Patent Application
20200375740
The present disclosure belongs to the field of biomedical instruments, and specifically relates to an adjustable artificial chordae tendineae fixing assembly and an implanting method thereof.
At present, mitral regurgitation is one of the most common valvular diseases. It is mainly caused by mitral annulus dilatation, chordae tendineae insufficiency, myxomatous degeneration of the mitral valve, mitral valve prolapses, rheumatic valvular diseases, ischemic diseases. The open mitral valvuloplasty and the prosthetic valve replacement are the most effective methods for the treatment of mitral regurgitation. However, this surgery needs technical support of cardiopulmonary bypass and thus produces a great surgical trauma to the human body, which leads to severe postoperative complications and extremely high mortality from senile patients and patients with more complications.
Hence, in recent years, medical staff and researchers in various countries have dedicated efforts to exploring percutaneous mitral valve repair techniques. The interventional treatment methods now used include mitral valve annuloplasty, negative pressure suction suture and MitraClip, among which the MitraClip shows the most reliable treatment outcome. In the MitraClip, an implantable clip is delivered to a vicinity of the mitral valve by puncturing the atrial septum, and free margins of the anterior leaflet and the posterior leaflet are clamped to allow the leaflets to fit well at the end of systole in order to reduce the mitral regurgitation. However, the chordae tendineae cannot be implanted by this medical instrument, which performs a non-physiological repair.
The repair method of implanting the artificial chordae tendineae has shortcomings as well. Implanting the artificial chordae tendineae on the valve is close to the physiological state and usually is performed through the transapical approach, which produces a great surgical trauma and a high risk. Alternatively, the percutaneous approach can produce a safer minimally invasive treatment outcome, but how to fix the artificial chordae tendineae remains an urgent problem to be solved with the percutaneous approach. Moreover, once the artificial chordae tendineae is fixed, the length of the chordae tendineae cannot be adjusted anew. As the cardiac volume of the patient changes or the patient is out of anesthesia, the length of the artificial chordae tendineae needs to be adjusted accordingly. Otherwise, an abnormality of the cardiac valve occurs and leads to a failure of the procedure.
In order to overcome the above-mentioned issues, the present disclosure provides a fixing assembly capable of repeatedly adjusting the length of the artificial chordae tendineae to fix the artificial chordae tendineae on the interventricular septum by an occlusion device.
The technical solutions of the present disclosure are as follows:
An adjustable artificial chordae tendineae fixing assembly includes an occlusion device and an adjusting rod. The occlusion device includes a first occlusion disc, a waist portion and a second occlusion disc. The middle of the first occlusion disc, the waist portion and the second occlusion disc of the occlusion device is provided with a penetrating passage allowing an artificial chordae tendineae to pass there through. A switch adjusting device is arranged at the opening of the penetrating passage of the first occlusion disc. The protruding portion on the outer side of the switch adjusting device is arranged outside the first occlusion disc. A valve and a plurality of friction plates on the inner side of the switch adjusting device extend inside the opening of the penetrating passage. The plurality of friction plates are connected to the valve, and the number of the plurality of friction plates is at least two. The plurality of friction plates are controlled to be opened or closed by rotating the valve, so as to control the penetrating passage to be opened or closed. The occlusion device is an elastic mesh structure capable of producing an elastic deformation.
The adjusting rod is a hollow rod-shaped structure allowing the artificial chordae tendineae to pass there through. Two clamping jaws are arranged at the head of the adjusting rod, and the two clamping jaws are connected to a handle at the tail of the adjusting rod by a spring. The two clamping jaws are controlled to be opened and closed by pressing the handle at the tail of the adjusting rod. The two clamping jaws can be clamped on the protruding portion of the switch adjusting device to be connected to the occlusion device.
Further, a protrusion is arranged on the inner side of each of the two clamping jaws of the adjusting rod. A groove is arranged at the protruding portion of the switch adjusting device, and the protrusion is engaged with the groove when the adjusting rod is connected to the occlusion device.
Further, the protrusion in each of the two clamping jaws is provided with a first magnet, and the groove of the switch adjusting device is provided with a second magnet, wherein the polarity of the first magnet is opposite to the polarity of the second magnet. The two clamping jaws of the adjusting rod are tightly clamped on the protruding portion of the switch adjusting device of the occlusion device by a magnetic attraction of the protrusion and the groove.
Further, the valve of the switch adjusting device is a threaded structure including a valve core and a knob. The valve core is connected to the plurality of friction plates. A thread is arranged on the outer side of the valve core, and a thread is arranged on the inner side of the knob. When the switch adjusting device is closed, the knob is screwed to be tightened, the valve core is tightened inward, and the gap between the plurality of friction plates is closed. When the switch adjusting device is opened, the knob is screwed to be loosened, the valve core restores, and the gap between the plurality of friction plates is opened.
Further, the occlusion device is woven from a nickel-titanium alloy wire, the diameter of the waist portion is 3 to 10 mm, the height of the waist portion is 2 to 20 mm, and the diameter of the first occlusion disc and the diameter of the second occlusion disc are both 7 to 28 mm.
Further, the diameter of the waist portion is 6 mm, the height of the waist portion is 8 mm, and the diameter of the first occlusion disc and the diameter of the second occlusion disc are both 10 mm.
An implanting method for the artificial chordae tendineae fixing assembly includes the following steps:
step 1, penetrating an interventricular septum by a puncture sheath catheter; inserting the artificial chordae tendineae into a free margin of a diseased mitral leaflet through the perforation of the interventricular septum; and pulling out the tail of the artificial chordae tendineae through the tail of the puncture sheath catheter;
step 2, connecting the adjusting rod to the switch adjusting device of the occlusion device; rotating the adjusting rod to open the plurality of friction plates of the switch adjusting device; wherein the artificial chordae tendineae penetrates into the occlusion device and the adjusting rod by using a traction pin, enters the penetrating passage from one side of the second occlusion disc, and is pulled out from the tail of the adjusting rod;
step 3, delivering the occlusion device and the adjusting rod along the puncture sheath catheter; releasing the second occlusion disc of the occlusion device on the left ventricular side of the interventricular septum; placing the waist portion of the occlusion device in the perforation of the interventricular septum; releasing the first occlusion disc of the occlusion device on the right ventricular side of the interventricular septum; clamping the occlusion device on the interventricular septum; pushing and pulling the artificial chordae tendineae outside the tail of the adjusting rod to adjust the length of the artificial chordae tendineae; and closing the plurality of friction plates of the switch adjusting device to fix the artificial chordae tendineae;
step 4, pressing the handle at the tail of the adjusting rod to open the two clamping jaws at the head of the adjusting rod; releasing the occlusion device;
withdrawing the adjusting rod; and retaining the artificial chordae tendineae outside a sheath catheter at a jugular venipuncture;
step 5, delivering the thread trimmer along the tail of the artificial chordae tendineae; triggering the handle at the tail of the thread trimmer to cut off the artificial chordae tendineae after the thread trimmer reaches the occlusion device; withdrawing the thread trimmer; and performing hemostasis by a compression.
Further, step 4a is between step 4 and step 5, including: inserting the artificial chordae tendineae into the adjusting rod when the length of the artificial chordae tendineae is unsuitable since anesthesia ends, or a cardiac volume changes; delivering the adjusting rod to the outer side of the first occlusion disc along the artificial chordae tendineae; pressing the handle at the tail of the adjusting rod to clamp the two clamping jaws of the adjusting rod outside the protruding portion of the switch adjusting device with the aid of the chordae tendineae and magnetism; rotating the switch adjusting device to allow the plurality of friction plates to open the gap after the two clamping jaws are securely clamped; loosening the artificial chordae tendineae to readjust the length of the artificial chordae tendineae; rotating the adjusting rod to close the plurality of friction plates of the switch adjusting device; fixing the artificial chordae tendineae; separating the adjusting rod from the occlusion device; and withdrawing the adjusting rod from the body.
Further, the thread trimmer is a rod-shaped structure, the thread trimmer includes a thread trimming end and a handle end at two ends thereof, respectively. The thread trimming end is provided with a groove and a blade capable of moving up and down along the groove. The handle end is provided with a push button, wherein the push button is connected to the blade inside the thread trimmer, and the blade is controlled to move by the push button.
The present disclosure has the following advantages by using the above-mentioned technical solution:
1. In the present disclosure, the artificial chordae tendineae is fixed on the interventricular septum by the occlusion device of the artificial chordae tendineae fixing assembly, which can occlude the perforation left by the puncture sheath catheter, and can also fix the artificial chordae tendineae.
2. The occlusion device is controlled to be opened and closed by the adjusting device of the occlusion device of the present disclosure. The artificial tendon fixing assembly can effectively fix the artificial chordae tendineae when the friction plates are closed, and can allow the artificial chordae tendineae to move in the occlusion device when the friction plates are opened, which facilitates an adjustment of the length of the artificial chordae tendineae.
3. In the present disclosure, the problem of unsuitable length of the artificial chordae tendineae due to cardiac changes occurring in most of patients after the procedure can be overcome by using the artificial chordae tendineae fixing assembly. The artificial chordae tendineae is retained at the skin puncture point for a short time. The length of the artificial chordae tendineae is adjusted again by using the artificial chordae tendineae fixing assembly according to a cardiac change of the patient in an early postoperative period, so as to realize the function of repeatedly adjusting the artificial chordae tendineae.
4. According to the artificial chordae tendineae fixing assembly of the present disclosure, the protrusion on the clamping jaw is engaged with the groove on the outer side of the switch adjusting device of the occlusion device to increase the clamping force. In addition, the protrusion and the groove are provided with magnets having opposite polarities, so that the adjusting rod can be quickly connected to the occlusion device when entering the body again, thereby improving procedural efficiency.
where, 1-occlusion device, 11-first occlusion disc, 12-waist portion, 13-second occlusion disc, 2-switch adjusting device, 21-protruding portion, 211-groove, 22-valve, 23-friction plate, 3-adjusting rod, 31-clamping jaw, 311-protrusion, 32-handle, 4-thread trimmer, 41-blade, 42-push button, 5-traction pin.
In order to clearly describe the objectives, technical solutions, and advantages of the present disclosure, the present disclosure will be further described in detail hereinafter with reference to the drawings and embodiments. It should be understood that the structural diagrams and specific embodiments described herein are only intended to illustrate the present disclosure rather than limiting the present disclosure.
As shown in
The occlusion device is woven from a nickel-titanium alloy wire. The diameter CD of the waist portion is 3 to 10 mm, preferably 6 mm. The height CE of the waist portion is 2 to 20 mm, preferably 8 mm. The diameter AB of the first occlusion disc and the diameter GH of the second occlusion disc are both 7 to 28 mm, and preferably 10 mm.
The switch adjusting device 2 is arranged at the opening of the penetrating passage of the first occlusion disc. The protruding portion 21 on the outer side of the switch adjusting device is arranged outside the first occlusion disc. The valve 22 and the plurality of friction plates 23 on the inner side of the switch adjusting device extend inside the opening of the penetrating passage. The plurality of friction plates are connected to the valve. The plurality of friction plates are controlled to opened and closed by rotating the valve, so as to control the penetrating passage of the first occlusion disc to be opened and closed. The plurality of friction plates can clamp the artificial chordae tendineae after being closed, to prevent a movement of the artificial chordae tendineae. The number of the plurality of friction plates is at least two. The number of the plurality of friction plates is not limited in the present disclosure, and thus can be even more according to different clamping forces required by the artificial chordae tendineae. For example, the number of the plurality of friction plates is five, and the plurality of friction plates are closed to form a “petal” shape, which enhances the clamping force on the artificial chordae tendineae.
The adjusting rod 3 is a hollow rod-shaped structure allowing the artificial chordae tendineae to pass through. Two clamping jaws 31 are arranged at the head of the adjusting rod, and the two clamping jaws are connected to the handle 32 at the tail of the adjusting rod by a spring piece. The two clamping jaws are controlled to be opened and closed by pressing the handle. The two clamping jaws can be clamped on the protruding portion of the switch adjusting device to be connected to the occlusion device.
In the present disclosure, the valve of the switch adjusting device is a threaded structure including a valve core and a knob, as shown in
After the adjusting rod is connected to the occlusion device, the knob of the valve of the switch adjusting device is rotated by clockwise rotating the adjusting rod so that the knob of the valve is rotated to reach the valve core of the occlusion device; the valve core is tightened, the friction plate is closed to clamp the artificial chordae tendineae, so as to limit the movement of the artificial chordae tendineae. The knob is rotated outward by rotating the adjusting rod counterclockwise, the valve core restores, and the plurality of friction plates that are closed to one another are loosened to form a gap so that the artificial chordae tendineae can move in the gap.
Preferably, as shown in
Preferably, the protrusion in each of the two clamping jaws is provided with a first magnet, and the groove of the switch adjusting device is provided with a second magnet, wherein the polarity of the first magnet is opposite to the polarity of the second magnet. The two clamping jaws of the adjusting rod are tightly clamped on the protruding portion of the switch adjusting device of the occlusion device by a magnetic attraction of the protrusion and the groove. The occlusion device is fixed at the interventricular septum to preliminarily fix the artificial chordae tendineae. When the length of the artificial chordae tendineae needs to be adjusted again, the adjusting rod needs to be connected to the switch adjusting device of the occlusion device again. The magnetic attraction of the protrusion and the groove allows the adjusting rod to be quickly connected to the occlusion device, which saves the time that the doctor spends in finding the connection point during the surgery, and facilitates repeatedly adjusting the artificial chordae tendineae.
Step 1, the puncture sheath catheter penetrates the interventricular septum; the artificial chordae tendineae is inserted into a free margin of a diseased mitral leaflet through the perforation of the interventricular septum; and the tail of the artificial chordae tendineae is pulled out through the tail of the puncture sheath catheter.
Step 2, the adjusting rod is connected to the switch adjusting device of the occlusion device; the adjusting rod is rotated to open the plurality of friction plates of the switch adjusting device; wherein the artificial chordae tendineae penetrates into the occlusion device and the adjusting rod by using a traction pin, enters the penetrating passage from one side of the second occlusion disc, and is pulled out from the tail of the adjusting rod.
Step 3, the occlusion device and the adjusting rod are delivered along the puncture sheath catheter; the second occlusion disc of the occlusion device is released on the left ventricular side of the interventricular septum; the waist portion of the occlusion device is placed in the perforation of the interventricular septum; the first occlusion disc of the occlusion device is released on the right ventricular side of the interventricular septum; the occlusion device is clamped on the interventricular septum; the artificial chordae tendineae outside the tail of the adjusting rod is pushed and pulled to adjust the length of the artificial chordae tendineae; and the plurality of friction plates of the switch adjusting device are closed to fix the artificial chordae tendineae.
Step 4, the handle at the tail of the adjusting rod is pressed to open the two clamping jaws at the head of the adjusting rod; the occlusion device is released; the adjusting rod is withdrawn; and the artificial chordae tendineae is retained outside a sheath catheter at a jugular venipuncture.
Step 5, the thread trimmer is delivered along the tail of the artificial chordae tendineae; the handle at the tail of the thread trimmer is triggered to cut off the artificial chordae tendineae after the thread trimmer reaches the occlusion device; the thread trimmer is withdrawn; and the hemostasis is performed by a compression.
Preferably, step 4a may be included between step 4 and step 5, and step 4a includes: the artificial chordae tendineae is inserted into the adjusting rod when the length of the artificial chordae tendineae is unsuitable due to a removal of anesthesia, a change in a cardiac volume, or other factors; the adjusting rod is delivered to the outer side of the first occlusion disc along the artificial chordae tendineae; the handle at the tail of the adjusting rod is pressed to clamp the two clamping jaws of the adjusting rod outside the protruding portion of the switch adjusting device; the switch adjusting device is rotated to allow the plurality of friction plates to open the gap; the artificial chordae tendineae is loosened to readjust the length of the artificial chordae tendineae; then, the adjusting rod is rotated to close the plurality of friction plates of the switch adjusting device; the artificial chordae tendineae is fixed; the adjusting rod is separated from the occlusion device; and the adjusting rod is withdrawn from the body.
In step 1, after the tail of the artificial chordae tendineae is pulled out of the body, the artificial chordae tendineae is hooked by a traction pin, so as to insert the artificial chordae tendineae into the fixing assembly. The structure of the traction pin is shown in
The present disclosure further provides a thread trimmer, as shown in
According to the present disclosure, the artificial chordae tendineae fixing assembly can fix the artificial chordae tendineae on the interventricular septum, and can also overcome the problem of unsuitable length of the artificial chordae tendineae due to cardiac changes occurring in most of patients after the procedure. The artificial chordae tendineae is retained at the skin puncture point for a short time. The length of the artificial chordae tendineae is adjusted again according to a cardiac change of the patient in an early postoperative period, thereby realizing the function of repeatedly adjusting the artificial chordae tendineae.
The above-mentioned embodiments are only intended to illustrate the embodiments of the present disclosure and thus are described in detail, which cannot be construed as a limitation on the scope of protection of the present disclosure. It should be noted that, those having ordinary skill in the art can make various modifications and improvements without departing from the concept of the present disclosure, and these modifications and improvements shall fall within the scope of protection of the present disclosure. Therefore, the scope of protection of the present disclosure is subject to the appended claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 201711340665.7 | Dec 2017 | CN | national |
This application is the national phase entry of International Application No. PCT/CN2018/113008, filed on Oct. 31, 2018, which is based upon and claims priority to Chinese Patent Application No. 201711340665.7, filed on Dec. 14, 2017, the entire contents of which are incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/CN2018/113008 | 10/31/2018 | WO | 00 |
