of 'the catheter, 'but it is desirably done before' so ~t ~e distal tip of the catheter will not be inadvertently moved out of position as the device is advanced.
Once the catheter is properly positioned, the first disk 20 of the device is urged out of the distal end ~f the catheter. With the constraint of the catheter walls removed, the frame 24 will elastically substantially return to its initial, non-deformed shape (Fig.
4) and pull the membrane 22 taut. The catheter C may then be retracted, retaining ttae vV0 93/1371 P(.'I'/LJS93/00489 1~ ~1~s3~~
second disk 30 within the catheter, until the first disk engages the distal side of the septum S as depicted in Figure 9. Since the disk is significantly larger than the defect, f . e., preferably at least 1.6 times the size of the defect, the fraane will engage the septum and may not readily be drawn through the defect.
The second disk 30 may' then be urged out of the distal end of the catheter on the proximal side of the defect. This may be accomplished by any number of means, such as by urging the disk with a plunger, as explained below. In another embodiment the catheter is simply retracted proximally. The first disk 20 will engage the distal side of the defect and, because the membranes 22,32 of the two disks are attached to one another to define the central conjoint disk, the second disk will be drawn out of the catheter as it ,:.:a is retracted. This will. also ensure that the second disk is deployed on the side of the septum opposite the first disk because the second disk will not be pulled out of the catheter until after the first disk firmly engages the opposite side of the septum.
The resilient frame 34 of the second disk will elastically substantially return to its initial; non-deformed shape and pull the. membrane 32 taut upon exiting the catheter. In so doing, the second disk will be urged against the proximal wall of the septum, as shown in Figure l0. This will'also automatically position the central conjoint disk 40 within the wdefect as the conjoint disk serves to connect the farst disk 20, which is disposed on one ~, side of the septum, to the second disk 30; which is disposed on the other side of the ,r',3 septum. , ' In an alternative; preferred embodiment of the invention, shown in Figure 11, a ,, ~~ second delivery catheter G' is used. In this embodiment, the initial step in closing a septal defect is to position an outer guiding catheter adjacent the defect.
Preferably, the guiding ' ~ catheter is passed through the defect so that its distal tip is disposed on the distal side of .z the'scptu~m, and is desirably' spaced sonne 'distance distally of the septum and towaid the a ' mid portion of the cardiac chamber.
A closure device of the.invention may be positioned within the delivery catheter ~C' ad,~acent its distal end, substantially as shown in Figure 8 with respect to the catheter _,C. The delivery catheter C' may then be passed coaxially through the guiding catheter C until it protrudes distally beyond the distal end of the guiding catheter.
The first disk °~ 20 of the closure device may then be urged out of the distal end of the catheter, s.:..
W~ 93/1372 PCT/U~93/UtD4~9 - is -substantially as described above with respect to the embodiment shown in Figures 8-10.
The deployment of the second disk 30 of the closure device is substantially similar to the method outlined above. For instance, the guiding catheter and the delivery catheter may be retracted proximally together as a unit, with the two coaxial catheters acting ., substantially the same as the single catheter described above.
Alternatively, one may retract the guiding catheter at any time after the delivery catheter C' is positioned on the distal side of the septal defect. For instance, once the first disk 20 is deployed, the guiding catheter C may be retracted to a position spaced proximally well away from the septal defect. The delivery catheter C' may then be individually retracted through the guiding catheter to deploy the second disk 30 rather than moving the guiding catheter and delivery catheter together as a unit.
Because the closure device of the invention is mechanically much simpler than prior art designs, the method of deploying it to occlude a defect is also much simpler.
dVhereas prior art devices require a great deal of remote manipulation in order to deploy and attach an umbrella to the septum; deployment of the present device IO is quite easy.
Because the resilient frames 24,34 automatically expand to the desired configuration and position the conjoint disk 40 within a defect, there is no need for a series of cables or the like tc~ remotely deploy a comphx arrangement of separate elements, such as a number r;
of different radial arms.
Furthermore, the present iawention can be used to treat patients untreatable with :.01...
prior art devices. The cumbersome anechanical devices taught by others cannot be delivered throu,~h a small catheter because they are too large and bulky to fit through such catheters prior art systems have generally been limited to use with I1 French (about 3.7mm) or larger catheters. Also; since they are composed of relatively rigid parts, such as radial umbrella arms, they cannot follow very tortuous paths. Because of its compact, .
collapsible design, a closure device 10 of the invention may readily be used with 6 to 8 French (2.Omm) catheters. The flexibility of the frames 24,34 also permits the device to follow a catheter through fairly t~rtuous paths. The reduction in the size of the delivery system allows a closure device of invention to be utilized to treat small children, e.g., ,under $ kilograms, which were simply untreatable with most prior art devices.
~O 93/1712 PGT/US93/00489 Figures 13-16 depict a preferred embodiment of a delivery system for delivering a closure device of the invention. The system generally includes a handle 210 for remotely manipulating the delivery system and a distal section 208 for urging the closure device into its desired position.
Referring first to Figures 13 and 14, the handle 210 includes a manually graspable housing 212. Although the housing may be of any desired size and shape, it is desirably generally rectangular in cross section and sized to be readily grasped with one hand by the surgeon during operation. The housing 212 is preferably elongate so that it may substantially enclose the control mechanism 230 crf the delivery system. The housing may include a first chamber 214 and a second chamber 216, with the first chamber being oriented generally perpendicularly to the second chamber. The first chamber 214 is adapted to receive a rotor 232 of the control mechanism and includes laterally extending walls 215 which are adapted to serve as stops for the rotor. As explained in more detail below, as the rotor is turned, it will urge a central member 270 to slide within the second chamber 216. The walls 215 of the first chamber serve as stops to prevent movement of the rotor with the cxntral member along the length of the handle.
The first chamber 214 may also be associated with a detent or detents 218 foraned on the outer surface of the handle: ('These detents are best seen in Figure 13.) Each decent may be substantially as wide as the first chamber 214 and extend inwardly of the exterior of the housing 212. The rotor 232 is sized so that its outer surface 234 protrudes outwardly of the housing 2I2 through these detents 2I8. In this manner, an operator may manually grasp and rotate the rotor by accessing the outer surface 234 of the rotor through the detents 218.
By having the detents recessed below the outer surface of the housing 212, the outer surface of the rotor 234 may be readily accessible through, the detents, yet not .
extend appreciably beyond the exterior of the rest of the handle. This permits the operator to readily manipulate the rotor, yet minimizes the risk that the rotor will be inadvertently turned through unintended contact. - Although one detent on a single face of the housing may suffice, it is preferred that two detents be used, with one detent being positioned on each of two opposing faces of the housing; as shown in Figure 13. If so desired, the outer surface 234 of the rotor may be textured, as shown, in order to make 2~.2~33$ . -~o-the rotor easier to grasp when the operator is wearing surgical gloves or the like.
The second chamber 216 is elongate and desirably extends generally along the center of the handle. The second chamber 216 may extend along substantially the entire length of the handle (as shown), but need not do so. The second chamber 216 must extend thraugh the distal end 211 of the housing to define a distal port 219 therein, though, to permit communication of the control means 230 with the catheter C.
The second chamber may be defined by a pair of generally parallel, spaced apart walls 21?
which define a chamber sufficiently wide enough for the central member 240 of the control mechanism 230 to slide axially therein without undue friction.
~Iowever, it is preferred that the walls 21? be spaced only slightly away from the central member 240 to limit lateral movement of the central member within the housing. ' ~,_ 'The housing 212 of the handle may also include a recess 220 for receiving a release lever 260. The recess is desirably sized so that it may substantially entirely enclose the release level' when the control mechanism, is in its fully retracted position, i:e.; before either of the disks of the device have been deployed, as explained in more detail t~elow: ~''he recess also includes a notch 222 which extends through a sidewall 217 of the first chamber. This notch is provided so that an end 264 of the release lever may ,a pass therethrough for operative conn~tion to the connecting rod 242: The notch should be sized to permit the release lever to be moved about pivot pin 262 in order to deploy the closure device of the invention. By providing a recess v~rhich substantially encloses the aelease lever 260 before the closure device has been deployed, the chance of inadvertent release of the closure device before it as in its desired position is minimized.
ps noted above, the rotor 232 and the central member 240 of the control ;mechanisnn hre operatively connected'to one another through a threaded engagement. The p' central member 240 is desirably generally cylindrical in~ shape and is externally threaded with screw-type threads extending ahng a significant portion of its length; if so desired, ,' the screw threads may extend along substantially the entire length of the cehtral member.
The rotor 232 is provided with internal threads (not shown) which mate with the external threads on the central member: Thus, by rotating the rotor within the first chamber 214, -a one can induce axial movement of the central member within the second chamber 216.
Furthermore; if the pitch of the threads on the rotor and the central member are known, the precise distance which the central member moves for a given angle of rotation of the rotor can be readily determined. This permits precise control of movement of the central member without any unnecessarily complex mechanical structure.
The generally cylindrical central member includes a bore (not shown) which extends along iu entire length. This bore is located generally along the axis of the cylindrical central member and is sized to receive a core wire 250 which passes through the central member. The core wire may advantageously comprise a standard guide wire, ~ as are lrnown. In a preferred embodiment, the core wire is formed of a superelastic material, such as NiTi alloy. The bore should be large enough to permit the central member to turn freely with respect to the core wire and to allow the core wire to slide axially within the central member.
The proximal end of the core wire 250 is operatively connected to an end 264 of the release lever 260. One preferred embodiment of such a connection, shown in Figure 14, utilizes a connecting rod 242 which may be attached at its distal end to the proximal end of the core wire and at its proximal end to the end 264 of the release lever. Thus, by pivoting the release lever 260 about its pivot pin 262, one may draw the core wire axially within the bare in central member 240 in a proximal direction.
For reasons made more clear below, the release lever 260 is desirably biased in a clockwise direction in Figure 14, i.e., such that the core wire 250 is generally urged in a distal direction. In the embodiment shown in Figure 14, the relzase lever is so biased by means of a biasing spring 244. The biasing spring is a tension spring connected at a first end to the connecting rod 242 and at its opposite end to the central member 240.
This urges the connecting rod in a distal direction, i.e., to the right in Figure 14, to thereby bias the release lever in a clockwise direction.
If so desired, a cap 246 may be provided at the distal end of the central member 240. The cap includes a bore therethrough which is axially aligned with the axis of the central member to permit the connecting rod 242 to slide with respect to the cap in response to movement of the release lever 260. The cap 246 may extend distally along the sides of a proximal portion of the central member 240, as shown. The cap 246 is desirably formed of a machinable or moldable plastic; Delrin*, which is available from DuPont, has been found to work well.
* trade-mark WO 93/13?12 PCT/US93/00489 ._ A generally tubular urging member 270 may be attached to the distal end 248 of .->i the central member. The urging member 270 should be attached to the central member so that it may move axially as the central member is moved by rotation of the rotor 232.
The axis of the urging member desirably generally coincides with the axis of the central member so that the core wire 250 may extend into and slide within the urging member, for reasons explained below.
The urging member and the core wire are received within a catheter C (see Figure 13). The proximal end of the catheter is desirably attached to the distal end 211 of the housing. Although the catheter may be directly attached to the distal end of the housing, in the embodiment shown in Figures 13 and 14 an integrally formed side arm connector, as is commercially readily available, is used. This connector 252 is attached to the housing and is desirably in sealing engagement with the distal port 219 of the housing, such as by means of mating threads, as shown. 1fie connector generally includes a first tubular member 258 which is generally axially aligned with the rest of the control mechanism, including the central: mennber 240; and a second tube 256 which extends radially outwardly at an angle from the first babe 258. The second tube 256 may be used to introduce fluids into he catheter during deployment of the closure de~rice;
these fluids ,, may include, for instance, isotonic saline (0.990) to flush the lumen of the catheter prior '' ~ to introduction to remove all air babbles. The connector 252 may include any useful r means fog connecting the catheter C such that a generally fluid-tight seal is achieved. For instance, a luer lock 254,. such as that shown, may be used. It is preferred that the catheter be joined to the handle in a manner which permits the catheter to be rotated or ~~~ y~rith respect to the handle.
Figures 15 and i6 show a distal portion of a preferred embodiment of a delivery .a .' device of the invention. ~.'he core wire 250 extends within the urging member 270 to a , ;
-, position adjacent the distal end of the urging member. Although the core wire 250 may remain substantially along the axis of the urging member, as best seen in Figure 15 it is ' generally preferred that the core wire be displaced slightly from that axis A.
The majority of the length of the urging member 270 comprises a flexible tube z~ 272, which may be substantially similar to catheters such as are commonly known. The flexible tube should be sized to'permit the core wire 250 to move freely therewithin, yet WO 93/13712 ~CT/US93/00489 2~~~~3~
permit the urging member to be guided through the catheter C along its length for deployment of the closure device 10, The final distal segment of the urging member comprises a short tube 2'74 which is formed of a stiffer material, such as a metal such as surgical stainless steel or the like. This metal tube 274 may be attached td ttie flexible tube 272 by any known means. For instance, a length of the tube 274 may be received within the distal end of the flexible tube 272 and may be held in place by means of a biologically compatible cementitious material or even a mere friction fit.
As best seen in Figure 15, the distal end 278 of the metal tube is adapted to contact ''' a closure device 10 of the invention, such as at the conjoint disk 40, as shown. Thus, by i moving the urging member 270 distally, i.e., to the left in Figure 15, one may urge the closure device toward the distal end of the catheter. The metal tube 274 should therefore be relatively small in its outer diameter so that the second disk 30 of the closure device ,' may be wrapped about the tube for deployment. This metal tube 274 may, for instance, have a lehgth of about 10-20 mm and an outer diameter on the order of about 2 mm or less. The fleuble tube 2?2 is desirably larger in outer diameter than the metal tube 2?4.
This presents a forward shoulder 2?3 on the fleuble tube which may engage the disk 30 to further urge it along the catheter:
If so desired, a relatively small, thin band 280 may be placed about the metal tube 274. This band 280 is desirably sized to space the metal tube from the wall of the catheter C as the metal tube is moved within the lumen of the catheter. This band may be formed of any suitable material and may simply be placed about an attached to the metal tube. In a prefera~ed embodiment, though; the band 280 is integrally formed with the metal tube, simply comprising a generally annular projection extending outwardly of ~,e generally cylindrical: metal tube:
,,, This preferred embodiment of a. delivery system may be ,used substantially. as ,~an,.:.;~"~ '~tl'1VP rn r~pntnv a closure device I0 of the invention. The urging member 270 is used tcp urge the closure device along the lumen of the catheter until it is positioned adjacent the distal end of the catheter; as explained in more detail above, the distal end of the catheter may be positioned on the distal side of the defect prior to deployment of the first disk 20. Once the catheter is ro rl ositioned, the first disk may be urged P Pe Y P
distally out of the catheter within the present device by turning the rotor 232 with respect WO 93/13712 PCT/US93l0~~89 '~,~"~~c~3e~~
to the housing 2I2 of the handle. As noted above, since the pitch of the threads on the central member 240 and the rotor 232 are known, by turning the rotor through a predetermined angle or number of revolutions, the central member may be urged distally by a fixed distance. 'this in turn forces the urging member 270 to move distally; urging ' the closure device 10 out of the distal end of the catheter. The control mechanism 230 of the delivery system therefore permits one to urge the first disk 20 out of the catheter without risking deploying the second disk 30 of the closure device on the distal side of the septum S by urging the closure device too far along the catheter. The second disk may be deployed on the distal side of the septal defect substantially as described above.
One additional aspect of the present delivery system is that it permits the closure device 10 to be securely held until it is properly deployed to prevent accidental release.
In a preferred embodiment, a tether (290 in Figure 16) is attached to the closure device.
This tether desirably defines a loop, as shown, and may be attached to any part of the closure device, although attaching the tother to the conjoint disk 40 is generally preferred.
The metal tube 274 is provided with an opening 276 in its side which permits access to the core wire 250. During deployment, the core wire 250 passes through a segment of the loop defined by the tether 29Q to hold it in place. The core wire desirably extends distally beyond the opening 276 to prevent the tether from being inadvertently slipped over the end of the core wires thereby releasing the closure device.
When the closure device has been properly deployed with one disk on either side of the defect, the tether may b~e released from the delivery system. Manually pressing on the flange 266 of the release lever 260 will cause the release lever to pivot in a generally i counterclockwise dir~tion in Figure 14~ This in turn draws the core wire 250 generally ,e axially in a proximal direction; as eacplained above. The distance which the full rotation ,, of the release lever about its pivot pin , imparts to the core wire should be sufficient to draw the core wire proximally behind the distal edge of the opening 276 in the metal tube, y:
and desirably is sufficient to draw the core wire substantially behind the opening so that a rearward portion of the opening may draw the tether off of the core wire.
This permits the tether 290 to slip off the core wire 250, completing deployment of the closure device.
It should be noted that when the central member is in its initial position before either disk has been deployed, the release lever 260 desirably is received substantially .°zr:- , ,... ,:;, :. :.;::- .. , ,,....: .:.. ... .,:",:., ::..:. , :,..:.,. .,.",.
WO 93/13712 PC~'/LJS93/OfD48l entirely within the recess 220 in the handle. Only when the central member is moved distally to deploy the closure device will the release lever be moved so that it may project outwardly of the handle. This will prevent the inadvertent depression of the release lever before the closure device has been deployed.
In an alternative embodiment (not shown), a slightly different means of releasing the tether 290 is used. Rather than using a core wire which is simply passed through the loop defined by the tether; the tether may actually be severed.
The metal tube 274 may have a small hole drilled diametrically therethrough.
The tether may be passed through this hole and be tied into a knot at its end. The core wire Z5U in ,;this variant (not shown) is disposed proximally of the tether, and has a sharpened edge at its distal end. When the device is to be released, the core wire is urged distally by the ' release mechanism (instead of being drawn proximally as in the previous embodiment).
The sharpened distal edge of the core wire then cuts the tether m a manner axin m a guillotine, releasing the device.
Although the foregoing has focused on application of the present invention to occlude atrial septal defects, the ia~vention is not limited to occluding such defects. For instance, the instant closure device can be used to treat ventricular septal defeats, patent ductus arteriosus or any other congenital or acquired orificial or tubular communications between vascular chambers or vessels.
While a preferred embodiment of the present invention has been described, it should be understood that (various changes, adaptations and modifications may be made therein without departing from the spirit of the invention and the scope of the appended claims:
y::$
second disk 30 within the catheter, until the first disk engages the distal side of the septum S as depicted in Figure 9. Since the disk is significantly larger than the defect, f . e., preferably at least 1.6 times the size of the defect, the fraane will engage the septum and may not readily be drawn through the defect.
The second disk 30 may' then be urged out of the distal end of the catheter on the proximal side of the defect. This may be accomplished by any number of means, such as by urging the disk with a plunger, as explained below. In another embodiment the catheter is simply retracted proximally. The first disk 20 will engage the distal side of the defect and, because the membranes 22,32 of the two disks are attached to one another to define the central conjoint disk, the second disk will be drawn out of the catheter as it ,:.:a is retracted. This will. also ensure that the second disk is deployed on the side of the septum opposite the first disk because the second disk will not be pulled out of the catheter until after the first disk firmly engages the opposite side of the septum.
The resilient frame 34 of the second disk will elastically substantially return to its initial; non-deformed shape and pull the. membrane 32 taut upon exiting the catheter. In so doing, the second disk will be urged against the proximal wall of the septum, as shown in Figure l0. This will'also automatically position the central conjoint disk 40 within the wdefect as the conjoint disk serves to connect the farst disk 20, which is disposed on one ~, side of the septum, to the second disk 30; which is disposed on the other side of the ,r',3 septum. , ' In an alternative; preferred embodiment of the invention, shown in Figure 11, a ,, ~~ second delivery catheter G' is used. In this embodiment, the initial step in closing a septal defect is to position an outer guiding catheter adjacent the defect.
Preferably, the guiding ' ~ catheter is passed through the defect so that its distal tip is disposed on the distal side of .z the'scptu~m, and is desirably' spaced sonne 'distance distally of the septum and towaid the a ' mid portion of the cardiac chamber.
A closure device of the.invention may be positioned within the delivery catheter ~C' ad,~acent its distal end, substantially as shown in Figure 8 with respect to the catheter _,C. The delivery catheter C' may then be passed coaxially through the guiding catheter C until it protrudes distally beyond the distal end of the guiding catheter.
The first disk °~ 20 of the closure device may then be urged out of the distal end of the catheter, s.:..
W~ 93/1372 PCT/U~93/UtD4~9 - is -substantially as described above with respect to the embodiment shown in Figures 8-10.
The deployment of the second disk 30 of the closure device is substantially similar to the method outlined above. For instance, the guiding catheter and the delivery catheter may be retracted proximally together as a unit, with the two coaxial catheters acting ., substantially the same as the single catheter described above.
Alternatively, one may retract the guiding catheter at any time after the delivery catheter C' is positioned on the distal side of the septal defect. For instance, once the first disk 20 is deployed, the guiding catheter C may be retracted to a position spaced proximally well away from the septal defect. The delivery catheter C' may then be individually retracted through the guiding catheter to deploy the second disk 30 rather than moving the guiding catheter and delivery catheter together as a unit.
Because the closure device of the invention is mechanically much simpler than prior art designs, the method of deploying it to occlude a defect is also much simpler.
dVhereas prior art devices require a great deal of remote manipulation in order to deploy and attach an umbrella to the septum; deployment of the present device IO is quite easy.
Because the resilient frames 24,34 automatically expand to the desired configuration and position the conjoint disk 40 within a defect, there is no need for a series of cables or the like tc~ remotely deploy a comphx arrangement of separate elements, such as a number r;
of different radial arms.
Furthermore, the present iawention can be used to treat patients untreatable with :.01...
prior art devices. The cumbersome anechanical devices taught by others cannot be delivered throu,~h a small catheter because they are too large and bulky to fit through such catheters prior art systems have generally been limited to use with I1 French (about 3.7mm) or larger catheters. Also; since they are composed of relatively rigid parts, such as radial umbrella arms, they cannot follow very tortuous paths. Because of its compact, .
collapsible design, a closure device 10 of the invention may readily be used with 6 to 8 French (2.Omm) catheters. The flexibility of the frames 24,34 also permits the device to follow a catheter through fairly t~rtuous paths. The reduction in the size of the delivery system allows a closure device of invention to be utilized to treat small children, e.g., ,under $ kilograms, which were simply untreatable with most prior art devices.
~O 93/1712 PGT/US93/00489 Figures 13-16 depict a preferred embodiment of a delivery system for delivering a closure device of the invention. The system generally includes a handle 210 for remotely manipulating the delivery system and a distal section 208 for urging the closure device into its desired position.
Referring first to Figures 13 and 14, the handle 210 includes a manually graspable housing 212. Although the housing may be of any desired size and shape, it is desirably generally rectangular in cross section and sized to be readily grasped with one hand by the surgeon during operation. The housing 212 is preferably elongate so that it may substantially enclose the control mechanism 230 crf the delivery system. The housing may include a first chamber 214 and a second chamber 216, with the first chamber being oriented generally perpendicularly to the second chamber. The first chamber 214 is adapted to receive a rotor 232 of the control mechanism and includes laterally extending walls 215 which are adapted to serve as stops for the rotor. As explained in more detail below, as the rotor is turned, it will urge a central member 270 to slide within the second chamber 216. The walls 215 of the first chamber serve as stops to prevent movement of the rotor with the cxntral member along the length of the handle.
The first chamber 214 may also be associated with a detent or detents 218 foraned on the outer surface of the handle: ('These detents are best seen in Figure 13.) Each decent may be substantially as wide as the first chamber 214 and extend inwardly of the exterior of the housing 212. The rotor 232 is sized so that its outer surface 234 protrudes outwardly of the housing 2I2 through these detents 2I8. In this manner, an operator may manually grasp and rotate the rotor by accessing the outer surface 234 of the rotor through the detents 218.
By having the detents recessed below the outer surface of the housing 212, the outer surface of the rotor 234 may be readily accessible through, the detents, yet not .
extend appreciably beyond the exterior of the rest of the handle. This permits the operator to readily manipulate the rotor, yet minimizes the risk that the rotor will be inadvertently turned through unintended contact. - Although one detent on a single face of the housing may suffice, it is preferred that two detents be used, with one detent being positioned on each of two opposing faces of the housing; as shown in Figure 13. If so desired, the outer surface 234 of the rotor may be textured, as shown, in order to make 2~.2~33$ . -~o-the rotor easier to grasp when the operator is wearing surgical gloves or the like.
The second chamber 216 is elongate and desirably extends generally along the center of the handle. The second chamber 216 may extend along substantially the entire length of the handle (as shown), but need not do so. The second chamber 216 must extend thraugh the distal end 211 of the housing to define a distal port 219 therein, though, to permit communication of the control means 230 with the catheter C.
The second chamber may be defined by a pair of generally parallel, spaced apart walls 21?
which define a chamber sufficiently wide enough for the central member 240 of the control mechanism 230 to slide axially therein without undue friction.
~Iowever, it is preferred that the walls 21? be spaced only slightly away from the central member 240 to limit lateral movement of the central member within the housing. ' ~,_ 'The housing 212 of the handle may also include a recess 220 for receiving a release lever 260. The recess is desirably sized so that it may substantially entirely enclose the release level' when the control mechanism, is in its fully retracted position, i:e.; before either of the disks of the device have been deployed, as explained in more detail t~elow: ~''he recess also includes a notch 222 which extends through a sidewall 217 of the first chamber. This notch is provided so that an end 264 of the release lever may ,a pass therethrough for operative conn~tion to the connecting rod 242: The notch should be sized to permit the release lever to be moved about pivot pin 262 in order to deploy the closure device of the invention. By providing a recess v~rhich substantially encloses the aelease lever 260 before the closure device has been deployed, the chance of inadvertent release of the closure device before it as in its desired position is minimized.
ps noted above, the rotor 232 and the central member 240 of the control ;mechanisnn hre operatively connected'to one another through a threaded engagement. The p' central member 240 is desirably generally cylindrical in~ shape and is externally threaded with screw-type threads extending ahng a significant portion of its length; if so desired, ,' the screw threads may extend along substantially the entire length of the cehtral member.
The rotor 232 is provided with internal threads (not shown) which mate with the external threads on the central member: Thus, by rotating the rotor within the first chamber 214, -a one can induce axial movement of the central member within the second chamber 216.
Furthermore; if the pitch of the threads on the rotor and the central member are known, the precise distance which the central member moves for a given angle of rotation of the rotor can be readily determined. This permits precise control of movement of the central member without any unnecessarily complex mechanical structure.
The generally cylindrical central member includes a bore (not shown) which extends along iu entire length. This bore is located generally along the axis of the cylindrical central member and is sized to receive a core wire 250 which passes through the central member. The core wire may advantageously comprise a standard guide wire, ~ as are lrnown. In a preferred embodiment, the core wire is formed of a superelastic material, such as NiTi alloy. The bore should be large enough to permit the central member to turn freely with respect to the core wire and to allow the core wire to slide axially within the central member.
The proximal end of the core wire 250 is operatively connected to an end 264 of the release lever 260. One preferred embodiment of such a connection, shown in Figure 14, utilizes a connecting rod 242 which may be attached at its distal end to the proximal end of the core wire and at its proximal end to the end 264 of the release lever. Thus, by pivoting the release lever 260 about its pivot pin 262, one may draw the core wire axially within the bare in central member 240 in a proximal direction.
For reasons made more clear below, the release lever 260 is desirably biased in a clockwise direction in Figure 14, i.e., such that the core wire 250 is generally urged in a distal direction. In the embodiment shown in Figure 14, the relzase lever is so biased by means of a biasing spring 244. The biasing spring is a tension spring connected at a first end to the connecting rod 242 and at its opposite end to the central member 240.
This urges the connecting rod in a distal direction, i.e., to the right in Figure 14, to thereby bias the release lever in a clockwise direction.
If so desired, a cap 246 may be provided at the distal end of the central member 240. The cap includes a bore therethrough which is axially aligned with the axis of the central member to permit the connecting rod 242 to slide with respect to the cap in response to movement of the release lever 260. The cap 246 may extend distally along the sides of a proximal portion of the central member 240, as shown. The cap 246 is desirably formed of a machinable or moldable plastic; Delrin*, which is available from DuPont, has been found to work well.
* trade-mark WO 93/13?12 PCT/US93/00489 ._ A generally tubular urging member 270 may be attached to the distal end 248 of .->i the central member. The urging member 270 should be attached to the central member so that it may move axially as the central member is moved by rotation of the rotor 232.
The axis of the urging member desirably generally coincides with the axis of the central member so that the core wire 250 may extend into and slide within the urging member, for reasons explained below.
The urging member and the core wire are received within a catheter C (see Figure 13). The proximal end of the catheter is desirably attached to the distal end 211 of the housing. Although the catheter may be directly attached to the distal end of the housing, in the embodiment shown in Figures 13 and 14 an integrally formed side arm connector, as is commercially readily available, is used. This connector 252 is attached to the housing and is desirably in sealing engagement with the distal port 219 of the housing, such as by means of mating threads, as shown. 1fie connector generally includes a first tubular member 258 which is generally axially aligned with the rest of the control mechanism, including the central: mennber 240; and a second tube 256 which extends radially outwardly at an angle from the first babe 258. The second tube 256 may be used to introduce fluids into he catheter during deployment of the closure de~rice;
these fluids ,, may include, for instance, isotonic saline (0.990) to flush the lumen of the catheter prior '' ~ to introduction to remove all air babbles. The connector 252 may include any useful r means fog connecting the catheter C such that a generally fluid-tight seal is achieved. For instance, a luer lock 254,. such as that shown, may be used. It is preferred that the catheter be joined to the handle in a manner which permits the catheter to be rotated or ~~~ y~rith respect to the handle.
Figures 15 and i6 show a distal portion of a preferred embodiment of a delivery .a .' device of the invention. ~.'he core wire 250 extends within the urging member 270 to a , ;
-, position adjacent the distal end of the urging member. Although the core wire 250 may remain substantially along the axis of the urging member, as best seen in Figure 15 it is ' generally preferred that the core wire be displaced slightly from that axis A.
The majority of the length of the urging member 270 comprises a flexible tube z~ 272, which may be substantially similar to catheters such as are commonly known. The flexible tube should be sized to'permit the core wire 250 to move freely therewithin, yet WO 93/13712 ~CT/US93/00489 2~~~~3~
permit the urging member to be guided through the catheter C along its length for deployment of the closure device 10, The final distal segment of the urging member comprises a short tube 2'74 which is formed of a stiffer material, such as a metal such as surgical stainless steel or the like. This metal tube 274 may be attached td ttie flexible tube 272 by any known means. For instance, a length of the tube 274 may be received within the distal end of the flexible tube 272 and may be held in place by means of a biologically compatible cementitious material or even a mere friction fit.
As best seen in Figure 15, the distal end 278 of the metal tube is adapted to contact ''' a closure device 10 of the invention, such as at the conjoint disk 40, as shown. Thus, by i moving the urging member 270 distally, i.e., to the left in Figure 15, one may urge the closure device toward the distal end of the catheter. The metal tube 274 should therefore be relatively small in its outer diameter so that the second disk 30 of the closure device ,' may be wrapped about the tube for deployment. This metal tube 274 may, for instance, have a lehgth of about 10-20 mm and an outer diameter on the order of about 2 mm or less. The fleuble tube 2?2 is desirably larger in outer diameter than the metal tube 2?4.
This presents a forward shoulder 2?3 on the fleuble tube which may engage the disk 30 to further urge it along the catheter:
If so desired, a relatively small, thin band 280 may be placed about the metal tube 274. This band 280 is desirably sized to space the metal tube from the wall of the catheter C as the metal tube is moved within the lumen of the catheter. This band may be formed of any suitable material and may simply be placed about an attached to the metal tube. In a prefera~ed embodiment, though; the band 280 is integrally formed with the metal tube, simply comprising a generally annular projection extending outwardly of ~,e generally cylindrical: metal tube:
,,, This preferred embodiment of a. delivery system may be ,used substantially. as ,~an,.:.;~"~ '~tl'1VP rn r~pntnv a closure device I0 of the invention. The urging member 270 is used tcp urge the closure device along the lumen of the catheter until it is positioned adjacent the distal end of the catheter; as explained in more detail above, the distal end of the catheter may be positioned on the distal side of the defect prior to deployment of the first disk 20. Once the catheter is ro rl ositioned, the first disk may be urged P Pe Y P
distally out of the catheter within the present device by turning the rotor 232 with respect WO 93/13712 PCT/US93l0~~89 '~,~"~~c~3e~~
to the housing 2I2 of the handle. As noted above, since the pitch of the threads on the central member 240 and the rotor 232 are known, by turning the rotor through a predetermined angle or number of revolutions, the central member may be urged distally by a fixed distance. 'this in turn forces the urging member 270 to move distally; urging ' the closure device 10 out of the distal end of the catheter. The control mechanism 230 of the delivery system therefore permits one to urge the first disk 20 out of the catheter without risking deploying the second disk 30 of the closure device on the distal side of the septum S by urging the closure device too far along the catheter. The second disk may be deployed on the distal side of the septal defect substantially as described above.
One additional aspect of the present delivery system is that it permits the closure device 10 to be securely held until it is properly deployed to prevent accidental release.
In a preferred embodiment, a tether (290 in Figure 16) is attached to the closure device.
This tether desirably defines a loop, as shown, and may be attached to any part of the closure device, although attaching the tother to the conjoint disk 40 is generally preferred.
The metal tube 274 is provided with an opening 276 in its side which permits access to the core wire 250. During deployment, the core wire 250 passes through a segment of the loop defined by the tether 29Q to hold it in place. The core wire desirably extends distally beyond the opening 276 to prevent the tether from being inadvertently slipped over the end of the core wires thereby releasing the closure device.
When the closure device has been properly deployed with one disk on either side of the defect, the tether may b~e released from the delivery system. Manually pressing on the flange 266 of the release lever 260 will cause the release lever to pivot in a generally i counterclockwise dir~tion in Figure 14~ This in turn draws the core wire 250 generally ,e axially in a proximal direction; as eacplained above. The distance which the full rotation ,, of the release lever about its pivot pin , imparts to the core wire should be sufficient to draw the core wire proximally behind the distal edge of the opening 276 in the metal tube, y:
and desirably is sufficient to draw the core wire substantially behind the opening so that a rearward portion of the opening may draw the tether off of the core wire.
This permits the tether 290 to slip off the core wire 250, completing deployment of the closure device.
It should be noted that when the central member is in its initial position before either disk has been deployed, the release lever 260 desirably is received substantially .°zr:- , ,... ,:;, :. :.;::- .. , ,,....: .:.. ... .,:",:., ::..:. , :,..:.,. .,.",.
WO 93/13712 PC~'/LJS93/OfD48l entirely within the recess 220 in the handle. Only when the central member is moved distally to deploy the closure device will the release lever be moved so that it may project outwardly of the handle. This will prevent the inadvertent depression of the release lever before the closure device has been deployed.
In an alternative embodiment (not shown), a slightly different means of releasing the tether 290 is used. Rather than using a core wire which is simply passed through the loop defined by the tether; the tether may actually be severed.
The metal tube 274 may have a small hole drilled diametrically therethrough.
The tether may be passed through this hole and be tied into a knot at its end. The core wire Z5U in ,;this variant (not shown) is disposed proximally of the tether, and has a sharpened edge at its distal end. When the device is to be released, the core wire is urged distally by the ' release mechanism (instead of being drawn proximally as in the previous embodiment).
The sharpened distal edge of the core wire then cuts the tether m a manner axin m a guillotine, releasing the device.
Although the foregoing has focused on application of the present invention to occlude atrial septal defects, the ia~vention is not limited to occluding such defects. For instance, the instant closure device can be used to treat ventricular septal defeats, patent ductus arteriosus or any other congenital or acquired orificial or tubular communications between vascular chambers or vessels.
While a preferred embodiment of the present invention has been described, it should be understood that (various changes, adaptations and modifications may be made therein without departing from the spirit of the invention and the scope of the appended claims:
y::$
Claims (31)
CLAIMS:
1. A septal defect closure device comprising first and second occluding disks, each disk comprising a flexible, biologically compatible membrane having a periphery and an elastically deformable frame carried about the periphery of the membrane, said frame being collapsible for passage through a catheter and elastically returning to a predetermined shape for tautly holding the membrane; a central portion of the membrane of the first disk being affixed to a central portion of the membrane of the second disk to define a central conjoint disk.
2. The closure device of claim 1 wherein the central conjoint disk is sized to be received within a septal defect.
3. The closure device of claim 2 wherein the central conjoint disk is sized to substantially fill the septal defect.
4. The closure device of claim 1 wherein the central conjoint disk is generally circular in shape.
5. The closure device of claim 1 wherein the central portions of the first and second membranes are sewn together to define the conjoint disk.
6. The closure device of claim 1 wherein the central portions of the first and second membranes are fixed to one another by a biologically compatible adhesive.
7. The closure device of claim 1 wherein the frame is formed of an elongate wire.
8. The closure device of claim 7 wherein the wire is formed of a superelastic material.
9. The closure device of claim 1 wherein the frame comprises a plurality of legs having opposed ends, one leg being flexibly connected to another leg at each end.
10. The closure device of claim 9 wherein the frame is integrally formed of a single wire.
11. The closure device of claim 10 wherein the wire is formed of a superelastic material.
12. The closure device of claim 10 wherein lengths of the wire define the legs, the wire being formed into a loop between adjacent ends of the legs to provide a flexible connection therebetween.
13. The closure device of claim 10 wherein lengths of the wire define the legs, at least one leg of the frame comprising two overlapping lengths of wire.
14. A septal defect closure device comprising first and second occluding disks, each disk comprising a flexible, biologically compatible membrane having a periphery and an elastically deformable frame carried about the periphery of the membrane, said frame being collapsible for passage through a catheter and elastically returning to a predetermined shape for tautly holding the membrane; a central portion of the membrane of the first disk being affixed to a central portion of the membrane of the second disk to define a central conjoint disk;
wherein the frame comprises a plurality of legs having opposed ends, one leg being flexibly connected to another leg at each end; and wherein the central conjoint disk has an axis, the legs being foldable such that the ends of each of the legs of one of said first or second disks converge upon a point spaced axially outwardly of the conjoint disk.
wherein the frame comprises a plurality of legs having opposed ends, one leg being flexibly connected to another leg at each end; and wherein the central conjoint disk has an axis, the legs being foldable such that the ends of each of the legs of one of said first or second disks converge upon a point spaced axially outwardly of the conjoint disk.
15. The closure device of claim 14 wherein the point of convergence of the legs of the first disk are spaced distally of the conjoint disk and the point of convergence of the legs of the second disk are spaced proximally of the conjoint disk.
16. The closure device of claim 1 wherein the frame and disk are integrally formed from a sheet of superelastic material.
17. The closure device of claim 1, further comprising a tether for releasably attaching the closure device to a delivery means.
18. The closure device of claim 1 further comprising an elastically deformable central frame carried about the conjoint disk.
19. A septal defect closure device comprising first and second flexible membranes connected together, each of the first and second flexible membranes including an elastically deformable frame disposed around at least a substantial portion of a periphery of the flexible membrane, wherein each deformable frame includes a flexible structure such that each frame is collapsible within a catheter and, when released from the catheter, returns elastically to a predetermined shape for tautly holding the flexible membrane.
20. The septal defect closure device of claim 19, wherein a central portion of the first flexible membrane is joined to a central portion of the second flexible membrane.
21. The septal defect closure device of claim 19, wherein each of the frames is disposed around a complete periphery of each of the first and second flexible membranes.
22. A septal defect closure device comprising first and second membranes which are connected together, the device further including at least two surfaces for concurrently abutting at least two points of an inner diameter of the septal defect which are a sufficient distance apart so as to retard the first and second membranes from moving laterally relative to a plane of the septal defect.
23. The septal defect closure device of claim 22, wherein the at least two surfaces include at least two portions of an outer edge of a connection between the first and second members.
24. The septal defect closure device of claim 22, wherein the at least two surfaces include at least two portions of an outer surface of a tubular segment joining the first and second members.
25. A septal defect closure device comprising first and second flexible members, each of the flexible members including an elastic structure such that each of the flexible members is collapsible for passage through a catheter and elastically reformable to an expanded shape when released from the catheter, the first flexible member connected to the second flexible member such that when both flexible members have reformed to the expanded shape, at least two portions of the closure device abut against at least two corresponding surfaces on an inner surface of a septal defect.
26. The septal defect closure device of claim 25, wherein the at least two portions of the closure device are a sufficient distance apart so as to retard the first and second members from moving parallel relative to a plane of the septum.
27. The septal defect closure device of claim 25, wherein the inner surface of the septal defect includes an inward facing, perimeter surface fo the septal defect.
28. A septal defect closure device comprising first and second occluding members which are connected together, each member having a structure including a superelastic material such that each member is capable of being collapsed for passage through a catheter and elastically reforming to an expanded shape.
29. The septal defect closure device of claim 28, wherein the superelastic material is a NiTi alloy.
30. The septal defect closure device of claim 28, wherein the structure includes a superelastic frame disposed around a flexible membrane.
31. The septal defect closure device of claim 28, wherein the structure includes a membrane formed of a superelastic material.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US82295192A | 1992-01-21 | 1992-01-21 | |
US822,951 | 1992-01-21 | ||
PCT/US1993/000489 WO1993013712A1 (en) | 1992-01-21 | 1993-01-21 | Septal defect closure device |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2128338A1 CA2128338A1 (en) | 1993-07-22 |
CA2128338C true CA2128338C (en) | 2004-10-12 |
Family
ID=25237397
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002128338A Expired - Lifetime CA2128338C (en) | 1992-01-21 | 1993-01-21 | Septal defect closure device |
Country Status (7)
Country | Link |
---|---|
US (4) | US5334217A (en) |
EP (2) | EP0876793B1 (en) |
JP (2) | JP3393383B2 (en) |
CA (1) | CA2128338C (en) |
DE (2) | DE69334196T2 (en) |
ES (2) | ES2133382T3 (en) |
WO (1) | WO1993013712A1 (en) |
Families Citing this family (739)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0876793B1 (en) * | 1992-01-21 | 2007-12-26 | Regents Of The University Of Minnesota | Septal Defect Closure Device |
US5766246A (en) | 1992-05-20 | 1998-06-16 | C. R. Bard, Inc. | Implantable prosthesis and method and apparatus for loading and delivering an implantable prothesis |
WO1994004080A1 (en) * | 1992-08-13 | 1994-03-03 | Brigham & Women's Hospital | Expanding polygonal surgical compressor |
US5681349A (en) * | 1992-08-13 | 1997-10-28 | Brigham & Women's Hospital | Expanding polygonal surgical compressor |
US5891162A (en) * | 1992-08-13 | 1999-04-06 | Brigham & Women's Hospital | Expanding polygonal surgical compressor |
JPH06233792A (en) * | 1993-01-08 | 1994-08-23 | Keisuke Hirata | Drum membrane performation prosthetic material and prum membrane rear surface cutting means |
US6346074B1 (en) | 1993-02-22 | 2002-02-12 | Heartport, Inc. | Devices for less invasive intracardiac interventions |
US5797960A (en) * | 1993-02-22 | 1998-08-25 | Stevens; John H. | Method and apparatus for thoracoscopic intracardiac procedures |
JP3185906B2 (en) * | 1993-11-26 | 2001-07-11 | ニプロ株式会社 | Prosthesis for atrial septal defect |
FR2714284B1 (en) * | 1993-12-23 | 1996-03-08 | Hubert Petitier | Prosthesis for the closure of ruptures of the cardiac walls, in particular interventricular septal ruptures. |
ATE310839T1 (en) | 1994-04-29 | 2005-12-15 | Scimed Life Systems Inc | STENT WITH COLLAGEN |
US5499995C1 (en) * | 1994-05-25 | 2002-03-12 | Paul S Teirstein | Body passageway closure apparatus and method of use |
DE69529338T3 (en) | 1994-07-08 | 2007-05-31 | Ev3 Inc., Plymouth | Intravascular filter device |
US5725552A (en) * | 1994-07-08 | 1998-03-10 | Aga Medical Corporation | Percutaneous catheter directed intravascular occlusion devices |
US6123715A (en) * | 1994-07-08 | 2000-09-26 | Amplatz; Curtis | Method of forming medical devices; intravascular occlusion devices |
US5846261A (en) | 1994-07-08 | 1998-12-08 | Aga Medical Corp. | Percutaneous catheter directed occlusion devices |
US5433727A (en) * | 1994-08-16 | 1995-07-18 | Sideris; Eleftherios B. | Centering buttoned device for the occlusion of large defects for occluding |
US6290708B1 (en) | 1994-09-29 | 2001-09-18 | Bard Asdi Inc. | Hernia mesh patch with seal stiffener |
US6171318B1 (en) | 1994-09-29 | 2001-01-09 | Bard Asdi Inc. | Hernia mesh patch with stiffening layer |
US6280453B1 (en) | 1994-09-29 | 2001-08-28 | Bard Asdi Inc. | Hernia mesh patch with stiffener line segment |
US6174320B1 (en) | 1994-09-29 | 2001-01-16 | Bard Asdi Inc. | Hernia mesh patch with slit |
US5916225A (en) | 1994-09-29 | 1999-06-29 | Surgical Sense, Inc. | Hernia mesh patch |
US6176863B1 (en) | 1994-09-29 | 2001-01-23 | Bard Asdi Inc. | Hernia mesh patch with I-shaped filament |
EP0738501B1 (en) * | 1994-11-02 | 2000-05-24 | Olympus Optical Co., Ltd. | Endoscope operative instrument |
US6171329B1 (en) * | 1994-12-19 | 2001-01-09 | Gore Enterprise Holdings, Inc. | Self-expanding defect closure device and method of making and using |
US5879366A (en) | 1996-12-20 | 1999-03-09 | W.L. Gore & Associates, Inc. | Self-expanding defect closure device and method of making and using |
US5702421A (en) * | 1995-01-11 | 1997-12-30 | Schneidt; Bernhard | Closure device for closing a vascular opening, such as patent ductus arteriosus |
US5634936A (en) * | 1995-02-06 | 1997-06-03 | Scimed Life Systems, Inc. | Device for closing a septal defect |
US5584884A (en) * | 1995-07-27 | 1996-12-17 | Anthony S. Pignataro | Mammary prosthesis and method of surgically implanting same |
US5810846A (en) * | 1995-08-03 | 1998-09-22 | United States Surgical Corporation | Vascular hole closure |
DE69612507T2 (en) * | 1995-10-30 | 2001-08-09 | Childrens Medical Center | SELF-CENTERING, SHIELD-LIKE DEVICE FOR CLOSING A SEPTAL DEFECT |
US6520904B1 (en) | 1996-01-02 | 2003-02-18 | The University Of Cincinnati | Device and method for restructuring heart chamber geometry |
US6592619B2 (en) | 1996-01-02 | 2003-07-15 | University Of Cincinnati | Heart wall actuation device for the natural heart |
US5957977A (en) * | 1996-01-02 | 1999-09-28 | University Of Cincinnati | Activation device for the natural heart including internal and external support structures |
US6168622B1 (en) | 1996-01-24 | 2001-01-02 | Microvena Corporation | Method and apparatus for occluding aneurysms |
DE19604817C2 (en) * | 1996-02-09 | 2003-06-12 | Pfm Prod Fuer Die Med Ag | Device for closing defect openings in the human or animal body |
US5853422A (en) * | 1996-03-22 | 1998-12-29 | Scimed Life Systems, Inc. | Apparatus and method for closing a septal defect |
WO1997035533A1 (en) | 1996-03-25 | 1997-10-02 | Enrico Nicolo | Surgical mesh prosthetic material and methods of use |
US6949116B2 (en) | 1996-05-08 | 2005-09-27 | Carag Ag | Device for plugging an opening such as in a wall of a hollow or tubular organ including biodegradable elements |
EP0900051A1 (en) * | 1996-05-08 | 1999-03-10 | Salviac Limited | An occluder device |
JP3304346B2 (en) * | 1996-06-20 | 2002-07-22 | ニプロ株式会社 | Suture for endocardial suture surgery |
US5690674A (en) * | 1996-07-02 | 1997-11-25 | Cordis Corporation | Wound closure with plug |
RU2108070C1 (en) * | 1996-07-09 | 1998-04-10 | Борис Петрович Кручинин | Microsurgical fastening device and manipulation pusher for its mounting |
USD387863S (en) * | 1996-07-22 | 1997-12-16 | Microvena Corporation | Medical device delivery handle |
US5741297A (en) * | 1996-08-28 | 1998-04-21 | Simon; Morris | Daisy occluder and method for septal defect repair |
US5861003A (en) * | 1996-10-23 | 1999-01-19 | The Cleveland Clinic Foundation | Apparatus and method for occluding a defect or aperture within body surface |
US5827268A (en) * | 1996-10-30 | 1998-10-27 | Hearten Medical, Inc. | Device for the treatment of patent ductus arteriosus and method of using the device |
US5976178A (en) | 1996-11-07 | 1999-11-02 | Vascular Science Inc. | Medical grafting methods |
US6036702A (en) | 1997-04-23 | 2000-03-14 | Vascular Science Inc. | Medical grafting connectors and fasteners |
US6120432A (en) | 1997-04-23 | 2000-09-19 | Vascular Science Inc. | Medical grafting methods and apparatus |
WO1998047430A1 (en) * | 1997-04-23 | 1998-10-29 | Vascular Science Inc. | Medical plug |
US20020087046A1 (en) * | 1997-04-23 | 2002-07-04 | St. Jude Medical Cardiovascular Group, Inc. | Medical grafting methods and apparatus |
DE29714242U1 (en) * | 1997-08-08 | 1998-12-10 | Applied Biometrics | Closure device for closing a physical anomaly such as vascular opening or opening in a septum |
FR2767671B1 (en) | 1997-08-27 | 1999-11-26 | Ethnor | PROSTHETIC SHUTTER DEVICE FOR SHUTTERING HERNARY CHANNELS |
US6241768B1 (en) | 1997-08-27 | 2001-06-05 | Ethicon, Inc. | Prosthetic device for the repair of a hernia |
FR2767672B1 (en) * | 1997-08-27 | 1999-11-26 | Ethnor | PROSTHESES FOR SEALING HERNIA CANALS |
US5954766A (en) * | 1997-09-16 | 1999-09-21 | Zadno-Azizi; Gholam-Reza | Body fluid flow control device |
US5895404A (en) * | 1997-09-29 | 1999-04-20 | Ruiz; Carlos E. | Apparatus and methods for percutaneously forming a passageway between adjacent vessels or portions of a vessel |
US6511468B1 (en) | 1997-10-17 | 2003-01-28 | Micro Therapeutics, Inc. | Device and method for controlling injection of liquid embolic composition |
US5976174A (en) * | 1997-12-15 | 1999-11-02 | Ruiz; Carlos E. | Medical hole closure device and methods of use |
US6036720A (en) * | 1997-12-15 | 2000-03-14 | Target Therapeutics, Inc. | Sheet metal aneurysm neck bridge |
US6994713B2 (en) * | 1998-01-30 | 2006-02-07 | St. Jude Medical Atg, Inc. | Medical graft connector or plug structures, and methods of making and installing same |
AU1923999A (en) * | 1998-01-30 | 1999-08-16 | Vascular Science Inc. | Medical graft connector or plug structures, and methods of making and installingsame |
US5944738A (en) | 1998-02-06 | 1999-08-31 | Aga Medical Corporation | Percutaneous catheter directed constricting occlusion device |
CH693017A5 (en) | 1998-02-10 | 2003-01-31 | Jump Jeffrey B | surgical device occlusion defects. |
US6190408B1 (en) | 1998-03-05 | 2001-02-20 | The University Of Cincinnati | Device and method for restructuring the heart chamber geometry |
JP3799810B2 (en) * | 1998-03-30 | 2006-07-19 | ニプロ株式会社 | Transcatheter surgery closure plug and catheter assembly |
JP3733580B2 (en) * | 1998-04-06 | 2006-01-11 | ニプロ株式会社 | Closure collection tool for defect closure |
US5972008A (en) * | 1998-04-29 | 1999-10-26 | Kalinski; Robert J. | Method and apparatus for retaining a surgical mesh |
EP1079767A1 (en) * | 1998-04-30 | 2001-03-07 | The Board Of Trustees Of The Leland Stanford Junior University | Expandable space frame |
US6497724B1 (en) * | 1999-04-30 | 2002-12-24 | The Board Of Trustees Of The Leland Stanford Junior University | Expandable space frame |
US6544167B2 (en) | 1998-05-01 | 2003-04-08 | Correstore, Inc. | Ventricular restoration patch |
US6024096A (en) | 1998-05-01 | 2000-02-15 | Correstore Inc | Anterior segment ventricular restoration apparatus and method |
US6221104B1 (en) | 1998-05-01 | 2001-04-24 | Cor Restore, Inc. | Anterior and interior segment cardiac restoration apparatus and method |
US20050283188A1 (en) * | 1998-05-29 | 2005-12-22 | By-Pass, Inc. | Vascular closure device |
US7396359B1 (en) * | 1998-05-29 | 2008-07-08 | Bypass, Inc. | Vascular port device |
US7452371B2 (en) * | 1999-06-02 | 2008-11-18 | Cook Incorporated | Implantable vascular device |
JP4399585B2 (en) | 1998-06-02 | 2010-01-20 | クック インコーポレイティド | Multi-sided medical device |
US6641593B1 (en) | 1998-06-03 | 2003-11-04 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6945980B2 (en) | 1998-06-03 | 2005-09-20 | Medtronic, Inc. | Multiple loop tissue connector apparatus and methods |
US6613059B2 (en) | 1999-03-01 | 2003-09-02 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6547821B1 (en) * | 1998-07-16 | 2003-04-15 | Cardiothoracic Systems, Inc. | Surgical procedures and devices for increasing cardiac output of the heart |
US6010447A (en) * | 1998-07-31 | 2000-01-04 | Kardjian; Paul M. | Bladder sling |
US6478773B1 (en) | 1998-12-21 | 2002-11-12 | Micrus Corporation | Apparatus for deployment of micro-coil using a catheter |
US5968075A (en) * | 1998-08-31 | 1999-10-19 | Silmed, Inc. | Nasal septal button |
US6166286A (en) * | 1998-09-16 | 2000-12-26 | Arcilius Consultadoria E Servicos Lda | Mesh plug kit for the inguinal box surgical technique for hernioplasty |
US6183496B1 (en) * | 1998-11-02 | 2001-02-06 | Datascope Investment Corp. | Collapsible hemostatic plug |
US6508252B1 (en) | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US7128073B1 (en) | 1998-11-06 | 2006-10-31 | Ev3 Endovascular, Inc. | Method and device for left atrial appendage occlusion |
US7044134B2 (en) * | 1999-11-08 | 2006-05-16 | Ev3 Sunnyvale, Inc | Method of implanting a device in the left atrial appendage |
US6152144A (en) * | 1998-11-06 | 2000-11-28 | Appriva Medical, Inc. | Method and device for left atrial appendage occlusion |
US6475222B1 (en) * | 1998-11-06 | 2002-11-05 | St. Jude Medical Atg, Inc. | Minimally invasive revascularization apparatus and methods |
US7713282B2 (en) | 1998-11-06 | 2010-05-11 | Atritech, Inc. | Detachable atrial appendage occlusion balloon |
US6835185B2 (en) * | 1998-12-21 | 2004-12-28 | Micrus Corporation | Intravascular device deployment mechanism incorporating mechanical detachment |
US8118822B2 (en) | 1999-03-01 | 2012-02-21 | Medtronic, Inc. | Bridge clip tissue connector apparatus and methods |
US7001400B1 (en) | 1999-03-04 | 2006-02-21 | Abbott Laboratories | Articulating suturing device and method |
US6964668B2 (en) | 1999-03-04 | 2005-11-15 | Abbott Laboratories | Articulating suturing device and method |
US7235087B2 (en) | 1999-03-04 | 2007-06-26 | Abbott Park | Articulating suturing device and method |
US7842048B2 (en) | 2006-08-18 | 2010-11-30 | Abbott Laboratories | Articulating suture device and method |
US20040092964A1 (en) | 1999-03-04 | 2004-05-13 | Modesitt D. Bruce | Articulating suturing device and method |
US8137364B2 (en) | 2003-09-11 | 2012-03-20 | Abbott Laboratories | Articulating suturing device and method |
AU3729400A (en) * | 1999-03-09 | 2000-09-28 | St. Jude Medical Cardiovascular Group, Inc. | Medical grafting methods and apparatus |
US6695859B1 (en) | 1999-04-05 | 2004-02-24 | Coalescent Surgical, Inc. | Apparatus and methods for anastomosis |
US6752813B2 (en) | 1999-04-09 | 2004-06-22 | Evalve, Inc. | Methods and devices for capturing and fixing leaflets in valve repair |
US7981126B2 (en) | 1999-04-16 | 2011-07-19 | Vital Access Corporation | Locking compression plate anastomosis apparatus |
US6623494B1 (en) | 1999-04-16 | 2003-09-23 | Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) | Methods and systems for intraluminally directed vascular anastomosis |
US6309350B1 (en) | 1999-05-03 | 2001-10-30 | Tricardia, L.L.C. | Pressure/temperature/monitor device for heart implantation |
US6258124B1 (en) | 1999-05-10 | 2001-07-10 | C. R. Bard, Inc. | Prosthetic repair fabric |
EP1214911B1 (en) * | 1999-05-13 | 2005-12-28 | St. Jude Medical ATG, Inc. | Septal defect closure device |
DE60025601T2 (en) * | 1999-05-13 | 2006-07-20 | St. Jude Medical ATG, Inc., Maple Grove | CLOSURE DEVICE OF A SEPTEME DAMAGE |
US6712836B1 (en) | 1999-05-13 | 2004-03-30 | St. Jude Medical Atg, Inc. | Apparatus and methods for closing septal defects and occluding blood flow |
US6656206B2 (en) * | 1999-05-13 | 2003-12-02 | Cardia, Inc. | Occlusion device with non-thrombogenic properties |
US6699256B1 (en) * | 1999-06-04 | 2004-03-02 | St. Jude Medical Atg, Inc. | Medical grafting apparatus and methods |
US7416554B2 (en) | 2002-12-11 | 2008-08-26 | Usgi Medical Inc | Apparatus and methods for forming and securing gastrointestinal tissue folds |
US7955340B2 (en) | 1999-06-25 | 2011-06-07 | Usgi Medical, Inc. | Apparatus and methods for forming and securing gastrointestinal tissue folds |
US7618426B2 (en) | 2002-12-11 | 2009-11-17 | Usgi Medical, Inc. | Apparatus and methods for forming gastrointestinal tissue approximations |
US6626899B2 (en) | 1999-06-25 | 2003-09-30 | Nidus Medical, Llc | Apparatus and methods for treating tissue |
US7637905B2 (en) | 2003-01-15 | 2009-12-29 | Usgi Medical, Inc. | Endoluminal tool deployment system |
US6497650B1 (en) | 1999-07-28 | 2002-12-24 | C. R. Bard, Inc. | Hernia prosthesis |
US7892246B2 (en) * | 1999-07-28 | 2011-02-22 | Bioconnect Systems, Inc. | Devices and methods for interconnecting conduits and closing openings in tissue |
US6293951B1 (en) * | 1999-08-24 | 2001-09-25 | Spiration, Inc. | Lung reduction device, system, and method |
US8529583B1 (en) | 1999-09-03 | 2013-09-10 | Medtronic, Inc. | Surgical clip removal apparatus |
AU5812299A (en) * | 1999-09-07 | 2001-04-10 | Microvena Corporation | Retrievable septal defect closure device |
IL131863A0 (en) * | 1999-09-10 | 2001-03-19 | Bruckheimer Elchanan | Intravascular device and method using it |
US7942888B2 (en) * | 1999-09-13 | 2011-05-17 | Rex Medical, L.P. | Vascular hole closure device |
US7662161B2 (en) | 1999-09-13 | 2010-02-16 | Rex Medical, L.P | Vascular hole closure device |
AU7373700A (en) * | 1999-09-13 | 2001-04-17 | Rex Medical, Lp | Vascular closure |
US8083766B2 (en) | 1999-09-13 | 2011-12-27 | Rex Medical, Lp | Septal defect closure device |
US7341595B2 (en) | 1999-09-13 | 2008-03-11 | Rex Medical, L.P | Vascular hole closure device |
US7267679B2 (en) * | 1999-09-13 | 2007-09-11 | Rex Medical, L.P | Vascular hole closure device |
US6231561B1 (en) * | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6964674B1 (en) * | 1999-09-20 | 2005-11-15 | Nuvasive, Inc. | Annulotomy closure device |
US6939361B1 (en) | 1999-09-22 | 2005-09-06 | Nmt Medical, Inc. | Guidewire for a free standing intervascular device having an integral stop mechanism |
US6592625B2 (en) * | 1999-10-20 | 2003-07-15 | Anulex Technologies, Inc. | Spinal disc annulus reconstruction method and spinal disc annulus stent |
US6551303B1 (en) | 1999-10-27 | 2003-04-22 | Atritech, Inc. | Barrier device for ostium of left atrial appendage |
US6652555B1 (en) * | 1999-10-27 | 2003-11-25 | Atritech, Inc. | Barrier device for covering the ostium of left atrial appendage |
US6689150B1 (en) | 1999-10-27 | 2004-02-10 | Atritech, Inc. | Filter apparatus for ostium of left atrial appendage |
US6926730B1 (en) | 2000-10-10 | 2005-08-09 | Medtronic, Inc. | Minimally invasive valve repair procedure and apparatus |
US6994092B2 (en) * | 1999-11-08 | 2006-02-07 | Ev3 Sunnyvale, Inc. | Device for containing embolic material in the LAA having a plurality of tissue retention structures |
US6458153B1 (en) | 1999-12-31 | 2002-10-01 | Abps Venture One, Ltd. | Endoluminal cardiac and venous valve prostheses and methods of manufacture and delivery thereof |
US7195641B2 (en) | 1999-11-19 | 2007-03-27 | Advanced Bio Prosthetic Surfaces, Ltd. | Valvular prostheses having metal or pseudometallic construction and methods of manufacture |
DE10000137A1 (en) * | 2000-01-04 | 2001-07-12 | Pfm Prod Fuer Die Med Ag | Implantate for closing defect apertures in human or animal bodies, bearing structure of which can be reversed from secondary to primary form by elastic force |
US9579091B2 (en) | 2000-01-05 | 2017-02-28 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US7842068B2 (en) | 2000-12-07 | 2010-11-30 | Integrated Vascular Systems, Inc. | Apparatus and methods for providing tactile feedback while delivering a closure device |
US6942674B2 (en) * | 2000-01-05 | 2005-09-13 | Integrated Vascular Systems, Inc. | Apparatus and methods for delivering a closure device |
US6197042B1 (en) | 2000-01-05 | 2001-03-06 | Medical Technology Group, Inc. | Vascular sheath with puncture site closure apparatus and methods of use |
US8758400B2 (en) | 2000-01-05 | 2014-06-24 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US6391048B1 (en) | 2000-01-05 | 2002-05-21 | Integrated Vascular Systems, Inc. | Integrated vascular device with puncture site closure component and sealant and methods of use |
US6461364B1 (en) | 2000-01-05 | 2002-10-08 | Integrated Vascular Systems, Inc. | Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use |
US6780197B2 (en) | 2000-01-05 | 2004-08-24 | Integrated Vascular Systems, Inc. | Apparatus and methods for delivering a vascular closure device to a body lumen |
CA2397746C (en) | 2000-02-03 | 2010-07-27 | Cook Incorporated | Implantable vascular device |
US7740637B2 (en) | 2000-02-09 | 2010-06-22 | Micrus Endovascular Corporation | Apparatus and method for deployment of a therapeutic device using a catheter |
US8474460B2 (en) * | 2000-03-04 | 2013-07-02 | Pulmonx Corporation | Implanted bronchial isolation devices and methods |
US20060020347A1 (en) * | 2004-03-08 | 2006-01-26 | Michael Barrett | Implanted bronchial isolation devices and methods |
US20030070683A1 (en) | 2000-03-04 | 2003-04-17 | Deem Mark E. | Methods and devices for use in performing pulmonary procedures |
US6679264B1 (en) | 2000-03-04 | 2004-01-20 | Emphasys Medical, Inc. | Methods and devices for use in performing pulmonary procedures |
US6551332B1 (en) | 2000-03-31 | 2003-04-22 | Coalescent Surgical, Inc. | Multiple bias surgical fastener |
US6214029B1 (en) * | 2000-04-26 | 2001-04-10 | Microvena Corporation | Septal defect occluder |
US6551344B2 (en) | 2000-04-26 | 2003-04-22 | Ev3 Inc. | Septal defect occluder |
US6334864B1 (en) | 2000-05-17 | 2002-01-01 | Aga Medical Corp. | Alignment member for delivering a non-symmetric device with a predefined orientation |
US6610006B1 (en) * | 2000-07-25 | 2003-08-26 | C. R. Bard, Inc. | Implantable prosthesis |
US6440152B1 (en) | 2000-07-28 | 2002-08-27 | Microvena Corporation | Defect occluder release assembly and method |
US6746461B2 (en) | 2000-08-15 | 2004-06-08 | William R. Fry | Low-profile, shape-memory surgical occluder |
AU2001285078A1 (en) * | 2000-08-18 | 2002-03-04 | Atritech, Inc. | Expandable implant devices for filtering blood flow from atrial appendages |
AU8800801A (en) | 2000-09-08 | 2002-03-22 | James E Coleman | Surgical staple |
US7404819B1 (en) | 2000-09-14 | 2008-07-29 | C.R. Bard, Inc. | Implantable prosthesis |
CA2423360A1 (en) | 2000-09-21 | 2002-03-28 | Atritech, Inc. | Apparatus for implanting devices in atrial appendages |
US6695833B1 (en) | 2000-09-27 | 2004-02-24 | Nellix, Inc. | Vascular stent-graft apparatus and forming method |
US6626918B1 (en) | 2000-10-06 | 2003-09-30 | Medical Technology Group | Apparatus and methods for positioning a vascular sheath |
US7806904B2 (en) | 2000-12-07 | 2010-10-05 | Integrated Vascular Systems, Inc. | Closure device |
US6719777B2 (en) * | 2000-12-07 | 2004-04-13 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6695867B2 (en) | 2002-02-21 | 2004-02-24 | Integrated Vascular Systems, Inc. | Plunger apparatus and methods for delivering a closure device |
US7211101B2 (en) | 2000-12-07 | 2007-05-01 | Abbott Vascular Devices | Methods for manufacturing a clip and clip |
US7905900B2 (en) | 2003-01-30 | 2011-03-15 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US8690910B2 (en) | 2000-12-07 | 2014-04-08 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6623509B2 (en) * | 2000-12-14 | 2003-09-23 | Core Medical, Inc. | Apparatus and methods for sealing vascular punctures |
US6890343B2 (en) | 2000-12-14 | 2005-05-10 | Ensure Medical, Inc. | Plug with detachable guidewire element and methods for use |
US6896692B2 (en) | 2000-12-14 | 2005-05-24 | Ensure Medical, Inc. | Plug with collet and apparatus and method for delivering such plugs |
US8083768B2 (en) | 2000-12-14 | 2011-12-27 | Ensure Medical, Inc. | Vascular plug having composite construction |
US6846319B2 (en) | 2000-12-14 | 2005-01-25 | Core Medical, Inc. | Devices for sealing openings through tissue and apparatus and methods for delivering them |
US20020112729A1 (en) * | 2001-02-21 | 2002-08-22 | Spiration, Inc. | Intra-bronchial obstructing device that controls biological interaction with the patient |
US7798147B2 (en) * | 2001-03-02 | 2010-09-21 | Pulmonx Corporation | Bronchial flow control devices with membrane seal |
US20040074491A1 (en) * | 2001-03-02 | 2004-04-22 | Michael Hendricksen | Delivery methods and devices for implantable bronchial isolation devices |
US7011094B2 (en) * | 2001-03-02 | 2006-03-14 | Emphasys Medical, Inc. | Bronchial flow control devices and methods of use |
WO2002071977A2 (en) * | 2001-03-08 | 2002-09-19 | Atritech, Inc. | Atrial filter implants |
DE60234020D1 (en) * | 2001-04-16 | 2009-11-26 | Gary A Strobel | NEW ENDOPHYTIC MUSHROOMS AND ITS USE |
US20030078579A1 (en) * | 2001-04-19 | 2003-04-24 | Ferree Bret A. | Annular repair devices and methods |
US8091556B2 (en) * | 2001-04-20 | 2012-01-10 | V-Wave Ltd. | Methods and apparatus for reducing localized circulatory system pressure |
US20050148925A1 (en) * | 2001-04-20 | 2005-07-07 | Dan Rottenberg | Device and method for controlling in-vivo pressure |
US20020173803A1 (en) | 2001-05-01 | 2002-11-21 | Stephen Ainsworth | Self-closing surgical clip for tissue |
JP2002338688A (en) * | 2001-05-15 | 2002-11-27 | Sumitomo Chem Co Ltd | Method for producing purified polyethersulfone |
US6537300B2 (en) | 2001-05-30 | 2003-03-25 | Scimed Life Systems, Inc. | Implantable obstruction device for septal defects |
US7338514B2 (en) | 2001-06-01 | 2008-03-04 | St. Jude Medical, Cardiology Division, Inc. | Closure devices, related delivery methods and tools, and related methods of use |
WO2002098282A2 (en) * | 2001-06-04 | 2002-12-12 | Albert Einstein Healthcare Network | Cardiac stimulating apparatus having a blood clot filter and atrial pacer |
IES20010547A2 (en) | 2001-06-07 | 2002-12-11 | Christy Cummins | Surgical Staple |
NZ530597A (en) * | 2001-06-20 | 2006-10-27 | Park Medical Llc | Anastomotic device |
US7115136B2 (en) | 2001-06-20 | 2006-10-03 | Park Medical Llc | Anastomotic device |
US6454780B1 (en) * | 2001-06-21 | 2002-09-24 | Scimed Life Systems, Inc. | Aneurysm neck obstruction device |
US6712859B2 (en) | 2001-06-28 | 2004-03-30 | Ethicon, Inc. | Hernia repair prosthesis and methods for making same |
US7011671B2 (en) * | 2001-07-18 | 2006-03-14 | Atritech, Inc. | Cardiac implant device tether system and method |
US7288105B2 (en) * | 2001-08-01 | 2007-10-30 | Ev3 Endovascular, Inc. | Tissue opening occluder |
US7708712B2 (en) * | 2001-09-04 | 2010-05-04 | Broncus Technologies, Inc. | Methods and devices for maintaining patency of surgically created channels in a body organ |
US6776784B2 (en) | 2001-09-06 | 2004-08-17 | Core Medical, Inc. | Clip apparatus for closing septal defects and methods of use |
US20060052821A1 (en) | 2001-09-06 | 2006-03-09 | Ovalis, Inc. | Systems and methods for treating septal defects |
US6702835B2 (en) | 2001-09-07 | 2004-03-09 | Core Medical, Inc. | Needle apparatus for closing septal defects and methods for using such apparatus |
US20070112358A1 (en) * | 2001-09-06 | 2007-05-17 | Ryan Abbott | Systems and Methods for Treating Septal Defects |
WO2003022344A2 (en) * | 2001-09-06 | 2003-03-20 | Nmt Medical, Inc. | Flexible delivery system |
US20030050648A1 (en) * | 2001-09-11 | 2003-03-13 | Spiration, Inc. | Removable lung reduction devices, systems, and methods |
US6596013B2 (en) | 2001-09-20 | 2003-07-22 | Scimed Life Systems, Inc. | Method and apparatus for treating septal defects |
US7892247B2 (en) | 2001-10-03 | 2011-02-22 | Bioconnect Systems, Inc. | Devices and methods for interconnecting vessels |
AU2002347900B8 (en) * | 2001-10-11 | 2006-01-12 | Emphasys Medical, Inc. | Bronchial flow control devices and methods of use |
US6592594B2 (en) * | 2001-10-25 | 2003-07-15 | Spiration, Inc. | Bronchial obstruction device deployment system and method |
US20060292206A1 (en) | 2001-11-26 | 2006-12-28 | Kim Steven W | Devices and methods for treatment of vascular aneurysms |
WO2003053493A2 (en) * | 2001-12-19 | 2003-07-03 | Nmt Medical, Inc. | Septal occluder and associated methods |
US7318833B2 (en) | 2001-12-19 | 2008-01-15 | Nmt Medical, Inc. | PFO closure device with flexible thrombogenic joint and improved dislodgement resistance |
US6790213B2 (en) | 2002-01-07 | 2004-09-14 | C.R. Bard, Inc. | Implantable prosthesis |
WO2003059152A2 (en) | 2002-01-14 | 2003-07-24 | Nmt Medical, Inc. | Patent foramen ovale (pfo) closure method and device |
JP4328209B2 (en) | 2002-01-25 | 2009-09-09 | アトリテック, インコーポレイテッド | Atrial appendage blood filtration system |
US6869436B2 (en) * | 2002-02-07 | 2005-03-22 | Scimed Life Systems, Inc. | Surgical clip with a self-releasing fluid reservoir |
US6689144B2 (en) * | 2002-02-08 | 2004-02-10 | Scimed Life Systems, Inc. | Rapid exchange catheter and methods for delivery of vaso-occlusive devices |
US20030154988A1 (en) * | 2002-02-21 | 2003-08-21 | Spiration, Inc. | Intra-bronchial device that provides a medicant intra-bronchially to the patient |
US20060235432A1 (en) * | 2002-02-21 | 2006-10-19 | Devore Lauri J | Intra-bronchial obstructing device that controls biological interaction with the patient |
US6929637B2 (en) | 2002-02-21 | 2005-08-16 | Spiration, Inc. | Device and method for intra-bronchial provision of a therapeutic agent |
US7349995B2 (en) * | 2002-03-07 | 2008-03-25 | Intel Corporation | Computing device with scalable logic block to respond to data transfer requests |
WO2003075796A2 (en) * | 2002-03-08 | 2003-09-18 | Emphasys Medical, Inc. | Methods and devices for inducing collapse in lung regions fed by collateral pathways |
US20030181922A1 (en) | 2002-03-20 | 2003-09-25 | Spiration, Inc. | Removable anchored lung volume reduction devices and methods |
US20030216769A1 (en) | 2002-05-17 | 2003-11-20 | Dillard David H. | Removable anchored lung volume reduction devices and methods |
US6755868B2 (en) | 2002-03-22 | 2004-06-29 | Ethicon, Inc. | Hernia repair device |
WO2003082076A2 (en) | 2002-03-25 | 2003-10-09 | Nmt Medical, Inc. | Patent foramen ovale (pfo) closure clips |
US7695488B2 (en) * | 2002-03-27 | 2010-04-13 | Boston Scientific Scimed, Inc. | Expandable body cavity liner device |
US20030195553A1 (en) * | 2002-04-12 | 2003-10-16 | Scimed Life Systems, Inc. | System and method for retaining vaso-occlusive devices within an aneurysm |
US20030195385A1 (en) * | 2002-04-16 | 2003-10-16 | Spiration, Inc. | Removable anchored lung volume reduction devices and methods |
US7976564B2 (en) * | 2002-05-06 | 2011-07-12 | St. Jude Medical, Cardiology Division, Inc. | PFO closure devices and related methods of use |
US20040117004A1 (en) * | 2002-05-16 | 2004-06-17 | Osborne Thomas A. | Stent and method of forming a stent with integral barbs |
US7828839B2 (en) | 2002-05-16 | 2010-11-09 | Cook Incorporated | Flexible barb for anchoring a prosthesis |
EP1507491A1 (en) * | 2002-05-28 | 2005-02-23 | Emphasys Medical, Inc. | Implantable bronchial isolation devices and lung treatment methods |
JP2005528162A (en) * | 2002-06-03 | 2005-09-22 | エヌエムティー メディカル インコーポレイテッド | Device with biological tissue scaffold for intracardiac defect occlusion |
US7850709B2 (en) | 2002-06-04 | 2010-12-14 | Abbott Vascular Inc. | Blood vessel closure clip and delivery device |
WO2003103476A2 (en) | 2002-06-05 | 2003-12-18 | Nmt Medical, Inc. | Patent foramen ovale (pfo) closure device with radial and circumferential support |
US20040010209A1 (en) * | 2002-07-15 | 2004-01-15 | Spiration, Inc. | Device and method for measuring the diameter of an air passageway |
US20040059263A1 (en) * | 2002-09-24 | 2004-03-25 | Spiration, Inc. | Device and method for measuring the diameter of an air passageway |
US7081084B2 (en) * | 2002-07-16 | 2006-07-25 | University Of Cincinnati | Modular power system and method for a heart wall actuation system for the natural heart |
US20040015041A1 (en) * | 2002-07-18 | 2004-01-22 | The University Of Cincinnati | Protective sheath apparatus and method for use with a heart wall actuation system for the natural heart |
US7850729B2 (en) | 2002-07-18 | 2010-12-14 | The University Of Cincinnati | Deforming jacket for a heart actuation device |
US20040059180A1 (en) * | 2002-09-23 | 2004-03-25 | The University Of Cincinnati | Basal mounting cushion frame component to facilitate extrinsic heart wall actuation |
EP1524942B1 (en) * | 2002-07-26 | 2008-09-10 | Emphasys Medical, Inc. | Bronchial flow control devices with membrane seal |
WO2004012603A2 (en) | 2002-07-31 | 2004-02-12 | Abbott Laboratories Vascular Enterprises, Limited | Apparatus for sealing surgical punctures |
US7101381B2 (en) * | 2002-08-02 | 2006-09-05 | C.R. Bard, Inc. | Implantable prosthesis |
US6988982B2 (en) * | 2002-08-19 | 2006-01-24 | Cardioenergetics | Heart wall actuation system for the natural heart with shape limiting elements |
WO2004024032A1 (en) | 2002-09-12 | 2004-03-25 | Cook Incorporated | Retrievable filter |
US8066724B2 (en) | 2002-09-12 | 2011-11-29 | Medtronic, Inc. | Anastomosis apparatus and methods |
US20040116997A1 (en) | 2002-09-20 | 2004-06-17 | Taylor Charles S. | Stent-graft with positioning anchor |
EP1542593B9 (en) | 2002-09-23 | 2008-08-20 | NMT Medical, Inc. | Septal puncture device |
US8679179B2 (en) * | 2002-10-03 | 2014-03-25 | Anova Corp. | Annular repair devices and methods |
US8105345B2 (en) | 2002-10-04 | 2012-01-31 | Medtronic, Inc. | Anastomosis apparatus and methods |
WO2004037333A1 (en) | 2002-10-25 | 2004-05-06 | Nmt Medical, Inc. | Expandable sheath tubing |
ATE420593T1 (en) * | 2002-11-07 | 2009-01-15 | Nmt Medical Inc | CLOSURE OF PERSONAL SEPTUM DAMAGE USING MAGNETIC FORCE |
US7481821B2 (en) | 2002-11-12 | 2009-01-27 | Thomas J. Fogarty | Embolization device and a method of using the same |
US7108710B2 (en) | 2002-11-26 | 2006-09-19 | Abbott Laboratories | Multi-element biased suture clip |
US7814912B2 (en) * | 2002-11-27 | 2010-10-19 | Pulmonx Corporation | Delivery methods and devices for implantable bronchial isolation devices |
WO2004049974A2 (en) * | 2002-11-27 | 2004-06-17 | Emphasys Medical, Inc. | Delivery method and device for implantable bronchial isolation devices |
WO2004052213A1 (en) | 2002-12-09 | 2004-06-24 | Nmt Medical, Inc. | Septal closure devices |
US7942884B2 (en) | 2002-12-11 | 2011-05-17 | Usgi Medical, Inc. | Methods for reduction of a gastric lumen |
US7942898B2 (en) | 2002-12-11 | 2011-05-17 | Usgi Medical, Inc. | Delivery systems and methods for gastric reduction |
US7160309B2 (en) | 2002-12-31 | 2007-01-09 | Laveille Kao Voss | Systems for anchoring a medical device in a body lumen |
GB0300786D0 (en) * | 2003-01-14 | 2003-02-12 | Barker Stephen G E | Laparoscopic port hernia device |
DE10362223B4 (en) * | 2003-01-21 | 2010-02-04 | pfm Produkte für die Medizin AG | Basic coil shape |
US7115135B2 (en) * | 2003-01-22 | 2006-10-03 | Cardia, Inc. | Occlusion device having five or more arms |
US6960224B2 (en) * | 2003-01-22 | 2005-11-01 | Cardia, Inc. | Laminated sheets for use in a fully retrievable occlusion device |
US20040143294A1 (en) * | 2003-01-22 | 2004-07-22 | Cardia, Inc. | Septal stabilization device |
US7087072B2 (en) * | 2003-01-22 | 2006-08-08 | Cardia, Inc. | Articulated center post |
US6960220B2 (en) * | 2003-01-22 | 2005-11-01 | Cardia, Inc. | Hoop design for occlusion device |
CA2512986A1 (en) * | 2003-01-24 | 2004-08-12 | Applied Medical Resources Corporation | Internal tissue retractor |
US8821534B2 (en) | 2010-12-06 | 2014-09-02 | Integrated Vascular Systems, Inc. | Clip applier having improved hemostasis and methods of use |
US8905937B2 (en) | 2009-02-26 | 2014-12-09 | Integrated Vascular Systems, Inc. | Methods and apparatus for locating a surface of a body lumen |
US7857828B2 (en) | 2003-01-30 | 2010-12-28 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8202293B2 (en) | 2003-01-30 | 2012-06-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8398656B2 (en) | 2003-01-30 | 2013-03-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8758398B2 (en) | 2006-09-08 | 2014-06-24 | Integrated Vascular Systems, Inc. | Apparatus and method for delivering a closure element |
WO2004069055A2 (en) * | 2003-02-04 | 2004-08-19 | Ev3 Sunnyvale Inc. | Patent foramen ovale closure system |
US20040260382A1 (en) * | 2003-02-12 | 2004-12-23 | Fogarty Thomas J. | Intravascular implants and methods of using the same |
US9333102B2 (en) * | 2003-02-24 | 2016-05-10 | Allium Medical Solutions Ltd. | Stent |
US20040176788A1 (en) * | 2003-03-07 | 2004-09-09 | Nmt Medical, Inc. | Vacuum attachment system |
US7658747B2 (en) | 2003-03-12 | 2010-02-09 | Nmt Medical, Inc. | Medical device for manipulation of a medical implant |
US7473266B2 (en) * | 2003-03-14 | 2009-01-06 | Nmt Medical, Inc. | Collet-based delivery system |
GB0307826D0 (en) * | 2003-04-04 | 2003-05-07 | Univ London | A device for transfixing and joining tissue |
US7100616B2 (en) | 2003-04-08 | 2006-09-05 | Spiration, Inc. | Bronchoscopic lung volume reduction method |
US20040267306A1 (en) | 2003-04-11 | 2004-12-30 | Velocimed, L.L.C. | Closure devices, related delivery methods, and related methods of use |
US8372112B2 (en) | 2003-04-11 | 2013-02-12 | St. Jude Medical, Cardiology Division, Inc. | Closure devices, related delivery methods, and related methods of use |
US7597704B2 (en) * | 2003-04-28 | 2009-10-06 | Atritech, Inc. | Left atrial appendage occlusion device with active expansion |
US6913614B2 (en) * | 2003-05-08 | 2005-07-05 | Cardia, Inc. | Delivery system with safety tether |
US10646229B2 (en) | 2003-05-19 | 2020-05-12 | Evalve, Inc. | Fixation devices, systems and methods for engaging tissue |
EP1648340B1 (en) | 2003-05-19 | 2010-03-03 | SeptRx, Inc. | Tissue distention device and related methods for therapeutic intervention |
US7200559B2 (en) * | 2003-05-29 | 2007-04-03 | Microsoft Corporation | Semantic object synchronous understanding implemented with speech application language tags |
WO2004110257A2 (en) * | 2003-06-09 | 2004-12-23 | The University Of Cincinnati | Power system for a heart actuation device |
WO2004110553A1 (en) * | 2003-06-09 | 2004-12-23 | The University Of Cincinnati | Actuation mechanisms for a heart actuation device |
US20060178551A1 (en) * | 2003-06-09 | 2006-08-10 | Melvin David B | Securement system for a heart actuation device |
WO2004112615A2 (en) | 2003-06-16 | 2004-12-29 | Galdonik Jason A | Temporary hemostatic plug apparatus and method of use |
US9861346B2 (en) | 2003-07-14 | 2018-01-09 | W. L. Gore & Associates, Inc. | Patent foramen ovale (PFO) closure device with linearly elongating petals |
US8480706B2 (en) | 2003-07-14 | 2013-07-09 | W.L. Gore & Associates, Inc. | Tubular patent foramen ovale (PFO) closure device with catch system |
US7678123B2 (en) | 2003-07-14 | 2010-03-16 | Nmt Medical, Inc. | Tubular patent foramen ovale (PFO) closure device with catch system |
US20050015110A1 (en) | 2003-07-18 | 2005-01-20 | Fogarty Thomas J. | Embolization device and a method of using the same |
US7182769B2 (en) | 2003-07-25 | 2007-02-27 | Medtronic, Inc. | Sealing clip, delivery systems, and methods |
US7533671B2 (en) * | 2003-08-08 | 2009-05-19 | Spiration, Inc. | Bronchoscopic repair of air leaks in a lung |
US8308765B2 (en) | 2004-05-07 | 2012-11-13 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
US8216252B2 (en) | 2004-05-07 | 2012-07-10 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US7735493B2 (en) | 2003-08-15 | 2010-06-15 | Atritech, Inc. | System and method for delivering a left atrial appendage containment device |
DE602004017750D1 (en) | 2003-08-19 | 2008-12-24 | Nmt Medical Inc | Expandable lock hose |
US20050043749A1 (en) | 2003-08-22 | 2005-02-24 | Coalescent Surgical, Inc. | Eversion apparatus and methods |
EP1663014B1 (en) * | 2003-09-11 | 2008-08-13 | NMT Medical, Inc. | Suture sever tube |
WO2005034763A1 (en) | 2003-09-11 | 2005-04-21 | Nmt Medical, Inc. | Devices, systems, and methods for suturing tissue |
US7192435B2 (en) * | 2003-09-18 | 2007-03-20 | Cardia, Inc. | Self centering closure device for septal occlusion |
US7144410B2 (en) * | 2003-09-18 | 2006-12-05 | Cardia Inc. | ASD closure device with self centering arm network |
US7658748B2 (en) | 2003-09-23 | 2010-02-09 | Cardia, Inc. | Right retrieval mechanism |
US7850600B1 (en) * | 2003-09-23 | 2010-12-14 | Tyco Healthcare Group Lp | Laparoscopic instrument and trocar system and related surgical method |
US8394114B2 (en) | 2003-09-26 | 2013-03-12 | Medtronic, Inc. | Surgical connection apparatus and methods |
US7462188B2 (en) | 2003-09-26 | 2008-12-09 | Abbott Laboratories | Device and method for suturing intracardiac defects |
JP2007527272A (en) * | 2003-10-10 | 2007-09-27 | コヒーレックス メディカル インコーポレイテッド | Patent foramen ovale (PFO) closure device, delivery device, and related methods and systems |
US20050192627A1 (en) * | 2003-10-10 | 2005-09-01 | Whisenant Brian K. | Patent foramen ovale closure devices, delivery apparatus and related methods and systems |
US8852229B2 (en) | 2003-10-17 | 2014-10-07 | Cordis Corporation | Locator and closure device and method of use |
US7361183B2 (en) * | 2003-10-17 | 2008-04-22 | Ensure Medical, Inc. | Locator and delivery device and method of use |
US7419498B2 (en) | 2003-10-21 | 2008-09-02 | Nmt Medical, Inc. | Quick release knot attachment system |
JP4496223B2 (en) | 2003-11-06 | 2010-07-07 | エヌエムティー メディカル, インコーポレイティッド | Septal penetration device |
US8292910B2 (en) | 2003-11-06 | 2012-10-23 | Pressure Products Medical Supplies, Inc. | Transseptal puncture apparatus |
US7056286B2 (en) | 2003-11-12 | 2006-06-06 | Adrian Ravenscroft | Medical device anchor and delivery system |
CA2545282A1 (en) | 2003-11-17 | 2005-05-26 | Prolapse Inc. | Pelvic implant with anchoring frame |
WO2005055834A1 (en) * | 2003-11-20 | 2005-06-23 | Nmt Medical, Inc. | Device, with electrospun fabric, for a percutaneous transluminal procedure, and methods thereof |
US7566336B2 (en) * | 2003-11-25 | 2009-07-28 | Cardia, Inc. | Left atrial appendage closure device |
US20050273119A1 (en) | 2003-12-09 | 2005-12-08 | Nmt Medical, Inc. | Double spiral patent foramen ovale closure clamp |
US7879047B2 (en) | 2003-12-10 | 2011-02-01 | Medtronic, Inc. | Surgical connection apparatus and methods |
US20050251189A1 (en) | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Multi-position tissue manipulation assembly |
US8080023B2 (en) | 2003-12-12 | 2011-12-20 | Vitalitec International, Inc. | Device and method for performing multiple anastomoses |
US7361180B2 (en) | 2004-05-07 | 2008-04-22 | Usgi Medical, Inc. | Apparatus for manipulating and securing tissue |
US7347863B2 (en) | 2004-05-07 | 2008-03-25 | Usgi Medical, Inc. | Apparatus and methods for manipulating and securing tissue |
DE10359789B3 (en) * | 2003-12-19 | 2005-06-23 | Dr. Osypka Gmbh | Device for covering hole in heart wall has retention and/or guide part holding membrane body in elongate shape during insertion before release to provide covering surface for hole in heart wall |
US7449024B2 (en) | 2003-12-23 | 2008-11-11 | Abbott Laboratories | Suturing device with split arm and method of suturing tissue |
US7553323B1 (en) | 2004-01-08 | 2009-06-30 | Perez Juan I | Steerable endovascular graft delivery system |
WO2005067817A1 (en) * | 2004-01-13 | 2005-07-28 | Remon Medical Technologies Ltd | Devices for fixing a sensor in a body lumen |
US20060106447A1 (en) * | 2004-01-26 | 2006-05-18 | Nmt Medical, Inc. | Adjustable stiffness medical system |
US20050178389A1 (en) * | 2004-01-27 | 2005-08-18 | Shaw David P. | Disease indications for selective endobronchial lung region isolation |
JP2007519498A (en) | 2004-01-30 | 2007-07-19 | エヌエムティー メディカル, インコーポレイティッド | Devices, systems, and methods for closure of cardiac openings |
US20050192626A1 (en) | 2004-01-30 | 2005-09-01 | Nmt Medical, Inc. | Devices, systems, and methods for closure of cardiac openings |
US20050192600A1 (en) * | 2004-02-24 | 2005-09-01 | Enrico Nicolo | Inguinal hernia repair prosthetic |
DE102004009892A1 (en) * | 2004-02-26 | 2005-09-15 | Gfe Medizintechnik Gmbh | Implantable prosthesis for the repair of hernia defects |
US8206684B2 (en) * | 2004-02-27 | 2012-06-26 | Pulmonx Corporation | Methods and devices for blocking flow through collateral pathways in the lung |
US7871419B2 (en) | 2004-03-03 | 2011-01-18 | Nmt Medical, Inc. | Delivery/recovery system for septal occluder |
US7976539B2 (en) | 2004-03-05 | 2011-07-12 | Hansen Medical, Inc. | System and method for denaturing and fixing collagenous tissue |
US7703459B2 (en) | 2004-03-09 | 2010-04-27 | Usgi Medical, Inc. | Apparatus and methods for mapping out endoluminal gastrointestinal surgery |
US7412993B2 (en) * | 2004-03-09 | 2008-08-19 | George Tzong-Chyi Tzeng | Expandable stent |
WO2005087140A1 (en) | 2004-03-11 | 2005-09-22 | Percutaneous Cardiovascular Solutions Pty Limited | Percutaneous heart valve prosthesis |
US8398670B2 (en) * | 2004-03-19 | 2013-03-19 | Aga Medical Corporation | Multi-layer braided structures for occluding vascular defects and for occluding fluid flow through portions of the vasculature of the body |
US8747453B2 (en) * | 2008-02-18 | 2014-06-10 | Aga Medical Corporation | Stent/stent graft for reinforcement of vascular abnormalities and associated method |
US8777974B2 (en) * | 2004-03-19 | 2014-07-15 | Aga Medical Corporation | Multi-layer braided structures for occluding vascular defects |
US8313505B2 (en) | 2004-03-19 | 2012-11-20 | Aga Medical Corporation | Device for occluding vascular defects |
US9039724B2 (en) * | 2004-03-19 | 2015-05-26 | Aga Medical Corporation | Device for occluding vascular defects |
US20050228434A1 (en) * | 2004-03-19 | 2005-10-13 | Aga Medical Corporation | Multi-layer braided structures for occluding vascular defects |
US20050234509A1 (en) * | 2004-03-30 | 2005-10-20 | Mmt Medical, Inc. | Center joints for PFO occluders |
US20050267524A1 (en) | 2004-04-09 | 2005-12-01 | Nmt Medical, Inc. | Split ends closure device |
US8361110B2 (en) | 2004-04-26 | 2013-01-29 | W.L. Gore & Associates, Inc. | Heart-shaped PFO closure device |
US8801746B1 (en) | 2004-05-04 | 2014-08-12 | Covidien Lp | System and method for delivering a left atrial appendage containment device |
US8308760B2 (en) | 2004-05-06 | 2012-11-13 | W.L. Gore & Associates, Inc. | Delivery systems and methods for PFO closure device with two anchors |
US7842053B2 (en) * | 2004-05-06 | 2010-11-30 | Nmt Medical, Inc. | Double coil occluder |
US8257394B2 (en) | 2004-05-07 | 2012-09-04 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
JP2007535997A (en) | 2004-05-07 | 2007-12-13 | エヌエムティー メディカル, インコーポレイティッド | Capturing mechanism of tubular septal occluder |
US8444657B2 (en) | 2004-05-07 | 2013-05-21 | Usgi Medical, Inc. | Apparatus and methods for rapid deployment of tissue anchors |
US7704268B2 (en) | 2004-05-07 | 2010-04-27 | Nmt Medical, Inc. | Closure device with hinges |
US7918869B2 (en) | 2004-05-07 | 2011-04-05 | Usgi Medical, Inc. | Methods and apparatus for performing endoluminal gastroplasty |
US7842069B2 (en) * | 2004-05-07 | 2010-11-30 | Nmt Medical, Inc. | Inflatable occluder |
US7736374B2 (en) | 2004-05-07 | 2010-06-15 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US7390329B2 (en) | 2004-05-07 | 2008-06-24 | Usgi Medical, Inc. | Methods for grasping and cinching tissue anchors |
IES20040368A2 (en) | 2004-05-25 | 2005-11-30 | James E Coleman | Surgical stapler |
WO2005118019A1 (en) * | 2004-05-28 | 2005-12-15 | Cook Incorporated | Implantable bioabsorbable valve support frame |
US7695493B2 (en) | 2004-06-09 | 2010-04-13 | Usgi Medical, Inc. | System for optimizing anchoring force |
US7736379B2 (en) | 2004-06-09 | 2010-06-15 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US7678135B2 (en) | 2004-06-09 | 2010-03-16 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US8206417B2 (en) | 2004-06-09 | 2012-06-26 | Usgi Medical Inc. | Apparatus and methods for optimizing anchoring force |
US20060030863A1 (en) * | 2004-07-21 | 2006-02-09 | Fields Antony J | Implanted bronchial isolation device delivery devices and methods |
US8048145B2 (en) | 2004-07-22 | 2011-11-01 | Endologix, Inc. | Graft systems having filling structures supported by scaffolds and methods for their use |
US8298290B2 (en) * | 2004-09-20 | 2012-10-30 | Davol, Inc. | Implantable prosthesis for soft tissue repair |
WO2006036837A2 (en) | 2004-09-24 | 2006-04-06 | Nmt Medical, Inc. | Occluder device double securement system for delivery/recovery of such occluder device |
US9211181B2 (en) | 2004-11-19 | 2015-12-15 | Pulmonx Corporation | Implant loading device and system |
US7771472B2 (en) * | 2004-11-19 | 2010-08-10 | Pulmonx Corporation | Bronchial flow control devices and methods of use |
US20070219630A1 (en) * | 2004-11-24 | 2007-09-20 | Xi Chu | Devices and Methods for Beating Heart Cardiac Surgeries |
US7905901B2 (en) * | 2004-11-29 | 2011-03-15 | Cardia, Inc. | Self-centering occlusion device |
US7582104B2 (en) * | 2004-12-08 | 2009-09-01 | Cardia, Inc. | Daisy design for occlusion device |
US8162905B2 (en) * | 2004-12-17 | 2012-04-24 | W. L. Gore & Associates, Inc. | Delivery system |
US10390714B2 (en) | 2005-01-12 | 2019-08-27 | Remon Medical Technologies, Ltd. | Devices for fixing a sensor in a lumen |
WO2006078988A2 (en) * | 2005-01-21 | 2006-07-27 | Loubert Suddaby | Aneurysm repair method and apparatus |
US8876791B2 (en) | 2005-02-25 | 2014-11-04 | Pulmonx Corporation | Collateral pathway treatment using agent entrained by aspiration flow current |
US20060241687A1 (en) * | 2005-03-16 | 2006-10-26 | Glaser Erik N | Septal occluder with pivot arms and articulating joints |
US20060217760A1 (en) * | 2005-03-17 | 2006-09-28 | Widomski David R | Multi-strand septal occluder |
EP1868507A1 (en) | 2005-03-18 | 2007-12-26 | NMT Medical, Inc. | Catch member for pfo occluder |
US8372113B2 (en) * | 2005-03-24 | 2013-02-12 | W.L. Gore & Associates, Inc. | Curved arm intracardiac occluder |
JP4951503B2 (en) * | 2005-03-29 | 2012-06-13 | テルモ株式会社 | Defect closure device |
US20060229657A1 (en) * | 2005-03-30 | 2006-10-12 | Wasicek Lawrence D | Single operator exchange embolic protection filter |
EP1871241B1 (en) * | 2005-04-22 | 2012-12-19 | Rex Medical, L.P. | Closure device for left atrial appendage |
WO2006116666A2 (en) * | 2005-04-28 | 2006-11-02 | Nmt Medical, Inc. | System and method for bonding closure of an intra-cardiac opening using energy |
US8926654B2 (en) | 2005-05-04 | 2015-01-06 | Cordis Corporation | Locator and closure device and method of use |
US8088144B2 (en) | 2005-05-04 | 2012-01-03 | Ensure Medical, Inc. | Locator and closure device and method of use |
US9585651B2 (en) | 2005-05-26 | 2017-03-07 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
US8298291B2 (en) | 2005-05-26 | 2012-10-30 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
US8926633B2 (en) | 2005-06-24 | 2015-01-06 | Abbott Laboratories | Apparatus and method for delivering a closure element |
US8313497B2 (en) | 2005-07-01 | 2012-11-20 | Abbott Laboratories | Clip applier and methods of use |
US8579936B2 (en) | 2005-07-05 | 2013-11-12 | ProMed, Inc. | Centering of delivery devices with respect to a septal defect |
AU2006269419A1 (en) | 2005-07-07 | 2007-01-18 | Nellix, Inc. | Systems and methods for endovascular aneurysm treatment |
US8267947B2 (en) | 2005-08-08 | 2012-09-18 | Abbott Laboratories | Vascular suturing device |
US7883517B2 (en) | 2005-08-08 | 2011-02-08 | Abbott Laboratories | Vascular suturing device |
US8083754B2 (en) | 2005-08-08 | 2011-12-27 | Abbott Laboratories | Vascular suturing device with needle capture |
US9456811B2 (en) | 2005-08-24 | 2016-10-04 | Abbott Vascular Inc. | Vascular closure methods and apparatuses |
US20070060895A1 (en) | 2005-08-24 | 2007-03-15 | Sibbitt Wilmer L Jr | Vascular closure methods and apparatuses |
US8920442B2 (en) | 2005-08-24 | 2014-12-30 | Abbott Vascular Inc. | Vascular opening edge eversion methods and apparatuses |
US7846179B2 (en) | 2005-09-01 | 2010-12-07 | Ovalis, Inc. | Suture-based systems and methods for treating septal defects |
WO2007030433A2 (en) * | 2005-09-06 | 2007-03-15 | Nmt Medical, Inc. | Removable intracardiac rf device |
US9259267B2 (en) | 2005-09-06 | 2016-02-16 | W.L. Gore & Associates, Inc. | Devices and methods for treating cardiac tissue |
US7972359B2 (en) | 2005-09-16 | 2011-07-05 | Atritech, Inc. | Intracardiac cage and method of delivering same |
US20070088388A1 (en) * | 2005-09-19 | 2007-04-19 | Opolski Steven W | Delivery device for implant with dual attachment sites |
US20070123934A1 (en) * | 2005-09-26 | 2007-05-31 | Whisenant Brian K | Delivery system for patent foramen ovale closure device |
US7715918B2 (en) | 2005-10-18 | 2010-05-11 | University Of Cincinnati | Muscle energy converter with smooth continuous tissue interface |
US8545530B2 (en) * | 2005-10-19 | 2013-10-01 | Pulsar Vascular, Inc. | Implantable aneurysm closure systems and methods |
CA2625826C (en) | 2005-10-19 | 2014-08-05 | Pulsar Vascular, Inc. | Methods and systems for endovascularly clipping and repairing lumen and tissue defects |
US7632308B2 (en) | 2005-11-23 | 2009-12-15 | Didier Loulmet | Methods, devices, and kits for treating mitral valve prolapse |
US20070135826A1 (en) | 2005-12-01 | 2007-06-14 | Steve Zaver | Method and apparatus for delivering an implant without bias to a left atrial appendage |
WO2007073566A1 (en) | 2005-12-22 | 2007-06-28 | Nmt Medical, Inc. | Catch members for occluder devices |
US8060214B2 (en) | 2006-01-05 | 2011-11-15 | Cardiac Pacemakers, Inc. | Implantable medical device with inductive coil configurable for mechanical fixation |
US9681948B2 (en) | 2006-01-23 | 2017-06-20 | V-Wave Ltd. | Heart anchor device |
US8726909B2 (en) | 2006-01-27 | 2014-05-20 | Usgi Medical, Inc. | Methods and apparatus for revision of obesity procedures |
US8162974B2 (en) | 2006-02-02 | 2012-04-24 | Boston Scientific Scimed, Inc. | Occlusion apparatus, system, and method |
DE102006013770A1 (en) * | 2006-03-24 | 2007-09-27 | Occlutech Gmbh | Occlusion instrument and method for its production |
US8551135B2 (en) * | 2006-03-31 | 2013-10-08 | W.L. Gore & Associates, Inc. | Screw catch mechanism for PFO occluder and method of use |
US8870913B2 (en) | 2006-03-31 | 2014-10-28 | W.L. Gore & Associates, Inc. | Catch system with locking cap for patent foramen ovale (PFO) occluder |
US7691151B2 (en) | 2006-03-31 | 2010-04-06 | Spiration, Inc. | Articulable Anchor |
JP2009532125A (en) | 2006-03-31 | 2009-09-10 | エヌエムティー メディカル, インコーポレイティッド | Deformable flap catch mechanism for occluder equipment |
US7829986B2 (en) * | 2006-04-01 | 2010-11-09 | Stats Chippac Ltd. | Integrated circuit package system with net spacer |
US20070244494A1 (en) * | 2006-04-18 | 2007-10-18 | Downing Stephen W | Methods and devices for treating atrial septal defects |
US20080027533A1 (en) * | 2006-04-19 | 2008-01-31 | Abbott Laboratories | Dedicated bifurcation stent apparatus and method |
US8808310B2 (en) | 2006-04-20 | 2014-08-19 | Integrated Vascular Systems, Inc. | Resettable clip applier and reset tools |
WO2007127802A2 (en) * | 2006-04-27 | 2007-11-08 | Wilfrido Castaneda | Methods and apparatus for extraluminal femoropoliteal bypass graft |
DE102006036649A1 (en) * | 2006-04-27 | 2007-10-31 | Biophan Europe Gmbh | Occluder for human or animal heart, has intermediate piece eccentrically connected with each closing body in edge area of bodies in closing condition, where occluder or its part forms electrical resonant oscillating circuit |
US20070265710A1 (en) * | 2006-05-10 | 2007-11-15 | Minnesota Medical Development | Method of making hernia patch and resulting product |
US20070270905A1 (en) * | 2006-05-18 | 2007-11-22 | Cook Incorporated | Patent foramen ovale closure device and method |
AU2007258592B2 (en) * | 2006-06-06 | 2012-10-25 | Cook Incorporated | Stent with a crush-resistant zone |
US7972361B2 (en) * | 2006-06-19 | 2011-07-05 | Cardia, Inc. | Occlusion device with flexible spring connector |
US7749238B2 (en) * | 2006-06-19 | 2010-07-06 | Cardia, Inc. | Occlusion device with flexible polymeric connector |
US7927351B2 (en) * | 2006-06-19 | 2011-04-19 | Cardia, Inc. | Occlusion device with flexible wire connector |
US7691115B2 (en) * | 2006-06-19 | 2010-04-06 | Cardia, Inc. | Occlusion device with flexible fabric connector |
US8556930B2 (en) | 2006-06-28 | 2013-10-15 | Abbott Laboratories | Vessel closure device |
USD611144S1 (en) | 2006-06-28 | 2010-03-02 | Abbott Laboratories | Apparatus for delivering a closure element |
US8870916B2 (en) | 2006-07-07 | 2014-10-28 | USGI Medical, Inc | Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use |
US8529597B2 (en) * | 2006-08-09 | 2013-09-10 | Coherex Medical, Inc. | Devices for reducing the size of an internal tissue opening |
US8864809B2 (en) | 2006-08-09 | 2014-10-21 | Coherex Medical, Inc. | Systems and devices for reducing the size of an internal tissue opening |
US9220487B2 (en) * | 2006-08-09 | 2015-12-29 | Coherex Medical, Inc. | Devices for reducing the size of an internal tissue opening |
EP2068759A4 (en) * | 2006-08-09 | 2013-04-10 | Coherex Medical Inc | Methods, systems and devices for reducing the size of an internal tissue opening |
EP1891902A1 (en) * | 2006-08-22 | 2008-02-27 | Carag AG | Occluding device |
US8676349B2 (en) | 2006-09-15 | 2014-03-18 | Cardiac Pacemakers, Inc. | Mechanism for releasably engaging an implantable medical device for implantation |
WO2008034077A2 (en) | 2006-09-15 | 2008-03-20 | Cardiac Pacemakers, Inc. | Anchor for an implantable sensor |
US20080071248A1 (en) * | 2006-09-15 | 2008-03-20 | Cardiac Pacemakers, Inc. | Delivery stystem for an implantable physiologic sensor |
WO2008036384A2 (en) * | 2006-09-21 | 2008-03-27 | Synecor, Llc | Stomach wall closure devices |
US20080077180A1 (en) * | 2006-09-26 | 2008-03-27 | Nmt Medical, Inc. | Scaffold for tubular septal occluder device and techniques for attachment |
DE102006050385A1 (en) * | 2006-10-05 | 2008-04-10 | pfm Produkte für die Medizin AG | Implantable mechanism for use in human and/or animal body for e.g. closing atrium septum defect, has partial piece that is folded back on another partial piece from primary form into secondary form of carrying structure |
US8029532B2 (en) * | 2006-10-11 | 2011-10-04 | Cook Medical Technologies Llc | Closure device with biomaterial patches |
US9232997B2 (en) | 2006-11-07 | 2016-01-12 | Corvia Medical, Inc. | Devices and methods for retrievable intra-atrial implants |
US10413284B2 (en) | 2006-11-07 | 2019-09-17 | Corvia Medical, Inc. | Atrial pressure regulation with control, sensing, monitoring and therapy delivery |
US10624621B2 (en) | 2006-11-07 | 2020-04-21 | Corvia Medical, Inc. | Devices and methods for the treatment of heart failure |
US20110257723A1 (en) | 2006-11-07 | 2011-10-20 | Dc Devices, Inc. | Devices and methods for coronary sinus pressure relief |
US8460372B2 (en) | 2006-11-07 | 2013-06-11 | Dc Devices, Inc. | Prosthesis for reducing intra-cardiac pressure having an embolic filter |
US20080167682A1 (en) * | 2007-01-09 | 2008-07-10 | Cardia, Inc. | Bioabsorbable occlusion device |
US8617205B2 (en) | 2007-02-01 | 2013-12-31 | Cook Medical Technologies Llc | Closure device |
WO2008094706A2 (en) * | 2007-02-01 | 2008-08-07 | Cook Incorporated | Closure device and method of closing a bodily opening |
US20080188892A1 (en) * | 2007-02-01 | 2008-08-07 | Cook Incorporated | Vascular occlusion device |
WO2008094691A2 (en) * | 2007-02-01 | 2008-08-07 | Cook Incorporated | Closure device and method for occluding a bodily passageway |
US8721679B2 (en) * | 2007-02-05 | 2014-05-13 | Boston Scientific Scimed, Inc. | Apparatus and method for closing an opening in a blood vessel using a permanent implant |
US8323296B2 (en) * | 2007-03-15 | 2012-12-04 | Boris Malyugin | Ring used in a small pupil phacoemulsification procedure |
US9918710B2 (en) * | 2007-03-15 | 2018-03-20 | Microsurgical Technology, Inc. | Expansion ring for eyeball tissue |
US20080228200A1 (en) * | 2007-03-16 | 2008-09-18 | Clinton Baird | Closure and reconstruction implants and the apparatus for delivery thereof |
US9005242B2 (en) | 2007-04-05 | 2015-04-14 | W.L. Gore & Associates, Inc. | Septal closure device with centering mechanism |
WO2008131167A1 (en) | 2007-04-18 | 2008-10-30 | Nmt Medical, Inc. | Flexible catheter system |
US8204599B2 (en) | 2007-05-02 | 2012-06-19 | Cardiac Pacemakers, Inc. | System for anchoring an implantable sensor in a vessel |
US8915958B2 (en) * | 2007-06-08 | 2014-12-23 | St. Jude Medical, Inc. | Devices for transcatheter prosthetic heart valve implantation and access closure |
EP2162185B1 (en) | 2007-06-14 | 2015-07-01 | Cardiac Pacemakers, Inc. | Multi-element acoustic recharging system |
US8574244B2 (en) | 2007-06-25 | 2013-11-05 | Abbott Laboratories | System for closing a puncture in a vessel wall |
US8226681B2 (en) | 2007-06-25 | 2012-07-24 | Abbott Laboratories | Methods, devices, and apparatus for managing access through tissue |
US8821507B2 (en) * | 2007-07-06 | 2014-09-02 | Howmedica Osteonics Corp. | Augmentation delivery device |
US8034061B2 (en) | 2007-07-12 | 2011-10-11 | Aga Medical Corporation | Percutaneous catheter directed intravascular occlusion devices |
US8906059B2 (en) | 2007-07-13 | 2014-12-09 | Rex Medical, L.P. | Vascular hole closure device |
US20090112251A1 (en) * | 2007-07-25 | 2009-04-30 | Aga Medical Corporation | Braided occlusion device having repeating expanded volume segments separated by articulation segments |
US8361138B2 (en) * | 2007-07-25 | 2013-01-29 | Aga Medical Corporation | Braided occlusion device having repeating expanded volume segments separated by articulation segments |
US20130197546A1 (en) | 2007-08-02 | 2013-08-01 | Bioconnect Systems, Inc. | Implantable flow connector |
WO2009018583A1 (en) | 2007-08-02 | 2009-02-05 | Bio Connect Systems | Implantable flow connector |
US8308752B2 (en) * | 2007-08-27 | 2012-11-13 | Cook Medical Technologies Llc | Barrel occlusion device |
US8734483B2 (en) * | 2007-08-27 | 2014-05-27 | Cook Medical Technologies Llc | Spider PFO closure device |
US8025495B2 (en) * | 2007-08-27 | 2011-09-27 | Cook Medical Technologies Llc | Apparatus and method for making a spider occlusion device |
US20090062838A1 (en) * | 2007-08-27 | 2009-03-05 | Cook Incorporated | Spider device with occlusive barrier |
US7771455B2 (en) * | 2007-08-31 | 2010-08-10 | Ken Christopher G M | Closure medical device |
US8366741B2 (en) | 2007-09-13 | 2013-02-05 | Cardia, Inc. | Occlusion device with centering arm |
US20090082803A1 (en) | 2007-09-26 | 2009-03-26 | Aga Medical Corporation | Braided vascular devices having no end clamps |
US7875054B2 (en) * | 2007-10-01 | 2011-01-25 | Boston Scientific Scimed, Inc. | Connective tissue closure device and method |
US8043301B2 (en) | 2007-10-12 | 2011-10-25 | Spiration, Inc. | Valve loader method, system, and apparatus |
EP2194933B1 (en) | 2007-10-12 | 2016-05-04 | Spiration, Inc. | Valve loader method, system, and apparatus |
WO2009052432A2 (en) | 2007-10-19 | 2009-04-23 | Coherex Medical, Inc. | Medical device for modification of left atrial appendange and related systems and methods |
US20090112311A1 (en) * | 2007-10-19 | 2009-04-30 | Coherex Medical, Inc. | Medical device for percutaneous paravalvular leak and related systems and methods |
US20090118745A1 (en) * | 2007-11-06 | 2009-05-07 | Cook Incorporated | Patent foramen ovale closure apparatus and method |
US9492149B2 (en) * | 2007-11-13 | 2016-11-15 | Cook Biotech Incorporated | Fistula grafts and related methods and systems useful for treating gastrointestinal and other fistulae |
US9308068B2 (en) | 2007-12-03 | 2016-04-12 | Sofradim Production | Implant for parastomal hernia |
US20090157101A1 (en) | 2007-12-17 | 2009-06-18 | Abbott Laboratories | Tissue closure system and methods of use |
US8893947B2 (en) | 2007-12-17 | 2014-11-25 | Abbott Laboratories | Clip applier and methods of use |
US7841502B2 (en) | 2007-12-18 | 2010-11-30 | Abbott Laboratories | Modular clip applier |
US20090171386A1 (en) | 2007-12-28 | 2009-07-02 | Aga Medical Corporation | Percutaneous catheter directed intravascular occlusion devices |
US8070772B2 (en) | 2008-02-15 | 2011-12-06 | Rex Medical, L.P. | Vascular hole closure device |
US9226738B2 (en) | 2008-02-15 | 2016-01-05 | Rex Medical, L.P. | Vascular hole closure delivery device |
US20110029013A1 (en) | 2008-02-15 | 2011-02-03 | Mcguckin James F | Vascular Hole Closure Device |
US8920462B2 (en) | 2008-02-15 | 2014-12-30 | Rex Medical, L.P. | Vascular hole closure device |
US8491629B2 (en) | 2008-02-15 | 2013-07-23 | Rex Medical | Vascular hole closure delivery device |
US8920463B2 (en) | 2008-02-15 | 2014-12-30 | Rex Medical, L.P. | Vascular hole closure device |
US20130165967A1 (en) | 2008-03-07 | 2013-06-27 | W.L. Gore & Associates, Inc. | Heart occlusion devices |
US8177836B2 (en) | 2008-03-10 | 2012-05-15 | Medtronic, Inc. | Apparatus and methods for minimally invasive valve repair |
WO2009121001A1 (en) * | 2008-03-28 | 2009-10-01 | Coherex Medical, Inc. | Delivery systems for a medical device and related methods |
US20090264920A1 (en) * | 2008-03-31 | 2009-10-22 | Alejandro Berenstein | Catheter-based septal occlusion device and adhesive delivery system |
CA2720206C (en) * | 2008-04-04 | 2016-10-04 | Curaseal, Inc. | Implantable fistula closure device |
US20110160765A1 (en) * | 2008-04-11 | 2011-06-30 | Cedars-Sinai Medical Center | Methods and devices for treatment of fistulas |
CA2721950A1 (en) | 2008-04-25 | 2009-10-29 | Nellix, Inc. | Stent graft delivery system |
EP2113208A3 (en) * | 2008-05-02 | 2010-01-20 | Fujifilm Corporation | Multiple clip device and multiple clip application apparatus |
US20110184439A1 (en) * | 2008-05-09 | 2011-07-28 | University Of Pittsburgh-Of The Commonwealth System Of Higher Education | Biological Matrix for Cardiac Repair |
US9282965B2 (en) | 2008-05-16 | 2016-03-15 | Abbott Laboratories | Apparatus and methods for engaging tissue |
AU2009256084A1 (en) | 2008-06-04 | 2009-12-10 | Nellix, Inc. | Sealing apparatus and methods of use |
WO2009149474A1 (en) | 2008-06-06 | 2009-12-10 | Vital Access Corporation | Tissue management methods, apparatus, and systems |
US9242026B2 (en) | 2008-06-27 | 2016-01-26 | Sofradim Production | Biosynthetic implant for soft tissue repair |
JP5362828B2 (en) | 2008-07-15 | 2013-12-11 | カーディアック ペースメイカーズ, インコーポレイテッド | Implant assist for an acoustically enabled implantable medical device |
WO2010022060A1 (en) | 2008-08-19 | 2010-02-25 | Wilson-Cook Medical Inc. | Apparatus for removing lymph nodes or anchoring into tissue during a translumenal procedure |
AU2009282868B2 (en) | 2008-08-19 | 2013-09-05 | Covidien Lp | Detachable tip microcatheter |
CA2736836C (en) * | 2008-08-29 | 2013-11-12 | Wilson-Cook Medical Inc. | Stapling device for closing perforations |
EP2330985A4 (en) * | 2008-09-04 | 2015-11-18 | Curaseal Inc | Inflatable devices for enteric fistula treatment |
US8388650B2 (en) | 2008-09-05 | 2013-03-05 | Pulsar Vascular, Inc. | Systems and methods for supporting or occluding a physiological opening or cavity |
WO2010026429A2 (en) * | 2008-09-05 | 2010-03-11 | Papworth Hospital Nhs Foundation Trust | Sutureless connector |
US8192461B2 (en) | 2008-09-11 | 2012-06-05 | Cook Medical Technologies Llc | Methods for facilitating closure of a bodily opening using one or more tacking devices |
WO2010030778A1 (en) * | 2008-09-11 | 2010-03-18 | Wilson-Cook Medical Inc. | Methods for achieving serosa-to-serosa closure of a bodily opening using one or more tacking devices |
EP2344049B1 (en) | 2008-10-03 | 2021-01-27 | C.R.Bard, Inc. | Implantable prosthesis |
US8398676B2 (en) | 2008-10-30 | 2013-03-19 | Abbott Vascular Inc. | Closure device |
US8940015B2 (en) * | 2008-11-11 | 2015-01-27 | Aga Medical Corporation | Asymmetrical medical devices for treating a target site and associated method |
JP5724134B2 (en) | 2008-12-09 | 2015-05-27 | クック・メディカル・テクノロジーズ・リミテッド・ライアビリティ・カンパニーCook Medical Technologies Llc | Retractable anchoring device |
WO2010080386A2 (en) | 2008-12-19 | 2010-07-15 | Wilson-Cook Medical Inc. | Clip devices and methods of delivery and deployment |
US8323312B2 (en) | 2008-12-22 | 2012-12-04 | Abbott Laboratories | Closure device |
US8858594B2 (en) | 2008-12-22 | 2014-10-14 | Abbott Laboratories | Curved closure device |
US8748508B2 (en) * | 2008-12-29 | 2014-06-10 | DePuy Synthes Products, LLC | Method of forming and the resulting membrane composition for surgical site preservation |
WO2010081033A1 (en) | 2009-01-08 | 2010-07-15 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9486191B2 (en) | 2009-01-09 | 2016-11-08 | Abbott Vascular, Inc. | Closure devices |
US20100179589A1 (en) | 2009-01-09 | 2010-07-15 | Abbott Vascular Inc. | Rapidly eroding anchor |
US9173644B2 (en) | 2009-01-09 | 2015-11-03 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US9414820B2 (en) | 2009-01-09 | 2016-08-16 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US9089311B2 (en) | 2009-01-09 | 2015-07-28 | Abbott Vascular Inc. | Vessel closure devices and methods |
US20100185234A1 (en) | 2009-01-16 | 2010-07-22 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US11197952B2 (en) | 2009-01-29 | 2021-12-14 | Advent Access Pte. Ltd. | Vascular access ports and related methods |
WO2010088532A1 (en) | 2009-01-29 | 2010-08-05 | Vital Access Corporation | Vascular access ports and related methods |
US9179901B2 (en) | 2009-01-29 | 2015-11-10 | Vital Access Corporation | Vascular access ports and related methods |
US8694129B2 (en) | 2009-02-13 | 2014-04-08 | Cardiac Pacemakers, Inc. | Deployable sensor platform on the lead system of an implantable device |
US8556990B2 (en) * | 2009-02-23 | 2013-10-15 | Barry K. Bartee | Reinforced PTFE medical barriers |
US8518060B2 (en) | 2009-04-09 | 2013-08-27 | Medtronic, Inc. | Medical clip with radial tines, system and method of using same |
CN102596083B (en) * | 2009-04-15 | 2016-11-16 | 微排放器公司 | Implant delivery system |
US8668704B2 (en) | 2009-04-24 | 2014-03-11 | Medtronic, Inc. | Medical clip with tines, system and method of using same |
US9034034B2 (en) | 2010-12-22 | 2015-05-19 | V-Wave Ltd. | Devices for reducing left atrial pressure, and methods of making and using same |
US10076403B1 (en) | 2009-05-04 | 2018-09-18 | V-Wave Ltd. | Shunt for redistributing atrial blood volume |
US20210161637A1 (en) | 2009-05-04 | 2021-06-03 | V-Wave Ltd. | Shunt for redistributing atrial blood volume |
EP2427143B1 (en) | 2009-05-04 | 2017-08-02 | V-Wave Ltd. | Device for regulating pressure in a heart chamber |
CA2763133A1 (en) | 2009-05-28 | 2010-12-02 | Cook Medical Technologies Llc | Tacking device and methods of deployment |
WO2010139771A2 (en) * | 2009-06-03 | 2010-12-09 | Symetis Sa | Closure device and methods and systems for using same |
US9883864B2 (en) * | 2009-06-17 | 2018-02-06 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9693781B2 (en) | 2009-06-17 | 2017-07-04 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9351716B2 (en) | 2009-06-17 | 2016-05-31 | Coherex Medical, Inc. | Medical device and delivery system for modification of left atrial appendage and methods thereof |
US10064628B2 (en) | 2009-06-17 | 2018-09-04 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9649115B2 (en) | 2009-06-17 | 2017-05-16 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US10631969B2 (en) | 2009-06-17 | 2020-04-28 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9381006B2 (en) * | 2009-06-22 | 2016-07-05 | W. L. Gore & Associates, Inc. | Sealing device and delivery system |
US9636094B2 (en) * | 2009-06-22 | 2017-05-02 | W. L. Gore & Associates, Inc. | Sealing device and delivery system |
US20120029556A1 (en) | 2009-06-22 | 2012-02-02 | Masters Steven J | Sealing device and delivery system |
US20110054492A1 (en) | 2009-08-26 | 2011-03-03 | Abbott Laboratories | Medical device for repairing a fistula |
US9757107B2 (en) | 2009-09-04 | 2017-09-12 | Corvia Medical, Inc. | Methods and devices for intra-atrial shunts having adjustable sizes |
KR101788338B1 (en) | 2009-09-04 | 2017-10-19 | 펄사 배스큘라, 아이엔씨. | Systems and methods for enclosing an anatomical opening |
FR2949688B1 (en) | 2009-09-04 | 2012-08-24 | Sofradim Production | FABRIC WITH PICOTS COATED WITH A BIORESORBABLE MICROPOROUS LAYER |
EP2496189A4 (en) | 2009-11-04 | 2016-05-11 | Nitinol Devices And Components Inc | Alternating circumferential bridge stent design and methods for use thereof |
US9649211B2 (en) | 2009-11-04 | 2017-05-16 | Confluent Medical Technologies, Inc. | Alternating circumferential bridge stent design and methods for use thereof |
US20110276078A1 (en) | 2009-12-30 | 2011-11-10 | Nellix, Inc. | Filling structure for a graft system and methods of use |
EP2528646A4 (en) | 2010-01-29 | 2017-06-28 | DC Devices, Inc. | Devices and systems for treating heart failure |
CA2785041A1 (en) | 2010-01-29 | 2011-08-04 | Dc Devices, Inc. | Devices and methods for reducing venous pressure |
US8500776B2 (en) * | 2010-02-08 | 2013-08-06 | Covidien Lp | Vacuum patch for rapid wound closure |
US8303624B2 (en) | 2010-03-15 | 2012-11-06 | Abbott Cardiovascular Systems, Inc. | Bioabsorbable plug |
KR20130054952A (en) | 2010-04-14 | 2013-05-27 | 마이크로벤션, 인코포레이티드 | Implant delivery device |
US20120109190A1 (en) * | 2010-05-06 | 2012-05-03 | Cvdevices, Llc (A California Limited Liability Company) | Devices, systems, and methods for closing an aperture in a bodily tissue |
US20110288533A1 (en) * | 2010-05-20 | 2011-11-24 | Bipore Medical Devices, Inc. | Tip Controllable Guidewire Device |
US8758399B2 (en) | 2010-08-02 | 2014-06-24 | Abbott Cardiovascular Systems, Inc. | Expandable bioabsorbable plug apparatus and method |
US8603116B2 (en) | 2010-08-04 | 2013-12-10 | Abbott Cardiovascular Systems, Inc. | Closure device with long tines |
US8663252B2 (en) | 2010-09-01 | 2014-03-04 | Abbott Cardiovascular Systems, Inc. | Suturing devices and methods |
US9370353B2 (en) | 2010-09-01 | 2016-06-21 | Abbott Cardiovascular Systems, Inc. | Suturing devices and methods |
CN101933850B (en) * | 2010-09-16 | 2012-07-18 | 先健科技(深圳)有限公司 | Stopper and manufacturing method thereof |
EP2627265B8 (en) | 2010-10-15 | 2019-02-20 | Cook Medical Technologies LLC | Occlusion device for blocking fluid flow through bodily passages |
US8489649B2 (en) | 2010-12-13 | 2013-07-16 | Oracle International Corporation | Extensible RDF databases |
US10076339B2 (en) | 2011-01-11 | 2018-09-18 | Amsel Medical Corporation | Method and apparatus for clamping tissue layers and occluding tubular body lumens |
US10820895B2 (en) | 2011-01-11 | 2020-11-03 | Amsel Medical Corporation | Methods and apparatus for fastening and clamping tissue |
WO2015134768A1 (en) | 2011-01-11 | 2015-09-11 | Amsel Medical Corporation | Method and apparatus for occluding a blood vessel and/or other tubular structures |
WO2012097086A1 (en) * | 2011-01-11 | 2012-07-19 | Amsel Medical Corporation | Method and apparatus for treating varicose veins |
US10398445B2 (en) | 2011-01-11 | 2019-09-03 | Amsel Medical Corporation | Method and apparatus for clamping tissue layers and occluding tubular body structures |
US8801768B2 (en) | 2011-01-21 | 2014-08-12 | Endologix, Inc. | Graft systems having semi-permeable filling structures and methods for their use |
US8608775B2 (en) | 2011-01-24 | 2013-12-17 | Covidien Lp | Two part tape adhesive for wound closure |
EP2673038B1 (en) | 2011-02-10 | 2017-07-19 | Corvia Medical, Inc. | Apparatus to create and maintain an intra-atrial pressure relief opening |
US8617184B2 (en) | 2011-02-15 | 2013-12-31 | Abbott Cardiovascular Systems, Inc. | Vessel closure system |
ITVI20110040A1 (en) * | 2011-03-03 | 2012-09-04 | Paolo Magagna | CLOSING DEVICE FOR PERFORATED FABRICS OF THE HUMAN BODY. |
AU2012225575B9 (en) | 2011-03-08 | 2015-08-20 | W. L. Gore & Associates, Inc. | Medical device for use with a stoma |
FR2972626B1 (en) | 2011-03-16 | 2014-04-11 | Sofradim Production | PROSTHETIC COMPRISING A THREE-DIMENSIONAL KNIT AND ADJUSTED |
US9149276B2 (en) | 2011-03-21 | 2015-10-06 | Abbott Cardiovascular Systems, Inc. | Clip and deployment apparatus for tissue closure |
US10201336B2 (en) | 2011-03-25 | 2019-02-12 | St. Jude Medical, Cardiology Division, Inc. | Device and method for delivering a vascular device |
US8821529B2 (en) | 2011-03-25 | 2014-09-02 | Aga Medical Corporation | Device and method for occluding a septal defect |
JP5976777B2 (en) | 2011-04-06 | 2016-08-24 | エンドーロジックス インコーポレイテッド | Methods and systems for the treatment of intravascular aneurysms |
US8795241B2 (en) | 2011-05-13 | 2014-08-05 | Spiration, Inc. | Deployment catheter |
US8556932B2 (en) | 2011-05-19 | 2013-10-15 | Abbott Cardiovascular Systems, Inc. | Collapsible plug for tissue closure |
WO2012167156A1 (en) | 2011-06-03 | 2012-12-06 | Pulsar Vascular, Inc. | Aneurysm devices with additional anchoring mechanisms and associated systems and methods |
KR102019025B1 (en) | 2011-06-03 | 2019-09-06 | 펄사 배스큘라, 아이엔씨. | Systems and methods for enclosing an anatomical opening, including shock absorbing aneurysm devices |
CN103874466B (en) | 2011-06-16 | 2016-10-05 | 库拉希尔公司 | Device and correlation technique for fistula treatment |
US9131941B2 (en) | 2011-06-17 | 2015-09-15 | Curaseal Inc. | Fistula treatment devices and methods |
FR2977789B1 (en) | 2011-07-13 | 2013-07-19 | Sofradim Production | PROSTHETIC FOR UMBILIC HERNIA |
FR2977790B1 (en) | 2011-07-13 | 2013-07-19 | Sofradim Production | PROSTHETIC FOR UMBILIC HERNIA |
US9629715B2 (en) | 2011-07-28 | 2017-04-25 | V-Wave Ltd. | Devices for reducing left atrial pressure having biodegradable constriction, and methods of making and using same |
US11135054B2 (en) | 2011-07-28 | 2021-10-05 | V-Wave Ltd. | Interatrial shunts having biodegradable material, and methods of making and using same |
US9770232B2 (en) | 2011-08-12 | 2017-09-26 | W. L. Gore & Associates, Inc. | Heart occlusion devices |
US9011468B2 (en) | 2011-09-13 | 2015-04-21 | Abbott Cardiovascular Systems Inc. | Independent gripper |
US8945177B2 (en) | 2011-09-13 | 2015-02-03 | Abbott Cardiovascular Systems Inc. | Gripper pusher mechanism for tissue apposition systems |
WO2013046058A2 (en) | 2011-09-30 | 2013-04-04 | Sofradim Production | Reversible stiffening of light weight mesh |
ES2809210T3 (en) | 2011-10-05 | 2021-03-03 | Pulsar Vascular Inc | Systems and devices for wrapping an anatomical opening |
CA2855003C (en) | 2011-11-08 | 2019-01-15 | Boston Scientific Scimed, Inc. | Handle assembly for a left atrial appendage occlusion device |
US9332976B2 (en) | 2011-11-30 | 2016-05-10 | Abbott Cardiovascular Systems, Inc. | Tissue closure device |
WO2013096965A1 (en) | 2011-12-22 | 2013-06-27 | Dc Devices, Inc. | Methods and devices for intra-atrial devices having selectable flow rates |
FR2985170B1 (en) | 2011-12-29 | 2014-01-24 | Sofradim Production | PROSTHESIS FOR INGUINAL HERNIA |
FR2985271B1 (en) | 2011-12-29 | 2014-01-24 | Sofradim Production | KNITTED PICOTS |
JP6178339B2 (en) * | 2012-01-17 | 2017-08-09 | スパイレーション インコーポレイテッド | System and method for treating lung and tracheal sputum |
WO2013112944A1 (en) | 2012-01-26 | 2013-08-01 | Endoshape, Inc. | Systems, devices, and methods for delivering a lumen occlusion device using distal and/or proximal control |
US9005155B2 (en) | 2012-02-03 | 2015-04-14 | Dc Devices, Inc. | Devices and methods for treating heart failure |
US10940167B2 (en) | 2012-02-10 | 2021-03-09 | Cvdevices, Llc | Methods and uses of biological tissues for various stent and other medical applications |
US9821145B2 (en) | 2012-03-23 | 2017-11-21 | Pressure Products Medical Supplies Inc. | Transseptal puncture apparatus and method for using the same |
US9173752B2 (en) | 2012-05-21 | 2015-11-03 | Manli International Ltd. | Coil bioabsorbable bifurcation stent |
US8864778B2 (en) | 2012-04-10 | 2014-10-21 | Abbott Cardiovascular Systems, Inc. | Apparatus and method for suturing body lumens |
US8858573B2 (en) | 2012-04-10 | 2014-10-14 | Abbott Cardiovascular Systems, Inc. | Apparatus and method for suturing body lumens |
US9314600B2 (en) | 2012-04-15 | 2016-04-19 | Bioconnect Systems, Inc. | Delivery system for implantable flow connector |
US10434293B2 (en) | 2012-04-15 | 2019-10-08 | Tva Medical, Inc. | Implantable flow connector |
US9265514B2 (en) | 2012-04-17 | 2016-02-23 | Miteas Ltd. | Manipulator for grasping tissue |
US10588611B2 (en) | 2012-04-19 | 2020-03-17 | Corvia Medical Inc. | Implant retention attachment and method of use |
JP6411331B2 (en) | 2012-05-10 | 2018-10-24 | パルサー バスキュラー インコーポレイテッド | Aneurysm device with coil |
US9241707B2 (en) | 2012-05-31 | 2016-01-26 | Abbott Cardiovascular Systems, Inc. | Systems, methods, and devices for closing holes in body lumens |
US10124087B2 (en) | 2012-06-19 | 2018-11-13 | Covidien Lp | Detachable coupling for catheter |
US9649480B2 (en) | 2012-07-06 | 2017-05-16 | Corvia Medical, Inc. | Devices and methods of treating or ameliorating diastolic heart failure through pulmonary valve intervention |
FR2994185B1 (en) | 2012-08-02 | 2015-07-31 | Sofradim Production | PROCESS FOR THE PREPARATION OF A POROUS CHITOSAN LAYER |
FR2995788B1 (en) | 2012-09-25 | 2014-09-26 | Sofradim Production | HEMOSTATIC PATCH AND PREPARATION METHOD |
FR2995779B1 (en) | 2012-09-25 | 2015-09-25 | Sofradim Production | PROSTHETIC COMPRISING A TREILLIS AND A MEANS OF CONSOLIDATION |
FR2995778B1 (en) | 2012-09-25 | 2015-06-26 | Sofradim Production | ABDOMINAL WALL REINFORCING PROSTHESIS AND METHOD FOR MANUFACTURING THE SAME |
AU2013322268B2 (en) | 2012-09-28 | 2017-08-31 | Sofradim Production | Packaging for a hernia repair device |
US9757106B2 (en) | 2012-12-03 | 2017-09-12 | Cook Medical Technologies Llc | Degradable expanding closure plug |
US9364209B2 (en) | 2012-12-21 | 2016-06-14 | Abbott Cardiovascular Systems, Inc. | Articulating suturing device |
EP2943131B1 (en) * | 2013-01-09 | 2019-07-17 | Cook Medical Technologies LLC | Abdominal retractor |
US10828019B2 (en) | 2013-01-18 | 2020-11-10 | W.L. Gore & Associates, Inc. | Sealing device and delivery system |
AU2014214700B2 (en) | 2013-02-11 | 2018-01-18 | Cook Medical Technologies Llc | Expandable support frame and medical device |
US9775636B2 (en) | 2013-03-12 | 2017-10-03 | Corvia Medical, Inc. | Devices, systems, and methods for treating heart failure |
US9289536B2 (en) | 2013-03-14 | 2016-03-22 | Endologix, Inc. | Method for forming materials in situ within a medical device |
EP2999412B1 (en) | 2013-05-21 | 2020-05-06 | V-Wave Ltd. | Apparatus for delivering devices for reducing left atrial pressure |
FR3006581B1 (en) | 2013-06-07 | 2016-07-22 | Sofradim Production | PROSTHESIS BASED ON TEXTILE FOR LAPAROSCOPIC PATHWAY |
FR3006578B1 (en) | 2013-06-07 | 2015-05-29 | Sofradim Production | PROSTHESIS BASED ON TEXTILE FOR LAPAROSCOPIC PATHWAY |
WO2014147605A2 (en) * | 2013-10-29 | 2014-09-25 | Amit Mishra | A device and method for closure of apical muscular ventricular septal defects |
US9730701B2 (en) | 2014-01-16 | 2017-08-15 | Boston Scientific Scimed, Inc. | Retrieval wire centering device |
US20150238194A1 (en) * | 2014-02-24 | 2015-08-27 | Boston Scientific Scimed, Inc. | Hemostasis devices and methods utilizing mechanical methods |
US10675450B2 (en) | 2014-03-12 | 2020-06-09 | Corvia Medical, Inc. | Devices and methods for treating heart failure |
WO2017185082A1 (en) | 2016-04-23 | 2017-10-26 | Nasser Rafiee | Devices and methods for closure of transvascular or transcameral access ports |
US10363040B2 (en) | 2014-05-02 | 2019-07-30 | W. L. Gore & Associates, Inc. | Anastomosis devices |
US11712230B2 (en) | 2014-05-02 | 2023-08-01 | W. L. Gore & Associates, Inc. | Occluder and anastomosis devices |
US9808230B2 (en) | 2014-06-06 | 2017-11-07 | W. L. Gore & Associates, Inc. | Sealing device and delivery system |
US10307150B2 (en) * | 2014-06-26 | 2019-06-04 | The Regents Of The University Of Colorado, A Body Corporate | Ocular tissue expansion ring |
JP6799526B2 (en) | 2014-07-23 | 2020-12-16 | コルヴィア メディカル インコーポレイテッド | Equipment and methods for the treatment of heart failure |
EP3000432B1 (en) | 2014-09-29 | 2022-05-04 | Sofradim Production | Textile-based prosthesis for treatment of inguinal hernia |
EP3000433B1 (en) | 2014-09-29 | 2022-09-21 | Sofradim Production | Device for introducing a prosthesis for hernia treatment into an incision and flexible textile based prosthesis |
EP3029189B1 (en) | 2014-12-05 | 2021-08-11 | Sofradim Production | Prosthetic porous knit, method of making same and hernia prosthesis |
US10188392B2 (en) | 2014-12-19 | 2019-01-29 | Abbott Cardiovascular Systems, Inc. | Grasping for tissue repair |
EP3059255B1 (en) | 2015-02-17 | 2020-05-13 | Sofradim Production | Method for preparing a chitosan-based matrix comprising a fiber reinforcement member |
US10524912B2 (en) | 2015-04-02 | 2020-01-07 | Abbott Cardiovascular Systems, Inc. | Tissue fixation devices and methods |
EP3085337B1 (en) | 2015-04-24 | 2022-09-14 | Sofradim Production | Prosthesis for supporting a breast structure |
WO2016178171A1 (en) | 2015-05-07 | 2016-11-10 | The Medical Research Infrastructure And Health Services Fund Of The Tel-Aviv Medical Center | Temporary interatrial shunts |
US9757574B2 (en) | 2015-05-11 | 2017-09-12 | Rainbow Medical Ltd. | Dual chamber transvenous pacemaker |
ES2676072T3 (en) | 2015-06-19 | 2018-07-16 | Sofradim Production | Synthetic prosthesis comprising a knitted fabric and a non-porous film and method of forming it |
US20170014604A1 (en) * | 2015-07-16 | 2017-01-19 | Francis Y. Falck, Jr. | Iris Dilator |
CN108882941B (en) | 2015-11-13 | 2021-08-24 | 心脏起搏器公司 | Bioabsorbable left atrial appendage closure with endothelialization-promoting surface |
EP3195830B1 (en) | 2016-01-25 | 2020-11-18 | Sofradim Production | Prosthesis for hernia repair |
JP7144404B2 (en) | 2016-05-26 | 2022-09-29 | ナノストラクチャーズ・インコーポレイテッド | Systems and methods for embolic embolization of neural aneurysms |
US20170340460A1 (en) | 2016-05-31 | 2017-11-30 | V-Wave Ltd. | Systems and methods for making encapsulated hourglass shaped stents |
US10835394B2 (en) | 2016-05-31 | 2020-11-17 | V-Wave, Ltd. | Systems and methods for making encapsulated hourglass shaped stents |
WO2018053314A1 (en) | 2016-09-16 | 2018-03-22 | Greg Mirigian | Occlusive implants with fiber-based release structures |
EP3312325B1 (en) | 2016-10-21 | 2021-09-22 | Sofradim Production | Method for forming a mesh having a barbed suture attached thereto and the mesh thus obtained |
US10426449B2 (en) | 2017-02-16 | 2019-10-01 | Abbott Cardiovascular Systems, Inc. | Articulating suturing device with improved actuation and alignment mechanisms |
WO2018158747A1 (en) | 2017-03-03 | 2018-09-07 | V-Wave Ltd. | Shunt for redistributing atrial blood volume |
US11291807B2 (en) | 2017-03-03 | 2022-04-05 | V-Wave Ltd. | Asymmetric shunt for redistributing atrial blood volume |
US11724075B2 (en) | 2017-04-18 | 2023-08-15 | W. L. Gore & Associates, Inc. | Deployment constraining sheath that enables staged deployment by device section |
CN110831520B (en) | 2017-04-27 | 2022-11-15 | 波士顿科学国际有限公司 | Occlusive medical devices with fabric retention barbs |
EP3398554A1 (en) | 2017-05-02 | 2018-11-07 | Sofradim Production | Prosthesis for inguinal hernia repair |
US10441258B2 (en) | 2017-06-16 | 2019-10-15 | Cardia, Inc. | Uncoupled LAA device |
US10993807B2 (en) | 2017-11-16 | 2021-05-04 | Medtronic Vascular, Inc. | Systems and methods for percutaneously supporting and manipulating a septal wall |
US10952741B2 (en) | 2017-12-18 | 2021-03-23 | Boston Scientific Scimed, Inc. | Occlusive device with expandable member |
WO2019144072A1 (en) | 2018-01-19 | 2019-07-25 | Boston Scientific Scimed, Inc. | Occlusive medical device with delivery system |
WO2019142152A1 (en) | 2018-01-20 | 2019-07-25 | V-Wave Ltd. | Devices and methods for providing passage between heart chambers |
US10898698B1 (en) | 2020-05-04 | 2021-01-26 | V-Wave Ltd. | Devices with dimensions that can be reduced and increased in vivo, and methods of making and using the same |
US11458287B2 (en) | 2018-01-20 | 2022-10-04 | V-Wave Ltd. | Devices with dimensions that can be reduced and increased in vivo, and methods of making and using the same |
EP3745965A4 (en) | 2018-01-31 | 2021-10-27 | Nanostructures, Inc. | Vascular occlusion devices utilizing thin film nitinol foils |
US11331104B2 (en) | 2018-05-02 | 2022-05-17 | Boston Scientific Scimed, Inc. | Occlusive sealing sensor system |
EP3793450A1 (en) | 2018-05-15 | 2021-03-24 | Boston Scientific Scimed, Inc. | Occlusive medical device with charged polymer coating |
US11672541B2 (en) | 2018-06-08 | 2023-06-13 | Boston Scientific Scimed, Inc. | Medical device with occlusive member |
WO2019237022A1 (en) | 2018-06-08 | 2019-12-12 | Boston Scientific Scimed, Inc. | Occlusive device with actuatable fixation members |
US11382635B2 (en) | 2018-07-06 | 2022-07-12 | Boston Scientific Scimed, Inc. | Occlusive medical device |
AU2019308262B2 (en) * | 2018-07-18 | 2022-08-04 | W. L. Gore & Associates, Inc. | Medical devices for shunts, occluders, fenestrations and related systems and methods |
CN112714632A (en) | 2018-08-21 | 2021-04-27 | 波士顿科学医学有限公司 | Barbed protruding member for cardiovascular devices |
EP3653171A1 (en) | 2018-11-16 | 2020-05-20 | Sofradim Production | Implants suitable for soft tissue repair |
US20200196944A1 (en) | 2018-12-21 | 2020-06-25 | W. L. Gore & Associates, Inc. | Implantable cardiac sensors |
US11504105B2 (en) | 2019-01-25 | 2022-11-22 | Rex Medical L.P. | Vascular hole closure device |
US11759101B2 (en) * | 2019-03-15 | 2023-09-19 | Modern Surgical Solutions Llc | Retractor for vaginal repair |
US11612385B2 (en) | 2019-04-03 | 2023-03-28 | V-Wave Ltd. | Systems and methods for delivering implantable devices across an atrial septum |
EP3972499A1 (en) | 2019-05-20 | 2022-03-30 | V-Wave Ltd. | Systems and methods for creating an interatrial shunt |
US11534303B2 (en) | 2020-04-09 | 2022-12-27 | Evalve, Inc. | Devices and systems for accessing and repairing a heart valve |
US11369355B2 (en) | 2019-06-17 | 2022-06-28 | Coherex Medical, Inc. | Medical device and system for occluding a tissue opening and method thereof |
WO2021011531A1 (en) | 2019-07-15 | 2021-01-21 | Evalve, Inc. | Wide clip with nondeformable wings |
CA3147410A1 (en) | 2019-07-15 | 2021-01-21 | Evalve, Inc. | Proximal element actuator fixation and release mechanisms |
EP3998962A1 (en) | 2019-07-17 | 2022-05-25 | Boston Scientific Scimed, Inc. | Left atrial appendage implant with continuous covering |
EP3986284A1 (en) | 2019-08-30 | 2022-04-27 | Boston Scientific Scimed, Inc. | Left atrial appendage implant with sealing disk |
US11707228B2 (en) | 2019-09-26 | 2023-07-25 | Evalve, Inc. | Systems and methods for intra-procedural cardiac pressure monitoring |
WO2021072209A1 (en) | 2019-10-11 | 2021-04-15 | Evalve, Inc. | Repair clip for variable tissue thickness |
US11622859B2 (en) | 2019-11-08 | 2023-04-11 | Evalve, Inc. | Medical device delivery system with locking system |
US11701229B2 (en) | 2019-11-14 | 2023-07-18 | Evalve, Inc. | Kit with coaptation aid and fixation system and methods for valve repair |
WO2021097124A1 (en) | 2019-11-14 | 2021-05-20 | Evalve, Inc. | Catheter assembly with coaptation aid and methods for valve repair |
AU2021207486B2 (en) * | 2020-01-17 | 2024-03-28 | W. L. Gore & Associates, Inc. | Medical implant comprising two frame components and pairs of eyelets |
WO2021151026A1 (en) * | 2020-01-24 | 2021-07-29 | PatchClamp Medtech, Inc. | Tissue repair and sealing devices having a detachable graft and clasp assembly and methods for the use thereof |
US11903589B2 (en) | 2020-03-24 | 2024-02-20 | Boston Scientific Scimed, Inc. | Medical system for treating a left atrial appendage |
EP3912563A3 (en) * | 2020-05-21 | 2022-01-26 | St. Jude Medical, Cardiology Division, Inc. | Biomaterial occluder delivery mechanism |
US11801369B2 (en) | 2020-08-25 | 2023-10-31 | Shifamed Holdings, Llc | Adjustable interatrial shunts and associated systems and methods |
US20220110735A1 (en) * | 2020-10-14 | 2022-04-14 | Jenkins NeuroSpine LLC | Surgical Implant For Repairing A Defect In Spinal Dura Mater |
US11857197B2 (en) | 2020-11-12 | 2024-01-02 | Shifamed Holdings, Llc | Adjustable implantable devices and associated methods |
US11234702B1 (en) | 2020-11-13 | 2022-02-01 | V-Wave Ltd. | Interatrial shunt having physiologic sensor |
US11812969B2 (en) | 2020-12-03 | 2023-11-14 | Coherex Medical, Inc. | Medical device and system for occluding a tissue opening and method thereof |
EP4104772A1 (en) * | 2021-06-15 | 2022-12-21 | St. Jude Medical, Cardiology Division, Inc. | Devices for the treatment of vascular abnormalities |
WO2023199267A1 (en) | 2022-04-14 | 2023-10-19 | V-Wave Ltd. | Interatrial shunt with expanded neck region |
Family Cites Families (30)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3124136A (en) * | 1964-03-10 | Method of repairing body tissue | ||
DE233303C (en) * | 1911-04-05 | |||
US3347234A (en) * | 1964-08-05 | 1967-10-17 | Joseph A Voss | Hygienic devices |
US3874388A (en) * | 1973-02-12 | 1975-04-01 | Ochsner Med Found Alton | Shunt defect closure system |
US4007743A (en) * | 1975-10-20 | 1977-02-15 | American Hospital Supply Corporation | Opening mechanism for umbrella-like intravascular shunt defect closure device |
US4031569A (en) * | 1976-03-15 | 1977-06-28 | Jacob H John | Nasal septum plug |
DE2822603A1 (en) * | 1978-05-24 | 1979-11-29 | Kay Dr Thierfelder | Tissue fault closing instrument - has skin fixed to scissor type supports expanded radially catheter in probe |
JPS6027303B2 (en) * | 1980-08-11 | 1985-06-28 | 花王株式会社 | tampon applicator |
US4665906A (en) * | 1983-10-14 | 1987-05-19 | Raychem Corporation | Medical devices incorporating sim alloy elements |
US5067957A (en) * | 1983-10-14 | 1991-11-26 | Raychem Corporation | Method of inserting medical devices incorporating SIM alloy elements |
US5190546A (en) * | 1983-10-14 | 1993-03-02 | Raychem Corporation | Medical devices incorporating SIM alloy elements |
DD233303A1 (en) * | 1984-12-28 | 1986-02-26 | Univ Berlin Humboldt | CLOSURE BODY FOR BLOOD OBJECTS AND METHOD FOR ITS INTRODUCTION |
US4728876A (en) * | 1986-02-19 | 1988-03-01 | Minnesota Mining And Manufacturing Company | Orthopedic drive assembly |
US4723936A (en) * | 1986-07-22 | 1988-02-09 | Versaflex Delivery Systems Inc. | Steerable catheter |
SU1468511A1 (en) * | 1987-02-17 | 1989-03-30 | Целиноградский государственный медицинский институт | Arrangement for fixing |
US4917089A (en) * | 1988-08-29 | 1990-04-17 | Sideris Eleftherios B | Buttoned device for the transvenous occlusion of intracardiac defects |
US5030204A (en) * | 1988-09-28 | 1991-07-09 | Advanced Cardiovascular Systems, Inc. | Guiding catheter with controllable distal tip |
GB2226245A (en) * | 1988-11-18 | 1990-06-27 | Alan Crockard | Endoscope, remote actuator and aneurysm clip applicator. |
FR2641692A1 (en) * | 1989-01-17 | 1990-07-20 | Nippon Zeon Co | Plug for closing an opening for a medical application, and device for the closure plug making use thereof |
WO1990009763A1 (en) * | 1989-03-02 | 1990-09-07 | Mcw Research Foundation, Inc. | Wound closing method and device |
US4994077A (en) * | 1989-04-21 | 1991-02-19 | Dobben Richard L | Artificial heart valve for implantation in a blood vessel |
NL8901350A (en) * | 1989-05-29 | 1990-12-17 | Wouter Matthijs Muijs Van De M | CLOSURE ASSEMBLY. |
DE69102515T2 (en) * | 1990-04-02 | 1994-10-20 | Kanji Inoue | DEVICE FOR CLOSING A SHUTTER OPENING BY MEANS OF A NON-OPERATIONAL METHOD. |
US5108420A (en) * | 1991-02-01 | 1992-04-28 | Temple University | Aperture occlusion device |
CA2078530A1 (en) * | 1991-09-23 | 1993-03-24 | Jay Erlebacher | Percutaneous arterial puncture seal device and insertion tool therefore |
US5389100A (en) * | 1991-11-06 | 1995-02-14 | Imagyn Medical, Inc. | Controller for manipulation of instruments within a catheter |
US5258000A (en) * | 1991-11-25 | 1993-11-02 | Cook Incorporated | Tissue aperture repair device |
US5258042A (en) * | 1991-12-16 | 1993-11-02 | Henry Ford Health System | Intravascular hydrogel implant |
EP0876793B1 (en) * | 1992-01-21 | 2007-12-26 | Regents Of The University Of Minnesota | Septal Defect Closure Device |
US5643317A (en) * | 1992-11-25 | 1997-07-01 | William Cook Europe S.A. | Closure prosthesis for transcatheter placement |
-
1993
- 1993-01-21 EP EP98116421A patent/EP0876793B1/en not_active Expired - Lifetime
- 1993-01-21 DE DE69334196T patent/DE69334196T2/en not_active Expired - Lifetime
- 1993-01-21 EP EP93903592A patent/EP0623003B1/en not_active Expired - Lifetime
- 1993-01-21 DE DE69324239T patent/DE69324239T2/en not_active Expired - Lifetime
- 1993-01-21 CA CA002128338A patent/CA2128338C/en not_active Expired - Lifetime
- 1993-01-21 JP JP51271893A patent/JP3393383B2/en not_active Expired - Lifetime
- 1993-01-21 ES ES93903592T patent/ES2133382T3/en not_active Expired - Lifetime
- 1993-01-21 ES ES98116421T patent/ES2296320T3/en not_active Expired - Lifetime
- 1993-01-21 WO PCT/US1993/000489 patent/WO1993013712A1/en active IP Right Grant
- 1993-05-14 US US08/062,095 patent/US5334217A/en not_active Expired - Lifetime
-
1994
- 1994-08-02 US US08/284,766 patent/US5578045A/en not_active Expired - Lifetime
-
1996
- 1996-11-26 US US08/756,776 patent/US6077291A/en not_active Expired - Fee Related
-
1999
- 1999-04-22 US US09/271,762 patent/US6077281A/en not_active Expired - Lifetime
-
2001
- 2001-12-19 JP JP2001386270A patent/JP3579874B2/en not_active Expired - Lifetime
Also Published As
Publication number | Publication date |
---|---|
EP0623003A4 (en) | 1995-10-18 |
DE69324239D1 (en) | 1999-05-06 |
EP0876793A2 (en) | 1998-11-11 |
EP0623003B1 (en) | 1999-03-31 |
JP3393383B2 (en) | 2003-04-07 |
JPH07502918A (en) | 1995-03-30 |
JP3579874B2 (en) | 2004-10-20 |
WO1993013712A1 (en) | 1993-07-22 |
US5578045A (en) | 1996-11-26 |
US6077291A (en) | 2000-06-20 |
EP0623003A1 (en) | 1994-11-09 |
ES2133382T3 (en) | 1999-09-16 |
JP2002248105A (en) | 2002-09-03 |
EP0876793B1 (en) | 2007-12-26 |
EP0876793A3 (en) | 1998-12-02 |
US6077281A (en) | 2000-06-20 |
DE69324239T2 (en) | 1999-11-04 |
ES2296320T3 (en) | 2008-04-16 |
DE69334196D1 (en) | 2008-02-07 |
DE69334196T2 (en) | 2009-01-02 |
US5334217A (en) | 1994-08-02 |
CA2128338A1 (en) | 1993-07-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2128338C (en) | Septal defect closure device | |
EP0947165B1 (en) | Vascular closure device and catheter | |
EP1768604B1 (en) | System for delivering a left atrial appendage containment device | |
US7780700B2 (en) | Patent foramen ovale closure system | |
US9622858B2 (en) | Device and method for temporary or permanent suspension of an implantable scaffolding containing an orifice for placement of a prosthetic or bio-prosthetic valve | |
US7727189B2 (en) | Filter apparatus for ostium of left atrial appendage | |
US8226670B2 (en) | Apparatus and method for connecting a conduit to a hollow organ | |
US6214029B1 (en) | Septal defect occluder | |
EP1659988B1 (en) | System and method for delivering a left atrial appendage blood clot barrier device | |
US8323309B2 (en) | Adjustable left atrial appendage implant | |
AU2003268220B8 (en) | Method and device for treating diseased valve | |
JP2016202905A (en) | Medical device for modification of left atrial appendage and related systems and methods | |
JP2000185048A (en) | Closure plug for transcatheter operation and catheter assembly | |
US20070166852A1 (en) | Diode-pumped microlasers including resonator microchips and methods for producing the same |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
MKEX | Expiry |
Effective date: 20130121 |