CARDIOVASCULAR DEVICE AND KIT FOR THE REDUCTION OF A CARDIAC CAVITY
20230057579 · 2023-02-23
Assignee
Inventors
- Roberto Parravicini (Modena, IT)
- Marco Bottaro (San Mauro Torinese, IT)
- James Leo Pokorney (Northfield, MN, US)
Cpc classification
A61M60/17
HUMAN NECESSITIES
A61M60/865
HUMAN NECESSITIES
A61M60/882
HUMAN NECESSITIES
A61M60/148
HUMAN NECESSITIES
International classification
A61M60/148
HUMAN NECESSITIES
Abstract
The cardiovascular device (1) comprises a diaphragm assembly designed to be inserted into a ventricular cavity (VS) substantially transverse in order to reduce its volume, said diaphragm assembly having a peripheral edge (2B) that can be sealingly engaged on the walls (5) of the cavity 7 and being alternately driven between an active blood thrust position and an inactive position, said assembly being at least partially deformable in response to contractions of the walls (5) and comprising a balloon-shaped elastic body (2; 100; 200; 300; 400) which has an external surface (2A; 103) that defines and encloses an internal cavity (CI; CI2) and which can be configured between a gathered position of minimum bulk, an everted position of maximum bulk and vice-versa, at least one mobile portion (3; 3′) of the peripheral surface which is disposed transverse/diagonal and which is surrounded by the peripheral edge and at least one aperture (3A) for access from the outside to the internal cavity (CI; CI2).
Claims
1. A cardiovascular device (1) designed for a cardiac cavity (VS) which has a volume and wherein blood flows, which is bounded by walls (5) and which has a greater longitudinal dimension and a smaller transverse dimension, said device comprising: a diaphragm assembly designed to be inserted into said cardiac cavity (VS) substantially transverse to said greater longitudinal dimension so as to reduce said volume, said diaphragm assembly having a peripheral edge (2B) sealingly engageable with said walls (5) and being alternately driven between an active blood thrust position and an inactive position, said diaphragm assembly that includes said peripheral edge (2B) being at least partially deformable in response to contractions of said walls (5); characterized in that said diaphragm assembly comprises: a balloon-shaped elastic body (2; 100, 200; 300, 400) which has an external surface (2A; 103) which defines and encloses an internal chamber (CI) and which is modifiable alternatively between a position of minimum bulk in said inactive position and an everted position of maximum bulk in said active position, and vice-versa; at least one mobile portion (3; 3′) of said external surface (2A; 103) which is transverse/diagonal with respect to said greater longitudinal dimension and which is peripherally surrounded by said peripheral edge (2B); at least one aperture (3A) for access from the outside to said internal chamber (CI).
2. The device according to claim 1, wherein said balloon-shaped body (2; 100, 200; 300, 400) has stiffening zones (6) of said external surface (2A) alternatively disposed alternated with more flexible zones (7).
3. The device according to claim 1, wherein said peripheral edge (2B) comprises a closed ring profile made of an elastically flexible material and everted with respect to said external surface (2A; 103).
4. The device according to claim 1, wherein said balloon-shaped body (2; 100, 200; 300, 400) comprises a segment of duct (10) for connection between said internal chamber (CI) and the outside.
5. The device according to claim 1, wherein said access aperture (3A) is equipped with valve control means (13), alternatively selectable in an open position or in a closed position.
6. Kit for dividing a cardiac cavity (VS), characterized in that it comprises: a cardiovascular device (1) which has a balloon-shaped elastic body (2; 100, 200; 300, 400) which has an external surface (2A; 103) which defines and encloses an internal chamber (CI) and which is mobile alternately between a folded position of minimum bulk and an everted position of maximum bulk, and vice-versa; at least one mobile portion (3; 3′) of said external surface (2A; 103) which is transverse/diagonal with respect to said greater longitudinal dimension and which is peripherally surrounded by a peripheral edge (2B); at least one aperture (3A) for access from the outside to said internal chamber (CI); a catheter (9) which has a housing tip (15) for internally receiving said cardiovascular device (1) in a folded configuration for introduction into a cardiac cavity (VS) and a plunger (17) for expelling said cardiovascular device (1) from said housing tip (15); a syringe (8) for injecting a volume of fluid into said internal chamber (CI).
7. The kit according to claim 6, wherein it further comprises at least one split pin (11) which can be associated with said balloon-shaped elastic body (2; 100, 200; 300, 400) outside said cardiac cavity (VS).
8. A balloon-shaped elastic body (2; 100, 200; 300; 400) intended for a cardiovascular device (1) able to be implanted in a cardiac cavity (VS) which has a volume and wherein blood flows, which is bounded by walls (5) and which has a greater longitudinal dimension and a smaller transverse dimension, said elastic body having an external surface (103) which defines and encloses an internal chamber (CI, CI2) and which is modifiable alternatively between a position of minimum bulk in said inactive position and an everted position of maximum bulk in said active position, and vice-versa, characterized in that said balloon-shaped elastic body comprises an internal core (101) which passes through said internal chamber (CI, CI2) in a hermetically sealed manner and extends between a distal end and an apical end and which has an axial length able to be modified elastically with modification means between a dilated position of said external surface (2A; 103) and a contracted position of said external surface (2A; 103).
9. The balloon-shaped elastic body according to claim 8, wherein said modification means are selected from a spring element (106), a sinusoid conformation of said internal core (101).
10. The balloon-shaped elastic body according to claim 8, wherein said central core (101) comprises a tubular body (105).
11. The balloon-shaped elastic body according to claim 8, wherein it comprises a balloon-shaped body (100; 200; 300; 400) and a second balloon-shaped elastic body (301).
12. The balloon-shaped elastic body according to claim 11, wherein said second balloon-shaped elastic body (301) is located internally or externally to said balloon-shaped elastic body (300).
13. The balloon-shaped elastic body according to claim 8, wherein said internal chamber (CI) and second internal chamber (CI2) have volumes selected from equal volumes or different volumes.
14. The balloon-shaped elastic body according to claim 10, wherein said tubular body (105) comprises at least two internal ducts (304, 305; 402, 403) equipped with apertures (302; 405, 406) for connection with said internal chamber (CI) and second internal chamber (CI2).
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] Other characteristics and advantages of the invention will become more apparent from the following description of preferred, but not exclusive, embodiments of a cardiovascular device and a kit for the reduction of a cardiac cavity, shown by way of a non-limiting example in the attached drawings wherein:
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DETAILED DESCRIPTION OF A PREFERRED EXAMPLE EMBODIMENT
[0059] With reference to the drawings above, number 1 indicates as a whole a cardiovascular device, hereafter briefly device 1, intended for implantation in a cardiac cavity which has a greater longitudinal dimension and a smaller transverse dimension, for example a left ventricle VS of a heart C of a patient with ventricular dilated heart disease.
[0060] The person of skill understands that the device 1 can also be implanted in other cardiac cavities, such as, as a non-limiting example, the right ventricle VD, or the left atrium AS or even the right atrium AD.
[0061] The device 1 can also be implanted in any other biological cavity whatsoever, the overall volume of which it is necessary to reduce in order to perform therapies.
[0062] In detail, the device 1, which on the whole forms a diaphragm assembly, comprises a balloon-shaped body 2 which defines an internal chamber CI and which can assume two configurations, typically a folded configuration for introduction into the left ventricle VS, suitable for the implant to be perfornied and visible in detail in
[0063] In detail, it can be noted that the body 2 in the normal dilated configuration of use consists of a substantially semi-spherical cap portion, indicated with 2A, and a peripheral edge 2B, slightly everted with respect to the cap portion 2A, which surrounds it and delimits a portion 3 mobile according to the directions indicated by the arrows F1 and F2, along the greater dimension of the left ventricle VS.
[0064] The cap portion 2A is conformed to be able to rest, self-adapting, on the bottom 4 of the left ventricle VS and on the internal wall 5 thereof, while the peripheral edge 2B, which is radially everted with respect to the cap portion 2A, adheres to the internal wall 5 of the ventricle, creating therewith a hermetically sealed peripheral rest coupling.
[0065] The body 2 and the edge 2B are advantageously made of elastically flexible material, typically a polymer, which is biologically compatible with the organic tissues of the heart C and which allows the device 1 to flex and stretch freely in response to contractions of the left ventricle VS during the systole and diastole phases.
[0066] As can be seen in the drawings, in particular in the systole phase, the mobile portion 3 is everted toward the inside of the left ventricle VS while, in the diastole phase, it is released in the direction of the bottom 4.
[0067] Therefore, the mobile portion 3 behaves like a pump which during the diastole phase, considered inactive, creates a suction of the blood coming from the left atrium indicated by VP and which accumulates inside the left ventricle VS, while, in the systole phase, considered an active phase, the mobile portion 3 is everted and thrusts the blood drawn during the diastole toward the aorta indicated in
[0068] When the device 1 is implanted in the left ventricle VS, it occupies a part of its overall volume, reducing it, that is, reducing its extension, and becoming an artificial prosthesis that restores the substantially original functional conditions of the heart in it, even in the presence of cardio-dilation pathologies.
[0069] The cap portion 2A comprises a series of stiffening elements which are preferably disposed in a radial pattern, indicated with reference 6, and which delimit wedge-shaped zones 7 between them which have an elasticity, and therefore a flexibility, greater than that of the stiffening elements 6.
[0070] With reference to
[0071] This specific characteristic allows to position the device 1 more accurately as a function of the morphological characteristics of the left ventricle VS of each patient, possibly rotating it during the positioning, as indicated schematically in
[0072] It should be noted that in order to expand the device 1 from the folded configuration of introduction to that of use, the internal cavity C1 of the body 2 is filled with a fluid, for example a saline solution, which is injected through a specific aperture, described below, by means of a syringe 8 (or equivalent device) and a catheter 9 which is also used to introduce the device 1 into the left ventricle VS.
[0073] In particular, the injection of the saline solution makes the edge 2B malleable and self-adaptable to the surface of the internal wall 5 in order to follow its profile in a mating manner and make a hermetically sealed contact with it.
[0074] As can be seen in the drawings, two versions of the device 1 can be made, namely one version for percutaneous implantation and one version for surgical implantation.
[0075] In the first case, which can be seen in
[0076] In this second case, on the end facing the outside of this segment of duct 10, there can be attached a stop split pin 11, provided to tighten between it and the body 2 the thickness of the tissue of the apical zone of the left ventricle VS.
[0077] In a preferred embodiment, the segment of duct 10 is equipped with a series of radial elements 12 which can be folded radially after passing through the split pin 11 in order to tighten it against the body 2.
[0078] In both versions, both the aperture 3A and also the free end of the segment of duct 10 are controlled with valve means 13 which can alternatively assume an open or closed configuration, according to requirements and, for example, can be manufactured as a one-way valve of the so-called “flute beak” type which allows a flow of saline solution to pass toward the internal chamber CI, but prevents it from refluxing in the opposite direction.
[0079] According to the invention, a kit of specific components is provided to implant the device 1 in the left ventricle VS.
[0080] In order to implant the device 1 percutaneously, the kit comprises the catheter 9, the syringe 8 and a handpiece 14 fitted on the catheter 9 to perform the implantation maneuvers.
[0081] In detail, the catheter 9 is equipped with a tip 15 which inside it has an axial cavity 16 inside which the device 1 is accommodated in the folded configuration of minimum bulk, designed for the introduction into the left ventricle VS and the implantation, as can be seen in detail in
[0082] The catheter 9 also comprises a plunger 17 which is used by the surgeon to thrust the device 1 out of the axial cavity 16 after the tip 15 has been positioned inside the left ventricle VS, using the passage through a large caliber blood vessel of a patient, for example the femoral artery.
[0083] In order to implant the device 1 surgically, the kit is substantially the same as the one described for percutaneous implantation, to which the split pin 11 and the radial elements 12 are added.
[0084] With reference to
[0085] The balloon-shaped body 100 has an expandable external surface 103 which is kept in contact with the internal wall 5 of the left ventricle VS, in such a way as to elastically follow the systole and diastole movements of the same ventricle VS, occupying the opposite part thereof with respect to the left atrium AS.
[0086] The internal chamber CI is expandable by introducing a fluid F, for example a saline solution, which can be injected through an annular passage 104 which is defined between the segment of duct 10 and the internal core 101 and which is driven by the valve means 13 (not visible in the drawings).
[0087] The internal core 101, in this specific embodiment, consists of a tubular element 105 made of a biocompatible plastic material, very elastic and very thin, which incorporates, preferably inside it, but possibly also on the outside, a spring element 106, able to be loaded axially, which forms the modification means 102 and which is able to allow the variations in length of the tubular element 105 during the transitions between the systole and diastole phases of the left ventricle VS, as schematically indicated with the arrows W1 (systole) and W2 (diastole).
[0088] The spring element 106, in one variant, can also be interposed between the segment of duct 10 and the tubular body 101.
[0089] Overall, the spring element 106 fulfills a role similar to that of a lung capable of accumulating the thrust of the balloon-shaped body 100 during the systole and diastole phases of the heart C.
[0090] It should be noted that the ends of the balloon-shaped body 100 are attached in a sealed manner respectively on the segment of duct 10 and on the tubular body 101 with known attachment means, for example with gluing means, however the person of skill can imagine using any other attachment mean whatsoever available in the specific sector.
[0091] In
[0092] With reference to
[0093] Also in this version, the balloon-shaped body 200 has an internal core 101, an external surface 103 and an internal chamber CI into which a fluid is intended to be introduced through the annular passages 104.
[0094] Also in this version, the length of the internal core 101 is modifiable to allow the balloon-shaped body 200 to follow the systole S and diastole D movements of the left ventricle VS in which the cardiovascular device according to the invention is intended to be implanted.
[0095] In this version, the modification means consist of the same sinusoid conformation of the central core 101, as can be seen in the drawings, which shortens during the diastole phase and lengthens during the systole phase.
[0096] Also in this version, the external surface 103 is kept constantly in sealed contact with the internal wall 5 of the left ventricle VS; this internal wall 5 is not shown for simplicity of representation.
[0097] Also in this version, the ends of the external surface 103 of the balloon-shaped body 200 are attached in a sealed manner respectively to the segment of duct 10 and to the core 101, preferably by means of gluing.
[0098] With reference to
[0099] Also in this version of the cardiovascular device according to the invention, there are provided the expandable external surface 103 of the balloon-shaped body 300, the internal core 101, the annular passage 104, controlled by the valve means 13 (not shown) and the segment of duct 10.
[0100] In the internal chamber CI defined in the balloon-shaped body 300 there is disposed a second balloon-shaped body 301, substantially concentric with the balloon-shaped body 300, and also able to expand or contract according to the movements of the left ventricle VS.
[0101] In detail, the core 101, also in this version, consists of the tubular element 105, therefore axially hollow, inside which a fluid can be fed, for example a saline solution, intended to occupy a second internal chamber CI2 defined in the balloon-shaped body 301, passing through at least one feed aperture 302 obtained in the tubular element 105 in correspondence with the second chamber CI2.
[0102] The second balloon-shaped body 301 also has its own elastically expandable or contractable external surface 303.
[0103] As in the previous versions, the ends of the balloon-shaped body 300 are attached in a sealed manner, preferably by means of gluing, to the duct segment 10 at one end and to the core 101 at the opposite end.
[0104] On the latter, the ends of the second balloon-shaped body 301 are also attached in a sealed manner, and also preferably by means of gluing.
[0105] As can be seen in detail in
[0106] With reference to
[0107] Similarly to the version shown in
[0108] The central core 101 also has a different conformation and consists of a tubular body 401 which includes two parallel channels 402 and 403 which are separated from each other for almost the entire length, but which join in reciprocal confluence in an end zone 404.
[0109] Both parallel channels 402 and 403 are provided with apertures 405 and 406 intended for the passage of at least one fluid used to expand or contract, elastically and alternatively, the two balloon-shaped bodies 300 and 301 following the systole and diastole movements of the left ventricle VS.
[0110] As can be seen in
[0111] The functioning of the cardiovascular device according to the invention in the embodiments shown in
[0112] In the case of percutaneous implantation, the surgeon makes a small access cut in the proximity of an artery, for example the femoral artery, and through this introduces the catheter 9 until the tip 15 reaches the inside of the left ventricle VS.
[0113] The surgeon holds the handpiece 14 with one hand and with the other acts on the plunger 17, thrusting the device 1 out of the axial cavity 16.
[0114] When this step is completed, the surgeon, by means of the syringe 8, injects, through the aperture 3A, into the internal cavity CI, a predetermined volume of saline solution, making the body 2 of the device 1 dilate, until it reaches a configuration in which the cap surface 2A and the edge 2B adhere in a sealed manner to the internal wall 5 and to the bottom 4 of the left ventricle VS, self-adapting to their profiles.
[0115] When the device 1 is correctly implanted, the surgeon detaches the catheter 9 from the aperture 3A, more precisely from the valve means 13 that control it and retracts it until it is completely removed from the artery in which it has been made to slide.
[0116] The device 1, since it is completely flexible, after implantation follows the cyclic contractions and dilations of the wall 5 of the left ventricle VS and, in particular when the systole phase of the latter occurs, the mobile portion 3 is everted toward the inside of the left ventricle VS, thrusting the blood accumulated inside it toward the aorta AO, while in the diastole phase the mobile portion 3 is released toward the bottom 4 allowing a new filling of blood in the left ventricle VS.
[0117] In the version for surgical implantation, the surgeon first proceeds to perform an incision on the patient's chest in the proximity of the heart C and makes an access cut also in the apical zone of the bottom 4 of the left ventricle VS.
[0118] Through this cut, the surgeon introduces the tip 15 of the catheter 9 and with the plunger 17 expels it from the internal cavity 16, releasing it in the left ventricle VS.
[0119] When the device 1 is correctly positioned, the surgeon injects the saline solution into the internal cavity CI with the syringe 8, passing through the one-way valve means 13, making the device 1 assume the dilated configuration until the cap portion 2A of the body 2 and the edge 2B adhere in a sealed manner to the internal wall 5.
[0120] The correct positioning of the device 1 inside the left ventricle VS allows, in this version, to keep the segment of duct 10 extended toward the outside of the apical zone of the heart C for a length sufficient to fit the split pin 11 over it, which in this way tightens between it and the body 2 the portion of cardiac tissue that forms the bottom 4 and on which the radial elements 12 are then folded in order to hold it.
[0121] After the implant, the surgeon sutures the cuts made and the device 1 begins its function, following the cyclical sequences of systole and diastole of the heart, as described above, acting as a pump and simultaneously reducing the internal volume of the left ventricle VS.
[0122] The person of skill will understand that the dimensions of the device 1 can be modified as needed, that is, according to the volume part of the left ventricle VS that the surgeon wishes to reduce.
[0123] The cardiovascular device in the other embodiment versions shown in from
[0124] In detail, in these other embodiment versions, the balloon-shaped body generally comprises the central core 101 which on the one hand, in certain cases, has the function of allowing expansions and contractions of the external surface 103 to follow the systole and diastole movements of the heart C, and on the other hand in some cases has the function of transporting and feeding a fluid, typically a saline solution, which has to occupy the internal chamber or chambers CI and/or CI2 in the case of a double balloon-shaped body.
[0125] The central core 101 is elastically deformable in the axial direction in such a way as to allow guided expansions and contractions of the balloon-shaped body and, consequently, shortenings and lengthening of the central core.
[0126] In detail, in the version visible in
[0127] The person of skill will understand that the difference in length that the central core 101 can assume between the two configurations, contracted and extended, can be predetermined a priori during the manufacturing step of the cardiovascular device 1.
[0128] Similarly to the version shown in
[0129] The movements of expansion and contraction of the external surface 103 perform, as mentioned, the phases of suction of the blood inside the left ventricle VS and of thrust toward the aorta AO.
[0130] In the embodiment version shown in
[0131] The feed of the saline solution into the internal chamber CI occurs through the annular passage 104 regulated by the valve means 13, while the feed into the second chamber CI2 occurs through the axial cavity of the central core 101, which is also regulated by the valve means 13, and the aperture 302 obtained in the latter.
[0132] It should be noted that in this embodiment version of the cardiovascular device 1, the saline solution passes in one of the two ducts 304 or 305 obtained in the central core 101, while the other is intended for the passage inside it of a conventional guide wire typically used by operators to correctly position the cardiovascular device 1 inside the left ventricle VS.
[0133] With reference to the other embodiment of the balloon-shaped body 400 shown in
[0134] The volumes of the two balloon-shaped bodies 300 and 301 may be the same or different in order to better adapt to the morphology of the internal wall 5 of the left ventricle VS.
[0135] It has been verified that the invention achieves the intended purposes.
[0136] The invention is susceptible to modifications and variants, all of which are within the scope of the inventive concept.
[0137] Furthermore, all the details can be replaced with other technically equivalent elements.
[0138] In their practical embodiment, any other materials, as well as shapes and sizes, can be used according to requirements, without departing from the main field of protection of the following claims.