Patent Grant
10856986
Some applications of the present invention relate in general to valve repair. More specifically, some applications of the present invention relate to repair of a mitral valve of a patient.
Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus.
Dilation of the annulus of the mitral valve prevents the valve leaflets from fully coapting when the valve is closed. Mitral regurgitation of blood from the left ventricle into the left atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the left ventricle secondary to a volume overload and a pressure overload of the left atrium.
U.S. Pat. No. 7,431,692 to Zollinger et al. describes an adjustable support pad for adjustably holding a tensioning line used to apply tension to a body organ. The adjustable support pad can include a locking mechanism for preventing slidable movement of the tensioning element in one or both directions. The locking mechanism may include spring-loaded locks, rotatable cam-like structures, and/or rotatable spool structures. The adjustable support pad may be formed from rigid, semi-rigid, and/or flexible materials, and may be formed to conform to the outer surface of a body organ. The adjustable support pad can be configured to adjustably hold one or more separate tensioning lines, and to provide for independent adjustment of one or more tensioning lines or groups thereof.
US Patent Application Publication 2007/0016287 to Cartledge et al. describes an implantable device for controlling shape and/or size of an anatomical structure or lumen. The implantable device has an adjustable member configured to adjust the dimensions of the implantable device. The implantable device is housed in a catheter and insertable from a minimally invasive surgical entry. An adjustment tool actuates the adjustable member and provide for adjustment before, during or after the anatomical structure or lumen resumes near normal to normal physiologic function.
US Patent Application Publication 2004/0236419 to Milo describes methods for reconfiguring an atrioventricular heart valve that may use systems comprising a partial or complete annuloplasty rings proportioned to reconfigure a heart valve that has become in some way incompetent, a pair of trigonal sutures or implantable anchors, and a plurality of staples which may have pairs of legs that are sized and shaped for association with the ring at spaced locations along its length. These systems permit relative axial movement between the staples and the ring, whereby a patient's heart valve can be reconfigured in a manner that does not deter subtle shifting of the native valve components. Shape-memory alloy material staples may have legs with free ends that interlock following implantation. Annuloplasty rings may be complete or partial and may be fenestrated. One alternative method routes a flexible wire, preferably of shape-memory material, through the bights of pre-implanted staples. Other alternative systems use linkers of shape-memory material having hooked ends to interengage with staples or other implanted supports which, following implantation, decrease in effective length and pull the staples or other supports toward one another so as to create desired curvature of the reconfigured valve. These linkers may be separate from the supports or may be integral with them and may have a variety of shapes and forms. Various ones of these systems are described as being implanted non-invasively using a delivery catheter.
US Patent Application Publication 2005/0171601 to Cosgrove et al. describes an annuloplasty repair segment and template for heart valve annulus repair. The elongate flexible template may form a distal part of a holder that also has a proximal handle. Alternatively, the template may be releasably attached to a mandrel that slides within a delivery sheath, the template being released from the end of the sheath to enable manipulation by a surgeon. A tether connecting the template and mandrel may also be provided. The template may be elastic, temperature responsive, or multiple linked segments. The template may be aligned with the handle and form a two- or three-dimensional curve out of alignment with the handle such that the annuloplasty repair segment attached thereto conforms to the curve. The template may be actively or passively converted between its straight and curved positions. The combined holder and ring is especially suited for minimally-invasive surgeries in which the combination is delivered to an implantation site through a small access incision with or without a cannula, or through a catheter passed though the patient's vasculature.
The following patents and patent application publications, relevant portions of which are incorporated herein by reference, may be of interest:
The following articles, which are incorporated herein by reference, may be of interest:
In some applications of the present invention, apparatus is provided comprising an adjustable annuloplasty structure configured to repair a dilated mitral valve of a patient. At least a portion of the annuloplasty structure comprises a flexible, longitudinally-compressible segment (e.g., coiled structures, stent-like struts, or a braided mesh). The annuloplasty structure is shaped to define a lumen thereof that houses a flexible member, e.g., a contracting wire. The annuloplasty structure comprises a contracting mechanism which facilitates contracting of the annuloplasty structure. The contracting mechanism comprises a spool to which a first end of the flexible member is coupled. Typically, a second end of the flexible member is not coupled to the spool, but rather is coupled to a portion of the annuloplasty structure.
In some applications of the present invention, the annuloplasty structure is shaped to provide an adjustable partial annuloplasty structure. In these applications, the annuloplasty structure comprises an elongate structure which is coupled at a first end thereof to the contracting mechanism. The first end of the flexible member is coupled to the spool while the second end of the flexible member is coupled to a second end of the elongate structure.
Typically, during a resting state thereof, the elongate structure assumes a linear configuration. The elongate structure is made to assume a curved configuration in which the elongate structure provides a partial annuloplasty ring. In some applications of the present invention, the first and second ends of the elongate structure are coupled together such that the elongate structure forms an annuloplasty ring. For example, the first and second ends of the elongate element are each coupled to a housing surrounding the contracting mechanism. In either application of the present invention, the annuloplasty structure is contracted by the contracting mechanism such that the dimensions of the annuloplasty structure are reduced and the structure contracts radially, thereby contracting the annulus.
As the operating physician rotates the spool of the contracting mechanism, a portion of the flexible member is wound around the spool. In response to continued rotation of the spool, increasing portions of the flexible member are wrapped around the spool, which causes the flexible member to pull on the second end of the elongate structure toward the contracting mechanism. Responsively, the compressible element is compressed between the first and second ends of the elongate structure. Thus, the flexible member helps regulate a spatial configuration of the annuloplasty structure.
In some applications of the present invention, during a resting state, the annuloplasty structure defines a linear shape. Subsequently, during implantation, the annuloplasty structure is made to assume at least part of a ring-shaped structure. The annuloplasty structure may be advanced toward the annulus of a valve in any suitable procedure, e.g., transcatheter, minimally invasive, or in an open heart procedure.
In some applications of the present invention, a delivery tool is provided for reversible coupling of a rotatable adjusting mechanism thereto, delivery of the adjusting mechanism to tissue of a patient, and rotation of a rotatable structure of the adjusting mechanism. Typically, the delivery tool facilitates implantation of the adjusting mechanism in cardiac tissue of the patient. Typically, the adjusting mechanism is coupled to an implant, e.g., an annuloplasty device, and facilitates contraction and expansion of the implant. For such applications in which the implant comprises an annuloplasty device, this contraction and expansion of the annuloplasty device facilitates, in turn, contraction and expansion of the annulus of an atrioventricular valve of the patient.
The rotatable structure of the adjusting mechanism is shaped to define proximal and distal openings and a channel extending between the proximal and distal openings. A proximal portion of an inner wall of the rotatable structure that surrounds the channel is shaped to define a threaded portion, e.g., a tapered threaded portion that decreases in diameter from the proximal opening.
The delivery tool has a distal end which is reversibly couplable to the adjusting mechanism and comprises a manipulator, e.g., a screwdriver tool. The manipulator is shaped to define a threaded portion that screws into the threaded portion of the rotatable structure. The delivery tool comprises an ergonomic proximal handle portion that comprises at least two separate rotating members which control separate functions of the manipulator at the distal end of the tool. A proximal-most first knob rotates the manipulator sufficiently to couple together the respective threaded portions of the manipulator and the rotatable structure. A second knob that is distal to the proximal-most knob facilitates rotation of the manipulator sufficiently to rotate the rotatable structure following the coupling of the manipulator to the rotatable structure. The second knob is coupled to a visual indicator which indicates the number of rotations of the screwdriver, and thereby, the number of rotations of the rotatable structure. Rotating the second knob in a first direction rotates the second knob such that it advances distally along a helical rotation path. The distal end of the helical rotation path restricts rotation of the second knob and thereby restricts rotation of the rotatable structure beyond a predetermined amount.
The rotatable structure is coupled to a locking mechanism which restricts rotation of the rotatable structure in a resting state of the locking mechanism. The delivery tool comprises an elongate locking mechanism release rod which is slidable within a lumen of the delivery tool in order to release the locking mechanism from the rotatable structure prior to the rotating of the rotatable structure responsively to the rotation of the second knob.
There is therefore provided, in accordance with some applications of the present invention, apparatus configured to be implanted in a body of a subject, including:
an implant structure having first and second portions thereof;
a rotatable structure coupled to the implant structure in a vicinity of the first portion thereof; and
a flexible member having a first portion and at least one end portion thereof, at least the first portion being disposed in contact with the rotatable structure, and the at least one end portion of the flexible member being not disposed in contact with the rotatable structure,
and, in response to rotation of the rotatable structure in a first direction thereof, successive portions of the flexible member contact the rotatable structure to pull the at least one end portion of the flexible member toward the first portion of the implant structure, and responsively to draw the first and second portions of the implant structure toward each other.
In some applications of the present invention, the rotatable structure includes a spool,
the flexible member includes a longitudinal member selected from the group consisting of: a wire, a thread, a cable, and a rope, and
in response to rotation of the spool in a first direction, successive portions of the longitudinal member wind around the spool.
In some applications of the present invention, the rotatable structure includes a rotatable structure having a plurality of teeth,
the flexible member includes a longitudinal member selected from the group consisting of: a band and a ribbon,
the flexible member is shaped so as to define a plurality of engaging elements, and
in response to rotation of the rotatable structure, the plurality of teeth matingly engage the plurality of engaging elements.
In some applications of the present invention, the first and second portions of the implant structure include first and second end portions,
the first portion of the flexible member is disposed at the first end portion of the implant structure, and
the at least one end portion of the flexible member is disposed at the second end portion of the implant structure.
In some applications of the present invention, the flexible member includes first and second end portions,
the at least one end portion of the flexible member defines at least one end selected from the group consisting of: the first end portion and the second end portion of the flexible member; and
the flexible member defines the first portion thereof in a vicinity of the flexible member that is between the first and second end portions thereof.
In some applications of the present invention, the implant structure includes first and second end portions, and the implant structure defines the first portion thereof in a vicinity of the implant structure that is between the first and second end portions thereof.
In some applications of the present invention, the flexible member includes first and second end portions,
the flexible member defines the first portion thereof in a vicinity of the flexible member that is between the first and second end portions thereof,
the first end portion of the flexible member is coupled to the first end portion of the implant structure, and
the second end portion of the flexible member is coupled to the second end portion of the implant structure.
In some applications of the present invention, the flexible member defines a first flexible member including first and second end portions and the first portion, and the first portion of the first flexible member defines the first end portion thereof, and
the first end portion of the first flexible member is coupled to the rotatable structure.
In some applications of the present invention, the apparatus includes a second flexible member including first and second end portions thereof, and
the first end portion of the second flexible member is coupled to the rotatable structure, and
the second end portion of the flexible member is coupled to the second end portion of the implant structure.
There is additionally provided, in accordance with some applications of the present invention, a method for adjusting a dimension of an implant structure having first and second portions, including:
rotating in a first direction a rotatable structure coupled to the first portion of the implant structure;
by the rotating, contacting with the rotatable structure successive portions of a flexible member;
by the rotating, pulling an end portion of the flexible member toward the first portion of the implant structure; and
responsively to the pulling, drawing the first and second portions of the implant structure toward each other.
There is further provided, in accordance with some applications of the present invention, apparatus configured to be implanted in a body of a subject, including:
an implant structure having first and second portions thereof;
a spool coupled to the implant structure in a vicinity of the first portion thereof; and
a flexible member coupled at a first end thereof to the spool, and not attached at a second end thereof to the spool, the flexible member:
In some applications of the present invention, the flexible member is configured to be unwound from around the spool and to facilitate expansion of the implant structure in response to rotation of the spool in a second direction thereof that is opposite the first direction.
In some applications of the present invention, the implant structure includes expanded polytetrafluoroethylene (ePTFE).
In some applications of the present invention, the implant structure is coated with polytetrafluoroethylene.
In some applications of the present invention, the implant structure is configured to be implanted along an annulus of a mitral valve of the subject,
the flexible member is configured to contract the implant structure in response to the rotation of the spool in the first direction, and
the implant structure is configured to contract the annulus in response to the contraction thereof.
In some applications of the present invention, the second portion of the implant structure is coupled to the spool in a manner that causes the implant structure to be shaped to define an annuloplasty ring.
In some applications of the present invention, the apparatus is configured to be implanted along an annulus of a mitral valve of the subject, and the apparatus is configured to be transcatheterally advanced toward the annulus.
In some applications of the present invention, the apparatus includes a locking mechanism coupled to the implant structure and configured to restrict rotation of the spool.
In some applications of the present invention, the first and second portions are disposed adjacently to first and second ends of the implant structure, respectively,
the apparatus is configured to be implanted along an annulus of a mitral valve of the subject in a manner in which the first end of the structure is distanced from the second end of the structure, and
the implant structure in its implanted state defines a partial annuloplasty ring.
In some applications of the present invention, the apparatus is configured to be implanted along an annulus of a mitral valve of the subject,
the first portion of the implant structure is configured to be coupled to a first location along the annulus in a vicinity of a first trigone adjacent to the mitral valve, and
the second portion of the implant structure is configured to be coupled to a second location along the annulus in a vicinity of a second trigone adjacent to the mitral valve.
In some applications of the present invention, the implant structure is shaped to provide first and second ends in communication with the first and second portions, respectively,
the first end is configured to be coupled to the first location along the annulus in the vicinity of the first trigone adjacent to the mitral valve, and
the second end of the implant structure is configured to be coupled to the second location along the annulus in the vicinity of the second trigone adjacent to the mitral valve.
In some applications of the present invention, the first portion has first and second ends, the first end of the first portion being coupled to the spool,
the second portion has first and second ends, the first end of the second portion being coupled to the spool,
the apparatus includes first and second flexible members each having first and second ends,
the first end of the first flexible member is coupled to the spool, and the second end of the first flexible member is coupled to the second end of the first portion, and
the first end of the second flexible member is coupled to the spool, and the second end of the second flexible member is coupled to the second end of the first portion.
In some applications of the present invention, in response to rotation of the spool in a first direction thereof, respective portions of the first and second flexible members are configured to be wound around the spool, and, responsively, to pull the respective second ends of the first and second flexible members toward the spool, and responsively to draw the first and second portions of the implant structure toward each other.
In some applications of the present invention, the apparatus is configured to be implanted along an annulus of a mitral valve of a heart of the subject,
a first section of the implant structure is flexible and longitudinally compressible, and
a second section in series with the first section of the implant structure, the second section being flexible and less longitudinally compressible than the first section.
In some applications of the present invention, the second section is not longitudinally compressible.
In some applications of the present invention, a radius of curvature at a center of the first section is smaller than a radius of curvature at a center of the second section, when no external force is applied to the implant structure.
In some applications of the present invention, the second section of the implant structure has first and second ends thereof and a body portion disposed between the first and second ends, the second section of the implant structure being configured to be disposed along a portion of the annulus in a manner in which:
the first end of the second section is configured to be coupled to the annulus in a vicinity of a left trigone of the heart that is adjacent to a mitral valve of the subject,
the second end of the second section is configured to be coupled to the annulus in a vicinity of a right trigone of the heart that is adjacent to the mitral valve, and
the body portion is configured to be disposed along the annulus in a vicinity of the annulus that is between the left and right trigones.
In some applications of the present invention, the body portion disposed between the first and second ends of the second section of the implant structure has a length of 10-50 mm.
In some applications of the present invention, in the apparatus is configured to be implanted along an annulus of a mitral valve of the subject in a manner in which the implant structure is formed into at least a portion of an annuloplasty ring.
In some applications of the present invention, the apparatus includes a plurality of sutures, each suture of the plurality of sutures being configured to be fastened to a respective location along a circumference of the annulus of the subject, the plurality of sutures being configured to facilitate advancement of the implant structure toward the annulus.
In some applications of the present invention, the plurality of sutures are configured to be coupled to the implant structure at respective locations thereof that are in parallel with the respective locations along the circumference of the annulus of the subject, and the implant structure is formed into the annuloplasty ring in response to the coupling.
In some applications of the present invention, the implant structure is compressible along a longitudinal axis of the implant structure.
In some applications of the present invention, the implant structure includes a coiled structure having a lumen thereof.
In some applications of the present invention, the flexible member is disposed within the lumen of the coiled structure.
In some applications of the present invention, in response to rotation of the spool, the flexible member is configured to longitudinally compress the implant structure.
In some applications of the present invention, the apparatus includes a plurality of sutures configured to be coupled to an annulus of a mitral valve of the subject and to facilitate implantation of the implant structure along the annulus.
In some applications of the present invention, the apparatus includes a plurality of anchors respectively coupled to the plurality of sutures and configured to be anchored to tissue of the annulus of the subject.
In some applications of the present invention, the plurality of anchors are configured to lock the implant structure in place with respect to the annulus.
In some applications of the present invention, the plurality of anchors are configured to be implanted along a circumference of the annulus, and to be coupled to the implant structure in a manner which forms the implant structure into a curved configuration.
In some applications of the present invention, the spool has a first end shaped to define a first opening, and a second end shaped to define a second opening, the spool being shaped to define a channel extending from the first opening to the second opening, the channel being configured for passage therethrough of an elongate tool, and
the second end of the spool has a lower surface thereof shaped to:
In some applications of the present invention, the apparatus includes a mechanical element having a planar surface coupled to the lower surface of the spool, the mechanical element being shaped to provide:
In some applications of the present invention, the spool has a first end and a second end, the first end being shaped to receive a portion of a tool, and
the first end of the spool has an upper surface thereof shaped to:
In some applications of the present invention, the apparatus includes:
a mechanical element having a planar surface coupled to the upper surface of the spool, the mechanical element being shaped to provide at least one protrusion protruding out of a plane of the planar surface of the mechanical element, the protrusion being disposed within one of the recesses during a resting state of the mechanical element, in a manner that restricts rotation of the spool; and
a compressible element coupled to the second end of the spool, the compressible element being configured to be compressed and facilitate dislodging of the protrusion from within the recess in response to a force applied to the spool by the elongate tool.
There is also provided, in accordance with some applications of the present invention, apparatus for adjusting at least one dimension of an implant, including:
a rotatable structure having a first end shaped to define a first opening, and a second end shaped to define a second opening, the rotatable structure being shaped to define a channel extending from the first opening to the second opening, the channel being configured for passage therethrough of an elongate tool, and the second end of the structure having a lower surface thereof shaped to define one or more recesses; and
a mechanical element having a surface coupled to the lower surface of the rotatable structure, the mechanical element being shaped to provide:
In some applications of the present invention, the lower surface is shaped to provide at least a portion thereof having a circumference, and the one or more recesses are disposed along the circumference.
In some applications of the present invention, during a first period:
In some applications of the present invention, during the first period, the rotatable structure is rotatable in first and second directions, the first direction being opposite the second direction.
In some applications of the present invention, the apparatus includes a housing surrounding the rotatable structure, the housing being coupled in part to a cap having a surface that is disposed in parallel with the lower surface of the rotatable structure, and the depressible portion is disposed between the lower surface of the rotatable structure and the cap, and the cap is shaped to define a recessed portion thereof configured to receive the depressible portion during a depressed state of the depressible portion.
In some applications of the present invention, the apparatus includes a housing surrounding the rotatable structure, the housing being shaped to define a recessed portion thereof configured to receive the protrusion during the resting state of the mechanical element.
In some applications of the present invention the apparatus includes, a flexible, longitudinal member having first and second end portions thereof, and at least the first end portion of the longitudinal member is coupled to the rotatable structure in a manner in which, as a result of rotation of the rotatable structure:
the first end portion of the longitudinal member advances with respect to the rotatable structure, and
a configuration of the longitudinal member changes.
In some applications of the present invention, in the first end portion of the longitudinal member is reversibly coupled to the rotatable structure.
In some applications of the present invention, the apparatus includes an annuloplasty device having at least one end portion,
the annuloplasty device defines the implant,
the rotatable structure is coupled to the annuloplasty device;
the longitudinal member is coupled at the second end portion thereof to the at least one end portion of the annuloplasty device, and
the rotatable structure is rotatable to advance the first end portion of the longitudinal member with respect to the rotatable structure in a manner which alters a distance between the second end portion of the longitudinal member and the rotatable structure.
In some applications of the present invention, the rotatable structure includes a spool, and the longitudinal member is coupled at at least the first end portion thereof to the spool and is wrapped around the spool in response to rotation of the spool in a first direction.
In some applications of the present invention, during a first period:
In some applications of the present invention, the apparatus includes an implant, and,
in response to rotation of the spool in a first direction thereof, the flexible member is configured to be wound around the spool, and, responsively, to contract the implant.
In some applications of the present invention, in the longitudinal member is configured to be unwound from around the spool and to facilitate expansion of the implant in response to rotation of the spool in a second direction thereof that is opposite the first direction.
In some applications of the present invention, a second end of the longitudinal member is not coupled to the spool.
In some applications of the present invention, the implant includes a compressible element shaped to define a lumen thereof, and the longitudinal member is disposed within the lumen of the compressible element.
There is further yet provided in accordance with some applications of the present inventions, apparatus for adjusting at least one dimension of an implant, including:
a rotatable structure having a first end shaped to define a first opening, and a second end shaped to define a second opening and having a lower surface thereof, the rotatable structure being shaped to define:
a mechanical element having a surface coupled to the lower surface of the rotatable structure, the mechanical element being shaped to provide:
There is yet additionally provided in accordance with applications of the present invention, an annuloplasty structure configured for implantation along an annulus of a mitral valve of a heart of a subject, the structure including:
a first portion that is flexible and longitudinally compressible; and
a second portion in series with the first portion, the second portion being flexible and less longitudinally compressible than the first portion, and having first and second ends thereof and a body portion between the first and second ends, the annuloplasty structure being configured for implantation along the annulus in a manner in which:
In some applications of the present invention, the body portion is not compressible.
In some applications of the present invention, a radius of curvature at a center of the first portion is smaller than a radius of curvature at a center of the second portion, when no external force is applied to the annuloplasty structure.
In some applications of the present invention, the annuloplasty structure includes an annuloplasty ring.
In some applications of the present invention, the annuloplasty structure includes a partial annuloplasty ring.
In some applications of the present invention, the body portion disposed between the first and second ends of the second portion has a length of 10-50 mm.
There is also additionally provided, in accordance with some applications of the present invention:
a rotatable structure having a first end shaped to define a first opening, and a second end shaped to define a second opening and having a lower surface thereof, the rotatable structure being shaped to define:
a mechanical element having a surface coupled to the lower surface of the rotatable structure, the mechanical element being shaped to provide:
a delivery tool configured to deliver the rotatable structure to a tissue site of a patient, the delivery tool including:
There is yet provided, in accordance with some applications of the present invention, a method, including:
coupling a delivery tool to a rotatable structure by rotating a rotatable knob of the delivery tool and screwing a screwdriver head of the delivery tool to a proximal portion the rotatable structure without rotating the rotatable structure, the rotatable structure having a first end shaped to define a first opening, and a second end shaped to define a second opening and having a lower surface thereof, the rotatable structure being shaped to define a channel extending from the first opening to the second opening, and at least one first coupling at the lower surface of the second end thereof,
subsequently to the coupling, disengaging a second coupling from within the at least one first coupling of the rotatable structure by:
subsequently to the disengaging, rotating the rotatable structure by rotating at least a portion of the delivery tool.
There is also provided, in accordance with some applications of the present invention, apparatus for adjusting at least one dimension of an implant, including:
a rotatable structure having a first end shaped to define a first opening, and a second end shaped to define a second opening and having a lower surface thereof, the rotatable structure being shaped to define:
a mechanical element having a surface coupled to the lower surface of the rotatable structure, the mechanical element being shaped to provide:
There is also provided, in accordance with some applications of the present invention, the following inventive concepts:
providing an implant structure having first and second portions thereof, the implant structure including:
advancing the implant structure, in a first configuration thereof, toward an annulus of the subject;
coupling the structure to the annulus; and
rotating the spool, and thereby:
contracting the annulus.
coupling the structure to a mitral valve of the annulus;
coupling the first portion of the implant structure to a first location along the annulus in a vicinity of a first trigone adjacent to the mitral valve; and
coupling the second portion of the implant structure to a second location along the annulus in a vicinity of a second trigone adjacent to the mitral valve.
forming the structure into the curved configuration comprises coupling the plurality of sutures to respective portions of the implant structure; and
advancing the implant structure in the curved configuration thereof comprises advancing the implant structure along the plurality of sutures.
providing a rotatable structure coupled to a mechanical locking element having a surface coupled to a lower surface of the rotatable structure;
implanting the rotatable structure in cardiac tissue;
advancing an elongate tool through a channel provided by the rotatable structure;
unlocking the rotatable structure from the mechanical locking element by pushing a depressible portion of the surface of the locking element;
responsively to the pushing of the depressible portion, dislodging a protrusion protruding out of a plane of the surface of the mechanical element from within a recess defined by the rotatable structure; and
in response to the dislodging, rotating the rotatable structure.
wherein rotating the rotating structure comprises, during a first period,
facilitating the rotating of the rotating structure by:
wherein the method further comprises, during a second period:
rotating the rotatable structure in a second direction; and
responsively to the rotating of the rotatable structure in the second direction, advancing the first end portion of the longitudinal member in a second direction with respect to the rotatable structure, the second direction being opposite the first direction.
the longitudinal member adjusts at least one dimension of an implant including an annuloplasty device,
a second end portion of the longitudinal member is coupled to at least one end portion of the annuloplasty device, the end portion being selected from the group consisting of: a first end portion of the annuloplasty device and a second end portion of the annuloplasty device, and
the method further comprises adjusting the at least one dimension of the implant responsively to the rotating by altering a distance between the second end portion of the longitudinal member and the rotatable structure.
rotating the rotatable structure in a second direction opposite the first direction; and
unwrapping the at least a portion of the first end portion of the longitudinal member from around the rotatable structure.
providing a rotatable structure, and a mechanical locking element that is coupled to a lower surface of the rotatable structure;
implanting the rotatable structure in cardiac tissue;
advancing an elongate tool through a channel provided by the rotatable structure;
unlocking the rotatable structure from the mechanical locking element by pushing a depressible portion of the locking element;
responsively to the pushing of the depressible portion, dislodging a first coupling provided by the rotatable structure from a second coupling provided by the mechanical element; and
in response to the dislodging, rotating the rotatable structure.
providing an annuloplasty structure having:
compressing the first portion of the annuloplasty structure while substantially not compressing the second portion of the annuloplasty structure.
a rotatable structure having a first end and a second end, the first end being shaped to receive a portion of a tool and having an upper surface thereof shaped to:
a mechanical element having a planar surface coupled to the upper surface of the rotatable structure, the mechanical element being shaped to provide at least one protrusion protruding out of a plane of the planar surface of the mechanical element, the protrusion being disposed within one of the recesses during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure; and
a compressible element coupled to the second end of the rotatable structure, the compressible element being configured to be compressed and facilitate dislodging of the protrusion from within the recess in response to a force applied to the rotatable element by the elongate tool.
the spool is coupled to at least a portion of the implant,
and the flexible member is disposed in communication with the implant and coupled at at least a first end thereof to the spool, and
in response to rotation of the spool in a first direction thereof, the flexible member is configured to be wound around the spool, and, responsively, to contract the implant.
providing an annuloplasty structure having:
implanting the annuloplasty structure along an annulus of a valve of a subject by:
compressing the first portion of the annuloplasty structure while substantially not compressing the second portion of the annuloplasty structure.
a rotatable structure having a first end and a second end, the first end being shaped to receive a portion of a tool and having an upper surface thereof shaped to:
a mechanical element having a planar surface coupled to the upper surface of the rotatable structure, the mechanical element being shaped to provide at least one protrusion protruding out of a plane of the planar surface of the mechanical element, the protrusion being disposed within one of the recesses during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure; and
a compressible element coupled to the second end of the rotatable structure, the compressible element being configured to be compressed and facilitate dislodging of the protrusion from within the recess in response to a force applied to the rotatable element by the elongate tool.
the spool is coupled to at least a portion of the implant,
and the flexible member is disposed in communication with the implant and coupled at at least a first end thereof to the spool, and
in response to rotation of the spool in a first direction thereof, the flexible member is configured to be wound around the spool, and, responsively, to contract the implant.
providing a rotatable structure, and a mechanical locking element that is coupled to a lower surface of the rotatable structure;
implanting the rotatable structure in cardiac tissue;
advancing an elongate tool through a channel provided by the rotatable structure;
unlocking the rotatable structure from the mechanical locking element by pushing a depressible portion of the locking element;
responsively to the pushing of the depressible portion, dislodging a first coupling provided by the rotatable structure from a second coupling provided by the mechanical element; and
in response to the dislodging, rotating the rotatable structure.
The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:
Reference is now made to
Typically, flexible contracting member 30 comprises a wire, a cable, or a rope, and taken together with the compressible element of body portion 24 and the braided mesh surrounding body portion 24, imparts flexibility to the entire annuloplasty structure.
Typically, body portion 24 comprises a flexible biocompatible material, e.g., nitinol, stainless steel, platinum iridium, titanium, expanded polytetrafluoroethylene (ePTFE), or cobalt chrome. In some applications of the present invention, body portion 24 is coated with PTFE (Polytetrafluoroethylene). In other applications of the present invention, body portion 24 comprises accordion-like compressible structures which facilitate proper cinching of the annulus when structure 22 is contracted. Body portion 24, when compressed, e.g., typically along a longitudinal axis of structure 22, enables portions of annuloplasty structure 22 to contract and independently conform to the configuration of the annulus of the mitral valve of a given subject. Thus, the compressible element of body portion 24 facilitates contraction of the annulus in response to contraction of structure 22.
Typically, flexible contracting member 30 comprises a flexible and/or superelastic material, e.g., nitinol, polyester, stainless steel, or cobalt chrome, and is configured to reside chronically within structure 22. In some applications of the present invention, flexible contracting member 30 comprises a braided polyester suture (e.g., Ticron). In some applications of the present invention, flexible contracting member 30 is coated with polytetrafluoroethylene (PTFE). In some applications of the present invention, flexible contracting member 30 comprises a plurality of wires that are intertwined to form a rope structure.
Adjusting mechanism 40 comprises a housing 44 which houses a rotatable structure 2900, or a spool 46. Spool 46 has a cylindrical body that is disposed perpendicularly with respect to the longitudinal axis of structure 22. As shown in FIG. 2, spool 46 is shaped to provide a hole 42 for coupling of the first end of flexible contracting member 30 thereto and, thereby, to adjusting mechanism 40. For some applications of the present invention, spool 46 is shaped to define one or more holes 42 configured for looping a portion of contracting member 30 therethrough, as described hereinbelow. In such an application: (a) a middle portion, which defines a first end portion, of contracting member 30 is coupled to spool 46 by being looped through one or more holes 42, (b) first and second portions that extend from the first end portion looped through spool 46 extend toward a second end 23 of structure 22, and (c) first and second free ends of contracting member 30 are coupled to second end 23 of structure 22 and define a second end portion of contracting member 30.
Spool 46 is shaped to define a channel 48 which extends through the cylindrical portion of spool 46 from an opening provided by an upper surface 150 of spool 46 to an opening provided by a lower surface 152 of spool 46. Channel 48 provides a lumen which is disposed along an axis that is perpendicular to the longitudinal axis of structure 22 in its elongate, linear configuration. As described hereinbelow, a distal portion of a screwdriver engages spool 46 via channel 48 and rotates spool 46 in response to a rotational force applied to the screwdriver. The rotational force applied to the screwdriver rotates spool 46 via the portion of the screwdriver that is disposed within channel 48 of spool 46.
It is to be noted that the linear structure 22 contracts to form a curved structure 22, as shown, by way of illustration and not limitation. In some applications of the present invention, contraction of structure 22 forms the structure into a curved configuration. Alternatively, structure 22 is made to assume the curved configuration prior to contracting thereof, and during the contracting, the curved structure is contracted. That is, without being formed into a curved configuration prior to the contracting, structure 22 is compressed linearly along the longitudinal axis thereof.
In some applications of the present invention, the contracting of structure 22 enables structure 22 to assume the configuration shown. Alternatively, or additionally, prior to contraction, structure 22 is anchored, or otherwise fastened, at least in part to the annulus of the valve of the subject at respective locations along structure 22. The anchoring, or otherwise fastening, of structure 22 to the annulus enables structure 22 to assume the configuration shown, as described hereinbelow.
Reference is now made to
Reference is now made to
(In this context, in the specification and in the claims, “proximal” means closer to the orifice through which tool 70 is originally placed into the body of the subject, and “distal” means further from this orifice.)
In some applications of the present invention, tool 70 is coupled to an annuloplasty sizer and the annuloplasty structure is wrapped around at least a portion of the sizer. Once wrapped around the sizer, the flexible member is contracted such that the annuloplasty structure hugs and is stabilized around the sizer. The sizer helps position the annuloplasty structure along the annulus and stabilize the structure as it is being contracted.
Typically, tool 70 facilitates the advancement of structure 22 and subsequent contraction thereof. The distal portion of tool 70 comprises a housing 82 which surrounds housing 44 of structure 22 and stabilizes housing 44 during the advancement and contraction of structure 22. Flexible rod 78 is coupled at a distal end thereof to screwdriver head 75. Screwdriver head 75 is shaped to define a distal protrusion 71 which is disposed within channel 48 of spool 46 during the advancement of structure 22 toward the annulus of the subject, and during the contraction of structure 22.
In some applications of the present invention, an advancement tool other than tool 70 is used to facilitate advancement of structure 22 toward the annulus, e.g., the tool described hereinbelow with reference to
A distal portion of protrusion 71 rests against a depressible portion 28 of a locking mechanism 45. Typically, locking mechanism 45 comprises a mechanical element having a planar surface that is coupled to spool 46. In some applications of the present invention, at least a portion of mechanism 45 is coupled to, e.g., soldered to or disposed adjacently to, housing 44. Typically, lower surface 152 of spool 46 is shaped to define one or more (e.g., a plurality, as shown) of recesses, e.g., holes (not shown for clarity of illustration). Locking mechanism 45 is shaped to provide a protrusion 56, or a first coupling, which protrudes out of the plane of the planar surface of the mechanical element of mechanism 45 and into one of the recesses, or a second coupling, of lower surface 152 of spool 46, as described hereinbelow.
It is to be noted that the planar, mechanical element of locking mechanism 45 is shown by way of illustration and not limitation and that any suitable mechanical element having or lacking a planar surface but shaped to define at least one protrusion may be used together with locking mechanism 45.
The enlarged image in
Protrusion 56 remains disposed within the recess of lower surface 152 of spool 46 until a force is applied to locking mechanism 45 which causes protrusion 56 to be dislodged from within the recess of lower surface 152 of spool 46. Typically, protrusion 56 is coupled to depressible portion 28 of locking mechanism 45. As described hereinbelow, tool 70 is pushed distally causes protrusion 71 of screwdriver head 75 to press down on depressible portion 28. As a result, protrusion 56 of locking mechanism 45 is pushed down together with depressible portion 28, and is thereby dislodged from within the recess of lower surface 152 of spool 46.
Once spool 46 is released from protrusion 56 of locking mechanism 45, flexible rod 78 of tool 70 is rotated in order to rotate screwdriver head 75, and thereby spool 46.
Typically, housing 82 of tool 70 functions to provide a reference force against housing 44 of structure 22 during the rotation of rotating element 46.
Tool 70 may be used in order to advance structure 22 toward the annulus in an open heart procedure, minimally-invasive procedure, and/or in a transcatheter procedure. For applications in which tool 70 is used during a transcatheter procedure, tool 70 comprises a substantially longer, more flexible body portion than if used during an open-heart or minimally-invasive procedure. In some applications of the present invention, tool 70 is used to advance structure 22 toward the annulus in a linear configuration (as shown), in a curved configuration (i.e., in manner in which structure 22 defines an annuloplasty band or a partial annuloplasty ring), or in a closed configuration (i.e., a configuration in which second end 23 of structure 22 is coupled to housing 44 such that structure 22 defines an annuloplasty ring).
In some applications of the present invention, structure 122 comprises a linear, elongate structure in a resting configuration thereof. Prior to implantation, first and second ends 21 and 23 of structure 122 are welded or otherwise attached to coupling members 31 and 35, respectively, thereby facilitating the formation of structure 122 into a substantially ring-shaped structure. As described hereinabove with respect to structure 22 with reference to
It is to be noted that for some applications of the present invention, flexible contracting member 30 may be coupled at both its first and second end portions, e.g., first and second ends, to spool 46 of adjusting mechanism 40. In some applications of the present invention, a first end of flexible contracting member 30 is coupled to spool 46 while a second end of flexible contracting member 30 is coupled to the housing which houses spool 46. For some applications, contracting member 30 comprises a continuous band that is looped through a portion of spool 46.
As shown, structure 122 defines a substantially ring-shaped configuration, e.g., a “D”-shaped configuration, as shown, which conforms to the shape of the annulus of a mitral valve of the subject. Prior to contracting of structure 122, the compressible element of body portion 24 is relaxed and structure 122 defines a first perimeter thereof. Structure 122 provides portions 49 which comprise a material in a configuration in which portions 49 are flexible and less longitudinally compressible, e.g., not longitudinally compressible, with respect to the compressible element of body portion 24. Portions 49 are configured to be disposed along the fibrous portion of the annulus that is between the trigones of the mitral valve of the heart when structure 122 is anchored, sutured, fastened or otherwise coupled to the annulus of the mitral valve. Portions 49 impart rigidity to structure 122 in the portion thereof that is disposed between the fibrous trigones such that structure 122 better mimics the conformation and functionality of the mitral valve. That is, during rotation of spool 46, and the concurrent contraction or expansion of structure 122, energy is not expended on contracting or expanding portions 49.
Typically, both portions 49 have a combined length of 10-50 mm.
Thus, structure 122 defines a compressible portion and a non-compressible portion. Typically, a radius of curvature at a center of the compressible portion of body portion 24 is smaller than a radius of curvature at a center of less-compressible portions 49, when no external force is applied to the annuloplasty structure.
It is to be noted that the compressible element of body portion 24 and less-compressible portions 49 comprise flexible coiled elements by way of illustration and not limitation. For example, the compressible element of body portion 24 and less-compressible portions 49 may comprise stent-like struts, or a braided mesh. In either configuration, portions 49 are chronically longitudinally compressed in a resting state of structure 122.
Housing 82 of tool 70 is coupled to structure 122 by surrounding housing 144. Tool 70 facilitates contracting of structure 122 via adjusting mechanism 40 in a manner as described hereinabove with respect to the contracting of structure 22 with reference to
Reference is again made to
Reference is again made to
Spool 46 is configured to be disposed within housing 144 and defines an upper surface 150, a lower surface 152 and a cylindrical body portion disposed vertically between surfaces 150 and 152. Spool 46 is shaped to provide channel 48 which extends from an opening provided by upper surface 150 to an opening provided by lower surface 152. The cylindrical body portion of spool 46 is shaped to define one or more holes 42. Typically, flexible contracting member 30 is coupled to spool 46 via hole 42. In some applications of the present invention, flexible contracting member 30 comprises a continuous ring-shaped band which passes through hole 42 of spool 46.
Lower surface 152 of spool 46 is shaped to define one or more (e.g., a plurality, as shown) recesses 154 disposed between portions 155 of lower surface 152. Although four recesses 154 are shown by way of illustration and not limitation, it is to be noted that any suitable number of recesses 154 may be provided, e.g., between 1 and 10 recesses. It is to be noted that four recesses 154 are shown by way of illustration and not limitation and that any suitable number of recesses 154 may be provided.
Locking mechanism 45 is coupled to lower surface 152. In some applications of the present invention, at least a portion of locking mechanism 45 is welded to housing 144. For other applications, locking mechanism 45 rests against spool 46 and is held in place with respect to spool 46 by a distal cap, as described hereinbelow. Typically, locking mechanism 45 defines a mechanical element having a planar surface that has at least one slit 58. Locking mechanism 45 is shaped to provide a protrusion 56 which projects out of a plane defined by the planar surface of the mechanical element. Slit 58 defines a depressible portion 28 of locking mechanism 45 that is disposed in communication with protrusion 56. Depressible portion 28 is moveable in response to a force applied thereto typically by tool 70, as described hereinabove, and as shown in detail hereinbelow with reference to
Reference is now made to
Following sufficient contraction of the annuloplasty structure, tool 70 and housing 82 are disengaged from housing 144 of the annuloplasty structure and are extracted from within the heart of the subject.
Reference is now made to
Channel 48 of spool 46 is shaped to accommodate the dimensions of insert 73 and protrusion 71 of screwdriver head 75. Insert 73 is shaped to provide an upper portion having a width that is wider than the protrusion 71 coupled thereto. In turn, channel 48 of spool 46 is shaped to accommodate insert 73 and protrusion 71 by defining an upper portion and a lower portion thereof in which the upper portion of channel 48 is wider than the lower portion. The narrower lower portion of channel 48 ensures that protrusion 71 is not advanced distally beyond a certain point as the narrower lower portion of channel 48 restricts passage therethrough of the upper, wider portion of insert 73.
It is to be noted that housing 144 and structure 122 are shown in
Reference is again made to
It is to be noted that an outer sheath surrounds screwdriver portion 75 of tool 70 in
Reference is now made to
Typically, during transcatheter procedures, sutures 110 are anchored to annulus 92, as shown in
It is to be noted that sutures 110 are anchored at locations 98, 100, and 102 by way of illustration and not limitation, and that sutures 110 may be anchored or otherwise fastened to any suitable location along annulus 92. Furthermore, it is to be noted that any suitable number of sutures 110 may be anchored or otherwise fastened to annulus 92, in accordance with the size of the dilated mitral valve of the subject. For example, between 2 and 20 sutures, typically between 2 and 14 sutures, may be anchored to annulus 92 via respective helical anchors 108.
During open-heart or minimally-invasive procedures to repair the dilated mitral valve, sutures 110 may be sutured directly to annulus 92 using techniques known in the art. Typically, a plurality of sutures are sutured along the entire circumference of the annulus in accordance with the size of the dilated annulus. In some applications of the present invention, adjacently-disposed sutures may overlap in part. In some applications of the present invention, the sutures are sutured to annulus in a manner in which the suture defines a portion disposed in the tissue, and first and second portions extending from either side of the portion of the suture that is disposed within the tissue. In such applications of the present invention, the suture may be sutured to the tissue in a manner in which the first and second portions of the tissue are disposed at a distance, e.g., 4 mm, from each other.
Prior to advancement toward annulus 92, structure 22 is coupled to tool 70, as described hereinabove. For applications in which structure 22 is transcatheterally implanted along annulus 92, structure 22 may be advanced linearly through the advancement catheter and pushed therethrough by tool 70. Typically, the advancement catheter is transseptally advanced toward the left atrium of the heart of the subject and tool 70 is advanced through the catheter.
In some applications of the present invention, structure 22 may be coupled at respective ends thereof to housing 44 of adjusting mechanism 40 such that structure 22 is advanced in a closed, substantially ring-shaped configuration. For applications in which structure 22 is transcatheterally advanced in a closed configuration, structure 22 may be folded, or otherwise collapsed, such that it fits within the lumen of the advancement catheter.
As shown in
Typically, each suture 110 defines a portion that is looped around a portion of a respective anchor 108, and first and second portions extending from the looped portion. Respective ends of the first and second portions of each suture 110 are accessible from outside the body of the subject. As shown, the two portions of respective sutures 110 may be threaded through fasteners 41 and 37 and through mesh 26. Alternatively, a first portion of each suture 110 may be threaded through a respective hole defined by fasteners 41 and 37 and through mesh 26 while a second portion of each suture 110 may be threaded around respective fasteners 41 and 37 and around mesh 26. In such applications of the present invention, following the positioning of structure 22 along annulus 92, the first and second portions of sutures 110 are tied together around fasteners 41 and 37, and around mesh 26.
Typically, locations 98 and 100 are by way of illustration and not limitation, on or adjacently to the trigones of the heart that are near the mitral valve. Thus, first and second ends 21 and 23 of structure 22 will be disposed on or adjacently to the trigones. In such applications of the present invention, a portion of structure 22 is not disposed in an area between the fibrous trigones. In some applications of the present invention, respective portions of body portion 24 that are disposed adjacently to first and second ends 21 and 23 of structure 22 are less compressible, e.g., not compressible, as compared to the compressible element of body portion 24.
It is to be noted that first and second ends 21 and 23 of structure 22 are disposed in respective vicinities of the left and right trigones by way of illustration and not limitation, and that respective ends 21 and 23 may be coupled to any suitable portion along the annulus. That is, annuloplasty structure 22 may be coupled along the annulus in any suitable orientation and at any suitable location along the annulus.
Structure 22 is coupled to sutures 130, e.g., metal or fabric, at distal ends thereof. As described hereinbelow, sutures 130 facilitate the advancement of respective anchors toward structure 22 following its initial anchoring to annulus 92 via sutures 110. It is to be noted that only two sutures 130 are coupled to structure 22 by way of illustration and not limitation, and that any suitable number of sutures 130 may be coupled to structure 22. Typically, the number of sutures 130 coupled to structure 22 is determined in accordance with the size of the dilated annulus, and thereby the number of anchoring sites needed in order to properly anchor structure 22 to the dilated annulus.
Following the initial locking of structure 22 with respect to annulus 92, sutures 130 remain extending from structure 22 and accessible from outside the body of the subject. Sutures 130 facilitate advancement of anchors toward structure 22 in order to further anchor structure 22 to annulus 92 at locations 1120 and 1122. It is to be noted that two sutures 130 are shown by way of illustration and not limitation, and that any suitable number of sutures 130 may be coupled to structure 22.
Following implantation of structure 22 along annulus 92 and prior to 20 contraction of structure 22, structure 22 provides a partial annuloplasty ring, or band, having a distance between first and second ends 21 and 23 of structure 22 such that structure 22 defines a first perimeter thereof.
It is to be noted that anchor 105 is shown as comprising two prongs 107 by way of illustration and not limitation, and that any suitable number or prongs may be used.
Typically, anchor 105 is compressed within a tubular housing prior to being advanced through tissue of the annulus. The tubular housing is first advanced through the annuloplasty structure prior to the pushing of anchor 105 from within the tubular housing and into tissue of the annulus. In some applications of the present invention, the tubular housing comprises anchor advancement tube 1150 which is first advanced through a portion of the annuloplasty structure, e.g., is advanced between adjacent coils of the annuloplasty structure, prior to advancing anchor 105 from within tube 150 and into tissue of the annulus. As anchor 105 penetrates tissue of annulus 92, prongs 107 gradually bend away from a longitudinal axis of the body portion of anchor 105 in order to assume their respective bent configurations. As prongs 107 assume their respective bent configurations, their pointed ends puncture surrounding tissue in order to further anchor 105 to tissue of the patient. In its expanded, bent configuration, anchor 105 is configured to restrict proximal motion of thereof through the tissue.
Once structure 22 is further anchored to annulus 92, a respective bead 146 and 148 is advanced along each suture 130 and toward an upper surface of structure 22 (
Following the contraction of structure 22, first and second ends 21 and 23, respectively, of structure 22 are pulled toward each such that structure 22 assumes a second perimeter. The second perimeter following the contracting of structure 22 is smaller than the first perimeter of structure 22 prior to the contracting. Structure 22 may be contracted such that the second perimeter defines any suitable dimension.
It is to be noted that structure 22 may be anchored to annulus 92 such that structure 22 is positioned along the entire perimeter of annulus 92. Alternatively, structure 22 may be anchored to annulus 92 such that it is positioned partially along the perimeter of annulus 92.
Reference is now made to
Recesses 254 of upper portion 252 of spool are is shaped to define a screw-driver-engaging recess 256 extending 0.1-2.0 mm downward from an upper surface of spool 246. Recess 256 provides a means by which at least a distal portion of an elongate tool engages and facilitates rotation spool 246. Typically, a distal portion of the elongate tool is advanced through an opening 206 in upper surface 204 of housing 202 prior to engaging spool 246 via recess 256. As shown hereinbelow, opening 206 is shaped to accommodate a size of a screwdriver tool.
Typically, recesses 254 are disposed along a circumference of at least a portion of upper portion 252 of spool 246. Similarly, projections 208 of upper surface 204 of housing 202 are disposed along a circumference of at least a portion of upper surface 204 of housing 202.
Tool 170 is pushed downward, as indicated by arrow 1, thereby pushing downward spool 246 and, responsively, compressing compressible element 256. In response to the compressing of compressible element 256, upper portion 252 of spool 246 is distanced from upper surface 204 of housing 202, and thereby, projections 208 are dislodged from within recesses 264 of upper portion 252 of spool 246. Once locking mechanism 200 is unlocked and spool 246 is free of projections 208, tool 170 is rotated (in the direction as indicated by arrow 2) in order to rotate spool 246 and wrap flexible contracting member 30 therearound, thereby facilitating contracting of the annuloplasty structure responsively to the rotating.
Following the rotating of spool 246 and the responsive contracting of the annuloplasty structure, tool 170 is pulled away from spool 246, allowing compressible element 256 to assume its relaxed, uncompressed state. As compressible element 256 assumes its relaxes, uncompressed state, compressible element 256 pushed spool 246 upwards in a manner in which recesses 254 are once again engaged by projections 208 of upper surface 204 of housing 202. Such engaging locks spool 246 in place and restricts rotation thereof.
It is to be noted that tool 170 may also be used to expand the annuloplasty structure by rotating in a direction that is opposite the direction used in order to contract the annuloplasty structure.
It is to be noted that portions of braided mesh 26 are shown for clarity of illustration and that body portion 24 of structure 1122 may be entirely surrounded by braided mesh 26. Adjusting mechanism 40 is disposed with respect to structure 1122 at a portion thereof that is between first and second ends 21 and 23 thereof, e.g., at the center, as shown by way of illustration and not limitation. For some applications, the portions of structure 1122 disposed on either side of adjusting mechanism 40 may comprise distinct segments. It is to be further noted that adjusting mechanism 40 may be disposed with respect to annuloplasty structure 1122 at any portion thereof (e.g., generally in the middle of structure 1122, as shown).
Adjusting mechanism 40 comprises a spool 46 as described hereinabove. Spool 46 of adjusting mechanism 40 of system 1140 is coupled to a first end 1131 of a first flexible contracting member 1130 and to a first end 1133 of a second flexible contracting member 1132. A second end 1135 of first flexible member 1130 is coupled to first end 21 of structure 1122. A second end 1137 of second flexible member 1132 is coupled to second end 23 of structure 1122. Flexible members 1130 and 1132 each comprise a wire, a ribbon, a rope, or a band, comprising a flexible metal.
During rotation of spool 46 of adjusting mechanism 40, as described hereinabove, respective portions of first and second flexible members 1130 and 1132 are wrapped around spool 46. That is, successive portions of respective members 1130 and 1132 contact spool 46 during the rotation thereof. Responsively to the winding of the portions of first and second flexible members 1130 and 1132 around spool 46, second ends 1135 and 1137 of flexible members 1130 and 1132, respectively, are pulled toward adjusting mechanism 40. As second ends 1135 and 1137 of flexible members 1130 and 1132, respectively, are pulled toward adjusting mechanism 40, first and second ends 21 and 23 of structure 1122 are pulled toward adjusting mechanism 40, thereby drawing together first and second ends 21 and 23.
It is to be noted that system 1140 is shown are comprising first and second flexible members 1130 and 1132 by way of illustration and not limitation. For some applications, adjusting mechanism 40 may be coupled to more than two flexible members 30. For other applications, adjusting mechanism 40 of structure 1122 may be coupled to only one flexible contracting member 30. In such an application: (1) a first free end of the flexible contracting member 30 is coupled to first end 21 of structure 1122, (2) a second free end of contracting member 30 is coupled to second end 23 of structure 1122, and (3) a portion of member 30 disposed between the first and second free ends thereof is looped through spool 46 of adjusting mechanism 40. In such an application, rotating spool 46 in a first direction winds a middle portion of member 30 around spool 46 such that: (1) successive portions of member 30 contact spool, and (2) the first and second free ends of member 30 (and thereby, first and second ends 21 and 23, respectively, of structure 1122) are pulled toward adjusting mechanism 40.
Holes 42a and 42b may be shaped to define holes, as shown, or slits through which respective portions of flexible member 30 are looped therethrough. In some embodiments, the outer surface of spool 46 is shaped so as to define male projections, e.g., knobs or hooks, around which respective portions of flexible member 30 are ensnared or looped and thereby coupled to spool 46.
As described hereinabove, locking mechanism 45 is coupled to lower surface 152 and is coupled, e.g., welded, at least in part to a lower surface of spool housing 1042. Typically, locking mechanism 45 defines a mechanical element having a planar surface that defines slits 58. It is to be noted that the surface of locking mechanism 45 may also be curved, and not planar. Locking mechanism 45 is shaped to provide a protrusion 156 which projects out of a plane defined by the planar surface of the mechanical element. Slits 58 define a depressible portion 128 of locking mechanism 45 that is disposed in communication with and extends toward protrusion 156. Depressible portion 128 is moveable in response to a force applied thereto typically by screwdriver head 95, as shown in detail hereinbelow with reference to
It is to be noted that the planar, mechanical element of locking mechanism 45 is shown by way of illustration and not limitation and that any suitable mechanical element having or lacking a planar surface but shaped to define at least one protrusion may be used together with locking mechanism 45.
A cap 1044 is provided that is shaped to define a planar surface and an annular wall having an upper surface 244 thereof. Upper surface 244 of the annular wall is coupled to, e.g., welded to, a lower surface provided by spool housing 1042. The annular wall of cap 1044 is shaped to define a recessed portion 1144 of cap 1044 that is in alignment with recessed portion 142 of spool housing 1042. For some applications, locking mechanism 45 is not welded to housing 1042, but rather, locking mechanism 45 is held in place by cap 1044.
During (1) the delivery of the annuloplasty structure to which adjusting mechanism 40 is coupled toward the implantation site (i.e., the annulus of an atrioventricular valve), (2) the attachment of the annuloplasty structure to the implantation site, and (3) the subsequent bidirectional rotation of spool 46 to adjust the dimensions of the annuloplasty structure, adjusting mechanism 40 is disposed in an unlocked state, as shown in
Channel 48 of spool 46 is shaped to accommodate the dimensions of spool-rotating portion 94 and force application 93 of screwdriver head 95. Spool-rotating portion 94 has a width that is wider than the force applicator 93. In turn, channel 48 of spool 46 is shaped to accommodate spool-rotating portion 94 and force application 93 defining an upper portion and a lower portion thereof in which the upper portion of channel 48 is wider than the lower portion. The narrower lower portion of channel 48 ensures that force applicator 93 is not advanced distally beyond a certain point as the narrower lower portion of channel 48 restricts passage therethrough of the upper, wider portion of spool-rotating portion 94. Screwdriver head 95 is shaped to define a shelf portion 91 which rests against upper surface 1041 of spool housing 1042. Similarly, spool-rotating portion 94 is shaped to define a shelf portion 143 which rests against a horizontal wall of spool 46 which defines a portion of channel 48. During the unlocked state of adjusting mechanism 40, screwdriver head 95 is disposed in a manner in which shelf portion 91 thereof rests against upper surface 1041 of spool housing 1042, and shelf 143 of spool-rotating portion 94 rests against the horizontal wall of channel 48, as shown.
During the unlocked state of adjusting mechanism 40, depressible portion 128 is maintained in a pushed state by force applicator 93. In such a state, protrusion 156 of locking mechanism 145 is maintained in a pushed state toward the planar surface of cap 1044. It is to be noted that the surface of cap 1044 may also be curved, and not planar. As described hereinabove, cap 1044 is shaped to provide a recessed portion 1144 for receiving protrusion 156 in its pushed-down state. As depressible portion 128 is pushed downward, protrusion 156 is freed from within a recess 154 defined by structural barrier portions 155 of the lower portion of spool 46. Additionally, protrusion 156 is freed from within recessed portion 142 provided by spool housing 1042. Responsively, adjusting mechanism 40 is unlocked, and spool 46 may be rotated by screwdriver head 95 in either clockwise or counter-clockwise directions in response to torque delivered to head 95 by torque-delivering tool 26 coupled thereto. In response to the torque, spool-rotating portion 94 of screwdriver head 95 engages and pushes against the wall defining channel 48 in order to rotate spool 46.
Cap 1044 functions to restrict distal pushing of depressible portion 128 beyond a desired distance so as to inhibit deformation of locking mechanism 145. Once adjusting mechanism 40 is implanted in heart tissue, cap 1044 also provides an interface between adjusting mechanism 40 and the heart tissue. This prevents interference of heart tissue on adjusting mechanism 40 during the locking and unlocking thereof. Additionally, cap 1044 prevents damage to heart tissue by depressible portion 128 as it is pushed downward.
Reference is now made to
Proximal handle portion 2026 is shaped to define an ergonomic hand-grasping portion 2120 for the physician to grasp and thereby hold tool 2022. Handle portion 2026 comprises a central lumen 2122 that extends from the distal end of handle portion 2026 toward the proximal end of handle portion 2026. A proximal end portion of shaft 2024 is disposed within lumen 2122 and is thereby coupled to handle portion 2026.
A distal end portion 2028 of shaft 2024 is coupled to, e.g., welded to, an adjusting mechanism holder 2029 which comprises a housing portion 2030 for receiving and reversibly coupling adjusting mechanism 40. Holder 2029 is shaped to define a lumen for slidable passage therethrough of a manipulator 2040 which comprises a distal screwdriver head 2042. Screwdriver head 2042 is ultimately coupled to rotatable structure 2900 and facilitates rotation of rotatable structure 2900 responsively to the rotation of manipulator 2040. Manipulator 2040 is coupled at a proximal end thereof to a distal end of torque-delivering tool 2050 which delivers torque to manipulator 2040 and effects rotation of screwdriver head 2042. As is described hereinbelow, a proximal end of torque-delivering tool 2050 is coupled to the rotating mechanism at proximal handle portion 2026. Shaft 2024 is shaped to define a central lumen through which torque-delivering tool 2050 passes.
Reference is again made to
Reference is now made to
Reference is again made to
It is to be noted that adjusting mechanism 40 may be coupled to the annuloplasty device along any portion thereof. For some applications, the flexible longitudinal contracting member comprises an artificial chordea tendinea which is coupled at a first portion to the rotating member of adjusting mechanism 40 and at a second portion to a leaflet of an atrioventricular valve of the patient. In such an application, adjusting mechanism 40 functions to adjust a dimension of the artificial chordea tendinea. Such techniques for artificial chordal adjustment may be implemented using any one of the techniques described in U.S. patent application Ser. No. 12/548,991 to Maisano et al., which issued as U.S. Pat. No. 8,808,368, and which is incorporated herein by reference.
Reference is now made to
Spool 2146 is disposed within housing 1042 and defines an upper surface 150, a lower surface 152 and a cylindrical body portion disposed vertically between surfaces 150 and 152. Spool 2146 is shaped to provide a driving interface, e.g., a channel 48, which extends from a first opening 180 provided by upper surface 150 to a second opening 182 provided by lower surface 152. A proximal portion of channel 48 of the driving interface is shaped to define a threaded portion 2046 which may or may not be tapered. The cylindrical body portion of spool 2146 is shaped to define one or more holes which function as respective coupling sites for coupling (e.g., looping through the one or more holes, or welding to spool 2146 in the vicinity of the one or more holes) of any number of longitudinal members (not shown for clarity of illustration) to spool 2146.
Lower surface 152 of spool 2146 is shaped to define one or more (e.g., a plurality, as shown) recesses 154 which define structural barrier portions 155 of lower surface 152. It is to be noted that any suitable number of recesses 154 may be provided, e.g., between 1 and 10 recesses, circumferentially with respect to lower surface 152 of spool 2146. It is to be noted that recesses 154 may be provided at lower surface 152 in a random pattern, and are not necessarily circumferentially oriented.
Reference is now made to
It is to be noted that the planar, mechanical element of locking mechanism 1045 is shown by way of illustration and not limitation and that any suitable mechanical element having or lacking a planar surface but shaped to define at least one protrusion may be used together with locking mechanism 1045.
A cap 1044 is provided that is shaped to define a planar surface and an annular wall having an upper surface thereof. The upper surface of the annular wall is coupled to, e.g., welded to, a lower surface provided by spool housing 1042. The annular wall of cap 1044 is shaped to define a recessed portion 1144 of cap 1044 that is in alignment with recessed portion 142 of spool housing 1042.
Reference is now made to
Reference is now made to
Reference is now made to
Prior to delivering and implanting adjusting mechanism 40, delivery tool 2022 is coupled to mechanism 40. Housing 2030 of adjusting mechanism holder 2029 surrounds housing 1042 of adjusting mechanism 40, which provides initial coupling of tool 2022 to adjusting mechanism 40. During the initial coupling, manipulator 2040 may be pushed proximally, along central axis 2200 of tool 2022, by the force of contact of adjusting mechanism 40 to tool 2022. Manipulator 2040 is coupled to a distal end of torque-delivering tool 2050, which in turn, is coupled at a proximal end thereof to torque-delivering-tool coupler 2086. Torque-delivering tool 2050 slides within a lumen provided by shaft 2024 of tool 2022. Tool 2022 enables such proximal pushing of manipulator 2040 by providing a tensile spring 2087 around torque-delivering-tool coupler 2086. As screwdriver head 2042 contacts adjusting mechanism 40, adjusting mechanism 40 responsively pushes and slides proximally (1) screwdriver head 2042 (2) manipulator 2040, (3) torque-delivering tool 2050, and (4) torque-delivering-tool coupler 2086. Responsively to the pushing of torque-delivering-tool coupler 2086, spring 2087 is compressed to enable such proximal sliding of (1) screwdriver head 2042 (2) manipulator 2040, (3) torque-delivering tool 2050, and (4) torque-delivering-tool coupler 2086.
Following the initial coupling of adjusting mechanism 40 to tool 2022, tool 2022 is then more firmly coupled to adjusting mechanism 40 by screwing screwdriver head 2042 into threaded portion 2046 of spool 2146 of adjusting mechanism 40. By the screwing, screwdriver head 2042 is advanced distally toward adjusting mechanism 40. This screwing of head 2042 is accomplished when the physician rotates knob 2070 (in the direction as indicated by arrow 1 in
Reference is now made to
Reference is now made to
The pushing distally of knob 2070 compresses and applies load to a tension spring 2078 that is disposed within knob 2070 and component 2071. As shown in the enlarged image of
It is to be noted that in order to release locking mechanism 1045 from spool 2146, protrusion 156 should be pushed distally by rod 2060 between 0.3 and 1.0 mm, e.g., 0.4 mm. When tool 2022 is decoupled from adjusting mechanism 40 and knob 2070 is disposed in a pushed state, the distal end portion of rod 2060 extends approximately 5 mm beyond the distal end of tool 2022. When adjusting mechanism 40 is coupled to tool 2022, and rod 2060 is pushed distally, distal end 2062 of rod 2060 contacts and is impeded by depressible portion 128 of locking mechanism 1045. Depressible portion 128 is capable of being depressed by an angle of up to 20 degrees, e.g., 7 degrees (i.e., cap 1044 restricts depressing of portion 128 beyond a certain angle). When the distal portion of rod 2060 contacts depressible portion 128, portion 128 restricts rod 2060 from extending further than 1 mm from second opening 182 of spool 2146. In order to compensate for the restricting of the extension of rod 2060 beyond a predetermined amount, spring 2078 contracts in order to slightly pull back rod 2060. Spring 2078 thus enables tool 2022 to be generally exacting in pushing protrusion 156 distally by 0.3-0.5, e.g., 0.4 mm.
Reference is again made to
It is to be noted that any elongate structure, e.g., a pull-wire, a rod, a thread, rope, or a suture, may be passed through lumen 2052 of torque-delivering tool 2050 independently of and/or in addition to rod 2060. It is to be noted that any elongate structure, e.g., a pull-wire, a rod, a thread, rope, or a suture, may be passed through the lumen of shaft 2024 independently of and/or in addition to tool 2050.
Typically, tool 2050 comprises a flexible material (e.g., a plastic or a plurality of strands of flexible metal such as stainless steel 304 that are bundled together). Once protrusion is displaced from within recess 154 of spool 2146, and spool 2146 is released from locking mechanism 1045, the physician rotates knob 2090 in a first direction thereof, as indicated by arrow 7, in order to rotate spool 2146, as described hereinbelow. The spool is free to rotate in either clockwise or counterclockwise direction, as long as protrusion 156 of locking mechanism 1045 is decoupled from spool 2146. The physician is able to freely rotate knob 2090 (and thereby spool 2146) without any obstruction from locking mechanism 1045 because locking mechanism 1045 is kept in an unlocked state (i.e., protrusion 156 remains outside of the recesses 154 of spool 2146) due to the pushed state of tool 2022. During this pushed state, knob 2070 is maintained in a pushed state as male couplings 2074 are coupled to female couplings 2081, and rod 2060 is maintained in a state in which distal end 2062 is disposed distally to the opening provided by lower surface 152 of spool 2146 and pushes on depressible portion 128 of locking mechanism 1045, as shown in the enlarged image of
Reference is now made to
Slits 2082 of rotator 2080 enable slidable advancement of pins 2084 during the distal sliding of component 2071 within lumen 2077 of rotator 2080 responsively to pushing distally knob 2070. During the resting state of tool 2022, as shown in
Sections A-A and B-B of
Since knob 2090 is coupled to rotator 2080, (and spool 2146 is now freed from locking mechanism due to the pushed state of knob 2070, as described hereinabove) rotation of knob 2090 in a first direction thereof (as indicated by arrow 7 in
Reference is now made to
Knob 2090 is coupled at a distal end 2091 thereof to a sliding indicator 2100 which is shaped to define a window 2102. Rotation of knob 2090 in the first direction (as indicated by arrow 7 in
Typically, adjusting mechanism 40 is coupled to an annuloplasty device, as described herein (specifically with reference to
Reference is now made to
Reference is now made to
Reference is now made to
As knob 2090 is rotated, it advances together with indicator 2100 distally along body component 2106 of tool 2022.
Following rotation of spool 2146 responsively to the rotation of knob 2090, screw 2094 is disposed at a distal end of groove 2092 (e.g., near or at distal end 2096 of groove 2092), and indicator 2100 is disposed at a distal position in which window 2102 approaches the distal-most number (i.e., number 7) in the series of numerical indicators 2104, indicating (1) that spool 2146 has been rotated about 7 times, (2) that contracting member 30 has been wound around spool 2146 about 7 times, and/or (3) the level of contraction of the annuloplasty device that is coupled to adjusting mechanism 40 in some applications.
Reference is now made to
Reference is again made to
In order to release knob 2070, the physician pushes inwardly the lateral portions of clip 2072 and knob 2070 is responsively pushed proximally from the proximal end of knob 2090 by expansion of spring 2078. As knob 2070 advances proximally, component 2071 that is coupled to knob 2070 slides proximally within lumen 2077 of rotator 2080 and pins 2084 slide proximally along slits 2082 of rotator 2080 and along slits 2085 of knob 2090.
The physician then rotates knob 2070 in the direction as indicated by arrow 9 in
Reference is now made to
Typically, body portion 24 comprises a biocompatible material, e.g., nitinol, stainless steel, platinum iridium, titanium, expanded polytetrafluoroethylene (ePTFE), or cobalt chrome. In some applications, body portion 24 is coated with PTFE (Polytetrafluoroethylene). In some applications, body portion 24 comprises accordion-like compressible structures which facilitate proper cinching of the annulus when device 1260 is contracted. Body portion 24, when compressed, e.g., typically along a longitudinal axis of device 1260, enables portions of annuloplasty device 1260 to contract and independently conform to the configuration of the annulus of the mitral valve of a given subject. Thus, the compressible element of body portion 24 facilitates contraction of the annulus in response to contraction of device 1260.
Typically, contracting member 30 comprises a flexible and/or superelastic material, e.g., nitinol, polyester, stainless steel, or cobalt chrome, and is configured to reside chronically within device 1260. In some applications, contracting member 30 comprises a braided polyester suture (e.g., Ticron). In some applications, contracting member 30 is coated with polytetrafluoroethylene (PTFE). In some applications, contracting member 30 comprises a plurality of wires that are intertwined to form a rope structure.
As shown in
A first area of ring 1270 (i.e., a first end of portion 24 that is coupled to adjusting mechanism 40) comprises a first swivel snap which is coupled to coupling member 31 of housing 1042, and thereby couples a first end of body portion 24 to adjusting mechanism 40. A second area of ring 1270 (i.e., a second end of portion 24 that is coupled to adjusting mechanism 40) comprises a second swivel snap which is coupled to coupling member 35 of housing 1042, and thereby couples a second end of body portion 24 to adjusting mechanism 40. Typically, (1) the first end of body portion 24 is welded to the first snap, and the first snap is loosely coupled to coupling member 31, and (2) the second end of body portion 24 is welded to the second snap, and the second snap is loosely coupled to coupling member 35. This configuration enables swiveling of adjusting mechanism 40 with respect to ring 1270, e.g., while ring 1270 remains stationary.
In some applications, the contracting of device 1260 enables device 1260 to assume the configuration shown. Alternatively, or additionally, prior to contraction, device 1260 is anchored, or otherwise fastened, at least in part to the annulus of the valve of the subject at respective locations along device 1260. The anchoring, or otherwise fastening, of device 1260 to the annulus enables device 1260 to assume the configuration shown, as described hereinbelow.
Reference is now made to
Reference is again made to
Reference is now made to
Once tool 2022 is disengaged from adjusting mechanism 40 following the adjusting of the dimension of the annuloplasty device, and thereby of the annulus of the valve, tool 2022 is extracted from the heart. Holder 2029 is shaped so as to define a cone-shaped proximal portion which acts as an obturator to enlarge the opening surrounded by the purse-string stitch. This shape enables ease and atraumatic extracting of distal portion 2028 of tool 2022. Following the extracting of tool 2022, the opening in the heart is closed, e.g., sutured, and the access site to the body of the patient is sutured.
Reference is now made to
Reference is now made to
Reference is now made to
It is to be noted that, for some applications, system 2500 described herein, may be provided independently of second rotatable structure 816. Also, for some applications, the plurality of engaging elements of first portion 813 are shaped so as to define a plurality of window (i.e., and not teeth, as shown). As rotatable structure 2900 is rotated, successive portions of member 30 contact rotatable structure 2900. Geared teeth of pinion 812 matingly engage the windows of portion 813, such that successive portions of member 30 pass between rotatable structure 2900 and a second rotatable structure 816.
Reference is again made to
Reference is made to
Valve 910 further comprises an annular base 932, to which leaflets 930 are coupled. Annular base is configured to be couplable to base ring 922 during an implantation procedure. For example, as show in
Base ring 922 implements one or more of the techniques of annuloplasty ring 22 described hereinabove. In particular, base ring 922 may be coupled to the annulus of the native diseased valve using the anchoring techniques described hereinabove. In addition, base ring 922 typically comprises a rotatable structure 936, such as a spool, which is typically implemented using techniques described herein. The rotatable structure is arranged such that rotation thereof contracts base ring 922, typically using techniques described herein. Such tightening may serve to couple base ring 922 to annular base 932, as shown in
For some applications, base ring 922 comprises a partial ring, as shown in
Valve prosthesis assembly 900 is typically implanted in a minimally invasive transcatheter procedure. The procedure begins with the introduction and implantation of base ring 922 into the heart, such as using techniques for implanting annuloplasty ring 22, described hereinabove with reference to
(a) a middle portion, which defines a first end portion 1230, of contracting member 30 is coupled to spool 2146 by being looped through one or more holes 42,
(b) first and second portions that extend (1) through coupling member 35 of housing 1042, from the first end portion looped through spool 2146 (2) through coupling member 31 of housing 1042, and (3) toward a second end 23 of structure 22, and
(c) first and second free ends (and respective portions of contracting member 30) are coupled to second end 23 of structure 122 and define a second end portion 1232 of contracting member 30.
Reference is now made to
Reference is now made to
For some applications, as shown in a system 3000 in
Reference is made to
For applications in which structure 122 is transcatheterally advanced toward annulus 92, structure 122 may be folded, or otherwise collapsed, such that it fits within the lumen of the advancement catheter.
Reference is again made to
Reference is yet again made to
It is to be noted that for applications in which structures 22, 122, and 1122, and device 1260 are implanted during an open-heart or minimally-invasive procedure, structures 22, 122, and 1122 and device 1260 may be provided independently or in combination with sutures 130.
Reference is now made to
Reference is again made to
Reference is again made to
Reference is yet again made to
Reference is yet again made to
It is to be noted that systems 20, 120, 1140, 2020, 2400, 2450, 2500, and assembly 900 for repairing a dilated annulus of the subject may be used to treat a valve of the subject, e.g., the tricuspid valve. It is to be still further noted that systems described herein for treatment of valves may be used to treat other annular muscles within the body of the patient. For example, the systems described herein may be used in order to treat a sphincter muscle within a stomach of the subject.
For some applications, techniques described herein are practiced in combination with techniques described in one or more of the references cited in the Background section and Cross-references section of the present patent application.
Additionally, the scope of the present invention includes applications described in one or more of the following:
All of these applications are incorporated herein by reference. Techniques described herein can be practiced in combination with techniques described in one or more of these applications.
It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
The present application is a continuation of U.S. patent application Ser. No. 14/567,472, filed on Dec. 11, 2014 which published as US 2015/0105855 which issued as U.S. Pat. No. 9,713,530 and which is a continuation of U.S. patent application Ser. No. 13/141,606, filed on Aug. 1, 2011, which issued as U.S. Pat. No. 8,926,696 and which is a US national phase of PCT Patent Application PCT/IL2009/001209 filed on Dec. 22, 2009, which published as WO 2010/073246, and which: (a) is a continuation-in-part of and claims the priority from U.S. patent application Ser. No. 12/341,960 to Cabiri, entitled, “Adjustable partial annuloplasty ring and mechanism therefor,” filed Dec. 22, 2008, which issued as U.S. Pat. No. 8,241,351; (b) is a continuation-in-part of and claims the priority from U.S. patent application Ser. No. 12/435,291 to Maisano et al., entitled, “Adjustable repair chords and spool mechanism therefor,” filed on May 4, 2009, which issued as U.S. Pat. No. 8,147,542; (c) claims the priority from U.S. Provisional Patent Application 61/283,445 to Sheps et al., entitled, “Delivery tool for rotation of spool and adjustment of annuloplasty device,” filed Dec. 2, 2009; and (d) is related to: (1) PCT Publication WO 06/097931 to Gross et al., entitled, “Mitral Valve treatment techniques,” filed Mar. 15, 2006;(2) U.S. patent application Ser. No. 12/548,991 to Maisano et al., entitled, “Implantation of repair chords in the heart,” filed on Aug. 27, 2009, which issued as U.S. Pat. No. 8,808,368; and(3) U.S. Provisional Patent Application 61/265,936 to Miller et al., entitled, “Delivery tool for implantation of spool assembly coupled to a helical anchor,” filed on Dec. 2, 2009. All of these applications are incorporated herein by reference.
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