ARTIFICIAL RIGHT ATRIUM DESIGN FOR FAILING FONTANS
20210154385 · 2021-05-27
Assignee
Inventors
- Cynthia S. HERRINGTON (Pasadena, CA, US)
- Jon David MENTEER (Calabasas, CA, US)
- Sarah BADRAN (Rolling Hills Estates, CA, US)
- Heng WEI (Los Angeles, CA, US)
- Niema M PAHLEVAN (La Canada, CA, US)
Cpc classification
A61M60/869
HUMAN NECESSITIES
A61M60/178
HUMAN NECESSITIES
A61M60/35
HUMAN NECESSITIES
A61M60/148
HUMAN NECESSITIES
International classification
Abstract
An artificial chamber including a first conduit, a second conduit, a third conduit, and a wall defining a space; in which the first conduit and the second conduit are positioned opposite one another; in which the third conduit is opposite the wall; and in which the wall has a concave surface is disclosed. The chamber can be part of a system for providing pulmonary support. The system includes the chamber and a first pump connected to the third conduit, and connected to a fourth conduit; in which the chamber receives fluid via the first conduit and the second conduit, in which the first pump receives fluid from the chamber via the third conduit; and in which the fourth conduit transports fluid from the first pump to a first blood vessel. Methods of making a chamber and a system, and methods of using the chamber and system are also disclosed.
Claims
1. An artificial chamber, comprising: a first conduit, a second conduit, a third conduit, and a wall defining a space; wherein the first conduit and the second conduit are positioned opposite one another; wherein the third conduit is opposite the wall; and wherein the wall has a concave surface.
2. A system for providing pulmonary support comprising: a chamber defined by a first conduit, a second conduit, a third conduit, and a wall; and a first pump connected to the third conduit, and connected to a fourth conduit; wherein the chamber receives fluid via the first conduit and the second conduit 16, wherein the first pump receives fluid from the chamber via the third conduit; and wherein the fourth conduit transports fluid from the first pump to a first blood vessel.
3. The system of claim 2, further comprising: a second pump connected to a fifth conduit, and connected to a sixth conduit; wherein the fifth conduit transports fluid from a second blood vessel to the second pump; and wherein the sixth conduit transports fluid from the second pump to a tissue.
4. The system of claim 2, wherein the wall has a concave surface.
5. The system of claim 2, wherein the chamber includes a convex surface and the wall has a concave surface.
6. The system of claim 5, wherein a ratio of a width of the convex surface to the concave surface is from about 0.0:4 to about 4:0.0.
7. The system of claim 2, wherein the chamber has a volume of from about 0.1 cc to about 150 cc.
8. The system of claim 2, wherein the chamber includes at least one convex surface.
9. The system of claim 2, wherein the chamber is made of a material that withstands a pressure of from about 0 mm Hg to about 10 mm Hg.
10. The system of claim 2, wherein the chamber expands from about 5% to about 95% in volume relative to an original size of the chamber.
11. The system of claim 2, wherein the chamber is made of a material chosen from polyester, polytetrafluoroethylene, and a combination thereof.
12. The system of claim 2, wherein the chamber includes an interior surface with a coating.
13. The system of claim 2, wherein each of the first conduit, the second conduit, and the third conduit includes at least one valve.
14. The system of claim 2, wherein each of the first pump and the second pump is one of a pressure-source pump and a flow-source pump.
15. A method for using a system for providing pulmonary support in a patient in need thereof, comprising: attaching the system to at least one blood vessel, wherein the system includes a chamber defined by a first conduit, a second conduit, a third conduit, and a wall; and a first pump connected to the third conduit, and connected to a fourth conduit.
16. The method of claim 15, further comprising attaching the first conduit to a third blood vessel.
17. The method of claim 15, further comprising attaching the second conduit to a fourth blood vessel.
18. The method of claim 15, further comprising attaching the fourth conduit to a first blood vessel.
19. A method of making a chamber for a patient in need thereof, comprising: imaging the patient to obtain measurements; determining a long axis plane for the chamber; and making the chamber.
20. The method of claim 19, wherein determining the long axis plane includes using computational fluid dynamic tools to minimize particle residence time based upon the patient's measurements obtained from the imaging.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] The present disclosure in its several aspects and embodiments can be more fully understood from the detailed description and the accompanying drawings, wherein:
[0014]
[0015]
[0016]
[0017]
[0018]
[0019]
[0020]
[0021] Throughout this specification and figures like reference numbers identify like elements.
DETAILED DESCRIPTION OF THE INVENTION
[0022] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only, and are intended to provide an explanation of various embodiments of the present teachings.
[0023] The present invention is directed to a system for providing pulmonary support to a patient in need thereof. The patient in need thereof can be failing from a prior Fontans procedure. In particular, the patient can be exhibiting at least one health problem chosen from pleural effusions, atrial scarring, atrial flutter, atrial fibrillation, protein-losing enteropathy, chronic renal insufficiency, and high central venous pressure. The system can stabilize a patient with a failing Fontans procedure by ameliorating and/or treating at least one of the health problems discussed above. The system can preserve compliance, i.e., prevent over-pressurizing blood vessels; and/or minimize particle residence time thereby preventing or reducing the likelihood of blood clots.
[0024]
[0025] The system 10 can further include a second pump 30 connected to a fifth conduit 34, and connected to a sixth conduit 32. The fifth conduit 34 can transport fluid from a second blood vessel 38 to the second pump 30. The sixth conduit 32 can transport fluid from the second pump 22 to an organ 36.
[0026] The conduits (e.g., first, second, third, etc.) of the system 10 can transport a fluid between two members (e.g., chamber 20, and first pump 22) and/or a member (e.g., second pump 30) and a tissue, such as a blood vessel (e.g., first, second, third, etc.). The fluid can be blood. The conduits are numbered “first”, “second”, “third”, etc. for ease of reference and it is not intended to limit the scope thereof. Each conduit 14, 16, 18, 28, 34, and 32 can include a first end and a second end. Each conduit 14, 16, 18, 28, 34, and 32 can include at least one valve located at the first end and/or the second end. As an example, the first conduit 14 can include a first end connected to the chamber 20, wherein the first end includes a valve (not shown), and the second end does not include a valve. As another example, the third conduit 18 can include a first end connected to the chamber 20 and including a first valve, and can include a second end connected to the first pump 22 and including second valve. In an aspect, each of the first conduit 14, the second conduit 16, and the third conduit 18 includes at least one valve. For example, each of the first conduit 14, the second conduit 16, and the third conduit 18 each have a first end including a valve.
[0027] The first conduit 14 can transport a fluid, such as blood, from a third blood vessel 15, such as a superior vena cava (SVC) 15 to the chamber 20. The second conduit 16 can transport a fluid, such as blood, from a fourth blood vessel 17, such as an inferior vena cava (IVC) 17. A blood vessel can be any vessel through which blood circulates. Non-limiting examples of blood vessels include artery, vein, capillary, arteriole, and venule.
[0028] The conduits 14, 16, 18, 28, 34, and 32 can be any size or shape to transport fluid. The conduits 14, 16, 18, 28, 34, and 32 can have a diameter, such as an inner diameter, that matches or substantially matches with a blood vessel, and/or an artificial implant. Each conduit 14, 16, 18, 28, 34, and 32 can have the same or different diameter, such as a diameter ranging from about 1.5 mm to about 35 mm, for example, from about 1.9 mm to about 24 mm, and as a further example, from about 2.1 mm to about 20 mm, including all points in between the ranges. Each of the first conduit 14, the second conduit 16, and the third conduit 18 can have the same diameter “D”.
[0029] As discussed above, each conduit 14, 16, 18, 28, 34, and 32 can include a first end and a second end. The diameter of each conduit can be the same from the first end to the second end. The diameter of each end of the conduit can be different. For example, the diameter can increase or decrease along a length of the conduit so that the first end and the second end are different.
[0030] Each conduit 14, 16, 18, 28, 34, and 32 can include a length from the first end to the second end. The length of each conduit 14, 16, 18, 28, 34, and 32 can be the same or different. Prior to insertion of the chamber 20 into a patient in need thereof, the length of each conduit can have an initial length. The initial length of each conduit can be shortened during insertion of the chamber.
[0031] In an aspect, a chamber 20 including the first, second, and third conduits can have standard sizes for each component. The standard sizes can be designed based upon a imaging data from patients. For example, patients age 2 years old could use a chamber 20 having first, second, and third conduits having a first standard size; and patients age 4 years old could use a chamber 20 having first, second, and third conduits having a second standard size. It is envisioned that some patients may not “fit” standard sizes and would require a custom-made chamber 20. A process for designing a chamber 20 is discussed more fully below.
[0032] In an example, the conduits 14, 16, 18, 28, 34, and 32 can be made of the same material as the chamber 20. In another example, the conduits 14, 16, 18, 28, 34, and 32 can be made of a different material from the chamber 20. Additionally, the conduits 14, 16, 18, 28, 34, and 32 can be made of the same material or can be made from a different material. For example, conduits 14, 16 can be the same material as conduit 18. As another example, conduits 14, 16 can be a different material from conduit 18.
[0033] The chamber 20 can be any size or shape to receive fluid. In an aspect, the chamber can be configured to mimic a right atrium of a heart.
[0034] The chamber 20 can be formed of any material. In an example, the chamber 20 can be made of a rigid material. In another example, the chamber 20 can be made of non-rigid (i.e., compliant) material. The chamber 20 can be made of a material that can withstand a pressure of from about 0 mm Hg to about 10 mm Hg, such as a pressure of from about 1 mm Hg to about 9 mm Hg, and for example, from about 2 mm Hg to about 8 mm Hg. Non-limiting examples of suitable materials include polyester, polytetrafluoroethylene, silicon, latex, any deformable FDA-approved biocompatible material, and a combination thereof. Moreover, the chamber 20 can be made of a material that can expand or contract (in volume) to about 5% to about 95%, such as from about 10% to about 90%, and as an example, from about 20% to about 85%, relative to an original size of the material.
[0035] The chamber 20 can include a coating on an exterior surface and/or an interior surface of the chamber 20. Such a coating can include an antibiotic coating or an anti-coagulant coating. The coating can include any drug-eluting material and/or matrix, for example, to facilitate the release a drug into a patient in need thereof. The drug can be any drug that does interfere with the operation of the chamber 20.
[0036] The chamber 20 can also include at least one external ring. For example, a first conduit 14 can include an external ring on at least one of the first end and the second end. The external ring can provide support. The external ring can prevent or inhibit external compression and distortion of each conduit and/or the chamber 20.
[0037]
[0038] With regard to
[0039] As shown in
[0040] In an aspect, the wall 11 of the chamber 20 can be increased or decreased a predetermined width relative to the diameter D of the first conduit 14 and/or the second conduit 16. In this manner, the wall 11 of the chamber 20 can have a convex surface or a concave surface. For example, as shown in
[0041] In another aspect, as shown in
[0042] Referring back to
[0043] In an aspect, the chamber 20 can include a third conduit 18 positioned on a convex surface and a wall 11 having a concave surface, as shown in
[0044] The chamber 20 can include a convex surface and a concave surface so that the shape of the chamber 20 mimics the shape of the right atrium. A ratio of the width of the convex surface to the concave surface can be from about 0.0:4 to about 4:0.0, such as from about 0.5:3 to about 3:0.5. A volume of the chamber 20 can include a volume from about 0.1 cc to about 150 cc, such as from about 2 cc to about 100 cc, for example from about 5 cc to about 50 cc. The chamber 20 can have a standard volume based upon standard sizes from a majority of patients sizes/ages. The chamber 20 can also have a custom designed volume based upon a patient-specific condition.
[0045] The first pump 22 and the second pump 30 can each be a pressure-source pump (i.e., flow drops as resistance increases) or a flow-source pump (i.e., flow does not drop with resistance increases).
[0046] Fluid, such as reduced or low-oxygen blood (AKA blue blood), from blood vessels 15, 17 can come together in chamber 20 via first conduit 14 and second conduit 16. The first pump 22 can pump the low-oxygen blood from the chamber 20 via third conduit 18 to a blood vessel 26, which can transport the fluid to the lungs for oxygenation.
[0047] In an example, if the left atrium and the left ventricle of the organ 36 are functional, then, the organ 36 can pump oxygenated fluid into the body via blood vessel 38. In another example, as shown in
[0048] There is disclosed a method for using a system for providing pulmonary support in a patient in need thereof, comprising attaching the system to at least one blood vessel, wherein the system includes a chamber 20 defined by a first conduit 14, a second conduit 16, a third conduit 18, and a wall 11; and a first pump 22 connected to the third conduit 18, and connected to a fourth conduit 28. The first conduit can be attached to a third blood vessel 15. The second conduit 16 can be attached to a fourth blood vessel 17. The fourth conduit 28 can be attached to a first blood vessel 26. The method can also include attaching a second pump 30. In particular, a sixth conduit 32 of the second pump 30 can be attached to an organ 36, such as the heart. Additionally, a fifth conduit 34 of the second pump 30 can be attached to a second blood vessel 28, such as an aorta.
[0049] There is also disclosed a method of making a chamber for a patient in need thereof, comprising imaging the patient to obtain measurements; determining a long axis plane for the chamber; and making the chamber 20. The imaging can be any three-dimensional and/or two-dimensional imaging of the patient. The step of determining a long axis plane can be determined using computational fluid dynamic (CFD) tools. The long axis plane is a cross-section with two flow inputs, for example, the first and second conduits 14, 16; and at least one output flow, for example, the third conduit 18. The long axis plane should minimize particle residence time (PRT) based upon a patient's anatomical data obtained from the imaging.
[0050] Using an appropriate material, such as a biocompatible material, a chamber 20 can be made. A patient-specific three-dimensional geometry of the chamber 20 can be created with the determined long axis plane. The chamber 20 can fit the patient's geometry and can preserve compliance using the blood vessel diameters of the patient and physiological data (e.g., volume flow rates). The chamber 20 can be made using three-dimensional printing and/or any known method for fabricating a medical implant.
[0051] The method can further include testing hemodynamic responses of the chamber 20. Non-limiting examples of hemodynamic responses include pressure, flow, collapse. The testing can be performed in physiologically accurate in-vitro systems.
[0052] The method can further include making a chamber 20 with a mechanical material property, such as elasticity, viscoelasticity) and three-dimensional geometry using an FDA-approved biocompatible material.
[0053] The chamber 20 can be surgically implanted into the patient.
EXAMPLES
[0054]
[0055] With regard to Examples 1-6 below, a rigid chamber with added compliance was studied by using a syringe at the following locations: chamber 20—0.1 ml/mmHg/kg; first conduit 14—0.08 ml/mmHg/kg; and second conduit 16—0.32 ml/mmHg/kg.
[0056] Example 1 (Comparative)—As shown in
[0057] Example 2—As shown in
[0058] Example 3—As shown in
[0059] Example 4 (Comparative)—As shown in
[0060] Example 5 (Comparative)—As shown in
[0061] Example 6—As shown in
[0062] Example 7 (Comparative)—As shown in
[0063] Example 8—As shown in
[0064] Example 9 (Comparative)—As shown in
[0065] Example 10 (Comparative)—As shown in
[0066] Results
[0067]
TABLE-US-00001 TABLE 1 Mean and pulse pressure results of cases 1-10 FC mean FC PP SC mean SC PP Cases (mmHg) (mmHg) (mmHg) (mmHg) Case 1 5.97 0.94 6.07 0.87 Case 2 5.45 19.98 5.55 19.03 Case 3 5.48 22.01 5.66 21.88 Case 4 5.54 23.24 5.58 22.57 Case 5 5.68 17.85 5.43 13.32 Case 6 5.60 17.51 5.66 13.04 Case 7 4.78 91.99 4.63 73.68 Case 8 5.31 85.32 5.05 71.71 Case 9 6.01 4.26 5.94 3.13 Case 10 5.88 4.82 5.34 4.10
[0068] Computational fluid dynamic (CFD) tools, such as using Lattice-Boltzmann (LB) method using equations 1-6, below, were conducted on various geometries to find an optimal chamber 20 size. The results indicate that the geometry of
ƒ.sub.i(x+e.sub.iΔx,t+Δt)=ƒ.sub.i(x,t)+Ω.sub.i(x,t) (eq.1)
Where, ƒ.sub.i is the particle velocity distribution function.
Ω.sub.i: the collision operator, τ: relaxation time μ: viscosity.
ρ=Σ.sub.iƒ.sub.i,ρu=Σ.sub.iƒ.sub.ie.sub.i (eq.3)
Carreau-Yasuda model (blood):
The rate-of-strain tensor is defined as:
The shear rate is defined as:
{dot over (γ)}=√{square root over (2Σ.sub.α,βS.sub.αβS.sub.αβ)} (eq.6)
TABLE-US-00002 TABLE 2 Average particle residence time in various geometries FIG. 2 PRT.sub.ave (unitless) FIG. 3 PRT.sub.ave (unitless) (a) 10.80 (a) 11.59 (b) 7.56 (b) 10.01 (c) 9.55 (c) 12.18 (d) 11.50 (d) 14.81 (e) 8.90 (e) 10.73 (f) 8.82 (f) 11.31
[0069] The description of the inventions herein in their many embodiments is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. Such variations are not to be regarded as a departure from the spirit and scope of the invention.