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    • 4. 发明授权
    • Laser device with auto-piercing tip for myocardial revascularization
procedures
    • 具有自动穿刺尖端的激光装置用于心肌血运重建手术
    • US6152918A
    • 2000-11-28
    • US58387
    • 1998-04-09
    • Henry N. PadillaRichard L. MuellerStuart D. Harman
    • Henry N. PadillaRichard L. MuellerStuart D. Harman
    • A61B1/018A61B1/267A61B1/313A61B17/00A61B17/22A61B17/34A61B18/20A61B18/22A61B18/24A61B19/00A61B18/18
    • A61B17/3403A61B18/22A61B18/24A61B2017/00172A61B2017/00247A61B2017/22074A61B2017/22075A61B2017/22077A61B2018/00291A61B2018/00392A61B2018/208A61B90/37
    • 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.
    • 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。
    • 6. 发明授权
    • Laser device for transmyocardial revascularization procedures
    • 用于经心肌血运重建手术的激光装置
    • US6019756A
    • 2000-02-01
    • US790193
    • 1997-01-30
    • Richard L. MuellerStuart D. HarmanRichard D. Phipps
    • Richard L. MuellerStuart D. HarmanRichard D. Phipps
    • A61B17/00A61B17/36
    • A61B17/00A61B2017/00247A61B2018/00392
    • 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.
    • 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。
    • 8. 发明授权
    • Laser device with piercing tip for transmyocardial revascularization
procedures
    • 具有穿刺尖端用于经心肌血运重建手术的激光装置
    • US5738680A
    • 1998-04-14
    • US628849
    • 1996-04-05
    • Richard L. MuellerStuart D. Harman
    • Richard L. MuellerStuart D. Harman
    • A61B18/20A61B17/00A61B17/22A61B18/24A61N5/06A61B17/36
    • A61B18/24A61B2017/00247A61B2017/22077A61B2018/00291A61B2018/00392
    • 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.
    • 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。
    • 9. 发明授权
    • Depth stop apparatus and method for laser-assisted transmyocardial
revascularization and other surgical applications
    • US5725521A
    • 1998-03-10
    • US627701
    • 1996-03-29
    • Richard L. Mueller
    • Richard L. Mueller
    • A61B18/20A61B17/00A61B17/22A61B17/34A61B18/22A61B18/24A61N5/06A61B17/36
    • A61B18/24A61B2017/00247A61B2017/22051A61B2017/22077A61B2017/3484A61B2017/3492A61B2018/00392A61B2018/00738A61B2018/2238
    • 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.