heart valve structure, multi-membrane heart valve structure and method for making a heart valve stru

专利摘要:
HEART VALVE STRUCTURE, MULTI-MEMBER HEART VALVE STRUCTURE AND METHOD FOR MANUFACTURING A HEART VALVE STRUCTURE Artificial heart valve structures and methods for their manufacture are described. Heart valve structures can be manufactured from biocompatible polymers and include one or more heart valve membrane structures embedded within a conduit. The valve structures can incorporate one or more conduits in the coronary sinus, as well as a gap between the lower margin of the valve membranes and the internal one of the conduit. In addition. The valve structures can include one or more valves in the coronary sinus created in a space between the valve membranes and the inner surface of the conduit. Computational fluid dynamics and mechanical modeling can be used to build valve membranes with optimal characteristics. A heart valve structure can also incorporate a biodegradable component to which cells can adhere. Embedded cells can elevate from the patient's cells by migrating to the biodegradable component, or the component can be pre-seeded with the cells prior to implantation in a patient.
公开号:BR112014002174B1
申请号:R112014002174-0
申请日:2012-07-30
公开日:2020-12-01
发明作者:Masahiro Yoshida；Douglas C. Bernstein；Onur Dur；Kerem Pekkan
申请人:University Of Pittsburgh Of The Commonwealth System Of Higher Education；Carnegie Mellon University；
IPC主号:

专利说明:

Prior art
[0001] The selection of a heart valve structure for reconstruction of the right ventricular outflow tract (RVOT) can present a challenge in the treatment of many congenital heart diseases including, without limitation, Fallot tetralogy with pulmonary atresia, truncus arteriosus, transposition major arteries with pulmonary stenosis, and congenital aortic stenosis / insufficiency.
[0002] Cardiac valve structures that can be used for RVOT reconstruction in pediatric patients can consist of homografts, which may not be readily available in many cases, and xenografts, which can be costly (often around $ 4,000 - $ 5,000) ). After the invention of the cryo-conservation process in the early 1980s, and especially with the increased availability of a wide range of sizes, the homograft became a frequent choice of cardiac structure for cardiac surgeons for RVOT reconstruction. However, longitudinal studies have shown that homografts may also require replacement of the heart valve structure due to stenosis and insufficiency. These complications can be caused by decrease and calcification and can be especially problematic for very young patients.
[0003] Currently, new xenograft designs have been evaluated for RVOT reconstruction including a pig aortic root and valve fixed by glutaraldehyde, and a glutaraldehyde-fixed segment of a bovine jugular vein with a venous valve. Although the anatomical shape of pig prostheses can attach well to RVOT, stenosis and calcification can still persist when the prosthesis is implanted in children. Similarly, recent reports on bovine heart valve structures suggest a significant early fibrotic ring formation in the distal anastomosis. Additionally, dramatic dilation of and regurgitation through a cardiac valve structure can occur in the setting of pulmonary hypertension or distal anastomotic ring. The most successful cardiac valve structures for RVOT reconstruction, the homograft and the bovine jugular vein, have both shown a rate of re-operation of around 10-20% after just two years. The rates of re-operation and re-intervention, especially for bovine xenografts, seem to increase significantly with increasing time and decreasing the diameter of the conduit.
[0004] Both the homograft and the xenografts can undergo calcification, which can result in stenosis and insufficiency, leading to the need for re-operation and replacement of the heart valve structure. Additionally, studies suggest that bioprosthetic cardiac valve structures, available for RVOT reconstruction, that is, both allograft and xenografts, may be ineffective due to poor hemodynamic performance and long-term complications, especially in very young patients . Even after the replacement of the bioprosthetic valve is performed, frequent surgeries for reconstruction of RVOT may be required until the individual reaches adulthood. Additional surgery may be required due to recurrent stenosis / insufficiency caused by calcification or degeneration processes, as well as relative stenosis due to somatic growth.
[0005] Artificial heart valve structures can be considered as an alternative for both homografts and xenografts. However, artificial mechanical valves may not be generally available for RVOT reconstruction for pediatric patients. One factor that can affect the availability of said cardiac valve structure may include the difficulty in designing a valve structure that can divide with very low pressures (which can be less than 20 mmHg in many cases) found in pediatric RVOT. Additional shape surveys may also include conduits of small diameter, a high degree of curvature along the conduit route, and the need for conduit flexibility when the patient grows. Intensive bioengineering studies may be required to produce effective personalized formats for the pediatric / neonatal population. In use, mechanical valves may have greater longevity when implanted in the pulmonary position compared to implantation in the aortic position, but may require aggressive anticoagulant therapy due to a much greater risk of thrombosis.
[0006] In addition to those conditions described above, for which RVOT is indicated, other disorders may also benefit from the implanted artificial heart valve structures. Hypoplastic left heart syndrome (HLHS) is a rare and complex congenital heart disorder that can be extremely difficult to successfully treat. HLHS can be characterized by a hypoplastic left ventricle that is unable to maintain systemic circulation, a hypoplastic aortic arch and an ascending aorta that requires reconstruction, and a patent arterial duct that can maintain systemic circulation in the lower body. In order to treat HLHS, three separate procedures may be required: a Norwood operation, a Glenn bidirectional procedure, and a Fontan procedure.
[0007] The Norwood operation typically involves connecting the base of the pulmonary artery to the aortic arch in order to redirect blood flow to the systemic tract. In order to continue to provide circulation to the pulmonary tract, a bypass or conduit can be placed after the Norwood operation to provide blood flow to the pulmonary artery. Currently, there are two typical options for this deviation: a Blalock-Taussig (BT) deviation that can connect the aorta to the base of the pulmonary artery, and a Sano deviation (RV-PA conduit) that can be placed between the right ventricle and the pulmonary artery.
[0008] BT deviation placement can result in blood flow from the aorta to the pulmonary artery during both systolic and diastolic phases. This constant flow due to BT deviation can cause low systemic diastolic pressure that can potentially lead to early mortality. The RV-PA conduit can prevent pulmonary tract flow by constantly leaching blood flow from the systemic tract by connecting the pulmonary artery directly to the right ventricle, in addition to the aorta. In this way, the RV-PA deviation can maintain a higher systemic diastolic pressure than the BT deviation. However, current RV-PA shunts do not contain valves so reflux can occur within the right ventricle. As a result of reflux, right ventricular enlargement may occur, eventually leading to the need for partial or total replacement of the heart.
[0009] The deviations used for the treatment of HLHS can be very small, usually having a diameter around 4 mm. This can make the design and manufacture of any heart valve structure containing said conduit extremely difficult. Attempts by the passer to use a single valve line have not been successful, as the placement and geometry of the valve has resulted in a valve sticking to the line. Valve adhesion can result in thrombus formation and flow impedance, which often results in early patient mortality.
[0010] Therefore, it seems to be a significant need for a heart valve structure, covering a conduit and a membrane structure of the heart valve, with greater durability for use with neonatal and pediatric patients. summary
[0011] Before the methods of the present invention are described, it should be understood that this invention is not limited to particular systems, methodologies or protocols described, as these may vary. It should be understood that the terminology used here is for the purpose of describing particular embodiments only, and is not intended to limit the scope of protection of the present invention, which will be limited only by the appended claims.
[0012] For the purpose of this description, the term "heart valve membrane structure" can be defined as a valve structure for use in coronary or vascular procedures, which may be composed of one or more heart valve membranes. The term may encompass, as non-limiting examples, a single heart valve membrane structure having a single heart valve membrane, or a multiple membrane heart valve structure having more than one heart valve membrane. Each heart valve membrane can include a coronary sinus border, a sinusoidal border, a coronary sinus structure, and a sinusoidal structure.
[0013] For the purpose of this description, the term "heart valve structure" can be defined as a structure with valves for use in coronary or vascular procedures composed of one or more structures of heart valve membranes and additional structural components. Additional structural components may include, without limitation, a conduit and one or more coronary sinus structures in the conduit. The term may encompass a single-membrane heart valve structure, or a multi-membrane heart valve structure composed of either single membrane structures of multiple heart valves or a structure of multiple heart valve membranes.
[0014] In one embodiment, a multiple heart valve membrane structure may include a first heart valve membrane, having a first coronary sinus edge ("coronary sinus edge") and a first sinusoidal edge ("fan edge"), and a second heart valve membrane, having a second edge of the coronary sinus and a second sinusoidal edge, in which the first sinusoidal edge can intersect the second sinusoidal edge at an external commissure point, and the first edge of the coronary sinus can intersect the second edge of the coronary sinus at an internal point of the commissure, thereby forming a commissure extending from the point of external commissure to the point of internal commissure. In addition, the first sinusoidal edge can intersect the first edge of the coronary sinus at a first point on the outer membrane, thereby forming a first baseline extending from the first outer point of the membrane to the commissure, the first line of base additionally having a first width when measured from the first outer membrane point to the commissure. In addition, the second sinusoidal edge can intersect the second edge of the coronary sinus at a second point on the outer membrane, thereby forming a second baseline extending from the second point of the outer membrane to the commissure, the second line of base also having a second width when measured from the second outer membrane point to the commissure. In addition, the second baseline can be essentially collinear with the first baseline. The first edge of the coronary sinus may also extend from and may not be coextensive with the first baseline, thereby forming a first structure of the coronary sinus connected, by the first edge of the coronary sinus, the commissure, and the first line base, and the second edge of the coronary sinus can extend from and can be coextensive with the second baseline forming, thus, a second structure of the coronary sinus is connected by the second edge of the coronary sinus, the commissure, and the second baseline. Furthermore, the first sinusoidal edge may extend from and may not be coextensive with the first baseline, thereby forming a first sinusoidal structure connected by the first sinusoidal edge, the commissure, and the first baseline, and the second edge sinusoidal may extend from and may not be coextensive with the second baseline, thereby forming a second sinusoidal structure connected by the second sinusoidal edge, the commissure, and the second baseline. In addition, the first heart valve membrane can include a biocompatible and hemocompatible polymer, and the second heart valve membrane can also effectively include the same biocompatible and hemocompatible polymer.
[0015] In one embodiment, a heart valve structure may include a conduit comprising an internal conduit surface, an external conduit surface, and a diameter, and a multiple heart valve membrane structure. The structure of multiple heart valve membranes can include a first heart valve membrane, having a first edge of the coronary sinus and a first sinusoidal edge, and a second heart valve membrane having a second edge of the coronary sinus and a second sinusoidal edge, where the first sinusoidal edge can intersect with the second sinusoidal edge at an external commissure point, and the first coronary sinus edge can intersect the second coronary sinus edge at an internal commissure point, thereby forming an extending commissure. if from the external commissure point to the internal commissure point. In addition, the first sinusoidal edge can intersect the first edge of the coronary sinus at a first external point of the membrane, thereby forming a first baseline extending from the first external point of the membrane to the commissure, the first line of base also having a first width when measured from the first external membrane point to the commissure. In addition, the second sinusoidal edge can intersect the second edge of the coronary sinus at a second outer point of the membrane, thereby forming a second baseline extending from the second outer point of the membrane to the commissure, the second line of base also having a second width when measured from the second outer point of the membrane to the commissure. In addition, the second baseline can be essentially collinear with the first baseline. The first edge of the coronary sinus may also extend from and may not be coextensive with the first baseline, thereby forming a first structure of the coronary sinus connected by the first edge of the coronary sinus, the commissure, and the first line base, and the second coronary sinus edge may extend from and may not be coextensive with the second baseline, thereby forming a second coronary sinus structure connected by the second coronary sinus edge, the commissure, and the second baseline. In addition, the first sinusoidal edge may extend from and may not be coextensive with the first baseline, thereby forming a first sinusoidal structure connected by the first sinusoidal edge to the commissure, and the first baseline, and the second sinusoidal edge it may extend from and may not be coextensive with the second baseline, thereby forming a second sinusoidal structure connected by the second sinusoidal edge, the commissure, and the second baseline. In addition, at least a portion of the first sinusoidal edge, at least a portion of the second sinusoidal edge, and at least a portion of the inner duct surface can be mutually arranged to form a vacuum valve. Furthermore, at least a portion of the first coronary sinus structure and a portion of the internal conduit surface may be non-adjacent, thereby forming a first valve coronary sinus connected at least in part by at least a portion of the internal conduit surface and at least a portion of the first coronary sinus structure, and at least a portion of the second coronary sinus structure and a portion of the inner surface of the conduit may be non-adjacent, thereby forming a second valve coronary sinus connected at least in it leaves at least a portion of the inner surface of the conduit and at least a portion of the second structure of the coronary sinus.
[0016] In one embodiment, a method for fabricating a heart valve structure, may include the provision of a flexible conduit comprising a wall, an inner surface, and an outer surface, providing a structure of multiple heart valve membranes, reversing the flexible conduit; fixing the multiple-membrane structure of the heart valve to the internal surface; and by reversing the conduit thereby forming a multi-membrane valve within the conduit, a heart valve structure may include a conduit comprising an internal conduit surface, an external conduit surface; and a diameter; and a structure of multiple heart valve membranes. The structure of multiple heart valve membranes can include a first heart valve membrane, having a first coronary sinus edge and a first sinusoidal edge, and a second heart valve membrane, having a second coronary sinus and a second sinusoidal edge , in which the first sinusoidal border can intersect the second sinusoidal border at an external point of the commissure; and the first edge of the coronary sinus can intersect the second edge of the coronary sinus at an internal point of the commissure, thereby forming a commissure extending from an external point of the commissure to the internal point of the commissure. In addition, the first sinusoidal edge can intersect the first edge of the coronary sinus at a first external point of the membrane, thereby forming a first baseline extending from the first external point of the membrane to the commissure, the first line of base still having a first width when measured from the first external point of the membrane to the commissure. In addition, the second sinusoidal edge can intersect the second edge of the coronary sinus at a second outer point of the membrane, thereby forming a second baseline extending from the second outer point of the membrane to the commissure, the second line of base still having a second width when measured from the second outer point of the membrane to the commissure. In addition, the second baseline can be essentially collinear with the first baseline. The first edge of the coronary sinus may also extend from and may not be coextensive with the first baseline, thereby forming a first structure of the coronary sinus connected by the first edge of the coronary sinus, the commissure, and the first line base, and the second coronary sinus edge may extend from and may not be coextensive with the second baseline, thereby forming a second coronary sinus structure connected by the second coronary sinus edge, the commissure, and the second baseline. In addition, the first sinusoidal edge may extend from and may not be coextensive with the first baseline, thereby forming a first sinusoidal structure connected by the first sinusoidal edge, the commissure, and the first baseline, and the second sinusoidal edge may extend from and may not be coextensive with the second baseline thereby forming a second sinusoidal structure connected by the second sinusoidal edge, the commissure, and the second baseline. In addition, at least a portion of the first sinusoidal edge, at least a portion of the second sinusoidal edge, and at least a portion of the inner surface of the conduit can be mutually arranged to form a vacuum valve. Furthermore, at least a portion of the first structure of the coronary sinus and a portion of the internal surface of the conduit may be non-adjacent, thereby forming a first valve coronary sinus connected to at least part of at least a portion of the internal surface of the conduit. conduit and at least a portion of the first coronary sinus structure, and at least a portion of the second coronary sinus structure and a portion of the internal surface of the conduit may be non-adjacent, thereby forming a second valve coronary sinus connected at least in part to at least a portion of the inner surface of the conduit and at least a portion of the second structure of the coronary sinus.
[0017] In one embodiment, a method for fabrication and a structure in heart valve membranes includes the provision of a set of membrane modeling parameters for a membrane modeling computer program, calculating an initial model of the membrane structure of the heart valve having one or more coronary sinus ends, one or more coronary sinus structures, one or more sinusoidal baselines, one or more sinusoidal ends, one or more sinusoidal structures, and one or more sinusoidal baselines , map one or more ends in the coronary sinus of the initial model of the structure in heart valve membranes on the inner surface of a conduit model, dividing one or more structures in the coronary sinus into one or more bundles of structures in the coronary sinus, calculate the general shape of each or more bundles of the coronary sinus structure, section each bundle of the coronary sinus structure into one or more elements-points of the bundle of the coronary sinus structure, in which at least a portion of the point elements of the bundle of the coronary sinus structure corresponds to the points along one or more baselines of the coronary sinus structure, map one or more baselines of the coronary sinus sinusoidal structure of the initial model of the cardiac valve membrane structure over point elements of the coronary sinus structure bundle corresponding to the points along one or more baseline lines of the coronary sinus structure, dividing one or more sinusoidal structure into one or more more structure beams, calculate the general shape of each or more sinusoidal structure beams, section each of the sinusoidal structure beams into one or more of the point elements of the structure beam, creating an aggregate of element-points from the point elements of the structure beam and point elements of the beam structure of the coronary sinus, calculate a combined representation of the point element aggregates, plan the repr combination of the element-point aggregate, calculate a solid structure model from the combined representation of the element-point aggregate, thereby forming a heart valve membrane model, providing fluid flow parameters and the solid structure model for a fluid flow analysis, calculate a valve cost function performance, repeat the solid modeling and fluid flow analysis until the valve functional cost performance is minimal, and provide an adjustment of the membrane size parameters of cardiac valve corresponding to the tense solid model the minimum value of the function and cost of performance of the valve.
[0018] In one embodiment, a valve duct constructed of hybrid fabric includes a duct having an internal duct surface, an external duct surface, a diameter, and at least one breach / breach duct having a first breaking end. conduit, a structure of multiple heart valve membranes, and at least one biodegradable structure having a first side attached to the first end of the conduit break and a second side attached to the second end of the conduit break. The structure of multiple heart valve membranes can include a first heart valve membrane, I have a first coronary sinus edge and a first sinusoidal edge, and a second heart valve membrane having a second coronary sinus edge and a second sinusoidal edge, in which the first sinusoidal edge can intersect the second sinusoidal edge at an external point of the commissure, and the first coronary sinus edge can intersect the second edge of the coronary sinus at an internal point of the commissure, thereby forming a commissure extending from the external point of the commissure to the internal point of the commissure. In addition, the first sinusoidal edge can intersect the first edge of the coronary sinus at a first external point of the membrane, thereby forming a first baseline extending from the first external point of the membrane to the commissure, the first line of base also having a first width when measured from the first external point of the membrane to the commissure. In addition, the second sinusoidal edge can intersect with the second edge of the coronary sinus at a second outer membrane point, thereby forming a second baseline extending from the second outer membrane point to the commissure, the second line of base having, still, a second width when measured from the second external point of the membrane towards the commissure. In addition, the second baseline can be essentially collinear with the first baseline. The first edge of the coronary sinus may also extend from and may not be coextensive with the first baseline, thereby forming a first structure of the coronary sinus connected by the first edge of the coronary sinus, the commissure, and the first line base, the second edge of the coronary sinus may extend from and may not be coextensive with the second baseline, thereby forming a second structure of the coronary sinus connected by the second edge of the coronary sinus, the commissure, and the second baseline thus forming a first structure connected by the first sinusoidal edge, the commissure, and the first baseline, and the second sinusoidal edge may extend from and may not be coextensive with the second baseline forming , thereby a second sinusoidal structure connected by the second sinusoidal edge, the commissure, and the second baseline. In addition, at least a portion of the first sinusoidal edge, at least a portion of the second sinusoidal edge, and at least a portion of the inner surface of the conduit can be mutually arranged to form a vacuum valve. In addition, at least a portion of the first coronary sinus structure and a portion of the internal conduit surface may be non-adjacent, thereby forming a first valve coronary sinus connected at least in part by at least a portion of the internal conduit surface and at least a portion of the first coronary sinus structure, and at least a portion of the second coronary sinus structure and a portion of the inner surface of the conduit may be non-adjacent, thereby forming a second valve coronary sinus connected at least in part of at least a portion of the inner surface of the conduit and at least a portion of the second structure of the coronary sinus.
[0019] In one embodiment, a method for manufacturing a valve duct constructed with hybrid tissue includes the provision of a heart valve structure having a duct comprising a duct wall, an internal duct surface, an external duct surface, and a diameter, and a structure of multiple heart valve membranes, forming at least one conduit break through the conduit wall, at least one conduit break having two conduit break ends, providing at least one biodegradable structure having at least two sides, attaching a first side of the biodegradable structure to a first end of the conduit break, and attaching a second side of the biodegradable structure to a second end of the conduit break. The structure of multiple cardiac valve membranes may include a first valve membrane, having a first coronary sinus edge and a first sinusoidal edge, and a second heart valve membrane, having a second coronary sinus and a second sinusoidal edge, in which the first sinusoidal edge can intersect the second sinusoidal edge at an external point of the commissure, and the first edge of the coronary sinus can intersect the second edge of the coronary sinus at an internal point of the commissure, thereby forming a commissure extending from the outer point of the commissure to the inner point of the commissure. In addition, the first sinusoidal edge can intersect the first edge of the coronary sinus at a first external point of the membrane, thereby forming a first baseline extending from the first external point of the membrane to the commissure, the first line of base still having a first width when measured from the first external point of the membrane to the commissure. In addition, the second sinusoidal edge can intersect the second edge of the coronary sinus at a second external point, thereby forming a second base line extending from the second external point of the membrane to the commissure, the second base line having , yet, a second width when measured from the second outer point of the membrane to the commissure. In addition, the second baseline can essentially be collinear with the first baseline. The first edge of the coronary sinus may also extend from and may not be coextensive with the first baseline, thereby forming a first structure of the coronary sinus connected by the first edge of the coronary sinus, the commissure, and the first line base, and the second coronary sinus edge may extend from and may not be coextensive with the second baseline, thereby forming a second coronary sinus structure connected by the second coronary sinus edge, the commissure, and the second baseline. In addition, the first sinusoidal edge may extend from and may not be coextensive with the first baseline, thereby forming a first sinusoidal structure connected by the first sinusoidal edge to the commissure, and the first baseline, and the second edge sinusoidal may extend from and may not be coextensive with the second baseline thus forming a second sinusoidal structure connected by the second sinusoidal edge, the commissure, and the second baseline. In addition, at least a portion of the first sinusoidal edge, at least a portion of the second sinusoidal edge, and at least a portion of the inner duct surface can be mutually arranged to form a vacuum valve. In addition, at least a portion of the first coronary sinus structure and a portion of the internal conduit surface may be non-adjacent, thereby forming a first valve coronary sinus connected, at least in part, by at least a portion of the internal surface of the conduit and at least a portion of the first coronary sinus structure, and at least a portion of the second coronary sinus structure and a portion of the inner surface of the conduit may be non-adjacent, thereby forming a second valve-connected coronary sinus at least in part to at least a portion of the inner surface of the conduit and at least a portion of the second structure of the coronary sinus. Brief Description of the Drawings
[0020] Figure 1 illustrates an embodiment of a heart valve membrane structure within a conduit;
[0021] Figure 2 illustrates a method for making a heart valve structure in accordance with the present description;
[0022] Figure 3A illustrates an embodiment and a heart valve membrane structure having a single membrane composed of an edge of the coronary sinus having a component according to the present description;
[0023] Figure 3B illustrates an embodiment of a heart valve membrane structure having a single membrane composed of an edge of the coronary sinus having multiple components according to the present description;
[0024] Figure 3C illustrates an embodiment of a heart valve membrane structure having structures of multiple membranes each composed of an edge of the coronary sinus having a component according to the present description;
[0025] Figure 3D illustrates an embodiment of a heart valve membrane structure having multiple membranes, each composed of an edge of the coronary sinus having multiple components according to the present description;
[0026] Figure 3E illustrates an embodiment of a coronary sinus mold according to the present invention;
[0027] Figure 4 illustrates an embodiment of a heart valve structure in accordance with the present description;
[0028] Figure 5 illustrates an embodiment of an open and closed heart valve membrane structure within a heart valve structure, according to the present invention;
[0029] Figure 6 illustrates embodiments of devices for forming one or more coronary conduit sinuses in a heart valve structure according to the present description;
[0030] Figure 7 illustrates a flow chart of an embodiment of a method for providing a model of a heart valve membrane structure according to the present description;
[0031] Figure 8A illustrates an embodiment of a model of the heart valve membrane structure representing the bundles of the coronary sinus structure according to the present invention;
[0032] Figure 8B illustrates an embodiment of a model of coronary sinus mold to be used in the simulation with the model of heart valve membrane structure of figure 8 A according to the present description;
[0033] Figure 8C illustrates an embodiment of a model of the coronary sinus structure with the bundles of the coronary sinus structure deposited against the inner surface of a conduit according to the present description;
[0034] Figure 8D illustrates an embodiment of a combined representation of the element-point aggregate according to the present invention; and
[0035] Figure 9 illustrates the embodiments of a heart valve structure constructed of hybrid tissue according to the present invention. Detailed description of the invention
[0036] Figure 1 illustrates an embodiment of an artificial heart valve structure 100 that can be used, in a non-limiting example, as a diversion for connecting the right ventricle to the pulmonary artery after a Norwood operation, as frequently performed for the treatment of hypoplastic left heart syndrome. In a non-limiting example, the artificial heart valve structure 100 can be indicated for the correction or reconstruction of the right ventricular outflow tract (RVOT) in pediatric patients. The referred reconstruction may be indicated for congenital heart disorders such as tetralogy of Fallot, Truncus Arteriosus, dextro-transposition of the major arteries, pulmonary atresia of the intact ventricular septum, or aortic valve disease. Said artificial heart valve structure 100 can also be indicated for the replacement of previously implanted homografts or valve ducts that have become insufficient or dysfunctional. In addition, the artificial heart valve structure 100 may have applications in the treatment of a wider range of cardiac disorders, including other areas of the heart.
[0037] In one embodiment, an artificial heart valve structure 100 may include a general tubular flexible conduit 110 containing a heart valve membrane structure 130. In one embodiment, a heart valve membrane structure 130 may be a membrane structure single heart valve. In another embodiment, the heart valve membrane structure 130 can be a multiple heart valve membrane structure. A conduit 110 can be characterized as having a wall with an internal conduit surface 120, an external conduit surface, and a diameter. In a non-limiting example, a conduit 110 may be less than or about 12 mm in size. In another non-limiting example, a conduit 110 may be larger than about 12 mm in size. In a non-limiting example, a heart valve membrane structure 130 may include at least one sinusoidal structure in triangular shape 150, and may be located along the minor curvature along the inner surface 120 of conduit 110. In a non-limiting example , a heart valve membrane structure may have extensions such as "flank" along with one or more structures in the coronary sinus, to allow the replacement of additional means of connection to the internal surface of the conduit. A heart valve membrane structure 130 may have one or more coronary sinus ends 140 attached to the inner surface 120 of a conduit 110, and one or more sinusoidal structures 150 that can take either the open or closed position with respect to the surface internal 120 of conduit 110. In another non-limiting example, one or more ends in coronary sinus 140 may be sinusoidal in shape.
[0038] In one embodiment, conduit 110 and / or the heart valve membrane structure 130 can be made from a biocompatible and hemocompatible polymer. In a non-limiting embodiment, the polymer can be a fluoropolymer. Non-limiting examples of said biocompatible and hemocompatible polymers can include polytetrafluoroethylene, expanded polytetrafluoroethylene, polyester, polyethylene terephthalate, polydimethylsiloxane, polyurethane, and / or combinations of those materials. In another embodiment, a conduit 110 and / or a heart valve membrane structure 130 can be made of a polymer coated with at least one bioactive coating. In yet another embodiment, a conduit 110 and / or a heart valve membrane structure 130 may be a structure modified to include a bioactive material. In a non-limiting embodiment, an active coating can be an anticoagulant coating or a surface treatment to promote biocompatibility. Non-limiting examples of an anticoagulant coating may include a coumadin, heparin, a heparin derivative, a factor Xa inhibitor, a direct thrombin inhibitor, hementin, sintered pore titanium microspheres, and / or combinations of these materials.
[0039] The material from which the heart valve membrane structure 130 can be manufactured can have a thickness of about 0.05 mm to about 0.2 mm. In a non-limiting embodiment, a heart valve membrane structure 130 can be cut from the material by hand, or with a portable tool. In one embodiment, a heart valve membrane structure 130 can be cut with a laser cutter. In one embodiment, the heart valve membrane structure 130 can be produced using a 3D printer and / or similar polymer injection devices. In a non-limiting example, a conduit 110 may have a thickness of about 0.5 mm to about 1 mm. In another non-limiting example, a conduit 110 can also have a diameter of about 8 mm to about 24 mm.
[0040] The edge of the coronary sinus 140 of a heart valve membrane structure 130 can be attached to the inner surface 120 of a conduit 110. In a non-limiting example, the edge of the coronary sinus 140 can be fixed by suture. In another non-limiting example, an edge of the coronary sinus 140 can be attached via a bonding method, such as laser casting, chemical casting, bonding, and / or suturing.
[0041] Figure 2 illustrates an embodiment of a method 200 for fabricating an artificial heart valve structure. A flexible conduit 210 can be provided including a wall having an inner surface 212 and an outer surface 215. The conduit can then be turned 220 thereby providing access to the inner surface 212. One or more heart valve membrane structures 234 can provided, which can be attached 230 to the exposed inner surface 212. In a non-limiting embodiment, illustrated in Figure 1, a heart valve membrane structure can comprise a single heart valve membrane structure. Alternatively, as illustrated in figure 2, single-membrane structures of multiple heart valves 235 can be separately attached to the exposed inner surface 212 of a conduit. In another alternative embodiment, a structure of multiple heart valve membranes can thus be attached.
[0042] As described above, without limitation, one or more structures in heart valve membrane 235 can be attached to an internal surface of conduit 212 by suture, chemical casting, heat casting, or bonding. In a non-limiting embodiment, a heart valve membrane structure can be provided by applying a heart valve membrane structure mold, having essentially the same measurement as the final heart valve membrane structure for a material. One or more marks can be made on the material to essentially follow the mold of the heart valve membrane structure. A user can use a means to cut or extract a heart valve membrane structure from the material based on at least part of the marks made on the material.
[0043] In one embodiment, one or more heart valve membrane structures 235 can be positioned against the inner surface 212 by the eye before the heart valve membrane structures being attached to the inner surface. In an alternative embodiment, a coronary sinus mold can be provided. A coronary sinus mold can be used by a manufacturer as a pattern to make on the inner surface 212, thereby providing the proper placement and alignment of one or more structures on the 235 heart valve membrane. it can be substantially the same as the coronary sinus mold. One or more edge of the coronary sinus of one or more structures in the heart valve membrane 235 can then be attached to the conduit together with the marked shape on the inner surface 212.
[0044] In one embodiment, a coronary sinus mold can have an identical shape, size and / or dimensions as one or more structures in a 235 heart valve membrane. In an alternative embodiment, the coronary sinus mold can have a shape, size, and / or dimensions that differ from the shape, size and / or dimensions of one or more heart valve membrane structures 235. Although figure 2 illustrates the attachment of one or more heart valve membrane structures to the inner surface 212 of the conduit, it can be appreciated that another, more complex heart valve membrane structure can be similarly fixed.
[0045] Once one or more of the heart valve membrane structures 235 has been attached to the inner surface 212 of the conduit, the conduit can be reversed 240. The heart valve membrane structure 250 having one or more valve membrane structures 255 on the inside of the conduit, and the outer surface 215 of the conduit being disposed on the external part of the conduit.
[0046] A heart valve membrane structure as illustrated in figure 1 can include a number of components. Figures 3A and 3B illustrate two embodiments of a heart valve membrane structure 350. A heart valve membrane structure can include a coronary sinus edge 355 and a sinusoidal edge 360 I can intersect at one or more outer points of the membrane 365 a, b. In one embodiment, a baseline 335 can be defined as a line essentially connecting the outer points of the membrane 365 a, b. in one embodiment, a base line 335 can thus divide the heart valve membrane structure 350 into two portions: a sinusoidal structure (connected to at least one sinusoidal edge 360 and the base line 335), and a sinus structure coronary (connected by at least one edge of the coronary sinus 355 and the base line 335).
[0047] Various molds can be applied to the 350 valve heart membrane structure. For example, a sinusoidal structure can have a height of the sinusoidal structure 340 as measured from a maximum point 370 on the sinusoidal edge 360 which is more distal to from baseline 335 to baseline. It can be appreciated that the sinusoidal edge 360 coextensive with its respective baselines 335 may not effectively have the height of the sinusoidal structure 340. Therefore, an embodiment and a heart valve membrane structure having a sinusoidal structure can have at least a portion of the sinusoidal edge 360 not coextensive with the base line 335. A coronary sinus structure can also have a height 320 measured from a maximum point 375 over the edge of the coronary sinus 355 most distal from the base line 335, for the baseline. It can also be appreciated that the edge of the coronary sinus 355 coextensive with its respective baselines 335 may not actually be height 320. Therefore, an embodiment of a heart valve membrane structure having a coronary sinus structure can have at least one portion of the edge of the coronary sinus 355 not coextensive with the baseline 335. The baseline 335 can also have a width when measured between the outer points of the membrane 365 a, b.
[0048] It can be appreciated that either one or both ends of the coronary sinus 355 and / or the sinusoidal edge 360 may be composed of multiple components. For example, as illustrated in figure 3B, an edge of the coronary sinus 355 can be composed of several components 355 a-f. In some non-limiting examples, the components can be essentially straight lines, such as 355a, c, d, f. In some other non-limiting examples, the components of the coronary sinus edge may have more complex shapes such as "flanks" 355b and 355e, in figure 3B. It can also be appreciated that the maximum point of a coronary sinus edge 375 can occur at the intersection of two components of the coronary sinus edge (for example, the intersection of 355c and 355d), which can conveniently be called an “coronary sinus intersection. ”.
[0049] It can be appreciated that a heart valve membrane structure can be composed of a membrane number. Figure 3C illustrates a non-limiting example of a multiple heart valve membrane structure composed of two heart valve membranes, 350 a, b. many of the components in figure 3C can be seen in figures 3A and 3B. Thus, there may be two ends in the coronary sinus 375 a, b, two sinusoidal ends 360 a, b, two maximum sinusoidal points 370 a, b, each defining a sinusoidal height 340 a, b, and two maximum points in the coronary sinus 375 a, b, each setting height 320 a, b.
[0050] In addition, the two membranes 350 a, b can be connected at their respective ends. Thus, two sinusoidal ends 360 a, b can intersect at a point 390 which can be called a commissure point, and two ends at the coronary sinus 355 a, b can intersect at a point 395 which can be called an internal commissure point. A commissure 330 can thus be defined as a structure effectively connected at least by an internal point of commissure 395 and the external point of commissure 390. Commissure 330 can be characterized by a length of the commissure. An embodiment of a two-membrane valve structure illustrated in figure 3c can be considered to have two base lines 335 a, b, a base line associated with each of the respective membranes 350 a, b. each baseline 335 a, b can be characterized by a width as measured from an outer point of the membrane 365 a, b to the commissure, 330. The two baselines 335 a, b can also be essentially collinear. As described above, with respect to the embodiment illustrated in Figure 3A, a sinusoidal structure can be that the portion of the membrane 350 connected to at least one sinusoidal edge 360 and a base line 335. It can be appreciated that a sinusoidal structure of either one or both heart valve membranes 350 a, b in a two membrane heart valve structure can also be connected to at least a portion of a commissure 330 in addition to the respective sinusoidal ends 360 a, b and baselines 335a, b. Similarly, it can be appreciated that a coronary sinus structure of either one or both heart valve membranes 350 a, b in a two membrane heart valve structure can be connected to at least a portion of a commissure 330 in addition to the respective ends in coronary sinus 375 a, b and baselines 335a, b.
[0051] It can be appreciated that a multiple heart valve structure may not necessarily include all features as described above in relation to figure 3C. in an alternative non-limiting embodiment, a multiple heart valve membrane structure may have a commissure 330 essentially losing its length. In the referred embodiment, an internal point in commissure 395 can essentially be coextensive with the external point of commissure 390.
[0052] It can also be understood, with reference to the method illustrated in figure 2, that one or more ends in coronary sinus 355 a, b of one or more heart valve membranes 350 a, b can serve as at least a portion of points connection between the heart valve blades and the inner surface of a conduit. It can also be appreciated that at least a portion of a commissure 330 can also be attached to the inner surface of a conduit.
[0053] Although figures 3 A-C illustrate embodiments of heart valve membrane structures composed of one or two membranes, it should be understood that a heart valve membrane structure can be composed of any number of membranes. For example, a structure of four membranes or three heart valve membranes can also be considered. By extension of the heart valve membrane structure illustrated in Figure 3C, a structure of three heart valve membranes may comprise three membranes, each of the membranes having one or more ends in the coronary sinus, a structure of the coronary sinus, a sinusoidal border, a sinusoidal structure, a baseline, a height, and a sinusoidal structure height. Said three-membrane structure can include, in one embodiment, two commissures: a commissure between the first membrane and a second membrane, and a second commissure between the second membrane and a third membrane. Each commissure can have a commissure length. The internal and external points of the commissures equivalent to 390 and 395, respectively, can also be defined between each pair of adjacent membranes.
[0054] It can further be appreciated that equivalent metrics describing each membrane of a multiple-membrane heart valve membrane structure may differ. In a non-limiting embodiment, a membrane can have a height that can differ from the height of any one or more other membranes composed of the multi-membrane heart valve membrane structure. In another non-limiting embodiment, a membrane may have an edge of the coronary sinus having a different perimeter length than the length of the perimeter of the edge of the coronary sinus of one or more other membranes. In yet another non-limiting embodiment, the shape of the coronary sinus edge of a membrane can differ from the shape of the coronary sinus edge of one or more other membranes. In yet another non-limiting example, a sinusoidal structure shape of a membrane may differ from the sinusoidal structure shape of one or more other membranes.
[0055] Alternatively, some membranes may have equivalent metrics that have about the same metric values. Thus, in a non-limiting example, some or all of the membranes in a multi-membrane heart valve membrane structure may have baselines having about the same width. In another non-limiting example, some or all of the membranes in a multi-membrane heart valve membrane structure can have heights having about the same length.
[0056] Another embodiment of a structure of multiple heart valve membranes 300 is illustrated in figure 3D. A structure of multiple heart valve membranes 300 may include a pair of heart valve membranes, each having an essentially triangular coronary sinus structure 302a and 302b. An edge of the coronary sinus of each membrane may be composed of a combination of two or more components, including, as non-limiting examples, an outer end component 305 a, b plus a respective inner end component 310 a, b. In addition, each heart valve membrane may have a sinusoidal structure 315a and 315b. An end of the sinusoidal edge can intersect an end of its respective outer edge components can intersect the sinusoidal edge of the second membrane at an external commissure point 390. In addition, the edge of the coronary sinus of a membrane can intersect the edge of the coronary sinus of the second membrane at an internal commissure point 395. With respect to the embodiment illustrated in figure 3D, an internal commissure point 395 can be found at an intersection of the first internal component of the end 310a and the second internal component of the end 310b. as described above with reference to figure 3C, a commissure 330 can be defined as the portion connected at least at an external point of commissure 390 and the internal point of commissure 395.
[0057] As described above with reference to figure 3C, each membrane can have a base line 335 a, b having a width measured between the respective point of the outer membrane of the base line 365 a, b and a commissure 330. Furthermore, each one of the inner end components 310a and 310b and each of the outer end components 305a and 305 b can be characterized by a length. Each membrane may also have a coronary sinus intersection 375 a, b located essentially at the intersection between an inner end component 310 a, b and the respective outer end component 305 a, b. In addition, each coronary sinus structure can be characterized as having a height of 320 a and 320b, measured from the respective base 335 a, b for the respective intersection in the coronary sinus 375 a, b. it can be appreciated that the coronary sinus intersection of each membrane 375 a, b can also be the maximum point on the respective border of the coronary sinus which is more distal from the respective base line 335 a, b.
[0058] It can be appreciated that the metrics associated with a heart valve membrane can be independent of each other. Thus, the length of the component of the inner end of the membrane 310a may differ from the length of the component of the inner end 310b; the length of the outer end component 305a may differ from the length of the outer end component 305b; height 320a may differ from height 320b; the width of the base line 335a may differ from the width of the base line 335b; and height of the sinusoidal structure 340 a may differ from the height of the sinusoidal structure 340b. Alternatively, in a non-limiting embodiment, the length of the inner component of the end 310 a can be substantially the same length as the inner component of the end 310b. In another non-limiting embodiment, the length of the outer component of the end 305a can be substantially the same length as the outer component of the end 305b. In another non-limiting embodiment, height 320 a can be substantially the same as height 320b. In yet another non-limiting embodiment, the width of the baseline 335 a can be substantially the same as the width of the baseline 335b. In yet another non-limiting embodiment, the height of the sinusoidal structure 340a can be substantially the same as that of the height of the sinusoidal structure 340b.
[0059] The metric associated with the structure of the heart valve membrane can be scaled with respect to each other. In a non-limiting example, the ratio between the height of a membrane, such as 320a or 320b, and the width of the baseline that the membrane, such as 335 a or 335b, respectively, can be about 0.41 to about 0.77. In another non-limiting example, the ratio between the length of the inner component of the end of a membrane, such as 310 a or 310b, and the width of the baseline that the membrane, such as 335 a or 335b, respectively, can be about 0.44 to about 0.77. Yet another non-limiting example, the ratio between a length of the commissure 330 and the width of the base of a membrane, such as 335 a or 335b, can be about 0.18 to about 0.38. In addition, the metrics associated with a heart valve membrane structure can be scaled with respect to a metric associated with a conduit to which it can be attached. In a non-limiting example, the ratio of the baseline width of a membrane, such as 335 a or 335b, to the duct diameter can be from about 0.054 to about 0.17.
[0060] Although the structure of the coronary sinus 302 a, b of a heart valve membrane as illustrated in Figure 3D may be of a generally triangular shape, it can be appreciated that the structure of the coronary sinus may also encompass alternative forms. Thus, embodiments of the coronary sinus structure 302 a, b can include, without limitation, a generally quadrilateral shape, any closed multilateral shape, curved shapes, oval shapes, or other geometric shapes that can provide an edge of the coronary sinus having one or more components that can be attached to an internal surface of a duct.
[0061] Each sinusoidal structure 315a and 315b can have any type of sinusoidal curved, angular, or linear border. In a non-limiting example, each sinusoidal structure, 315a and 315b, can have a lobular end, each lobular sinusoidal structure characterized by a height of the sinusoidal structure 340a and 340b, measured from the maximum point of each sinusoidal edge to its respective base 335a and 335b. In a non-limiting embodiment, a sinusoidal structure 315 a or 315 b can be essentially bilaterally symmetric. In another embodiment, the sinusoidal structure 315 a or 315 b can be asymmetric and have a lobular end composed of an angular portion proximal to an external component of the end (such as 305 a or 305b) of the coronary sinus edge of its respective membrane of a heart valve 350 a or 350b, and a superficial portion proximal to the external commissure point 390. In another embodiment, the sinusoidal structure 315 a of a membrane can essentially be a mirror image symmetrical to the sinusoidal structure 315 b with respect to the commissure . In another embodiment, the sinusoidal structure 315a can be essentially identical to the sinusoidal structure 315b. In yet another embodiment, the sinusoidal structure 315 a may differ from the sinusoidal structure 315b in the shape of the end, the length of the end perimeter, the area of the sinusoidal structure, or other metrics.
[0062] The dimensions of a sinusoidal structure 315 a and 315b, can be scaled with respect to other dimensions of a structure of multiple heart valve membranes. In a non-limiting example, the ratio between the height of the sinusoidal structure of a valve membrane, such as 340 a or 340b, and the width of the baseline of that membrane, such as 335 a or 335b, respectively, can be about from 0.07 to about 0.14. Although a sinusoidal structure, as described above, can include a single asymmetric lobe disposed towards the outer component of the end 305 a, b of the multiple membrane structure of the heart valve, it can be appreciated that said structure can be a non-limiting embodiment of a sinusoidal structure. Alternatively, membrane structures can include one or more lobes, angles, and / or other geometries. Additional features may include symmetrical or asymmetric distributions of said lobular, angular, or sinusoidal linear structures, which may appear along any one or more portions along the baseline.
[0063] As described above, with respect to figure 2, a heart valve membrane structure can be positioned on the inner surface 212 of an everted duct by using a mark on the inner surface having a shape essentially similar to a mold in coronary sinus. Figure 3E illustrates an embodiment of a coronary sinus mold 300 'that can be used in conjunction with the multiple valve heart membrane structure 300 shown in Figure 3D. In one embodiment, a coronary sinus mold 300 'can be shaped like two essentially connected triangular portions having coextensive bases, similar to those of the connected coronary sinus structures 302a, b illustrated in figure 3D. in one embodiment, a 300 'coronary sinus mold may lose one or more sinusoidal structures. In an alternative embodiment, a coronary sinus mold 300 'may include one or more sinusoidal structures or portions of the sinusoidal structures. In a non-limiting example, a coronary sinus mold 300 'can include, for each coronary sinus structure 302 a and 302b, an external component of the coronary sinus mold 305a' and 305b ', an internal component of the mold end in coronary sinus 310a 'and 310b', and a baseline of the coronary sinus mold 335a 'and 335b'. The internal components of the coronary sinus mold 310a 'and 310b' can essentially intersect at the collinear bases of the coronary sinus mold 335a 'and 335b'. Alternatively, the internal components of the coronary sinus mold end 310a 'and 310b' may intersect at some point outside the basin lines of the collinear coronary sinus 335a 'and 335b', thereby forming a commissure of the coronary sinus mold 330 '. Each external component of the coronary sinus mold end 305a 'and 305b' and an internal end component 310a 'and 310b' can be characterized by a respective length. In addition, each coronary sinus mold can be characterized by one or more heights 320a 'and 320b'. In addition, each baseline of the coronary sinus mold 335a 'and 335b' can be characterized by a respective width. The commissure of the coronary sinus 330 'can also be characterized by a length of the commissure of the coronary sinus.
[0064] It can be appreciated that the metrics associated with a coronary sinus mold 300 'may be about the same or differ from the respective equivalent metrics associated with a heart valve membrane structure 300. It can be understood that the "respective equivalent metrics" reference can be made to the measurements of the equivalent components of a multiple heart valve structure 300 and a coronary sinus mold 300 '. Thus, the outer component of the end of the heart valve membrane structure 305b or 305a may be an equivalent component to an outer component of the coronary sinus mold end 305b 'or 305a', respectively. An internal component of the end of the membrane structure of the heart valve 310 b or 310 a can be an equivalent component to an internal component of the end of the coronary sinus mold 310b 'or 310a' respectively. A height of the membrane structure of the heart valve 320b or 320a, can be a component equivalent to a height of the coronary sinus mold 320b 'or 320a', respectively. A baseline of the heart valve membrane structure 335 b or 335 a can be an equivalent component in a baseline of the coronary sinus mold 335b 'or 335a', respectively. A commissure of the heart valve membrane structure 330 can be a component equivalent to a commissure of the coronary sinus 330 '.
[0065] Although figure 3E illustrates a coronary sinus mold 300 'having two coronary sinus structures 302a' and 302b ', it can be appreciated that a coronary sinus mold can be composed of any number of the coronary sinus structures. It can be appreciated that the number of coronary sinus structures 302a 'and 302b', of a coronary sinus mold 300 'may correspond to the number of heart valve membranes 350a, b of a heart valve membrane structure 300 with which be used. A heart valve membrane structure 300 composed of a single or multiple membranes (e.g., three membranes) can have an equivalent coronary sinus mold 300 'composed of the same number of coronary sinus structures. Thus, a heart valve membrane structure 300 having a single membrane can have an equivalent coronary sinus mold 300 'having a single coronary sinus structure, although a heart valve membrane structure having three membranes (as a non-limiting example) it may have an equivalent coronary sinus mold having three coronary sinus structures.
[0066] Once the structure of multiple heart valve membranes has been properly positioned on the inner surface of an everted conduit, the structure of multiple heart valve membranes can be attached to the conduit as described above in figure 2, 230. In one Non-limiting embodiment, a structure of multiple heart valve membranes can be attached in one set along at least a portion of the edge of the coronary sinus. In the embodiment illustrated in Figure 3D, a portion of the edge of the coronary sinus can include any portion or portions along the combination of the outer end component 305a, or 305b plus the inner end components 310a or 310b of the respective membranes. In another embodiment, a structure of multiple heart valve membranes can also be attached to the inner surface at least along a portion of the commissure 330. Since the structure of multiple heart valve membranes has been properly attached to the inner surface of the conduit , the conduit can be reversed (Figure 2, 240).
[0067] As described above, any one or more of the metrics associated with a coronary sinus mold 300 'can be around the same or different from the respective equivalent metric of a multi-valve heart 300 membrane structure. In a non-limiting embodiment , the metrics associated with the multiple heart valve membrane structure 300 may be the same as the respective equivalent metric associated with the 300 'coronary sinus mold. For said embodiment, it can be appreciated that the coronary sinus structures 302a and 302b can be essentially rested against and effectively in contact with the surface of the conduit.
[0068] In another non-limiting embodiment, one or more metrics associated with a multiple membrane or single membrane structure on heart valve 300 may be greater than the respective equivalent metric associated with a 300 'coronary sinus mold. As a non-limiting example, an internal component of the end of a multi-valve heart membrane structure 310a, for example, can be about 8.1 mm long, although the equivalent internal component length of the sinus mold end coronary 310a ', for example, may be about 7.7 mm. For said embodiment, it can be appreciated that at least a portion of the coronary sinus structures 302a and 302b may be non-adjacent to the inner surface of the conduit. Thus, some portion of the coronary sinus structures 302 a and 302 b may be unconnected to and have or have minimal contact with the internal surface of the conduit, however, some other portion of the coronary sinus structures can be directly connected to and in effective contact with an internal surface of the duct. The portion of the coronary sinus structure 302a and 302b that can be directly connected to and in contact with an internal surface of the conduit can include at least some portion of the edge of the coronary sinus. At least some portion of the coronary sinus structure 302a and 302b can be wrinkled from the inner surface of a conduit when a structure of multiple heart valve membranes is attached to the inner surface of the conduit. This creasing effect can thus produce a valve coronary sinus connected by at least some portion of a coronary sinus structure 302a or 302b and at least a portion of the inner surface of the conduit. Depending on the orientation of the sinusoidal structures 315 a with respect to the inner surface of a conduit, a valve coronary sinus may also be partly connected by at least a portion of the sinusoidal structures 315a, b and / or the baseline 335a, b.
[0069] Figure 4 illustrates an internal view downstream of a heart valve structure in an opening 440 configuration, and in a closed configuration 450. In an open configuration 440, blood can flow through the structure of multiple heart valve membranes , forcing the sinusoidal structures 415a and 415b towards the inner surface of a conduit. In a closed configuration 450, the sinusoidal structures 415a 'and 415b' can form a closure against the fluid backflow. In some non-limiting examples, the lobes of sinusoidal structures 415a 'and 415b' may be proximal, juxtaposed, and / or superimposed in whole or in part. In some non-limiting examples, the closure may be planar, concave, and / or convex, or form another non-planar surface.
[0070] The closed configuration 450 further illustrates the relative locations of sutures or other means of attaching a structure of multiple heart valve membranes to the internal surface of a conduit. Specifically, the internal components of the end of two membrane structures can be fixed as indicated by 410, although the external components of the end of two membrane structures can be fixed as indicated by 405a and 405b. In one embodiment, a structure of multiple heart valve membranes and at least a portion of an inner conduit surface can be arranged to form a small gap 460 connected by at least a portion of the inner conduit surface and a portion of the sinusoidal edge of each of the sinusoidal structures. For a structure of multiple heart valve membranes in figure 4, corresponding to the embodiment of a structure of multiple heart valve membranes 300 in figure 3D, an interval 460 can be connected by pronounced ends of the sinusoidal structures 315a, b and the internal surface of a conduit. It can be understood that the structure of multiple cardiac valve membranes can include sinusoidal structures having sinusoidal ends with different shapes than those described above with respect to the 3D figure. However, at least some portion of the sinusoidal edge of each of said sinusoidal structures, when in a closed configuration 450, can also form a gap 460 with the inner surface of the conduit.
[0071] Although figure 4 illustrates a heart valve structure having two membranes, it can be appreciated that a heart valve structure can include any number of membranes. Thus, a heart valve structure can incorporate a single membrane, as illustrated in figure 1. Alternatively, a heart valve structure can incorporate a heart valve membrane structure composed of three or more membranes. In a non-limiting example, a heart valve membrane structure can have three membranes, the third membrane positioned to cover the 460 gap in order to essentially prevent regurgitative flow through the heart valve structure.
[0072] Figure 5 illustrates another embodiment of a heart valve structure. Top view 500 shows a partial cross-sectional view of a heart valve structure in a portion slightly downstream of the multiple heart valve membrane structure (shown in a closed configuration). The upstream end 502 of a heart valve structure can be positioned in a patient's vasculature or heart structure to receive blood flowing to the heart valve structure. The closure of a heart valve structure can be formed from two sinusoidal structures 515 a and 515b from a structure of multiple heart valve membranes. The closure may not be completely closed to flow blood. In one embodiment, a small gap 560 can be formed by the mutual arrangement of at least some portion of the sinusoidal edge of each sinusoidal structure 515 a and / or 515b and the inner surface of a conduit. In a non-limiting example, the gap 560 can include about 15% of the circumference of an inner surface of the conduit.
[0073] Additional structures may also be present. In one embodiment, one or more coronary sinus structures of conduit 575a and 757b may also be present. The coronary sinus structures of the conduit 575a and 575b can be formed by deformation of the conduit wall, and can be placed downstream of a multiple heart valve membrane structure. The coronary sinus structures of the conduit 575a and 575b can generally be concave with respect to the internal surface of the conduit. In a non-limiting example, conduit structures 575a and 575b can generally be spheroidal concave. In another non-limiting example, the coronary sinus structures of conduit 575 a and 575b can generally be cubically concave. It can be understood that the outline and the cross section of the structures in the coronary sinus of the conduit 575 a and 575b can have any geometry as long as the structures in the coronary sinus of the conduit maintaining a concavity with respect to the internal surface of the conduit.
[0074] View 540 shows an embodiment of a heart valve structure in an open configuration, and 550 shows an embodiment of a heart valve structure in a closed configuration. In an open configuration 540, the sinusoidal structures 515 a 'and 515b' can be arranged in an extended downstream position. An internal concavity of each of the coronary sinus structures of the conduit 575a 'and 575b' can also be observed. In one embodiment, the sinusoidal structures 515a 'and 515b' although in an open configuration 540 can also extend within at least a portion of the coronary sinus structures of the conduit 575a 'and 575b'. In a closed 550 configuration, each of the sinusoidal structures (for example, 515a ”) of the multiple heart valve membrane structure can be arranged in a neutral position. In a neutral position, the two sinusoidal structures can be arranged in relation to each other in order to form a close close to the complete. In the closed configuration 550, a small gap 560 'can develop from the arrangement and at least a portion of the sinusoidal ends (e.g., the pronounced end of each of the sinusoidal structures) and an inner surface of the conduit.
[0075] Although figure 5 illustrates an embodiment of a two-membrane heart valve structure, it can be appreciated that a heart valve structure can include additional heart valve membranes. In a non-limiting example, a three-membrane heart valve structure can be considered. Said cardiac valve structure can incorporate a closure formed by juxtaposition, proximity and / or overlap of three sinusoidal structures. The mutual arrangement of some portions of three sinusoidal ends together with the internal surface of the conduit can result in a structure with an interval similar to 560 '. Alternatively, three sinusoidal structures can be arranged so that, effectively, no gap is formed.
[0076] One or more structures in the coronary sinus of the conduit 575a and 575b can be formed from the conduit wall according to any appropriate method for deformation of the conduit wall material. Figure 6 illustrates non-limiting examples of the conduit coronary sinus manufacturing device 610a and 610b that can be used to form said conduit coronary sinus structure. Examples of a method of deformation of the duct wall may include, without limitation, one or more mechanical deformations (such as stretching or mechanical forming), heat forming, and / or vacuum forming. In one example, the geometry of the conduit coronary sinus structure can be created using a conduit 610a coronary sinus manufacturing device having a dome 650 which can be shaped like the desired conduit coronary sinus geometry. A coronary sinus duct fabrication device 610a can deform the duct material from within a duct via applied pressure and / or heat. In addition, the conduit portion outside the dome portion 650 may be conserved by a semi-cylindrical mechanical stabilizer 625, or a cylindrical stabilizer 620a, b having components located inside and outside a conduit. In one embodiment, a stabilizer 625 may contain an opening to allow the dome 650 and the deformed conduit wall material to move while preventing movement of the conduit wall out of a coronary sinus structure. In one embodiment, an internal stabilizer 620b and an external stabilizer 620a can be manually aligned by connecting to a coronary sinus manufacturing device of conduit 610a and 610b. In another non-limiting embodiment, a coronary sinus duct fabrication device 610a and 610b may include magnets to assist in stabilizing the duct wall material. Non-limiting examples of a duct making device 610a and 610b may have the dome 650 manually actuated, by a potential energy device (such as a spring), or by magnets / electromagnets. In another non-limiting example, the dome 650 can be constructed from thermally conductive material and heated by an electrical heating device 640 contained within the dome itself.
[0077] The shape and / or metric associated with a multiple heart valve membrane structure can be determined by a health care provider based on his or her experience and / or their knowledge. In an alternative embodiment, the shape and / or metric associated with a heart valve membrane structure can be determined, at least in part, based on the calculation including, without limitation, mathematical models and / or optimization methods. In a non-limiting embodiment, custom cardiac valve membrane structures can be manufactured for an individual patient. In another non-limiting embodiment, a "standardized" heart valve membrane structure can be manufactured so that it can be used by a number of patients who may not require a completely personalized heart valve structure as a remedy for pathology.
[0078] In one embodiment, calculations for modeling and / or optimization can be used to reduce regurgitation of diastolic flow through a cardiac valve structure, as well as to improve the effective orifice area and the complete function of the valve structure . In a non-limiting embodiment, the heart valve membrane structure modeling program can preventively generate one or more models of heart valve membrane structures based on at least one geometric parameter and solid mechanical principles. In another non-limiting embodiment, one or more models of solid heart valve membrane structures can be analyzed according to one or more fluid flow analytical methods. Non-limiting examples of said fluid flow analytical methods may include structure-fluid interaction (FST) and computational fluid dynamics (CFD) simulations. In a non-limiting embodiment, an interactive optimization method for producing heart valve membrane structure models may include: (1) calculating a heart valve membrane structure model based on a set of parameters including one or more geometric parameters; (2) analyze the performance of the heart valve membrane structure model based, at least in part, on one or more analytical fluid flow methods; (3) calculate the cost-performance function according to the data calculated by one or more analytical methods of fluid flow; and (4) varying one or more modeling parameters of the heart valve membrane structure in a way to minimize the value of the cost-performance function of the valve.
[0079] The mathematical modeling and / or optimization calculations that can be used to calculate the shapes and / or dimensions of the structures in heart valve membranes can include, without limitation, the computational fluid dynamics (CFD), mechanical- solid, fluid / structure interaction modeling (FSI), and blood flow optimization algorithms. Calculations based on CFD models can demonstrate a difference in the speed of blood flow based on a curvature of the conduit component of a heart valve structure. For example, a blood flow model may indicate greater flow along the conduit axis having a small radius of curvature as opposed to blood flow in a conduit having a greater radius of curvature. CFD models, for example, can provide data to suggest that a curved conduit may not have a heart valve membrane structure at the bottom of the conduit as a smaller membrane of the heart valve membrane structure may become adherent in the closing phase. thus leading to thrombosis.
[0080] Mathematical calculations and / or optimization calculations can be performed, for example, by means of one or more computer devices. Said computer devices may include, without limitation, one or more of the following: central processor units, numerical accelerators, dynamic and / or static memories, data storage devices, data entry devices, data output devices , communication interfaces, and visual displays. Although a single computing device can be used for such calculations, multiple computing devices, for example, in a shared network or cloud configuration, can also be used. It can be appreciated that one or more computing devices can operate independently or together. In addition, communications between one or more users and one or more computing devices can occur on one or more input interface devices, including, without limitation, a keyboard, a mouse, a receiving device (“track-ball”) , a stylus, a voice recognition system, and / or a touch screen. In addition, one or more computer devices can provide output information to one or more users via one or more interface output devices, including, without limitation, a visual display, a printer, and / or an audio interface. Data communication between computer devices can occur on one or more communication interfaces on the computer system, including, but not limited to, a serial interface, a parallel interface, an Ethernet interface, a wireless interface, and / or an optical interface. Additional communications between computer devices, or between computer devices and users can be accompanied by one or more computer system communication protocols including, but not limited to, a personal area network (such as BlueTooth), a local area network, a wide area network, and / or a satellite network.
[0081] Figure 7 represents a flowchart illustrating an embodiment of a method for designing a heart valve membrane structure.
[0082] Initially, the membrane modeling parameters can be provided to the heart valve membrane structure model 700. Non-limiting examples of the membrane modeling parameters can include one or more of the coronary sinus edge shape, a length of the perimeter of the coronary sinus edge, a shape of the sinusoidal edge, a length of the perimeter of the sinusoidal edge, a height, a height of the sinusoidal structure, a baseline width, a length of the commissure, a modulus of elasticity of the heart valve membrane structure, a pressure across the heart valve membrane structure, and a fluid flow rate through the heart valve membrane structure. The computation of the modeling of the membrane structure can then initially create two dimensional shapes of the membrane.
[0083] The data provided to the said computer for modeling the membrane structure and for calculating the optimization, for example, can be used by said models and optimization calculations to calculate the specific format for the patient and the dimensions of the membrane structures of the heart valve and / or its related coronary sinus mold. In one embodiment, the data used in modeling and / or computer programs for optimization may include, without limitation, at least some anatomical and / or physiological data from a specific patient to receive a heart valve membrane structure (such as a custom device). In another embodiment, the physiological and / or anatomical data obtained from a number of individuals can be used both as aggregate raw data and as statistically analyzed data (for example, mean values, variation values, and / or standard deviation) , in modeling calculations for heart valve membrane structures. In one embodiment, data can be derived from the individual distribution of at least one characteristic with a patient, including without limitation, age, sex, height, weight, blood pressure, and degree of pathology (if any).
[0084] The coronary sinus ends and the coronary sinus structures of a heart valve membrane structure of the initial model can then be mapped onto the inner surface of a 705 duct model. A coronary sinus model can be used to map the edge of the coronary sinus of the cardiac valve membrane structure of the initial model over the inner surface of a conduit model. The points of composition of the edge of the coronary sinus can act as points of attachment to the internal surface of a conduit model; for convenience, such connections may be referred to as a "fixed" connection. For the purpose of modeling a heart valve membrane structure within a conduit, the flexibility of the coronary sinus edge, at the points of the coronary sinus edge, can result in a moment of negligent transfer from the fixed connection through the structure of the coronary sinus. In one embodiment of a mapping step, a model of the heart valve membrane structure, including the structures in the coronary sinus, can be assumed to be bilaterally symmetrical with respect to a commissure.
[0085] The structures in the coronary sinus can be sectioned in a finite number of thickness, from the structure beams in nearby bells 710. In a non-limiting embodiment, the beams of the coronary sinus structure can be created after the model of the membrane structure of a heart valve to be mapped to the internal surface of a conduit model. In an alternative embodiment, the bundles of the coronary sinus structure can be created as part of an initial model of the heart valve membrane structure. The general shape of each bundle (as a thin strip) can then be calculated 715. In a non-limiting embodiment, a form of deformation of the bundles of the coronary sinus structure can be by curving. A length of each bundle of the coronary sinus structure can be very long compared to its distance from point to point after being fixed to the inner surface of a conduit. The very thin (1 mm) flexible coronary sinus structure bundles can easily bend and may not retain significant compressive stress. The tension between the nearby bundles of the coronary sinus structure can occur along the shape of the coronary sinus structure. In a non-limiting embodiment, the deformation of the shape between the bundles of the nearby coronary sinus structure can be ignored during modeling. In another non-limiting embodiment of a model of the heart valve membrane structure, the stress due to the weight of the heart valve membranes can be neglected. As a non-limiting example, for the heart valve membrane structure model based on a heart valve membrane structure composed of expanded PTFE, the thickness of the membrane can be very low compared to its elastic modulus and therefore any tension induced by the weight of the membranes can be ignored.
[0086] In a non-limiting example, a calculation can be performed according to a curved analysis of multiple numerical modules. Each bundle of the coronary sinus structure can undergo multiple interactions, both with the opposite membrane and with the inner surface of the conduit. Many possible forms of bending can be considered by, both online or offline, including fixed-fixed (ie, from one end of the unbound coronary sinus structure to another end of the unbound coronary sinus structure) , immobilized-immobilized (that is, from one end of the coronary sinus structure attached to an internal surface of the conduit to another end of the coronary sinus structure attached to the internal surface of the conduit), and immobilized-fixed. In a non-limiting embodiment, these forms of bending can be solved numerically. In a non-limiting embodiment, a solution for numerical curving in multiple ways can be used.
[0087] A general solution for a beam undergoing curving can be shown as: y = Asin (kx) + Bcos (kx) + Cx + D (Eq. 1)
[0088] Where y can be the perpendicular distance from the beam of the original coronary sinus structure at any given point. Finding the first and second derivatives of Eq. 1, the slope and the instant can be shown as: y '= Akcos (kx) Bksin (kx) + C (Eq. 2) y ”= Ak2sin (kx) - Bk2cos ( kx) (Eq. 3) at each point along the bundle of the coronary sinus structure. By imposing limiting conditions (such as “yo” = yt ”= 0 for a fixed-fixed coronary sinus beam), and maintaining the length of the coronary sinus beam and complete continuity, a beam shape of the structure of the collapsed coronary sinus can be calculated. By maintaining continuity of distance from a given point along the coronary sinus beam to a fixed coronary sinus edge before and after bending, a three-dimensional shape of the coronary sinus beam can be observed after the curving.
[0089] Where a beam shape of the clarified coronary sinus structure intersects a solid boundary, the point of intersection can be assumed as a vertex, so that the segments before and after that vertex can pass independently curving while maintaining continuity between the two segments at the point of intersection. This corner point can then be repeatedly varied along the limit using an optimization routine. In a non-limiting embodiment, an optimization routine may include a vertex point cost function defined as the discrepancy in a vertex between a moment applied from one side of the beam of the coronary sinus structure and a moment applied from a solid boundary side. Under an optimization condition, a discrepancy between the applied moment can reach around zero, since continuity may require that the applied moments can be equal. By repeating the application of this procedure for all the intersections that appear, a final shape of each bundle of the structure of the coronary sinus can be calculated. In a non-limiting embodiment, the calculation can be simplified by assuming that the beam shapes of the coronary sinus structure in the line of symmetry between the heart valve membranes can be linear. The results of modeling the coronary sinus structures may include locations on the end of the coronary sinus structure immobilized on the inner surface of a conduit model, and at the baseline location of the modeled coronary sinus structure.
[0090] After the general shape of each bundle has been calculated, each bundle of the coronary sinus structure can be further divided into a finite number of 720 element points. One position of each bundle element point of the coronary sinus structure can then be calculated 715. One or more metric positions for each element point of the bundle of the coronary sinus structure can be calculated according to a number of different methods. In a non-limiting example, a location of the coronary sinus beam point element can be calculated based on at least part of a change in its position along the coronary sinus beam from its position along the initial beam length of the coronary sinus structure. In another example, a distance can be calculated between the beam element point of the individual coronary sinus structure. In yet another example, a distance from each point element of the bundle of the coronary sinus structure can be calculated from the maximum point of the edge of the relevant coronary sinus or the intersection in the coronary sinus. In another example, a location of the beam element point of the coronary sinus structure can be adjusted to calculate small amounts of tension in the membranes.
[0091] After the locations of the point-element of the coronary sinus beam structure have been calculated, as described above, each membrane of the sinusoidal structure can be similarly modeled. A sinusoidal structure can initially have its baseline outlined from its respective modeled coronary sinus structures. In a non-limiting embodiment, a sinusoidal structure can be sectioned into a number of sinusoidal structure beams 730. In one embodiment, the sinusoidal structure beams can be created after the baseline of the sinusoidal structure is delineated over the baseline of the modeled coronary sinus structure. In another embodiment, the sinusoidal structure beams can be created as part of an initial model of the heart valve membrane structure. A general shape of each bundle of the sinusoidal structure can then be calculated 735 according to the modeling and optimization calculations as substantially described above with reference to the bundles of the coronary sinus structure. Then, each beam of the sinusoidal structure can be sectioned into a number of point elements of the sinusoidal structure beam 740, and one or more positions of each point-element of the sinusoidal structure beam can be calculated in a manner substantially described above 745 with relation to the points of the bundle of the structure of the coronary sinus.
[0092] After the location of the beam-point element of the coronary sinus structure and the beam-point element of the sinusoidal structure have been calculated. Both sets of point elements can be incorporated into a single set that can conveniently be called a “point element aggregate”. The point elements composing the aggregate can then be modeled by a mesh representation of element-point aggregates 750. The mesh representation of element-point aggregates can then be planed 755. In a non-limiting embodiment, the planing calculation can be be derived from the use of Bezier curves.
[0093] Once the mesh representation of the point-element aggregate has been calculated, a solid model can be generated from the 760 mesh model, incorporating a thickness based on the material of the heart valve membrane structure.
[0094] Figures 8A and 8B illustrate non-limiting examples of the results that can be obtained from modeling the membrane structure on a computer as described above. Figure 8A illustrates a model 800 of a heart valve membrane structure having a pair of blades. Coronary sinus ends 805 a, b and 810 a, b are illustrated. Two coronary sinus structures, 802 a and 802b are illustrated having the coronary sinus structure bundles (such as 810) dividing the coronary sinus structure. Figure 8B illustrates a coronary sinus mold 800 'that can be used to outline the valve membrane structure 800 over the inner surface of a conduit. Figure 8C illustrates an embodiment of a non-limiting example of a result of the mapping of the extremities in the coronary sinus 805 a, b and 810 a, b on the inner surface of a conduit model 840. It can be appreciated that the bundles of the sinus structure coronary artery 810 can form a complex two-dimensional structure. Figure 8D illustrates a non-limiting example of a mesh representation of the 870 element-point aggregate that can result from the modeling of the heart valve membrane. The intersections 880 of the mesh can represent the locations of the member point of an element-point aggregate.
[0095] After a solid model of the membranes has been generated, a performance model of the heart valve membrane structure can be assessed according to one or more analytical fluid flow calculations. In a non-limiting embodiment, fluid flow analytical methods can include CFD and FSI analyzes. Analytical fluid flow methods can be used to evaluate the performance of the heart valve membrane structure model. The fluid flow parameters that can be entered as part of the fluid flow analytical methods may include, without limitation, one or more cardiac and vascular geometries, patient blood flow parameters, patient size and / or weight, size / curvature of the conduit, a cardiac output from a patient's heart, and the patient's blood pressure. In a non-limiting example, the fluid flow parameters associated with a patient can be acquired by direct quantitative and qualitative measurements of the patient. In another non-limiting example, the mean values or reference values of said fluid flow parameters can be acquired from clinical literature or other computer simulations. The fluid flow parameters can then be used in one or more fluid flow calculations to provide a three-dimensional blood flow and pressure field throughout the patient's RVOT. The flow field can be produced to simulate diastole, systole, or any intermediate period within the cardiac cycle. The flow field and pressure information, along with the parameters associated with the patient's RVOT, can be provided to a simulation of solid structural modeling that can predict the shape of the heart valve membrane structure during multiple points in the cardiac cycle.
[0096] After each model of the heart valve membrane structure has been analyzed, a value of a valve performance cost function can be determined based on a performance of the model of the heart valve membrane structure according to one or more optimization analysis. A method of optimizing the heart valve membrane structure can then include the provision of interactive addition changes to one or more parameters of membrane modeling and remodeling of the heart valve membrane structures. An optimal set of membrane modeling parameters can thus be found which can minimize the cost-performance function of the valve. In a non-limiting embodiment, a cost-performance function of the heart valve can be based on the effective orifice area of a heart valve membrane structure during systole and the regurgitation flow during diastole. In another non-limiting embodiment, the cost performance function of the valve may be based on a ratio of the closed conduit area of the fluid flow to the open area for the fluid flow. In another non-limiting embodiment, the cost performance function of the valve can be based on a ratio of the valve opening and closing. In yet another non-limiting embodiment, a cost performance function of the valve can be based on a ratio of the regurgitation flow rate during diastole to the flow rate during systole.
[0097] Upon completion of the optimization calculation, a set of heart valve membrane size parameters can be calculated. In a non-limiting embodiment, a set of heart valve membrane size parameters can be provided to the user by a computing device. Thus, with reference to a two-membrane heart valve membrane structure as illustrated in figure 3D, the calculations of the computer device can provide values for the external length 305a and 305b, internal lengths 310 a and 310b, height 320a and 320b, width 335 a and 335b, membrane structures 315a and 315b, height of the membrane structure 340a and 340b, and commissure length 330. A user of the optimization and modeling calculations can then use one or more of these calculated heart valve membrane sizing parameters by the computing device for manufacture and one or more structures in heart valve membranes. For example, a user can use the calculated values for the external lengths, internal lengths, heights, widths, membrane structures, sheet structure heights, and commissure length. In an alternative embodiment, a computing device may also provide a mold of the heart valve membrane structure at least in part during these calculated heart valve membrane sizing parameters. A mold of the heart valve membrane structure can be produced by an output device, such as a printer, for use by a user. A user can then take the mold of the heart valve membrane structure and apply it to a thin sheet of material to prepare the heart valve membrane structure, and cut the heart valve membrane structure based on the mold of the heart valve structure. heart valve membrane. The shapes and / or metrics so calculated can be used by a healthcare provider, a manufacturer, or a production line to produce a variety of cardiac valve structures including, but not limited to, single membrane, two membranes, or heart valve structures with three membranes.
[0098] In addition to the heart valve membrane size parameters related to a heart valve membrane structure, a user can also receive the sizing parameters of the coronary sinus mold. Thus, with reference to a coronary sinus mold of the two-membrane heart valve membrane structure, as illustrated in figure 3E, the calculation of the computer device can provide values for the external lengths 305a 'and 305b', internal lengths 310a ' and 310b ', heights 320a' and 320b ', widths 335a' and 335b ', and commissure lengths 330'. In an embodiment in which a coronary sinus mold additionally incorporates sinusoidal structures, the sizing parameters of the coronary sinus mold can also include parameters for defining the sinusoidal structure, including, without limitation, sinusoidal structure heights. A user of the modeling and optimization calculations can then use one or more of these calculated values from the computing device to produce one or more coronary sinus molds that can be applied to the inner surface of a conduit to place the valve membrane structure as described above. In another embodiment, a computer device may also provide the coronary sinus mold based, at least in part, on the size parameters calculated for the coronary sinus mold. A coronary sinus mold provided by a computer device can be provided to a user from a printing device associated with the computer device.
[0099] As described above, in a non-limiting embodiment, an artificial heart valve structure may be composed of a conduit, a heart valve membrane structure, and one or more coronary sinus structures in the conduit. In an alternative embodiment, an artificial heart valve structure can further incorporate one or more biodegradable structures. Said cardiac valve structures can conveniently be referred to as a valve conduit constructed from hybrid tissues (hybrid TEVC). A hybrid TEVC may include, in a non-limiting example, a conduit constructed of synthetic material and having a cross section forming a partially closed circle, and a biodegradable structure that can be incorporated within the conduit wall to form an involved tubular structure. A hybrid TEVC can also include one or more heart valve membrane structures, and one or more structures in the coronary sinus of the conduit arranged within the conduit.
[0100] Figure 9 illustrates several views of an embodiment of a hybrid TEVC. View 900a illustrates a "rear" view of an embodiment of a valve duct constructed of hybrid fabric 905. The material of duct 905 as illustrated in view 900a may be a synthetic biocompatible and / or hemocompatible polymer which may include, as limiting, PTFE or ePTFE. View 900a also illustrates a pair of coronary sinus structures of conduit 902 a and 902b that can be incorporated within conduit wall 905. Next to conduit 95 can be seen in a portion of a biodegradable structure 910.
[0101] View 900b illustrates a “front” view of TEVC. It can be appreciated that the conduit may not be completely closed, but may have one or more ruptures 928 along with the conduit wall. Each break may include at least one end of the break in the duct pair from a wall in the duct. In a non-limiting embodiment, one or more breaks in conduit 928 may extend along the entire axis of a conduit. In another embodiment, a rupture of the conduit 928 may extend only partially along the long axis of a conduit. In yet another embodiment, the multiple conduit breaks 928, each extension along a portion of the long axis of a conduit wall, can be arranged in a helical pattern. In a non-limiting example, said rupture in multiple conduits 928, arranged in a helical pattern, may not overlap together with any circumferential portion of a conduit wall. In addition, the heart valve membranes 912a and 912b can be seen in view 900b. A 910 portion of a biodegradable structure can be seen close to the body of a hybrid TEVC.
[0102] View 900c illustrates a cross-sectional view of an embodiment of a hybrid TEVC. Two heart valve membranes 912a and 912b can be seen in view 900c as well. In addition, a portion of a biodegradable structure 910 can be seen to be incorporated within the conduit of the hybrid TEVC. In a non-limiting embodiment, a biodegradable structure 910 can have at least two sides, on which each side can be attached to one end of the conduit rupture. View 900d illustrates a biodegradable structure 910 attached within a conduit break 928 of the hybrid TEVC 905. The biodegradable structure 910 can be attached to the ends of the conduit break via one or more laser beam casting, monocoque technique, casting by heat or chemistry, and / or the use of an adhesive.
[0103] Although figure 9 illustrates several views of a hybrid TEVC in which a conduit rupture essentially extends along the long axis of the conduit, it can be appreciated that one or more conduit ruptures can be oriented according to the alternative geometry . In a non-limiting example, a conduit rupture can take the form of a helical transverse curve of conduit length. In yet another embodiment, one or more duct breaks can essentially cross one or more circumferences of a duct. In yet another embodiment, one or more duct breaks can be arranged along a duct wall at one or more angles with respect to the long axis of the duct. In a non-limiting embodiment, the rupture of multiple conduits can form one or more structures of the continuous rupture. In yet another non-limiting embodiment, the rupture of multiple conduits can be separated, and not form a structure of the continuous rupture. In a non-limiting embodiment, a multiple conduit rupture can be made up of a single straight line segment. In another non-limiting embodiment, a conduit rupture can be made up of a single curved line segment. In yet another non-limiting embodiment, a conduit break may be compote from a serrated line segment. It can be appreciated that a conduit rupture may be composed of one or more segments of straight or curved lines arranged in any convenient manner.
[0104] It can also be understood that one or more biodegradable structures can be incorporated within one or more duct breaks. In a non-limiting example, as illustrated in figure 9, a single biodegradable structure 910 can be incorporated within the duct wall along a single duct break 928. In another non-limiting example, multiple biodegradable structures can be aligned for incorporation within a single conduit break. In yet another embodiment, multiple biodegradable structures can be provided, each biodegradable structure being incorporated within the conduit wall in a separate conduit break.
[0105] A biodegradable structure in the hybrid TEVC can be composed of one or more materials that can degrade within a body over a period of time. In a non-limiting example, one or more biodegradable structures can be made from poly (glycerol sebacate). In another non-limiting example, one or more biodegradable structures can be a compound, a combination of multiple synthetic materials. In another non-limiting example, one or more biodegradable structures can be made from poly (glycerol sebacate) encapsulated by a poly (caprolactone) coating. In a non-limiting example, poly (caprolactone) may have been formed using electro-swelling techniques to improve its mechanical and biological properties. In another non-limiting example, one or more biodegradable structures can include any other degradable biocompatible and / or hemocompatible material. It can be appreciated that a hybrid TEVC composed of multiple biodegradable structures can include a number of biodegradable structures having essentially the same composition. Alternatively, multiple biodegradable structures can include a number of biodegradable structures having different compositions.
[0106] In an embodiment of a hybrid TEVC, a biodegradable structure can be replaced for a time by autologous tissue, thereby allowing the heart valve structure to increase with the growth of the patient. In a non-limiting embodiment, a biodegradable structure 910 can be incorporated within a heart valve structure and implanted within a patient. In said embodiment, cells from a patient can migrate within a biodegradable structure 910 over time to replace the material from which the biodegradable structure can be manufactured. In another non-limiting embodiment, a biodegradable structure 910 can be seeded with the cells prior to implantation within a patient. The seeded cells may include, without limitation, autologous cells harvested from the patient. Examples of autologous cells may include, without limitation, one or more of the CD34 cells, mesenchymal cells, myocytes, smooth muscle cells, endothelial cells, and human cardiac stem cells. In another embodiment, the biodegradable structure can include collagen fibers. In other non-limiting embodiments, a biodegradable structure can also include growth or other trophic factors, for promoted biocompatibility and / or hemocompatibility, or other biologically active materials to provide more effective therapies.
[0107] A hybrid TEVC can be manufactured from a heart valve structure as described above. A heart valve structure, including one or more structures in heart valve membranes and or structures in the coronary sinus of the conduit, can be obtained. One or more duct breaks can be manufactured in the duct wall, each duct break having a pair of ends of the duct break. One or more duct breaks can be formed by cutting a duct wall including, but not limited to, cuts, incisions, or heating. Implements that can form one or more ruptures in the conduit may include, without limitation, scissors, a scalpel, a dagger, or a focused laser. Once one or more duct breaks have been fabricated into a duct wall, one or more biodegradable structures can be incorporated within one or more duct breaks by attaching at least a portion of the biodegradable structure to each end of the duct. conduit rupture associated with each conduit rupture. After each biodegradable structure has been fixed to a rupture in the conduit wall, an essentially closed tubular structure composed of the conduit wall and one or more fixed biodegradable structures can be formed. One or more biodegradable structures can be attached to the ends of the conduit rupture by any appropriate means including, without limitation, bonding, hot casting, chemical casting, and / or suturing.
[0108] EXAMPLES Example 1: A structure in two heart valve membranes.
[0109] A two-membrane heart valve structure, essentially as illustrated and described in Figure 3D, was manufactured from expanded PTFE having a thickness of about 0.1 mm. A structure in two membranes was designed for integration in a 20 mm diameter conduit. A cardiac valve structure in two membranes was bilaterally symmetrical in relation to the commissure, so the measurement of the equivalent components between the two membranes were about the same. The length of each end in internal coronary sinus (equivalent to that of the 3D figure, 310a, b) was about 16 mm, the height of each membrane (equivalent to the 3D figure, 320a, b) was about 15 mm, the width of each baseline (equivalent to the 3D figure, 335a, b) was about 27.7 mm, and each height of the sinusoidal structure (equivalent to the 3D figure, 340a, b) was about 2.8 mm. The sinusoidal structure of each membrane was similar to the structure illustrated as 315a, b, in the 3D figure, and the sinusoidal structures were bilaterally symmetrical in relation to the commissure. In addition, the length of the commissure (equivalent to the 3D figure, 330) was about 7 mm. Example 2: values for the accumulation of the parameters of the heart valve membrane structure for the diameter of the conduit.
[0110] Figures 3D and 3E illustrate embodiments of a heart valve membrane structure and a coronary sinus mold that can be used to mark the connection of the coronary sinus ends to a conduit as part of the method for fabricating a coronary structure. heart valve. As described above, the metric associated with the membrane elements can be scaled according to the diameter of the conduit into which the heart valve membrane structure can be inserted. Table 1, described below, provides some values for the membrane metric, including some non-limiting ranges. The metric launches equivalent references for the structures in Figures 3D (for the membrane) and 3E (for the mold). The bands are provided as examples only. The membrane value corresponds to the metric for a heart valve membrane. The value of the coronary sinus mold corresponds to the metric for an equivalent coronary sinus mold. The values in table 1 are scaled values for the duct diameter, and can be used as multipliers for the duct diameter to provide appropriate length and width. Thus, a heart valve membrane structure used in a conduit with a diameter of about 10 mm, can have a height of about 8.1 mm. Table 1

[0111] The blood flow through a conduit of the modeled membrane valve structure was made as an incompressible and Newtonian fluid with constant hemodynamic properties (p = 1060 kg / mA3, μ = 3.71 E-3 Pa.s ) without a turbulence model. A cardiovascular blood flow simulator with accurate 2nd order validity of accurate artificial numerical compressibility from multiple resolution networks was used to evaluate the flow through the conduit. The blood flow was simulated in a high resolution unstructured Cartesian immersion network with finite difference numerical treatment. Example 4: Simulation of a heart valve structure
[0112] A conduit with a diameter of 20 mm was modeled according to the same geometric parameters that were used in a clinical application 91 = 15.98 mm, h = 15.3 mm, p = 27.7 mm, c = 6.9 mm, F = 2.8 mm). A solid model thus generated was observed to be significantly similar to the current valve was modeled. An analysis of fluid flow through the heart valve structure thus modeled determined that the regurgitation through the heart valve structure during diastole was about 8.27 mL / s. This was determined by representing about 7.84% of flow through the valve for the cardiac cycle having a flow rate of 3.7 L / minutes, which may be normal for children.
[0113] The present description is not limited in terms of the particular embodiment described in this application, which are intended as illustrations of various aspects. Many modifications and variations can be made without departing from its spirit and scope of protection, which is apparent to technicians in the subject. The functionally equivalent methods and devices within the scope of protection of the description, in addition to those listed in this description, will be apparent to those skilled in the art from the above description. Said modifications and variations are intended within the scope of the appended claims. The present description is limited only in terms of the appended claims, together with the full scope of equivalents to which said claims are entitled. It should be understood that the terminology used in this description is for the descriptive purpose of the particular embodiments only, and is not intended to be limiting.
[0114] With respect to the use of substantially any term in the plural and / or the singular in this description, those having knowledge of the subject may translate the plural into the singular and / or from the singular to the plural when appropriate to the context and / or application. The various singular / plural exchanges can be expressly represented in this description for the sake of clarity. It should be understood by those within the subject, in general terms, used in the description and, especially in the attached claims (for example, in the body of the attached claims) they are generally intended as "open" terms (for example, the term "including" should be interpreted as "including but not limited to", the term "having" should be interpreted as "having at least ', the term" includes "should be interpreted as" includes but is not limited to ", etc.).
[0115] It should also be understood by those skilled in the art that if a specific number of citations introduced in the claims are intended, such claims will be explicitly cited in the claims and, in the absence of said citations, no claim is present. For example, as an aid to understanding, the following claims may contain the use of introductory phrases “at least one” and “one or more” to introduce quotes in the claims. However, the use of said phrases must be constructed to imply that the introduction of a quote in the claim for indefinite articles "one", "one", limits any particular claim containing that quote introduced in the claim to embodiments containing only a certain quote, even when the same claim includes the introductory phrase “one or more” or “at least one” and indefinite articles such as “one” or “one” (for example, “one” and / or “one” must be interpreted by “at least one” or “one or more”); it contains the truth for use of the defined articles used to enter a quote in the claim. In addition, even if a specific number of a quote entered in the claim is explicitly quoted, those skilled in the art will recognize that such quotes must be interpreted by means of at least one quoted number (for example, the revealed quote of “two quotes” without other modifications, means at least two citations, or two or more citations). It will be further understood by those skilled in the art that virtually any disjunctive conjunction and / or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood as contemplating the possibilities of including one of the terms, some terms, or both the terms. For example, the phrase "A or B" will be understood to include the possibilities of "A" or "B" or "A and B".
[0116] It will be understood by a technician on the subject that for any and all purposes, such as in terms of providing a written description, all of the ranges described in this description also cover any and all possible sub-ranges and combinations of sub-ranges of the same. . As will be understood by a person skilled in the art, all language such as "until", "at least" and the type include the quoted number and refer to the bands that can subsequently be broken into sub-bands as discussed above. Finally, it will be understood by a technician on the subject that a track includes each individual member.
[0117] From the above description, it will be appreciated that several embodiments of the present description have been described for illustrative purposes, and that various modifications can be made without departing from the scope of protection and the spirit of the described embodiments are not intended to be limiting, with the true scope of protection being indicated by the following claims.

权利要求:
Claims (12)
[0001]
1. A heart valve structure, comprising: - a conduit (110, 210) comprising an internal conduit surface (120, 212); and - a multi-membrane heart valve structure having an open and a closed state, the multi-membrane heart valve structure comprising: - a first heart valve membrane (130, 235, 350), having a first structure sinusoidal (302, 575), a first edge of the coronary sinus (140, 355), a first ventilation structure (150, 315), and a first ventilation edge (360), with at least a portion of the first edge of the coronary sinus (140) is affixed to the internal surface of the conduit (120); - a second heart valve membrane, comprising a second coronary sinus structure, a second sinusoidal edge, a second ventilation structure, and a second ventilation edge, with at least a portion of the second sinusoidal edge being affixed to the internal surface of the conduit (120, 212); and - commissure (330) joining the first heart valve membrane (130, 235, 350), and the second heart valve membrane; said structure being characterized by the fact that there is a valve space (460, 560) formed between the first ventilation edge and the second ventilation edge, when the multi-membrane heart valve structure is in the closed state.
[0002]
Valve structure according to claim 1, characterized in that the first coronary sinus edge comprises a plurality of the first sinusoidal edge components and the second sinusoidal edge comprises a plurality of the second sinusoidal edge components.
[0003]
3. Valve structure according to claim 1, characterized in that the first edge of the coronary sinus comprises a first accentuated portion of the proximal edge to the first sinusoidal edge, and a first gradual portion of the ventilation edge; and a second ventilation edge comprising a second accentuated portion of the ventilation edge proximal to the second sinoidal edge, and a second gradual portion of the ventilation edge.
[0004]
4. Method for manufacturing a cardiac valve structure, as defined in claim 1, said method being characterized by the fact that it comprises: - everting a flexible conduit having a wall, an internal surface, and an external surface; - affixing a multi-membrane heart valve structure to the internal surface of the conduit, the multi-membrane structure comprising: - a first heart valve membrane, having a first coronary sinus structure, a first sinusoidal edge; a first ventilation structure, and a first ventilation edge; - a second cardiac valve membrane, having a second coronary sinus structure, and a second sinusoidal border, a ventilation structure; and a second ventilation edge; - a commissure joining the first heart valve membrane and the second heart valve membrane; and - a valve space formed between the first ventilation edge, the second ventilation edge, and the inner surface when the multi-membrane structure is in a closed state; and - reversing the duct, thus forming a multi-layered valve inside the duct.
[0005]
5. Method, according to claim 4, characterized in that the fixation of the multi-membrane structure of the heart valve to the internal surface comprises: - fixing the first edge of the coronary sinus to the internal surface of the conduit; and - fixing the second edge of the coronary sinus to the internal surface of the conduit.
[0006]
6. Method, according to claim 4, characterized by the fact that it also comprises: - preparing the internal surface with the coronary sinus mold to form a marked internal surface before fixing the structure in multiple layers and fixing the structure in multiple layers to the along the marked inner surface.
[0007]
Valve structure according to claim 1, characterized in that the first structure of the coronary sinus and the internal surface forms a first sinusoidal valve connected by the internal surface and the first sinusoidal structure; and - the second coronary sinus structure and the inner surface form a second sinusoidal valve connected by the inner surface and the second sinusoidal structure.
[0008]
Valve structure according to claim 1, characterized in that the first multilayered coronary valve and the second multilayered valve independently have a ratio of a baseline width to a diameter of the 0.054 to 0.17.
[0009]
9. Valve structure according to claim 1, characterized in that the first multi-layered coronary valve and the second coronary valve independently have a ratio of a length of the commissure to a baseline width of 0, 18 to 0.38.
[0010]
10. Method according to claim 4, characterized in that it further comprises deforming the conduit to form a structure of the coronary sinus of the conduit over the conduit downstream of the coronary valve in multiple layers.
[0011]
11. Method according to claim 10, characterized in that the deformation comprises mechanical deformation of the conduit, heat deformation of the conduit, vacuum deformation of the conduit, and combinations thereof.
[0012]
12. Method according to claim 10, characterized by the fact that it also comprises the application of a device for manufacturing the coronary sinus conduit to the conduit.

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同族专利:

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公开号 | 公开日

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CN104039271A|2014-09-10|

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WO2013019756A2|2013-02-07|

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ZA201401023B|2017-05-31|

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CA2855943A1|2013-02-07|

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EP2736456A2|2014-06-04|

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US20200170790A1|2020-06-04|

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EP2736456B1|2018-06-13|

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CA2855943C|2019-10-29|

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BR112014002174A2|2017-03-01|

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US9585746B2|2017-03-07|

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AU2012290221B2|2017-02-23|

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US20140288642A1|2014-09-25|

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WO2013019756A3|2014-05-08|

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CN104039271B|2016-09-07|

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US20170196685A1|2017-07-13|

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ZA201505504B|2016-11-30|

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ZA201505503B|2018-11-28|

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AU2012290221A1|2014-02-20|

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US10624737B2|2020-04-21|

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EP2736456A4|2015-04-01|

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法律状态:
2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|

---

2019-10-15| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|

---

2020-09-01| B09A| Decision: intention to grant|

---

2020-12-01| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 30/07/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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