Prosthesis (i.e. – artificial body members) – parts thereof – or ai – Corporeal artificial heart – heart assist – control... – Having flexible diaphragm or chamber
Utility Patent
1998-11-16
2001-01-02
Prebilic, Paul B. (Department: 3738)
Prosthesis (i.e., artificial body members), parts thereof, or ai
Corporeal artificial heart, heart assist , control...
Having flexible diaphragm or chamber
C623S003280, C623S904000, C600S016000
Utility Patent
active
06168624
ABSTRACT:
FIELD AND BACKGROUND OF THE INVENTION
The present invention relates to cardiology generally and particularly to methods and apparatus for intramyocardial and intraventricular revascularization and perfusion.
In a normal heart, the myocardium is supplied with blood via the coronary arteries during diastole. In certain heart diseases or malfunctions, particularly involving arteriosclerotic coronary arteries, the myocardial tissue does not receive an adequate supply of blood, and may become dormant or “hibernate” and eventually become necrotic. Myocardial damage due to coronary disease is the largest cause of death in the Western world.
Coronary bypass surgery and coronary angioplasty are well known techniques for combating problems due to arteriosclerotic coronary arteries. However, bypass and angioplasty techniques for most patients are not long term solutions. Recently a technique called transmyocardial laser revascularization (TLR) has been introduced. A series of holes are drilled through the myocardial wall. When the procedure is finished, what remains are blind holes in the myocardial wall which are open inwards to the intraventricular cavity. During the pumping action of the heart, blood flows directly into the blind holes and hopefully nourishes the myocardial tissue, thereby compensating for the malfunctioning coronary arteries.
TLR is gaining more and more use because it appears to be suitable for a greater population of heart disease patients, and may be implemented as a last resort when other solutions have failed or cannot be used.
Nevertheless, there are several disadvantages to TLR. It is a long surgical procedure with general anesthesia. The position of the holes to be drilled may be difficult to plan, and in some places it may be impossible to drill. Extreme caution must be exercised to avoid damage to the heart muscle or other body tissues and organs, and to prevent disturbances in the heartbeat. Furthermore, in a normal heart, blood is pumped to the myocardium during diastole, whereas in TLR, it is not yet clear whether blood is pumped into the myocardial tissue during systole or diastole. In addition, the blind holes may tend to collapse or close up with time.
SUMMARY OF THE INVENTION
The present invention seeks to provide an improved methods and apparatus for revascularization and perfusion which are intramyocardial and intraventricular.
In accordance with a preferred embodiment of the present invention, an intraventricular pump or pump assembly is introduced into the left ventricle by a catheter. The pump preferably includes a valve disposed inside a tube.
During systole, the valve may either be inactive or may divert flow of blood into a reservoir. During diastole, the valve opens and blood is pumped into the tube from the reservoir, and further into the myocardial wall. Thus, the myocardial tissue is correctly and efficiently nourished with blood during diastole.
Preferably a plurality of such pumps are anchored in predetermined strategic locations in the ventricular wall, so as to provide an optimal supply of blood to the myocardial tissue.
The procedure of the present invention substantially overcomes the disadvantages of the prior art. The procedure is non-surgical, does not require general anesthesia and may be quickly performed. The procedure may be employed when immediate myocardial revascularization is warranted and other procedures of the art cannot be used.
There is thus provided in accordance with a preferred embodiment of the present invention, a method for intraventricular revascularization and perfusion of a myocardium, including the steps of introducing at least one pump into a ventricle of a heart, the at least one pump including an inlet for flow of fluid therein and an outlet for flow of fluid therefrom, and attaching the at least one pump to the myocardium so that the outlet is in fluid communication therewith, such that while the heart beats, the at least one pump draws blood from the ventricle via the inlet and pumps blood into the myocardium via the outlet, thereby causing revascularization and perfusion of the myocardium.
In accordance with a preferred embodiment of the present invention, the at least one pump draws blood from the ventricle during systole and pumps blood into the myocardium during diastole. Preferably a catheter is used to introduce the at least one pump into the ventricle. Preferably the method further includes substantially spatially fixing a portion of the at least one pump inside the ventricle.
In accordance with a preferred embodiment of the present invention, the method includes using a reservoir in fluid communication with the at least one pump for drawing blood thereinto during systole and for pumping blood therefrom during diastole.
Additionally in accordance with a preferred embodiment of the present invention, the method includes introducing a plurality of the pumps into the ventricle, wherein the pumps share a common reservoir for drawing blood thereinto during systole and for pumping blood therefrom during diastole. Preferably the method includes substantially spatially commonly fixing a portion of the pumps inside the ventricle.
In accordance with a preferred embodiment of the present invention, the method includes fluidly connecting one end of a bypass tube to the at least one pump and passing another end of the bypass tube out of the ventricle, the other end of the bypass tube being in fluid communication with an extraventricular blood vessel, wherein pumping of the at least one pump causes blood to be pumped through the bypass tube to the blood vessel.
There is also provided in accordance with a preferred embodiment of the present invention, an intraventricular pump for intraventricular revascularization and perfusion of a myocardium, including a tube of such size which permits insertion thereof into a ventricle of a heart by means of a catheter, a tip of the tube being insertable into the myocardium, the tube being formed with at least one aperture for flow of blood therethrough, such that during systole blood flows through the at least one aperture into the tube. The pump preferably includes a valve disposed inside the tube, such that during diastole the valve opens, thereby allowing blood to be pumped through the tube into the myocardium, thereby causing revascularization and perfusion thereof.
In accordance with a preferred embodiment of the present invention there is also provided a reservoir in fluid communication with the tube, wherein the valve permits drawing blood into the reservoir during systole and wherein during diastole, the valve opens to permit the pump to pump blood from the reservoir into the myocardium.
Additionally in accordance with a preferred embodiment of the present invention, there is provided at least one anchoring member for anchoring the tube to the myocardium.
Further in accordance with a preferred embodiment of the present invention, there is provided fixing apparatus for substantially spatially fixing an outer surface of the tube in the ventricle.
There is also provided in accordance with a preferred embodiment of the present invention, an intraventricular pumping assembly for intraventricular revascularization and perfusion of a myocardium, including a plurality of pumps, each pump including a tube of such size which permits insertion thereof into a ventricle of a heart by means of a catheter, a tip of the tube being insertable into the myocardium, the tube being formed with at least one aperture for flow of blood therethrough. preferably, the tube includes a valve disposed inside the tube, such that during diastole the valve opens, thereby permitting blood to be pumped through the tube into the myocardium, thereby causing revascularization and perfusion thereof.
In accordance with a preferred embodiment of the present invention, the assembly includes a reservoir in fluid communication with at least one of the tubes, for drawing blood thereinto during systole and for pumping blood therefrom during diastole. The reservoir may be common to at least some of the tubes.
Friedman Mark M.
Prebilic Paul B.
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