DE10049813C1 - Instrument for the local removal of built-up matter at an aortic valve, in a human or animal heart, is a hollow catheter with a cutting unit at the far end within a closure cap for minimum invasion - Google Patents
Instrument for the local removal of built-up matter at an aortic valve, in a human or animal heart, is a hollow catheter with a cutting unit at the far end within a closure cap for minimum invasionInfo
- Publication number
- DE10049813C1 DE10049813C1 DE2000149813 DE10049813A DE10049813C1 DE 10049813 C1 DE10049813 C1 DE 10049813C1 DE 2000149813 DE2000149813 DE 2000149813 DE 10049813 A DE10049813 A DE 10049813A DE 10049813 C1 DE10049813 C1 DE 10049813C1
- Authority
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- Germany
- Prior art keywords
- hollow catheter
- cutting tool
- opening
- cutting edge
- cutting
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- 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.)
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22097—Valve removal in veins
Abstract
Description
Die Erfindung bezieht sich auf eine Vorrichtung zum lokalen Abtrag einer Aortenklappe am menschlichen oder tierischen Herz.The invention relates to a device for the local removal of a Aortic valve on the human or animal heart.
Bei einer Vielzahl von Patienten kommt es vor, dass sich im Laufe der Zeit irreversible Ablagerungen an der Herzklappe bilden, insbesondere an der Aortenklappe, häufig in Form von Kalkablagerungen oder sonstigen Materialdepositionen. Durch derartige Materialablagerungen an der Aortenklappe, die in einem gesunden Zustand als ein feines flexibles Gewebesegel ausgebildet ist, kommt es zu einer irreversiblen Versteifung der Aortenklappe, wodurch insbesondere der Blutabfluss aus dem Herzen erheblich in Mitleidenschaft gezogen wird. Blutunterversorgung im gesamten Körper ist die Folge, so dass in einem derart fortgeschrittenen Stadium akuter Handlungsbedarf besteht, will man schwerwiegende Folgen für den Patienten vermeiden. Bisher bekannte medikamentöse Behandlungsmethoden zeigen jedoch nur begrenzten Erfolg, so dass nach heutiger Kenntnis eine Verkalkung von Aortenklappen lediglich durch einen schwerwiegenden chirurgischen Eingriff begegnet werden kann. Üblicherweise wird in diesem Fall im Rahmen einer Sternotomie der Brustkorb eines Menschen geöffnet um Zugang zum Herz und insbesondere zu den verkalkten Aortenklappen zu erhalten, die mit bekannten Schneidewerkzeugen aus dem Körper extrahiert werden. Beispielsweise eignen sich hierzu Extraktionswerkzeuge wie sie in den amerikanischen Druckschriften US 6,033,419 sowie US 5,827,316 beschrieben sind. Nach erfolgtem operativen Eingriff und Wiederverschluss des Brustkorbes steht dem Patienten eine langwierige Heilungsdauer bevor, die in den meisten Fällen von einer ebenso langwierigen Rehabilitationszeit gefolgt ist.In a large number of patients it happens that over time form irreversible deposits on the heart valve, especially on the Aortic valve, often in the form of limescale or other Material deposition. Through such material deposits on the aortic valve, which is formed in a healthy state as a fine, flexible tissue sail, there is an irreversible stiffening of the aortic valve, which in particular the drainage of blood from the heart is severely affected. Undersupply of blood throughout the body is the result, so in one advanced stage there is an acute need for action, one wants Avoid serious consequences for the patient. Known so far drug treatment methods, however, show only limited success, so that, according to current knowledge, calcification of aortic valves only by serious surgery may be encountered. Usually in this case, the chest of a person becomes part of a sternotomy opened to access the heart and especially the calcified aortic valves to get that extracted from the body with known cutting tools become. For example, extraction tools such as those in the American publications US 6,033,419 and US 5,827,316 are described. After the surgery and the chest reseal, the Patients face a lengthy healing period, in most cases from one just as long rehabilitation time followed.
Aus der US 5,720,760 geht eine Resektionsvorrichtung hervor mit einem kanülenartig ausgebildeten Schneidkopf mit zwei relativ beweglichen Schnittkanten, doch ist diese Resektionsvorrichtung nicht zum Aortenabtrag geeignet zumal die Ansteuerung wenigstens einer Schnittkante über eine geradlinig starre Verbindung vom proximalen Ende der Kanülenanordnung aus erfolgt. Eine deratige Anordnung kann aufgrund der Starrheit nicht durch das Gefäßsystem zur Aortenklappe geführt werden.From US 5,720,760 a resection device emerges with a cannula-like cutting head with two relatively movable cutting edges, however, this resection device is not suitable for aortic ablation, especially since Control of at least one cutting edge via a straight, rigid connection from the proximal end of the cannula assembly. Such an arrangement cannot pass through the vascular system to the aortic valve due to its rigidity become.
Bislang sind keine Möglichkeiten bekannt, die Entfernung einer verkalkten Aortenklappe unter Umgehung der vorstehend genannten Sternotomie durchzuführen.So far, there are no known ways of removing a calcified Aortic valve bypassing the sternotomy mentioned above perform.
Der Erfindung liegt daher die Aufgabe zugrunde, eine Vorrichtung zum lokalen Abtrag einer verkalkten Aortenklappe am menschlichen oder tierischen Herz derart auszubilden, so dass ein chirurgischer Eingriff minimal invasiv durchgeführt werden kann, ohne die vorstehend genannten Nachteile bei der Sternotomie in Kauf nehmen zu müssen. Es gilt insbesondere eine Vorrichtung anzugeben, mit der es möglich ist, eine verkalkte Aortenklappe sicher und schonend zu entfernen, ohne dabei die Herztätigkeit während des minimal invasiven Eingriffes in Mitleidenschaft zu ziehen.The invention is therefore based on the object of a device for local Removal of a calcified aortic valve on the human or animal heart in this way to train so that a surgical procedure can be performed minimally invasively can accept the sternotomy without the disadvantages mentioned above to have to. It is particularly important to specify a device with which it is possible to safely and gently remove a calcified aortic valve without removing the Impact heart activity during the minimally invasive procedure.
Die Lösung der der Erfindung zugrunde liegende Aufgabe ist im Anspruch 1 angegeben. den Lösungsgedanken vorteilhaft weiterbildende Merkmale sind Gegenstand der Unteransprüche sowie der Beschreibung unter Bezugnahme auf die Ausführungsbeispiele zu entnehmen.The object of the invention is achieved in claim 1 specified. are advantageous further developing the idea of the solution Subject of the subclaims and the description with reference to the To see embodiments.
Erfindungsgemäß ist eine Vorrichtung zum lokalen Abtrag einer Aortenklappe vorzugsweise am menschlichen Körper derart ausgebildet, dass ein Hohlkatheter vorgesehen ist, der zumindest im distalen Bereich flexibel ausgebildet ist und sich durch intrakorporales Einbringen in den Aortenbogen dem natürlichen Verlauf des Aortenbogens anpasst. Am distalen Ende des Hohlkatheters ist eine Schervorrichtung vorgesehen, die eine fluiddicht mit dem Hohlkatheter verbundene Abschlusskappe vorsieht, die wenigstens eine Öffnung mit wenigstens einer die Öffnung begrenzenden Schneidkante aufweist. Schließlich ist innerhalb der Abschlusskappe linear- oder drehbeweglich gelagert ein Schneidwerkzeug mit einer Schnittkante vorgesehen, die gegen die Schneidkante der Abschlusskante bewegbar ist. Schließlich ist ein von dem Schneidwerkzeug umgebendes Volumen vorgesehen, das mit dem Hohlkatheter proximalwärts verbunden ist. Um das Schneidwerkzeug innerhalb der Abschlusskappe auszulenken, schließen das Schneidwerkzeug und die Abschlusskappe einem distalseitig angeordneten Raumbereich ein, in dem ein Antriebsmodul vorgesehen ist, das aus einem Gas, einer Flüssigkeit befüllt und/oder aus einem mechanischen Expansionsmittel besteht. According to the invention is a device for local ablation of an aortic valve preferably formed on the human body such that a hollow catheter is provided, which is flexible at least in the distal region and itself by intracorporeal insertion into the aortic arch the natural course of the Adapts aortic arch. There is one at the distal end of the hollow catheter Shear device is provided, which is connected in a fluid-tight manner to the hollow catheter Provides end cap that has at least one opening with at least one Has opening limiting cutting edge. After all, is within the End cap a cutting tool with a linear or rotating movement Cutting edge provided, which is movable against the cutting edge of the end edge is. Finally, a volume surrounded by the cutting tool is provided, which is connected proximally to the hollow catheter. To the cutting tool deflect within the end cap, close the cutting tool and the End cap a distal side space in which a Drive module is provided which fills and / or from a gas, a liquid consists of a mechanical expansion agent.
Mit dem erfindungsgemäß ausgebildeten Werkzeug ist es möglich, den Hohlkatheter über einen Schnitt im Leistenbereich eines Patienten über entsprechende intrakorporale Gefäßkanäle in die Aorta einzuführen und dem Aortaverlauf folgend die Schervorrichtung an der verkalkten Aortenklappe zu positionieren. Hierzu ist der Hohlkatheter insbesondere im distalen Bereich flexibel ausgebildet, so dass der Hohlkatheter mit seinem distalen Ende ohne dabei den natürlichen Verlauf der Aorta zu schädigen oder gar zu verformen unmittelbar im Bereich der verkalkten Aortaklappe positioniert werden kann. Zu Zwecken der Navigation sowie Positionierung des Katheters innerhalb des menschlichen oder tierischen Gefäßes ist der Hohlkatheter mit geeigneten Seilzugvorrichtungen ausgestattet, die innerhalb des Hohlkatheters über entsprechend vorgesehene Kanäle verlaufen. Die Seilzüge können proximalseits entsprechend von einem geeignet geschulten Personal bedient werden. Ferner dienen dillatierbare Volumen in Form von ballonartigen Gebilden, die an der Außenwand des Hohlkatheters angebracht sind und über entsprechende Zuleitungen dillatiert werden können, ebenso zu Zwecken der Navigation und Positionierung, Zentrierung und Fixierung. So sind Hohlkatheterlängen von einem Meter und mehr durchaus denkbar und üblich, doch bemisst sich die Länge grundsätzlich nach der Körpergröße des zu behandelnde Patienten.With the tool designed according to the invention, it is possible to use the hollow catheter about a cut in the groin area of a patient about corresponding Introduce intracorporeal vascular channels into the aorta and follow the course of the aorta position the shear device on the calcified aortic valve. For this is the Hollow catheter, in particular in the distal area, is flexible, so that the Hollow catheter with its distal end without changing the natural course of the aorta to damage or even deform directly in the area of calcified Aortic valve can be positioned. For navigation purposes as well Positioning of the catheter within the human or animal vessel the hollow catheter is equipped with suitable cable pulling devices, which within the Hollow catheters run over correspondingly provided channels. The cables can be operated on the proximal side by suitably trained personnel become. Dillatable volumes in the form of balloon-like structures also serve are attached to the outer wall of the hollow catheter and via corresponding Supply lines can be dilated, also for the purposes of navigation and Positioning, centering and fixation. So are hollow catheter lengths of one Meters and more are conceivable and common, but the length is measured basically according to the height of the patient to be treated.
Die Positionierung und Navigation des distalen Endes des Hohlkatheters erfolgt vorzugsweise unter Röntgenbeobachtung oder mit geeigneten ähnlichen Beobachtungstechniken, so dass die Katheterspitze exakt im Bereich der verkalkten Aortenklappe positioniert werden kann.The distal end of the hollow catheter is positioned and navigated preferably under X-ray observation or with suitable similar Observation techniques so that the catheter tip is exactly in the calcified area Aortic valve can be positioned.
Die erfindungsgemäß ausgebildete Schervorrichtung soll anhand der nachstehenden Figuren näher erläutert werden.The shearing device designed according to the invention is intended to be based on the following Figures are explained in more detail.
Die Erfindung wird nachstehend ohne Beschränkung des allgemeinen Erfindungsgedankens anhand von Ausführungsbeispielen unter Bezugnahme auf die Zeichnung exemplarisch beschrieben. Es zeigen: The invention is hereinafter described without limitation of the general The inventive concept based on exemplary embodiments with reference to the Drawing described as an example. Show it:
Fig. 1 schematisierte, perspektivische Darstellung des Hohlkatheters, Fig. 1 shows a schematic, perspective view of the hollow catheter,
Fig. 2 Querschnitt durch das distale Ende der Schervorrichtung sowie Fig. 2 cross section through the distal end of the shear device as well
Fig. 3 schematisierte Gesamtdarstellung der Vorrichtung. Fig. 3 schematic overall view of the device.
In Fig. 1 ist eine schematisierte, perspektivische Darstellung des Hohlkatheters 1 dargestellt. Die Figur gestattet einen perspektivischen. Einblick in das Innere des proximalseitigen Endes des Hohlkatheters 1, an dessen distalen Ende die Schervorrichtung 2 vorgesehen ist. Um den Hohlkatheter 1 in das entsprechende Aortengefäß einzuführen und das distale Ende mit der Schervorrichtung 2 gezielt an den Ort der Aortenklappe zu navigieren, sind innerhalb des Hohlkatheters 1 Navigationsseilzüge 3 vorgesehen, die proximalseitig von einer Bedienperson entsprechend betätigt werden. Zu Zwecken der genauen Positionierung des Hohlkatheters innerhalb der Aorta sind im distalen Bereich des Hohlkatheters 1 zusätzliche, aufblasbare Ballone 4 vorgesehen, die die Schervorrichtung 2 inmitten der Aorta zu zentrierten vermögen. Nicht dargestellt sind die Zuleitungen zum Befüllen der Ballone, die vorzugsweise ebenso wie die Navigationsseilzüge 3 innerhalb des Hohlkatheters 1 verlaufen.In Fig. 1 is a schematic, perspective view of the hollow catheter 1 is shown. The figure allows a perspective. Insight into the interior of the proximal end of the hollow catheter 1 , at the distal end of which the shear device 2 is provided. In order to insert the hollow catheter 1 into the corresponding aortic vessel and to navigate the distal end with the shear device 2 specifically to the location of the aortic valve, navigation cables 3 are provided within the hollow catheter 1 , which are actuated accordingly on the proximal side by an operator. For the exact positioning of the hollow catheter within the aorta, additional inflatable balloons 4 are provided in the distal region of the hollow catheter 1 , which are able to center the shear device 2 in the middle of the aorta. The supply lines for filling the balloons, which preferably run like the navigation cables 3 within the hollow catheter 1, are not shown.
In der Querschnittsdarstellung gemäß Fig. 2 ist die Schervorrichtung 2 detaillierter dargestellt. Die Schervorrichtung 2 weist eine Abschlusskappe 5 auf, die fluiddicht mit dem Hohlkatheter 1 an ihrem proximalseitigen Ende verbunden ist (nicht in Fig. 2 dargestellt). Die Abschlusskappe 5 weist eine Öffnung 6 auf, deren proximal Öffnungsseite eine Schneidkante 7 vorsieht. Im Inneren der Abschlusskappe 5 ist ein längsbewegliches Schneidwerkzeug 8 vorgesehen (siehe Doppelpfeil bezüglich seiner Längsbeweglichkeit), das ebenso wie die Abschlusskappe 5 eine Öffnung 9 vorsieht. Die Öffnung 9 des Schneidwerkzeuges 8 entspricht in ihrer Geometrie und Größe der Öffnung 6 der Abschlussklappe 5. Beide Öffnungen 9 und 6 weisen eine Öffnungsweite w von etwa 3-10 mm auf und sehen eine Öffnungstiefe t in der gleichen Größenordnung vor. Das Schneidwerkzeug 8 weist an seiner distalen Öffnungsseite eine schart ausgebildete Schnittkante 10 auf, die gleichsam wie die Schneidkante 7 spitz ausgebildet ist. Ferner umschließt das Schneidwerkzeug 8 ein inneres Volumen 11, das lediglich über die Öffnungen 9 offen ausgebildet ist.In the cross-sectional view of FIG. 2, the cutter 2 is shown in more detail. The shaving device 2 has an end cap 5 , which is connected in a fluid-tight manner to the hollow catheter 1 at its proximal end (not shown in FIG. 2). The end cap 5 has an opening 6 , the proximal opening side of which provides a cutting edge 7 . A longitudinally movable cutting tool 8 is provided in the interior of the end cap 5 (see double arrow with regard to its longitudinal mobility), which, like the end cap 5, provides an opening 9 . The geometry and size of the opening 9 of the cutting tool 8 corresponds to the opening 6 of the end flap 5 . Both openings 9 and 6 have an opening width w of approximately 3-10 mm and provide an opening depth t of the same order of magnitude. The cutting tool 8 has a sharply formed cutting edge 10 on its distal opening side, which, like the cutting edge 7, is pointed. Furthermore, the cutting tool 8 encloses an inner volume 11 , which is only designed to be open via the openings 9 .
Das Schneidwerkzeug 8 ist innerhalb der Abschlusskappe 5 längsbeweglich koaxial zur gedachten Längsachse des Hohlkatheters 1 angeordnet, so dass das Schneidwerkzeug 8 wechselweise distal- und proximalseitig derart bewegbar ist, so dass die Schnittkante 10 des Schneidwerkzeuges 8 unterhalb der Schneidkante 7 der Aschlusskappe 5 gelangen kann, wodurch das Volumen 11 vollständig eingeschlossen ist.The cutting tool 8 is arranged within the end cap 5 so as to be longitudinally movable coaxially to the imaginary longitudinal axis of the hollow catheter 1 , so that the cutting tool 8 can be moved alternately on the distal and proximal sides, so that the cutting edge 10 of the cutting tool 8 can reach below the cutting edge 7 of the end cap 5 , whereby the volume 11 is completely enclosed.
Um das Schneidwerkzeug 8 innerhalb der Abschlusskappe 5 in der vorstehend beschriebenen Weise auszulenken, schließen das Schneidwerkzeug 8 und die Abschlusskappe 5 ein distalseitig angeordnetes Volumen (Raumbereich) 12 ein, in dem ein Antriebsmodul vorgesehen sein kann. So ist es zum einen möglich, innerhalb des Volumens 12 Gas einzubringen, das durch lokale Erhitzung expandiert und das Schneidwerkzeug 8 proximalwärts bewegt. Der Energieeintrag kann beispielsweise mit Hilfe eines Lasers erfolgen, dessen Licht auf die Außenwand der Abschlusskappe 5 gerichtet ist und diese lokal erhitzt oder direkt in den Hohlraum 12 eingebracht werden. Laserlicht kann beispielsweise mit geeigneter Kathetertechnik an die vorstehend beschriebene Stelle der Abschlusskappe geleitet werden. Andere Formen der Energieeinbringung sind denkbar.In order to deflect the cutting tool 8 within the end cap 5 in the manner described above, the cutting tool 8 and the end cap 5 enclose a volume (space area) 12 arranged on the distal side, in which a drive module can be provided. Thus, on the one hand, it is possible to introduce gas within the volume 12 , which expands through local heating and moves the cutting tool 8 proximally. The energy input can take place, for example, with the aid of a laser, the light of which is directed onto the outer wall of the end cap 5 and is heated locally or introduced directly into the cavity 12 . Laser light can, for example, be directed to the location of the end cap described above using suitable catheter technology. Other forms of energy input are conceivable.
Ferner ist es möglich innerhalb des Volumens 12 Flüssigkeit einzubringen, die über einen entsprechend, nicht dargestellten Zuleitungskanal durch den Hohlkatheter 1 extrakorporal zugeführt werden kann. Durch entsprechendes Anlegen einer schwingenden Flüssigkeitssäule innerhalb des Zuleitungskanals, die in dem Volumen 12 mündet, kann das Schneidwerkzeug 8 gezielt innerhalb der Abschlusskappe 5 ausgelenkt werden. Furthermore, it is possible to introduce liquid within the volume 12 , which can be supplied extracorporeally through the hollow catheter 1 via a corresponding supply channel, not shown. The cutting tool 8 can be deflected in a targeted manner within the end cap 5 by appropriate application of a vibrating liquid column within the feed channel, which opens into the volume 12 .
Schließlich ist es denkbar, ein mechanisches Expansionsmittel, beispielsweise eine Feder innerhalb des Volumens 12 einzubringen, die über entsprechende Wirkmechanismen entspannt und komprimiert werden kann.Finally, it is conceivable to introduce a mechanical expansion means, for example a spring, within the volume 12 , which can be relaxed and compressed by means of corresponding active mechanisms.
Befindet sich das Schneidwerkzeug 2 im Bereich einer verkalkten Aortaklappe, so ist das Schneidwerkzeug derart relativ zur Aortaklappe zu positionieren, dass zumindest Teile der Aortaklappe in das Innere der Öffnungen 6 und 9 hineinragen. In diesem Fall wird wie vorstehend beschrieben, das Schneidwerkzeug 8 proximalwärts getrieben, wodurch die Schnittkante 10 gegen die Schneidkante 7 getrieben wird und das innerhalb des Volumens 11 hineinragende Teil der Aortaklappe gezielt abgeschnitten werden kann. Der abgeschnittene Teil der Klappe gelangt nun über das Volumen 11 in das Innere des Hohlkanals 1 und kann durch entsprechende Absaugtechnik extrakorporal verbracht werden. Um zu vermeiden, dass Material aus dem Volumen 11 aus der Schervorrichtung austritt, ist proximalseitig am Schneidwerkzeug 8 ein Flatterventil 13 vorgesehen, das einen entsprechenden Rückfluss unterbindet. Überdies dient das Flatterventil 13 auch als Anschlagfläche zum distalseitigen Verschieben des Schneidwerkzeugs 8 bspw. mittels Impulswellen oder einem Flüssigkeitsstrom, den man proximalseits zum Flatterventil anlegtIf the cutting tool 2 is in the area of a calcified aortic valve, the cutting tool is to be positioned relative to the aortic valve such that at least parts of the aortic valve protrude into the interior of the openings 6 and 9 . In this case, as described above, the cutting tool 8 is driven proximally, as a result of which the cutting edge 10 is driven against the cutting edge 7 and the part of the aortic valve protruding within the volume 11 can be cut off in a targeted manner. The cut-off part of the flap now reaches the interior of the hollow channel 1 via the volume 11 and can be moved extracorporeally by appropriate suction technology. In order to prevent material from the volume 11 from escaping from the shearing device, a flap valve 13 is provided on the proximal side of the cutting tool 8 , which prevents a corresponding backflow. In addition, the flutter valve 13 also serves as a stop surface for displacing the cutting tool 8 on the distal side, for example by means of pulse waves or a liquid flow which is applied to the flap valve on the proximal side
Mit Hilfe der in Fig. 2 dargestellten Schervorrichtung ist es möglich, die verkalkte Aortaklappe stückweise abzuschneiden und die abgeschnittenen Teile extrakorporal sicher zu verbringen.With the help of the shearing device shown in FIG. 2, it is possible to cut off the calcified aortic valve piece by piece and to safely spend the cut off parts extracorporeally.
Vorzugsweise ist das Schneidwerkzeug 8 aus leichtem Material gefertigt, beispielsweise aus Keramik (lange scharfe Kante), um eine möglichst trägheitsfreie Bewegung des Schneidwerkzeuges 8 zu gewährleisten.The cutting tool 8 is preferably made of light material, for example ceramic (long sharp edge), in order to ensure that the cutting tool 8 moves as inertly as possible.
In Fig. 3 ist der gesamte Hohlkatheter 1 mit der erfindungsgemäß ausgebildeten Schervorrichtung 2 dargestellt. Proximalseitig zum Hohlkatheter 1 befinden sich Manipulationsvorrichtungen M zum Betätigen des Hohlkatheters zu Zwecken seiner Einführung in die Aorta. Zusätzlich sind ein Spülbehälter 14 sowie ein Auffanggefäß 15 vorgesehen, um einen gezielten Transport von abgetrennten Gewebematerial aus dem Hohlkatheter 1 zu gewährleisten.In Fig. 3 the entire hollow catheter 1 is shown with the inventive design shear device 2. On the proximal side of the hollow catheter 1 there are manipulation devices M for actuating the hollow catheter for the purpose of its introduction into the aorta. In addition, a rinsing container 14 and a collecting vessel 15 are provided in order to ensure a targeted transport of separated tissue material from the hollow catheter 1 .
Der Hohlkatheter selbst ist vorzugsweise aus Kunststoffmaterial gefertigt, das über hochflexible Eigenschaften verfügt, so dass sich ein leichtes Anschmiegen des Hohlkatheters 1 beispielsweise an den Aortenbogen ergibt.The hollow catheter itself is preferably made of plastic material, which has highly flexible properties, so that the hollow catheter 1 clings gently to the aortic arch, for example.
Die Schervorrichtung 2 ist vorzugsweise auswechselbar über einen Konektor 16 mit dem distalen Ende des Hohlkatheters 1 verbindbar. Auf diese Weise ist es möglich, bei Verschleiß der Schnitt- und Schneidkante die Schervorrichtung 2 vom Hohlkatheter 1 zu trennen und entsprechend auszuwechseln. The shear device 2 can preferably be connected interchangeably to the distal end of the hollow catheter 1 via a connector 16 . In this way, it is possible to separate the shear device 2 from the hollow catheter 1 when the cutting and cutting edge is worn and to replace it accordingly.
11
Hohlkatheter
hollow catheter
22
Schervorrichtung
shearing device
33
Navigationsseilzüge
Navigation cables
44
Ballon
balloon
55
Abschlusskappe
end cap
66
Öffnung
opening
77
Schneidkante
cutting edge
88th
Schneidwerkzeug
cutting tool
99
Öffnung
opening
1010
Schnittkante
cutting edge
1111
Volumen
volume
1212
Volumen (Raumbereich)
Volume (room area)
1313
Flatterventil
flutter valve
1414
Behälter mit Spülflüssigkeit
Container with rinsing liquid
1515
Auffanggefäß
collecting vessel
1616
Konektor
Konektor
Claims (11)
einem Hohlkatheter (1), der zumindest im distalen Bereich flexibel ausgebildet ist und durch intrakorporales Einbringen in den Aortenbogen sich dem natürlichen Verlauf des Aortenbogens anpaßt,
einer am distalen Ende des Hohlkatheters (1) vorgesehenen Schervorrichtung (2), die eine fluiddicht mit dem Hohlkatheter (1) verbundene Abschlußkappe (5) vorsieht, die wenigstens die Öffnung (6) mit wenigstens einer, die Öffnung (6) begrenzenden Schneidkante (7) aufweist,
mit einem innerhalb der Abschlußkappe (5) linear- oder drehbeweglich gelagerten Schneidwerkzeug (8) mit einer Schnittkante (10), die gegen die Schneidkante (7) der Abschlußkappe (5) bewegbar ist, sowie ein von dem Schneidwerkzeug (8) umgebendes Volumen (11), das mit dem Hohlkatheter (1) proximalwärts verbunden ist und
mit einem Raumbereich (12), der distalseits zum Schneidwerkzeug (8) von diesem und der Abschlußkappe (5) einschlossen ist, der mit Gas oder einer Flüssigkeit befüllt und/oder mit einem mechanischen Expansionsmittel versehen ist und als Antrieb zur Bewegung des Schneidwerkzeuges (8) dient.1. Device for local removal of an aortic valve on the human or animal heart with
a hollow catheter ( 1 ) which is flexible at least in the distal area and which adapts to the natural course of the aortic arch by intracorporeal insertion into the aortic arch,
a shear device ( 2 ) provided at the distal end of the hollow catheter ( 1 ), which provides a closure cap ( 5 ) which is connected to the hollow catheter ( 1 ) in a fluid-tight manner and which has at least the opening ( 6 ) with at least one cutting edge ( 6 ) delimiting the opening ( 6 ) 7 ) has
with a cutting tool ( 8 ) mounted linearly or rotatably within the end cap ( 5 ) with a cutting edge ( 10 ) which can be moved against the cutting edge ( 7 ) of the end cap ( 5 ), and a volume () surrounding the cutting tool ( 8 ) 11 ), which is connected to the hollow catheter ( 1 ) proximally and
with a space area ( 12 ) which is included distal to the cutting tool ( 8 ) and the end cap ( 5 ), which is filled with gas or a liquid and / or is provided with a mechanical expansion means and as a drive for moving the cutting tool ( 8 ) serves.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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DE2000149813 DE10049813C1 (en) | 2000-10-09 | 2000-10-09 | Instrument for the local removal of built-up matter at an aortic valve, in a human or animal heart, is a hollow catheter with a cutting unit at the far end within a closure cap for minimum invasion |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE2000149813 DE10049813C1 (en) | 2000-10-09 | 2000-10-09 | Instrument for the local removal of built-up matter at an aortic valve, in a human or animal heart, is a hollow catheter with a cutting unit at the far end within a closure cap for minimum invasion |
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Publication Number | Publication Date |
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DE10049813C1 true DE10049813C1 (en) | 2002-04-18 |
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DE2000149813 Expired - Fee Related DE10049813C1 (en) | 2000-10-09 | 2000-10-09 | Instrument for the local removal of built-up matter at an aortic valve, in a human or animal heart, is a hollow catheter with a cutting unit at the far end within a closure cap for minimum invasion |
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DE (1) | DE10049813C1 (en) |
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