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1.发明授权Method for treating a patient at risk of loss of cardiac function by cardiac ischemia 有权用心脏缺血治疗心脏功能丧失危险的患者的方法公开(公告)号：US07392077B2
公开(公告)日：2008-06-24
申请号：US10822600
申请日：2004-04-12
申请人： Richard L. Mueller , U. Hiram Chee
发明人： Richard L. Mueller , U. Hiram Chee
IPC分类号： A61B5/00
CPC分类号： A61B17/32053 , A61B17/3417 , A61B17/3478 , A61B18/1492 , A61B18/22 , A61B2017/00247 , A61B2018/00392 , A61B2090/036
摘要： Various methods and devices for treating a patient who has lost, or is at risk of losing cardiac function by cardiac ischemia are disclosed. Treatment includes first imaging a patient's heart, or a portion thereof, to identify underperfused regions of cardiac muscle, and a source of oxygenated blood that is proximate to the underperfused region. Between the underperfused regions and the oxygenated blood source, a target area is selected where thermal or mechanical injury is introduced, and optionally reintroduced, to convert initial capillary blush, resulting from the injury.
摘要翻译： 公开了用于治疗由于心脏缺血而失去或有丧失心脏功能风险的患者的各种方法和装置。 治疗包括首先对患者的心脏或其一部分进行成像以识别心肌的不足灌注区域，以及接近欠灌注区域的充氧血液源。 在欠灌注区域和氧合血液源之间，选择引入热或机械损伤的目标区域，并且可选地重新引入，以转化由损伤引起的初始毛细血管腮红。
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公开(公告)号：US06748258B1
公开(公告)日：2004-06-08
申请号：US09706584
申请日：2000-11-03
申请人： Richard L. Mueller , U. Hiram Chee
发明人： Richard L. Mueller , U. Hiram Chee
IPC分类号： A61B505
CPC分类号： A61B17/32053 , A61B17/3417 , A61B17/3478 , A61B18/1492 , A61B18/22 , A61B2017/00247 , A61B2018/00392 , A61B2090/036
摘要： Various methods and devices for treating a patient who has lost, or is at risk of losing cardiac function by cardiac ischemia are disclosed. Treatment includes first imaging a patient's heart, or a portion thereof, to identify underperfused regions of cardiac muscle, and a source of oxygenated blood that is proximate to the underperfused region. Between the underperfused regions and the oxygenated blood source, a target area is selected where thermal or mechanical injury is introduced, and optionally reintroduced, to convert initial capillary blush, resulting from the injury.
摘要翻译： 公开了用于治疗由于心脏缺血而失去或有丧失心脏功能风险的患者的各种方法和装置。 治疗包括首先对患者的心脏或其一部分进行成像以识别心肌的不足灌注区域，以及接近欠灌注区域的充氧血液源。 在欠灌注区域和氧合血液源之间，选择引入热或机械损伤的目标区域，并且可选地重新引入，以转化由损伤引起的初始毛细血管腮红。
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3.发明授权Laser device with auto-piercing tip for myocardial revascularization procedures 失效具有自动穿刺尖端的激光装置用于心肌血运重建手术
公开(公告)号：US6152918A
公开(公告)日：2000-11-28
申请号：US58387
申请日：1998-04-09
IPC分类号： A61B1/018 , A61B1/267 , A61B1/313 , A61B17/00 , A61B17/22 , A61B17/34 , A61B18/20 , A61B18/22 , A61B18/24 , A61B19/00 , A61B18/18
CPC分类号： A61B17/3403 , A61B18/22 , A61B18/24 , A61B2017/00172 , A61B2017/00247 , A61B2017/22074 , A61B2017/22075 , A61B2017/22077 , A61B2018/00291 , A61B2018/00392 , A61B2018/208 , A61B90/37
摘要： The apparatus for combined mechanical/laser myocardial revascularization of a human heart includes: inserting a mechanical piercing device and an elongated flexible lasing apparatus into the chest cavity of a patient; mechanically auto-piercing, micro-tearing or spreading the epicardium of the heart; and then lasing from beneath the epicardium through the myocardium. The apparatus is guided to an area exterior to a ventricle of the patient's heart, and the distal end of the energy delivery device such as an optical fiber apparatus is placed internal to the exterior wall of the heart through an opening which has been created by mechanically piercing, micro-tearing or spreading the epicardium, so that the myocardium and not the epicardium is irradiated with laser energy to allow passage of said energy delivery device such as an optical fiber distal end or said laser energy into the left ventricular cavity without causing a laser irradiation of the epicardium which might be a cause of operative bleeding and for better allowing the sealing of the epicardium after the apparatus is removed. The apparatus includes a hand-held device controllable by the physician having a removable distal head portion with an auto-piercing mechanism and can use a vacuum source to provide a suction force at the head portion. The auto-piercing mechanism is implemented by various ways such as a spring-biased actuating member in the TMR hand-held device and an electro-mechanical operated piercing mechanism. The hand-held TMR device with handle assembly can also be controlled by a computer to provide auto- sequencing of the auto-piercing needle mechanism and the laser firing with auto-fiber advancement.
摘要翻译： 用于人体心脏联合机械/激光心肌血运重建的装置包括：将机械刺穿装置和细长的柔性激光装置插入患者的胸腔中; 机械自动穿刺，微撕裂或散布心脏的心外膜; 然后通过心肌从心外膜下射出。 该装置被引导到患者心脏的心室的外部区域，并且诸如光纤装置的能量输送装置的远端通过已经通过机械产生的开口放置在心脏的外壁内部 穿透，微裂或扩散心外膜，使得心肌而不是心外膜被激光能量照射，以允许所述能量输送装置如光纤远端或所述激光能量通过到左心室，而不引起 心外膜的激光照射可能是手术出血的原因，并且在移除装置之后更好地允许密封心包膜。 该装置包括由医师控制的手持式装置，其具有带有自动穿孔机构的可拆卸远端头部，并且可以使用真空源在头部提供吸力。 自动穿孔机构通过各种方式实现，例如TMR手持装置中的弹簧偏压致动构件和机电操作的穿孔机构。 具有手柄组件的手持式TMR装置还可以由计算机控制，以提供自动穿刺针机构的自动排序和使用自动纤维前进的激光烧制。
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公开(公告)号：US6056742A
公开(公告)日：2000-05-02
申请号：US852011
申请日：1997-05-06
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/00973 , A61B2018/00392
摘要： Apparatus for treating a patient's heart by stimulating revascularization of the heart or creating channels in the heart. The apparatus includes a catheter, a laser energy source coupled to the catheter, and a control circuit. The control circuit is configured to cause the laser energy source to deliver an output of laser energy over a first time period shorter than a heart beat cycle.
摘要翻译： 用于通过刺激心脏血运重建或在心脏中产生通道来治疗患者心脏的装置。 该装置包括导管，耦合到导管的激光能量源和控制电路。 控制电路被配置为使得激光能量源在比心跳周期短的第一时间段内传递激光能量的输出。
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公开(公告)号：US6019756A
公开(公告)日：2000-02-01
申请号：US790193
申请日：1997-01-30
CPC分类号： A61B17/00 , A61B2017/00247 , A61B2018/00392
摘要： A laser surgery device for performing laser myocardial revascularization procedures on a human heart comprises a hand-held body portion with a forwardly extending probe member with an enlarged head end assembly including a piercing tip. A movable fiber bundle connected to a laser source extends through the body portion and the probe member with its distal tip at the head end assembly. A control button on the body portion enables the device to move the distal tip forwardly from the head end, and selectable stop members are provided on the body portion to provide different travel distances for the optical fiber bundle during a procedure. The body portion has a rotatable nose-piece with an internal ratchet mechanism which enables the device user to rotate the probe member and its head end to a selected optimum position before commencing a procedure. The head end assembly includes an easily replaceable piercing member in combination with a concave disk having a yieldable liner for cushioning the head assembly contact with the patient's heart. The device is used with a TMR procedure wherein the epicardium is initially pierced to provide access to the myocardium for the distal tip of the fiber bundle which then emits laser pulses as it is moved through the myocardium.
摘要翻译： 用于在人心脏上进行激光心肌血运重建手术的激光手术装置包括具有向前延伸的探针部件的手持主体部分，其具有包括穿刺尖端的扩大的头端组件。 连接到激光源的可移动光纤束通过主体部分和探针部件延伸，其远端在头端组件上。 主体部分上的控制按钮使得设备能够从头端向前移动远侧末端，并且可选择的止动构件设置在主体部分上，以在过程期间为光纤束提供不同的行进距离。 主体部分具有带有内部棘轮机构的可旋转鼻部，其使得设备使用者能够在开始过程之前将探针构件及其头端旋转到选定的最佳位置。 头端组件包括易于更换的刺穿构件，其与具有用于缓冲头部组件与患者心脏接触的可收缩内衬的凹盘组合。 该装置与TMR方法一起使用，其中最初刺穿心外膜以提供对于纤维束的远端的心肌的通路，然后当心肌移动通过心肌时发射激光脉冲。
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6.发明授权Controllable trocar for transmyocardial revascularization (TMR) via endocardium method and apparatus 失效通过心内膜法和器械进行经心肌血运重建（TMR）的可控套管针
公开(公告)号：US5766163A
公开(公告)日：1998-06-16
申请号：US675732
申请日：1996-07-03
CPC分类号： A61B17/3417 , A61B18/24 , A61B17/3498 , A61B2017/00247 , A61B2017/00867 , A61B2017/3488 , A61B2018/00392 , A61B2018/2238
摘要： A minimally invasive surgical apparatus for providing access to the inside of a chamber of the heart for performing TMR on anterior and posterior walls therein. A unitary or a two piece trocar assembly is positioned through the chest wall. An obturator with a tissue piercing blade at one end is used to saw, pierce or otherwise cut a hole through the epicardium into and through myocardium. Once the trocar assembly extends into the heart chamber, a laser delivery device with deflection means is introduced into the chamber. Deflection or curvature of the end of the laser delivery device can be controlled by angulation control components, such that TMR channels can be created at various positions on the anterior and posterior walls of the chamber. Rotation control components for the fiber or other laser delivery devices will allow the surgeon to rotate the fiber once a predetermined deflection or curvature has been imparted to the distal end of the laser delivery device.
摘要翻译： 一种微创外科手术装置，用于提供进入心脏室内部以在其中的前壁和后壁上进行TMR。 一体式或两片套管针组件通过胸壁定位。 在一端具有组织穿刺刀片的闭孔器用于锯切，刺穿或以其他方式切割通过心外膜通过心肌的孔。 一旦套管针组件延伸到心室中，具有偏转装置的激光输送装置被引入腔室。 可以通过角度控制部件来控制激光输送装置的端部的偏转或弯曲，使得可以在腔室的前壁和后壁上的各个位置处产生TMR通道。 一旦向激光输送装置的远端施加了预定的偏转或曲率，则用于纤维或其他激光输送装置的旋转控制部件将允许外科医生旋转纤维。
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7.发明授权Laser device with piercing tip for transmyocardial revascularization procedures 失效具有穿刺尖端用于经心肌血运重建手术的激光装置
公开(公告)号：US5738680A
公开(公告)日：1998-04-14
申请号：US628849
申请日：1996-04-05
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/22077 , A61B2018/00291 , A61B2018/00392
摘要： The method for combined mechanical/laser myocardial revascularization of a human heart includes: inserting a mechanical piercing device and an elongated flexible lasing apparatus into the chest cavity of a patient; mechanically piercing, micro-tearing or spreading the epicardium of the heart; and then lasing from beneath the epicardium through the myocardium. The apparatus is guided to an area exterior to a ventricle of the patient's heart, and the distal end of the optical fiber apparatus is placed internal to the exterior wall of the heart through an opening which has been created by mechanically piercing, micro-tearing or spreading the epicardium, so that the myocardium and not the epicardium is irradiated with laser energy to allow passage of said optical fiber distal end or said laser energy into the left ventricular cavity without causing a laser irradiation of the epicardium which might be a cause of operative bleeding and for better allowing the sealing of the epicardium after the apparatus is removed. The apparatus includes a hand-held device controllable by the surgeon having a removable distal head end with a replaceable piercing member and utilizing a vacuum source to provide a suction force at the head end.
摘要翻译： 人心脏联合机械/激光心肌血运重建的方法包括：将机械穿刺装置和细长的柔性激光装置插入患者的胸腔; 机械穿刺，微裂或散布心脏的心外膜; 然后通过心肌从心外膜下射出。 该装置被引导到患者心脏的心室的外部区域，并且光纤装置的远端通过开口被放置在心脏的外壁的内部，所述开口通过机械刺穿，微撕裂或 扩散心外膜，使得心肌而不是心外膜被激光能量照射以允许所述光纤远端或所述激光能量通过到左心室腔而不引起激光照射心外膜，这可能是手术的原因 出血并且更好地允许在除去装置之后密封心外膜。 该装置包括可由外科医生控制的手持式装置，其具有可移除的远端头端，其具有可更换的刺穿构件，并利用真空源在头端提供吸力。
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公开(公告)号：US5725521A
公开(公告)日：1998-03-10
申请号：US627701
申请日：1996-03-29
申请人： Richard L. Mueller
发明人： Richard L. Mueller
IPC分类号： A61B18/20 , A61B17/00 , A61B17/22 , A61B17/34 , A61B18/22 , A61B18/24 , A61N5/06 , A61B17/36
CPC分类号： A61B18/24 , A61B2017/00247 , A61B2017/22051 , A61B2017/22077 , A61B2017/3484 , A61B2017/3492 , A61B2018/00392 , A61B2018/00738 , A61B2018/2238
摘要： Improved methods and apparatuses related to laser-assisted transmyocardial revascularization, and more particularly, to improved methods and apparatuses for precisely positioning a fiber-optic or other waveguide adjacent the area or areas to be lased, including at positions adjacent the posterior epicardial and endocardial surfaces of the heart and at trans-septal positions within the chambers of the heart, thereby making possible the creation of channels in myocardial tissue at precisely the positions in the heart where ischemia or infarction or other have rendered such treatment desirable or necessary. These methods and apparatuses can be adapted for use in surgical applications throughout the human body or in animals for transmitting laser energy precisely, at predetermined positions and to predetermined depths. A catheter device for performing laser-assisted transmyocardial revascularization (TMR), the device particularly adapted for delivery of laser energy via a laser delivery device or manipulation of some other apparatus inside a body cavity or organ chamber where the depth of delivery of the laser energy is critical to the procedure, the device comprising an outer lumen and a depth stop, the depth stop having a deploying device, such that when the catheter device is placed adjacent tissue to be lased and the depth stop is deployed, the spatial reference of the position of the catheter device and the laser delivery device or other apparatus used in the catheter device is maintained in a predetermined position relative to the position of the distal end of the outer lumen. Deployment of the depth stop consists of inflating a balloon tip, or there may also be an inner lumen such that deployment comprises slightly retracting the inner lumen such that an expanding mechanism such as a braided basket or "moly bolt" device increases the diameter of the end of the catheter device, thereby providing a contacting surface for performing the surgical procedure, whether it be laser ablation, visualization, or other. A method of use is also described.
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公开(公告)号：US5041089A
公开(公告)日：1991-08-20
申请号：US242012
申请日：1988-09-08
CPC分类号： A61M25/104 , A61M25/0119
摘要： An improved vascular dilation catheter comprises an involuted tubular structure including outer and inner tubular walls which extend the entire length of the catheter. The outer tubular wall is enlarged at a distal end of the catheter to form a dilation balloon, and extends back the remaining length of the flexible tube at a reduced diameter to define an annular lumen which is used to inflate the balloon. Alternatively, the outer tubular wall may conform to the exterior of the inner tubular wall and separate axial lumens may be provided for inflation. By providing means for heating inflation medium within the balloon, the catheter may be utilized for performing thermal ablation therapy.
摘要翻译： 改进的血管扩张导管包括渐开线管状结构，其包括延伸导管整个长度的外管壁和内管壁。 外管状壁在导管的远端处扩大以形成扩张气囊，并以减小的直径向后延伸柔性管的剩余长度，以限定用于使气囊膨胀的环形腔。 或者，外部管状壁可以符合内部管状壁的外部，并且可以提供用于充气的分开的轴向内腔。 通过提供用于加热球囊内的充气介质的装置，导管可用于进行热消融治疗。
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公开(公告)号：US06814700B1
公开(公告)日：2004-11-09
申请号：US09527485
申请日：2000-03-16
申请人： Richard L. Mueller , Stephen W. Boyd , James R. Flom , Lorraine F. Mangosong , William S. Peters
发明人： Richard L. Mueller , Stephen W. Boyd , James R. Flom , Lorraine F. Mangosong , William S. Peters
IPC分类号： A61B132
CPC分类号： A61B17/0293 , A61B17/02 , A61B17/0206 , A61B17/025 , A61B17/3417 , A61B17/3423 , A61B17/3431 , A61B17/3468 , A61B2017/00243 , A61B2017/3482 , A61B2090/306
摘要： The present invention provides a retractor for providing surgical access through a passage in tissue, together with methods for its use and deployment. The retractor comprises an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis. A flexible tensioning member is attached to the frame, and is extendable from the frame out of the body through the passage when the frame is positioned through the passage and into a body cavity. This tensioning member is selectively tensionable to spread the tissue radially outwardly from the axial axis. Hence, it is the tension imposed on the flexible liner which effects retraction of the tissue, rather than relying on the structural integrity of an artificial lumen.
摘要翻译： 本发明提供一种用于通过组织中的通道提供外科手术进入的牵开器，以及用于其使用和部署的方法。 牵开器包括具有上表面，下表面和通过其限定轴向轴线的开口的锚固框架。 柔性张紧构件附接到框架，并且当框架通过通道定位并进入体腔时，柔性张紧构件附接到框架并且可从框架伸出身体穿过通道。 该张紧构件可选择性地张紧以使组织从轴向轴线向外径向扩张。 因此，施加在柔性衬垫上的张力会影响组织的缩回，而不是依靠人造管腔的结构完整性。
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