Surgery – Diagnostic testing – Cardiovascular
Reexamination Certificate
1998-08-21
2001-06-05
O'Connor, Cary (Department: 3736)
Surgery
Diagnostic testing
Cardiovascular
C600S508000
Reexamination Certificate
active
06241678
ABSTRACT:
BACKGROUND OF THE INVENTION
I. Field of the Invention
The present invention relates generally to a device and non-surgical method for determining the size of an internal opening within a patient. More particularly, the present invention relates to a sizing catheter and method of using the same, wherein the sizing catheter may be utilized to determine the stretched diameter of an internal passage within a patient. The sizing catheter of the present invention is particularly well suited for determining the stretched diameter of a defect, such as a septal defect, within the heart of a patient. Once the stretched diameter of the defect is known, a properly sized occluding device may be selected and positioned within the opening of the defect.
II. Description of the Related Art
Over the years various medical devices, including stents and occluders, have been developed for placement within a preselected internal passage, opening, or defect of a patient. Complex devices may be delivered and used in treating specific abnormal conditions, such as devices used in removing vascular occlusions or devices used in treating septal defects and the like. Through advancement in a variety of devices, stents and occluders may be delivered non-surgically. Certain intravascular devices, such as catheters and guide wires, may be used to deliver certain medical devices to a specific location within a patient's heart, for example. Further, a catheter may be used to reach a selected coronary artery within the vascular system or a catheter and/or guidewire may be used to deliver a device to an interior chamber of the patient's heart.
Prior to delivering the particular medical device, the size of the internal passage, opening or defect must be determined in order that an appropriately sized device may be provided. Further, determination of the “stretched diameter” of the opening or defect is desirable to provide a preferred fit between the medical device and the surrounding tissue. In the past, physicians have utilized a balloon catheter in an attempt to determine the size of the internal opening or defect. Typically, the physician will position the balloon within the opening and slowly inflate the balloon, pushing or pulling the balloon of the catheter fore or aft until the physician feels resistance against the balloon. The size of the balloon corresponding with the size of the opening is then determined. The technique of pulling or pushing a balloon catheter through the opening or defect is unreliable and does not determine the size of the opening when the surrounding tissue is stretched.
A balloon catheter and a calibrated guidewire having radiopaque regions of known length, may be utilized by a physician during a preliminary fluoroscopic procedure to estimate the defect's size, shape and thickness of the septal wall near the defect. Although useful, the defects exact size when stretched and the shape cannot be determined, thereby increasing the possibility of leakage around the device.
Echocardiography has also been used to estimate the diameter of the opening or defect, however, echo measurements are always significantly smaller than the “stretched diameter”. The differences between echo measurements and stretched diameters may range between 2 mm to 10.5 mm. It has been suggested that the stretched diameter can be estimated from echo measurements by multiplying 1.05 times the echo measurement and then adding 5.49. Although this formula may prove sufficient in some cases, differences of up to 4.5 mm between the actual stretched diameter and the estimated diameter from this formula have been observed. The errors in echo measurements can be explained by the fact that most communications are not perfectly round whereas the balloon transforms the deformed communication into a round structure. If a device is selected which is too small, the risk of embolization and residual shunting increases significantly. On the other hand, if the device is too large, the device may not fit properly within the opening or defect.
Other methods have been described for determining the size of the internal opening utilizing a balloon catheter. For example, Taheri et al. in U.S. Pat. No. 5,591,195 describes a sizing catheter, wherein the pressure within an inflatable balloon is measured. Taheri et al. teaches that when the balloon makes contact with a vessel to be measured, the pressure within the balloon increases. The size of the balloon may then be determined from a chart of known balloon pressures and diameters. As seen in
FIG. 9
, the pressure within the balloon may vary even though the actual diameter being measured remains the same. A need therefore exists for a device that can determine the stretched diameter of an internal passage, opening or defect. The present invention meets these and other needs which will become apparent to those skilled in the art.
SUMMARY OF THE INVENTION
The purpose of the present invention is to provide a device and method for determining the nominal and/or “stretched diameter” of an internal opening or defect within a patient. Those skilled in the art will appreciate that the device and method of the present invention may be utilized to determine the size of any of several defects, passages, or internal openings within a patient. For ease of discussion, and without any limitation intended, the device and method of the present invention will be described in conjunction with determining the stretched diameter of a septal defect within the heart of a patient.
The device and method of the present invention may be utilized in conjunction with radiology, fluoroscopy, echocardiography, and/or other known suitable means for viewing the distal end of a catheter positioned within a patient's heart. The sizing catheter of the present invention includes a tubular shaft having a longitudinal axis extending between a proximal end and a distal end of the tubular shaft. The tubular shaft has one or more lumens formed within the tubular shaft, wherein the lumens are adapted for receiving, for example, a guidewire, device, pressurized fluid, etc. One of the lumens extends between the proximal end and a region short of the distal end of the tubular shaft and terminates into a series of ports extending through the tubular shaft from the lumen to an outer surface of the tubular shaft. The series of ports may be aligned in a spiral fashion around the circumference of the tubular shaft. An elongated dilation balloon is affixed to the tubular shaft proximate the distal end of the tubular shaft and encloses the series of ports.
The dilation balloon is constructed of a thin expandable plastic having an inflation threshold which corresponds with the stretchability of the tissue of the defect. In use, when the dilation balloon is positioned within the predetermined opening and inflated, the dilation balloon resists deformation up to the inflation threshold, thereby causing the tissue surrounding the opening to stretch. Once the inflation threshold is reached, the dilation balloon deforms about the predetermined opening, such that a noticeable waist of the balloon is formed adjacent the predetermined opening. Markings on the distal end of the catheter having known separation distances may be utilized to determine a size of the dilation balloon adjacent the predetermined opening, thereby assisting in the determination of the stretched diameter of the predetermined opening.
Alternatively, when the inflation threshold is reached and the dilation balloon deforms, the pressure within the dilation balloon may be noted. The catheter may then be removed from the heart and the distal end inserted in a template having apertures of known dimension. The balloon may then be inflated to the noted pressure within an aperture estimated to be larger than the stretched diameter of the septal defect. If the balloon deforms, the selected aperture in the template may approximate the stretched diameter of the septal defect. The next size larger aperture may be tested to verify that the balloon does not deform in this
Afremov Michael R.
Amplatz Kurt
AGA Medical Corporation
Carter Ryan
Nikolai Mersereau & Dietz, P.A.
O'Connor Cary
LandOfFree
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