摘要:
Lacrimal implants and related methods providing secure, wedgable retention within a lacrimal punctum and associated canaliculus of an eye are disclosed. The lacrimal implants can comprise an implant body configured for at least partial insertion through the lacrimal punctum and into the canaliculus. The implant body can include first and second portions, and can extend from a proximal end of the first portion defining a longitudinal proximal axis to a distal end of the second portion defining a longitudinal distal axis. The implant body can be configured such that, when implanted using an integral dilator, an angled intersection exists between the proximal and distal axes. In this way, at least a portion of the implant body can be biased against at least a portion of the lacrimal canaliculus located at or more distal to a canalicular curvature, thereby retaining an implanted position of the lacrimal implant using anatomical structures.
摘要:
Methods and devices are adapted for regulating fluid flow to and from a region of a patient's lung, such as to achieve a desired fluid flow dynamic to a lung region during respiration and/or to induce collapse in one or more lung regions. Pursuant to an exemplary procedure, an identified region of the lung is targeted for treatment. The targeted lung region is then bronchially isolated to regulate airflow into and/or out of the targeted lung region through one or more bronchial passageways that feed air to the targeted lung region.
摘要:
Disclosed are methods and devices for regulating fluid flow to and from a region of a patient's lung, such as to achieve a desired fluid flow dynamic to a lung region during respiration and/or to induce collapse in one or more lung regions. Pursuant to an exemplary procedure, an identified region of the lung is targeted for treatment. The targeted lung region is then bronchially isolated to regulate airflow into and/or out of the targeted lung region through one or more bronchial passageways that feed air to the targeted lung region.
摘要:
Methods and devices for manufacturing a conduit for placing a target vessel in fluid communication with a source of blood, such as a heart chamber containing blood. The conduit includes first and second portion adapted to be placed in fluid communication with a heart chamber and a target vessel. The conduit lies on the exterior of the myocardium between the blood source and the target vessel and delivers blood in multiple directions within the lumen of the target vessel. The conduit, which may be formed of any suitable synthetic vascular graft material, is generally T-shaped with the leg having two free ends disposed in the target vessel, preferably being secured thereto via a suture-free attachment. The conduit comprises vascular graft material and may be manufactured various ways, such as molding a conduit from any suitable biocompatible material or fabricating a conduit from one or more pieces of vascular graft material.
摘要:
Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.
摘要:
Methods and devices for forming an anastomosis utilize a graft vessel secured to a vessel coupling that is fixed to a target vessel without using suture. The vessel coupling may be collapsed for introduction into the target vessel and then expanded to engage the vessel wall. The vessel coupling may be a stent attached to a graft vessel to form a stent-graft assembly. The anastomosis may be carried out to place the graft and target vessels in fluid communication while preserving native proximal flow through the target vessel, which may be a coronary artery. As a result, blood flowing through the coronary artery from the aorta is not blocked by the vessel coupling and thus is free to move past the site of the anastomosis.
摘要:
Surface treated implantable articles and related methods are disclosed. The surface treated implantable articles can be substantially flash-free, include one or more rounded edges, or include an enhanced optical clarity, one or all of which can be produced by polishing. The polishing can include causing the implantable articles to be repeatedly impacted with polishing media when the articles are swelled to an enlarged state. The polishing process can be particularly useful for smoothing lacrimal implants insertable in a lacrimal canaliculus.
摘要:
Devices and methods for delivering conduits into the wall of a patient's heart to communicate a coronary vessel with a heart chamber. The devices are passed through the coronary vessel and the heart wall to place the conduit and establish a blood flow path between the vessel and the heart chamber. Additional devices and methods are provided for removing tissue from a coronary vessel or the heart wall to establish a flow path between the coronary vessel in communication with the heart chamber.
摘要:
Disclosed is an anesthesia adapter that is suitable for the simultaneous insertion of multiple devices or instruments into the lungs during ventilation of the patient, while minimizing or eliminating gas leaks. The anesthesia adapter comprises in one embodiment a first port sized to receive a first elongate instrument; a second port sized to receive a second elongate instrument; an endotrachial tube fitting configured to be coupled to an endotrachial tube, the endotrachial tube fitting fluidly coupled to the first and second ports; and a hose fitting configured to be coupled to a ventilator hose, the hose fitting fluidly coupled to the first and second ports. The first port seals around the first elongated instrument and the second port seals around the second elongate instrument.
摘要:
Devices and methods for delivering conduits into the wall of a patient's heart to communicate a coronary vessel with a heart chamber. The devices are passed through the coronary vessel and the heart wall to place the conduit and establish a blood flow path between the vessel and the heart chamber. Additional devices and methods are provided for removing tissue from a coronary vessel or the heart wall to establish a flow path between the coronary vessel in communication with the heart chamber.