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公开(公告)号：US06174307B1
公开(公告)日：2001-01-16
申请号：US09227458
申请日：1999-01-08
IPC分类号： A61B1818
CPC分类号： A61B1/00154 , A61B1/00098 , A61B1/00179 , A61B1/00183 , A61B1/018 , A61B1/267 , A61B1/3132 , A61B18/24 , A61B90/37 , A61B90/39 , A61B2017/00247 , A61B2017/22075 , A61B2017/22077 , A61B2017/306 , A61B2018/00166 , A61B2018/00291 , A61B2018/00392 , A61B2018/00982 , A61B2018/2238
摘要： A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the work device such as for drug delivery. In a second embodiment a rigid endoscope with a viewing channel has an introducer member that is slidably disposed and detachable from the viewing channel and has a transparent convex distal tip which provides non-articulation at the distal end. This introducer member can also be used in conjunction with the first embodiment where the catheter shaft requires non-articulation. Both types of visualization scopes include a working channel in which the working device can translationally egress from the scope's distal end. Additionally, the rigid introducer member can be modified to include a movable transparent rotatable member design for varying the direction which the working devices egresses the apparatus' distal end. The preferred surgical procedure is transmyocardial revascularization and the preferred working device is an optical fiber element that is translatable from the distal end of the apparatus during the procedure. The working device can optionally include a flexible piercing needle with an internal lumen which allows translation of a working device such as an optical fiber or act as a conduit for drug delivery.
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公开(公告)号：US5999678A
公开(公告)日：1999-12-07
申请号：US773430
申请日：1996-12-27
申请人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Steve A. Daniel , Larry Witham , Bruce Richardson
发明人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Steve A. Daniel , Larry Witham , Bruce Richardson
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2018/00392
摘要： A drug delivery apparatus for dispensing a predetermined amount of one or more drugs into a laser created opening in the human body, the apparatus consisting of a laser delivery means such as an optical fiber or fiber bundle, a drug conduit which transfers the one or more drugs, drug solutions or other substances to the distal end of the laser delivery means, and the laser delivery means disposed essentially coaxially with the drug conduit. Laser delivery means is used to create a TMR channel or other opening in the body. Dispensed drug or other substance travels through the drug conduit and emanates from the drug conduit to be delivered into the TMR channel or other laser created opening. Drug is dispensed by manually or automatically activating an electric motor which actuates a piston element. A method of use is also disclosed.
摘要翻译： 一种用于将预定量的一种或多种药物分配到人体内的激光产生开口中的药物输送装置，该装置由诸如光纤或纤维束的激光输送装置组成，药物导管将一个或多个 药物，药物溶液或其它物质，并且激光输送装置基本上与药物导管同轴地设置。 激光输送装置用于在体内产生TMR通道或其他开口。 分配的药物或其他物质通过药物导管，并从药物导管发出，以被输送到TMR通道或其他激光产生的开口中。 药物通过手动或自动激活致动活塞元件的电动机来分配。 还公开了一种使用方法。
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公开(公告)号：US5766164A
公开(公告)日：1998-06-16
申请号：US675698
申请日：1996-07-03
CPC分类号： A61B17/3403 , A61B18/22 , A61B2017/00247 , A61B2017/22075 , A61B2018/00392
摘要： Improved methods and devices related to laser-assisted transmyocardial revascularization (TMR), and more particularly, to improved methods and devices for creating branched TMR channels through myocardium in which a single opening is made in an epicardial surface with a plurality of channel branches, having predetermined geometries extending into and through myocardium, depending therefrom. A method of creating branched TMR channels comprises piercing an epicardial surface mechanically or with laser energy, directing laser energy through the opening in a first predetermined angular orientation with respect to the epicardial surface to create a first channel and delivering laser energy in a second predetermined angular orientation to create a second branch. A plurality of branches can thus be created in a single channel structure. A guide block device allows an opening to be made in an epicardial surface mechanically or with laser energy and provides a structure for directing laser energy into myocardium in a plurality of channels depending from the opening. Rotating guide devices and finger held devices with rotating head means include a hand held device with an elongated wand-like handle portion, a rotating head portion and a hollow guide needle means. Preferred embodiments further comprise a laser delivery means advancing mechanism and guide needle rotating means.
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公开(公告)号：US5742718A
公开(公告)日：1998-04-21
申请号：US696301
申请日：1996-08-13
申请人： Stuart D. Harman , Mark Roush
发明人： Stuart D. Harman , Mark Roush
CPC分类号： G02B6/3813 , A61B18/24 , G02B6/4296 , A61B2017/00123 , A61B2017/00247 , A61B2017/00725 , A61B2018/00392 , A61B2018/00988 , G02B2006/4297 , G02B6/3869 , G02B6/3887
摘要： A laser connector and electronic security system for a laser delivery system controls connection of the delivery system to a source of laser energy for medical procedures by storing encrypting codes to allow access by authorized, unused, delivery assemblies. The connector is specially dimensioned to further control delivery system access to the source, and the electronic security system utilizes EEPROM memory to allow storage and accumulation of information about the laser parameters used in the medical procedure. The connector and electronic security system is particularly suitable for pulsed laser transmyocardial revascularization (TMR) procedures and enables automatic power level calibration in accordance with the connected delivery system specifications, maximum time of usage settings, storage of the number/power level of the pulses delivered, and storage of the total number of TMR channels created.
摘要翻译： 用于激光传送系统的激光连接器和电子安全系统通过存储加密代码来控制传送系统与用于医疗过程的激光能量源的连接，以允许经授权的未使用的传送组件访问。 该连接器的尺寸被特别设计以进一步控制对源的传送系统访问，并且电子安全系统利用EEPROM存储器来允许存储和累积关于在医疗过程中使用的激光参数的信息。 连接器和电子安全系统特别适用于脉冲激光心肌血运重建（TMR）程序，并能够根据所连接的输送系统规格进行自动功率电平校准，最大使用时间设置，存储发送的脉冲数/功率电平 ，并存储创建的TMR频道总数。
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公开(公告)号：US06706011B1
公开(公告)日：2004-03-16
申请号：US09288251
申请日：1999-04-08
申请人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Steve A. Daniel , Larry Witham , Bruce Richardson
发明人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Steve A. Daniel , Larry Witham , Bruce Richardson
IPC分类号： A61M3100
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2018/00392
摘要： A drug delivery apparatus for dispensing predetermined volumes of drug, drug solution or other substances into an opening, such as a TMR channel in the human heart, or other laser treated area within the human body, the apparatus consisting of a bifurcated needle with a laser inlet for guiding a laser delivery means, such as an optical fiber or fiber bundle, to adjacent a surface of the human heart or other body structure for creating an opening, such as a TMR channel, or other laser treated area thereon. A drug inlet is for receiving the drug and transmitting the drug to the TMR channel or other laser treated area. Optionally, a piercing tip and/or suction device assists in positioning the apparatus adjacent the tissue to be treated. Drug is dispensed by manually or automatically actuating a piston or syringe element. A method of use is also disclosed.
摘要翻译： 用于将预定体积的药物，药物溶液或其它物质分配到诸如人心脏中的TMR通道或人体内的其它激光处理区域的开口中的药物递送装置，该装置由具有激光的分叉针 用于将诸如光纤或纤维束的激光传送装置引导到靠近人心或其他身体结构的表面以在其上形成诸如TMR通道或其他激光处理区域的开口。 药物入口用于接收药物并将药物传输到TMR通道或其他激光治疗区域。 可选地，刺穿尖端和/或抽吸装置有助于将装置定位在待处理组织附近。 通过手动或自动启动活塞或注射器元件来分配药物。 还公开了一种使用方法。
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16.发明授权Contiguous, branched transmyocardial revascularization (TMR) channel, method and device 失效连续分支的经心肌血运重建（TMR）通道，方法和装置
公开(公告)号：US6066131A
公开(公告)日：2000-05-23
申请号：US92798
申请日：1998-06-05
CPC分类号： A61B17/3403 , A61B18/22 , A61B2017/00247 , A61B2017/22075 , A61B2018/00392
摘要： Improved methods and devices related to laser-assisted transmyocardial revascularization (TMR), and more particularly, to improved methods and devices for creating branched TMR channels through myocardium in which a single opening is made in an epicardial surface with a plurality of channel branches, having predetermined geometries extending into and through myocardium, depending therefrom. A method of creating branched TMR channels comprises piercing an epicardial surface mechanically or with laser energy, directing laser energy through the opening in a first predetermined angular orientation with respect to the epicardial surface to create a first channel and delivering laser energy in a second predetermined angular orientation to create a second branch. A plurality of branches can thus be created in a single channel structure. A guide block device allows an opening to be made in an epicardial surface mechanically or with laser energy and provides a structure for directing laser energy into myocardium in a plurality of channels depending from the opening. Rotating guide devices and finger held devices with rotating head means include a hand held device with an elongated wand-like handle portion, a rotating head portion and a hollow guide needle means. Preferred embodiments further comprise a laser delivery means advancing mechanism and guide needle rotating means.
摘要翻译： 改进的与激光辅助心肌血运重建（TMR）相关的方法和装置，更具体地说，涉及通过心肌产生分支TMR通道的改进方法和装置，其中在具有多个通道分支的心外膜表面中形成单个开口， 预定的几何形状延伸到心肌中并通过心肌，这取决于它们。 创建分支TMR通道的方法包括机械地或用激光能量刺穿心外膜表面，以相对于心外膜表面的第一预定角度方向引导激光能量通过开口，以产生第一通道并将激光能量传送到第二预定角度 方向创建第二个分支。 因此，可以在单个信道结构中创建多个分支。 引导块装置允许以机械方式或用激光能量在心外膜表面制造开口，并且提供用于将激光能量引导到依赖于开口的多个通道中的心肌的结构。 具有旋转头装置的旋转导向装置和手指保持装置包括具有细长的棒状手柄部分的手持装置，旋转头部分和中空导向针装置。 优选实施例还包括激光输送装置前进机构和引导针旋转装置。
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公开(公告)号：US6015427A
公开(公告)日：2000-01-18
申请号：US882774
申请日：1997-07-07
IPC分类号： A61B17/02 , A61B17/04 , A61B17/122 , A61B17/00
CPC分类号： A61B17/02 , A61B17/0466 , A61B17/0487 , A61B17/1227 , A61B2017/0243 , A61B2017/0454 , A61B2017/0464 , A61B2017/0496
摘要： A heart stabilizer and suture control device for stabilizing the heart and for occluding a preselected portion of coronary artery by developing a downward force on the heart and simultaneously developing an upward force across a coronary artery in a predetermined position. The device has at least two stabilization pads, the stabilization pads each having an operative size and shape, and each having a first end and a second end and a lower contacting surface. The second ends have suture retaining grooves, and the stabilization pad has a suture locking means for securing the distal end of a suture means thereto. The device also comprises a linking member locking the two stabilization pads an operative distance apart. The device has suture means with a proximal end coupled to the linking member and extending from the first end to the suture retaining groove of the second end, the suture means having a distal end which can be locked to the stabilization pad with the suture locking means thereon. The device also has means for rotating the linking member such that when operatively positioned adjacent a coronary artery to be occluded with the suture threaded between the coronary artery and the remaining portion of the heart muscle, rotating the linking member will cause the proximal end of the suture means to be wound onto the linking member and thus tighten the suture between the first end and the second end of each stabilization pad and urge the coronary artery against the contacting surface, thereby causing occlusion of the coronary artery as desired.
摘要翻译： 一种心脏稳定器和缝合线控制装置，用于通过在心脏上产生向下的力同时在预定位置上跨越冠状动脉形成向上的力来稳定心脏并阻塞冠状动脉的预选部分。 该装置具有至少两个稳定垫，稳定垫各自具有可操作的尺寸和形状，并且每个具有第一端和第二端和下接触表面。 第二端具有缝合线保持槽，并且稳定垫具有用于将缝线装置的远端固定到其上的缝合线锁定装置。 该装置还包括连接构件，其将两个稳定垫片间隔开操作距离。 该装置具有缝合装置，其近端联接到连接构件并且从第一端的第一端延伸到缝合线保持槽，缝合线装置具有远端，该远端可利用缝合线锁定装置锁定到稳定垫 上。 该装置还具有用于旋转连接构件的装置，使得当可操作地定位成邻近冠状动脉以被缝合在冠状动脉与心脏肌肉的剩余部分之间的缝合线时，旋转连接构件将导致连接构件的近端 缝合装置被缠绕到连接构件上，从而在每个稳定垫的第一端和第二端之间紧固缝合线，并且迫使冠状动脉抵靠接触表面，从而根据需要引起冠状动脉闭塞。
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公开(公告)号：US5931834A
公开(公告)日：1999-08-03
申请号：US904222
申请日：1997-07-31
申请人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Jeffrey J. Giba , Mark Roush , Fred G. Kinley
发明人： Douglas Murphy-Chutorian , Richard L. Mueller , Stuart D. Harman , Jeffrey J. Giba , Mark Roush , Fred G. Kinley
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00703 , A61B2018/00392
摘要： A method of selecting laser parameters for performing laser-assisted myocardial revascularization to avoid inducing undesired cardiac arrhythmia without synchronization of delivery of laser energy and the patient's cardiac cycle, the method comprising the steps of minimizing the power level of laser energy used, thereby decreasing the overall trauma to the heart, selecting a pulse frequency as great as possible while avoiding adverse summation effects, selecting a pulse width as wide as possible to prevent excessively high peak powers per pulse and not so wide as to cause undesired thermal damage, selecting an energy flux rate, shaping the front end of each pulse of laser energy to provide efficient, non-explosive TMR channeling, and correcting the selected power level, pulse width, pulse frequency and energy flux rate for mechanical events, including method of access to the heart, position of selected portions of myocardium in the heart, temporal duration of the procedure, natural movement of the heart, specific heart geometry, pre-existing heart arrhythmia and other factors causing a predisposition to heart arrhythmia. A method for performing laser-assisted transmyocardial revascularization (TMR) and percutaneous transluminal myocardial revascularization (PTMR) using such laser energy with parameters selected to avoid inducing undesired cardiac arrhythmia, the method comprising the steps of generating laser energy having a predetermined non-square wave shape, a predetermined wavelength, a predetermined energy flux and a predetermined power level, and delivering the laser energy in a plurality of pulses, the plurality of pulses having a predetermined pulse frequency and a predetermined pulse width, to selected portions of myocardium to form TMR and PTMR channels without synchronizing delivery of the laser beam with the cardiac cycle.
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公开(公告)号：USD405883S
公开(公告)日：1999-02-16
申请号：US64162
申请日：1996-12-23
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公开(公告)号：US5840075A
公开(公告)日：1998-11-24
申请号：US702024
申请日：1996-08-23
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00973 , A61B2017/306 , A61B2018/00291 , A61B2018/00392 , A61B2018/207
摘要： A method of and apparatus for performing a transmyocardial revascularization procedure is disclosed which utilizes two laser power sources. A first laser source provides a coagulating or blanching effect on tissue and a second laser source capable of tissue ablation are supplied to a combined optical fiber bundle comprising a plurality of fibers which can be moved axially or rotatively by the operating physician. As the distal end of the fiber bundle is moved forward, bursts of laser energy therefrom may be programmed to first penetrate the epicardium with minimal bleeding and thereafter provide channels or pockets in the myocardium for causing or stimulating angiogenesis.
摘要翻译： 公开了一种利用两个激光电源进行心肌血运重建手术的方法和装置。 第一激光源对组织提供凝固或漂白效果，并且能够组织消融的第二激光源被提供给包括可由操作医师轴向或旋转地移动的多个纤维的组合光纤束。 当纤维束的远端向前移动时，其脉冲激光能量可以被编程为首先以最小的渗透渗透心外膜，此后在心肌中提供通道或口袋以引起或刺激血管生成。
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