CA2084545C - Apparatus for monitoring bronchial electrocardiogram - Google Patents
Apparatus for monitoring bronchial electrocardiogramInfo
- Publication number
- CA2084545C CA2084545C CA002084545A CA2084545A CA2084545C CA 2084545 C CA2084545 C CA 2084545C CA 002084545 A CA002084545 A CA 002084545A CA 2084545 A CA2084545 A CA 2084545A CA 2084545 C CA2084545 C CA 2084545C
- Authority
- CA
- Canada
- Prior art keywords
- balloon
- catheter
- ecg lead
- lead electrodes
- bronchial
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
- A61B5/6853—Catheters with a balloon
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
- A61B5/285—Endotracheal, oesophageal or gastric probes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
Abstract
An intrabronchial catheter has an inflatable balloon with the bronchial ECG lead electrodes. Upon inserting the intrabronchial catheter into the trachea or bronchus of a human body, air is supplied to the balloon so that the balloon is stably retained in the trachea or bronchus, thereby bringing the bronchial ECG lead electrodes in close contact with the internal wall surface of the trachea or bronchus so as to effectively monitor bronchial electrocardiogram.
Description
t,~ ?.
APPARATUS FOR MONITORING BRONCHIAL ELECTROCARDIOGRAM
This invention relates generally to an apparatus for monitoring bronchial electrocardiogram, and more particularly to an intrabronchial catheter for use in the bronchial electrocardiographic monitoring apparatus, which is inserted into the trachea or bronchus of a human body and provided at the leading end portion thereof with a balloon having electrocardiographic lead electrodes, '0 capable of being inflated within the trachea or bronchus of the human body so as to bring the lead electrodes in close contact with the internal surface of the trachea or bronchus.
An electrocardiogram is essential to diagnose possible heart disorders such as arrhythmia and ischemia. There are commonly known body-surface electrocardiography as the most popular electrocardiography widely practiced at present, transesophageal lead electrocardiography capable of precisely diagnosing the cardiac function, intracardiac 20 lead electrocardiography, and intrabronchial electrocar-diography.
As known, in the body-surface electrocardiography, electrocardiographic (ECG) lead electrodes are located at icanatomically prescribed locations (usually, twelve regions) on the surface of the human body in order to detect an ECG lead current generated by the heart. This 2~~~5~-medical method is convenient because it can be easily effected by merely attaching the ECG lead electrodes to the surface of the human body. However, since the ECG
lead electrodes are positioned at the locations far from the heart, the ECG lead current cannot sufficiently be detected. Particularly, this medical method is not applicable for searching for a location causing cardiac insufficiency.
The transesophageal lead electrocardiography is effected by inserting a catheter provided at its leading end portion with ECG lead electrodes into the esophagus through the oral cavity or nasal cavity and bringing the lead electrodes into contact with the internal surface of the esophagus so as to detect the ECG lead current.
Though this medical method enjoys an advantage in that the lead electrodes can be positioned near the heart, especially, the posterior wall of the left atrium of the heart, thereby obtaining more reliable cardiac information compared with the aforenoted the body-surface electrocar-diography. However, this medical method demands skill in inserting the catheter into the esophagus and attaching the lead electrodes to the internal wall of the esophagus.
Accordingly, this medical method cannot easily be practiced.
On the other hand, the intracardiac lead electrocar-diography uses a catheter with ECG lead electrodes which is introduced into the heart through thick blood vessels and secured onto the internal wall of the heart in order to directly pick up a lead current. Thus, this is looked on as a medical method capable of obtaining most precise cardiac information. However, this medical method entails a disadvantage such that it cannot easily be effected since it requires remarkably high-level surgical skill for inserting the catheter with the lead electrodes into the heart while applying the X-ray to the human body to secure 10 the lead electrodes onto the anatomically prescribed locations in the heart with a high accuracy.
In the intrabronchial electrocardiography similar to the transesophageal lead electrocardiography, a catheter with ECG lead electrodes is inserted into the trachea or bronchus in place of esophagus to detect the ECG lead current from the trachea or bronchus. This medical method is effected by positioning the ECG lead electrodes mounted on the leading end portion of the catheter at the bifurcation or the internal surface of at least one of the 20 left and right bronchi in order to detect the ECG lead current near the heart. This intrabronchial electrocar-diography also suffers a disadvantage such that, though the X-ray must be irradiated in inserting the lead electrodes into the trachea and bronchus, the lead electrodes disposed on the leading end portion of the catheter cannot easily be secured in position on the anatomically prescribed locations in the trachea or bronchus. The fact of the matter is that the catheter can be inserted into the trachea with relative ease because the trachea is hollow at all times, whereas the work of stably positioning the lead electrodes at the optimum locations in the trachea or bronchus often becomes much harder and more time-consuming, and besides, possibly entails the risk of causing a patient pain. Under these circumstances, this medical method is little available 10 clinically.
As noted above, various medical method for obtaining an electrocardiogram have been so far proposed and applied practically, but as is also apparent from the foregoing, the body-surface electrocardiography makes it impossible to obtain precise cardiac information for diagnosing possible heart disorders, and the transesophageal electrocardiography, intracardiac electrocardiography and intrabronchial electrocardiography disadvantageously call for high-level surgical skill and specificmedical 20 equipment and the work of inserting the lead electrodes which consumes much time and labor. However, a need has been earnestly felt for easy and reliable electrocar-diography capable of obtaining precise cardiac information for making a diagnosis of heart disorders such as arrhythmia.
In the light of the present circumstances, the inventors of this invention have studied the intra-bronchial electrocardiography and eventually could developed new intrabronchial electrocardiography capable of being practiced easily and reliably.
As described above, the intrabronchial electrocar-diography suffers from the defect that the lead electrodes cannot easily and stably be positioned at the anatomically prescribed locations in the trachea or bronchus. In particular, the lead electrodes should be kept in close contact with the internal surface of the trachea or bronchus in order to measure a precise electrocardiogram, whereas the conventional intrabronchial electrocar-diography has not employed means for stably retaining the lead electrodes at the suitable locations on the internal surface of the trachea or bronchus for effectively picking up the ECG lead current. Moreover, it is inadmissible to dislocate the lead electrodes in the trachea or bronchus, and thus, there has been a great need for a safe, reliable and handy intrabronchial catheter which can be suitably 20 applied for intrabronchial electrocardiography and has ECG
lead electrodes capable of being secured reliably onto the anatomically prescribed locations in the trachea or bronchus.
To overcome the drawbacks of the conventional apparatus for monitoring bronchial electrocardiogram applicable for intrabronchial electrocardiography, this - 6 - ~~~4~4~
invention has an object to provide an apparatus capable of stably and reliably monitoring bronchial electrocardiogram with a high accuracy, which has a structure capable of securely and easily retaining ECG lead electrodes at anatomically prescribed locations in the trachea or bronchus, and effectively detecting an ECG lead current.
Another object of this invention is to provide an apparatus for monitoring bronchial electrocardiogram, which has a catheter capable of being safely and easily 10 inserted into and pulled out from the trachea or bronchus without causing a patient pain.
A further object of this invention is to provide an apparatus for monitoring bronchial electrocardiogram, which is effectually applicable for not only intra bronchial electrocardiography, but also atrial pacing so as to obtain various cardiac information for diagnosing possible heart disorders such as supraventricular tachyarrhythmia and distinguishing supraventricular tachyarrhythmia from ventricular tachycardia while 20 effecting the atrial pacing.
To attain the aforementioned objects according to this invention, there is provided an apparatus for monitoring bronchial electrocardiogram, which comprises an elastic intrabronchial catheter to be inserted into the trachea or bronchus, at least one inflatable balloon disposed around the outer periphery at the leading end portion of the ~~4~~~
_~_ intrabronchial catheter, and one or more bronchial ECG lead electrodes mounted on the balloon.
The invention in one broad aspect provides apparatus for obtaining a bronchial electrocardiogram and effecting cardiac pacing. The apparatus comprises an elastic hollow intrabronchial catheter capable of being inserted into the trachea or bronchus, the catheter having a leading end portion. The apparatus also comprises an electrically non-conductive inflatable balloon disposed at the leading end portion of the intrabronchial catheter. Two pairs of bronchial ECG
electrodes are provided which detect an ECG lead current and effect cardiac pacing, respectively. Two of the bronchial ECG lead electrodes are mounted on an inflatable portion of the balloon so as to move outwardly away from the catheter as the balloon is being inflated; the other two bronchial ECG lead electrodes are also mounted to the balloon. An air tube extends along the catheter and has a leading end connected to the balloon such that air can be introduced into the balloon from the tube. The balloon is inflatable to a degree at which the balloon can contact an inner wall portion of the trachea or bronchus so that the ECG electrodes can be brought to anatomically prescribed locations on the inner wall portion when the catheter is inserted into the trachea or bronchus and the balloon is inflated to the degree.
This invention will become more fully understood from the detailed description given hereinbelow and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the present invention, and wherein:
Figure 1 is a partially sectioned side view showing _ g _ one embodiment of an apparatus for monitoring bronchial electrocardiogram according to this invention, Figure 2 is an explanatory diagram of the apparatus in use, Figure 3 is an enlarged view showing another embodiment having four ECG lead electrodes mounted in line on one peripheral side of a balloon, Figure 4 is an enlarged view showing still another embodiment having two ECG lead electrodes mounted on one peripheral side of a balloon, Figure 5 is an enlarged view showing yet another embodiment having four ECG lead electrodes mounted on the other peripheral side of a balloon, Figure 6 is a partially sectioned side view showing a further embodiment of an apparatus according to this invention, having an a~iliary balloon, and Figure 7 is an enlarged view showing the principal portion of Figure 6.
The presnet invention will become more fully understood from the detailed description given hereinbelow and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the 20 present invention.
The apparatus for monitoring bronchial electrocar-diogram according to this invention is shown in Figures 1 and 2 as one example and basically comprises an intrabronchial catheter 1 to be inserted into the trachea or bronchus, and an inflatable balloon 2 disposed around the outer periphery at the leading end portion of the _ g _ intrabronchial catheter 1, an air tube 3 for supplying air to the balloon 2 therethrough, and bronchial ECG lead electrodes 4a and 4b mounted on the balloon 2.
The intrabronchial catheter 1 is made from an elastic material such as synthetic resins. In this embodiment, a tube to be inserted into the trachea T for the purpose of general anesthesia or artificial respiration may be substituted for the intrabronchial catheter 1. Therefore, the catheter 1 is provided at the tail end portion thereof 10 with a connector 5 which is generally utilized in an air supply tube connected to an artificial respirator.
The balloon 2 mounted on the leading end portion of the catheter 1 is made of a thin membrane of synthetic resins or rubber, and shaped in a bag enveloping the leading end portion of the catheter I. The balloon 2 assumes a deflated state in its normal condition and is inflated by being supplied with air when the catheter 1 is completely inserted into the trachea as illustrated in Figure 2.
20 The balloon 2 mounted on the catheter 1 has a function of not only fixedly retaining the leading end portion of the catheter 1 at a prescribed location in the trachea T, but also preventing the air introduced into the lungs through the outside periphery of the catheter 1 from leaking out. Therefore, the balloon 2 is designed so that the outer surface thereof comes into tight contact with - l~ -the internal wall surface of the trachea or bronchus when being inflated with supply of air.
The air tube 3 enters inside the catheter 1 from the middle portion of the catheter and extends toward the leading end portion of the catheter along the internal surface of the catheter. Where the air tube 3 reaches the balloon 2, the air tube 3 pierces the wall of the catheter to be connected to the balloon. The air tube 3 is provided at the tail end thereof with a check valve 6 through which it is connected to an air pump 7 so as to supply the air to the balloon 2. Though the air pump 7 fundamentally serves to supply the air to the balloon 2, it may possess a function of releasing the air in the balloon 2 by force to deflate the balloon.
The bronchial ECG lead electrodes 4a and 4b are secured on the surface of the balloon 2 at a prescribed interval. The ECG lead electrodes are connected to respective lead wires 8 extending along the internal wall surface of the catheter 1 in the same manner as the air tube 3. The tail ends of the ECG lead electrodes have external terminals 9a and 9b connected to a not-shown electrocardiograph.
The locations at which the bronchial ECG lead electrodes 4a and 4b are attached to the balloon 2 are variously determined in accordance with the material of the balloon. In a case of using the balloon of non-conductive material such as rubber, the ECG lead electrodes may be attached to the outside of the membrane of the balloon. However, the ECG lead electrodes may be arbitrarily disposed on either side of the membrane of the balloon. In either case, the ECG lead electrodes must be secured so as not to fall away from the balloon when inserting the catheter into the trachea. Therefore, it is preferable to partially bury each electrode in the membrane of the balloon so as to expose a part of the 10 electrode outside to ensure an electrical connection of the electrode to the internal wall surface of the trachea.
The aforementioned intrabronchial catheter 1 is applied practically in performing general anesthesia or inserted into the trachea T through the oral cavity or nasal cavity as illustrated in Figure 2. The intra-bronchial catheter 1 is introduced until the leading end thereof reaches the bifurcation Y of the trachea in the same way as a tube for general anesthesia. The bronchial 20 ECG lead electrodes can easily be inserted into the trachea and located at the anatomically prescribed position on the bifurcation Y of the trachea by a person who has some experience of practicing medicine. When the leading end of the catheter reaches the anatomically prescribed location on the bifurcation Y of the trachea, air is supplied to the balloon 2 through the air tube 3 to inflate the balloon.
As mentioned above, the balloon 2 is inflated with air in the trachea, thereby bringing the outer surface of the balloon in tight contact with the internal wall surface of the trachea. Consequently, the ECG lead electrodes 4a and 4b are stably fixed in the state closely contacted with the internal wall surface of the trachea, to thereby enable the ECG lead current to be detected through the lead wires 8.
10 When taking off the catheter 1 from the trachea, the air in the balloon 2 is released through the air tube 3 by operating the air pump, thereby deflating the balloon.
In the illustrated embodiment, the catheter 1 has the connector 5 at the tail end thereof because of using a common tube for general anesthesia or artificial respiration as the catheter 1, but the connector 5 is by no means necessary to this invention.
Furthermore, the balloon 2 may be provided with only a single bronchial ECG lead electrode or a plurality of ECG
20 lead electrodes. When using the single bronchial ECG lead electrodes, a counterpart ECG lead electrode may be attached onto the surface of the human body. When using the plurality of ECG lead electrodes, the electrodes are arranged on the membrane of the balloon at intervals.
Also, when using the plurality of ECG lead electrodes, the electrodes must fundamentally be disposed in pairs, but _ 13 _ ~, ~ '' the number of the electrodes should not be understood as limitative.
Figure 3 through Figure 5 illustrate other embodiments of modified catheters each having additional bronchial ECG
lead electrodes 4c and 4d on the balloon 2. These catheters can be applied for not only monitoring bronchial electrocardiogram, but also effecting cardiac pacing.
In the embodiment shown in Figure 3, four bronchial ECG lead electrodes 4a, 4b, 4c and 4d are arranged on the 10 left side portion of the membrane of the balloon 2 in line in the lengthwise direction of the catheter. It is possible to use the pair of ECG lead electrodes 4a and 4c used for monitoring an electrocardiogram, and the pair of ECG lead electrodes 4b and 4d for cardiac pacing. The two pairs of ECG lead electrodes are arranged in line alternatively at regular intervals so as to ensure a sufficient distance between the paired electrodes for effectively detecting the ECG lead current. Thus, when practicing cardiac pacing, the ECG lead electrodes 20 sufficiently separated can be applied to detect a faint pacing current, and therefore, a patient will little feel an unpleasant sensation such as a cauterized feeling. The ECG lead electrodes arranged in line in this embodiment are separated by a distance of about 20 mm so as to leave a distance of 40 mm between the electrodes 4a-4c and 4b-4d which are substantially paired off.
2~g~~45 In the embodiment shown in Figure 4, two bronchial ECG
lead electrodes 4a and 4b are attached to the peripheral side surface of the balloon 2, and another set of two bronchial ECG lead electrodes 4c and 4d are attached to the front surface of the balloon. The embodiment shown in Figure 5 has four bronchial ECG lead electrodes 4a, 4b, 4c and 4d arranged in line on the right side surface of the balloon 2.
These embodiments having the different arrangements of the ECG lead electrodes are expected to undergo a change in electrocardiogram. Then, the inventors experimentally produced some intrabronchial catheters based on these embodiments for ascertaining the cardiac pacing performance, but the difference among them was not noticeable even on careful observation.
As was touched on earlier, the bronchial ECG lead electrodes can easily be inserted into the trachea and located at the anatomically prescribed position on the bifurcation Y of the trachea by a person skilled in practicing medicine. However, if the inflated balloon 2 slightly deviates from the prescribed position on the bifurcation Y, thereby separating the ECG lead electrodes from the anatomically prescribed locations in the trachea or bronchus, an electrocardiogram is not affected too much.
Next, a modified embodiment of the apparatus for monitoring bronchial electrocardiogram according to this invention will be described with reference to Figure 6 and Figure 7. The apparatus in this embodiment has an auxiliary balloon 11 for supporting the intrabronchial catheter 1 in addition to the balloon 2 with the ECG lead electrodes 12a and 12b. The auxiliary balloon 11 is disposed distant from the primary balloon 2 at the leading end portion of the catheter 1 by a suitable distance.
The auxiliary balloon 11 is connected to an air tube ?0 13 which extends along the internal surface of the catheter 1 in the same manner as the air tube 3 connected to the primary balloon 2. Similarly to the air tube 3 with the check valve 6, the air tube 13 is also provided at the tail end thereof with a check valve 14 through which the air tube 13 is connected to an air pump. By selectively operating the air pumps, the balloons 2 and 11 can be optionally inflated or deflated.
The ECG lead electrodes 12a and 12b in this embodiment are connected to external terminals 9a and 9b through lead 20 wires 8 extending along the internal surface of the catheter 1.
The ECG lead electrodes 12a and 12b are disposed one on either side of the outer surface of the balloon 2, and can be used as electrodes for electrocardiogram or cardiac pacing.
In the illustrated embodiment, reference numeral 17 denotes vent holes formed in the leading end portion la of the catheter 1 between the balloons 2 and 11.
The intrabronchial catheter 1 in this embodiment is inserted into the trachea until the balloon 2 reaches the bifurcation Y of the trachea, and thereafter, both the balloons 2 and 11 are inflated by being supplied with air through the respective air tubes. The balloon 2 may be inserted into the right or left bronchus B1 or B2. In Figure 7, the balloon 2 is inserted into the left bronchus 10 H2 and inflated with air, thereby bringing the ECG lead electrodes 12a and 12b into close contact with the internal wall surface of the bronchus.
The vent holes 17 serves as paths for permitting air to flow into the right bronchus B1 therethrough.
The intrabronchial catheter 1 in this embodiment is inserted across the bifurcation Y of the bronchus B2 so that the ECG lead electrodes 12a and 12b can be brought further close to the heart. Therefore, precise cardiac measurement or cardiac pacing can be effected with ease.
20 To facilitate the insertion of the intrabronchial catheter into the trachea and further into the bronchus having a smaller inner diameter than the trachea, it is desirable to made the balloon 2 smaller in diameter when being inflated than the inflated balloon 11, and the part la of the intrabronchial catheter between the balloons 2 and 11 may preferably be made rather small in diameter.
2~8~5~~
As is described above, though the apparatus according to this invention was fundamentally developed for the purpose of monitoring bronchial electrocardiogram for diagnosing the cardiac function, this apparatus can be effectively applied to transbronchial atrial pacing which is effected by inserting the intrabronchial catheter into the bronchus near the atrium of the heart in the manner identical to transesophageal atrial pacing which is effected by inserting pacing electrodes into the esophagus. When practicing the transbronchial atrial pacing by using the apparatus according to this invention, the connection of the bronchial ECG lead electrodes mounted on the balloon in this invention may be switched from an electrocardiograph to a pacing device for imparting electrical stimulation to the heart. However, since the atrial pacing which is generally effected while monitoring the cardiac function requires plural sets of the bronchial ECG lead electrodes, namely, at least four ECG lead electrodes are necessary. Also, the ECG lead electrodes are required to be arranged at regular intervals as described above. In this respect, the apparatus of this invention has a rational structure capable of arranging the ECG lead electrodes at regular intervals on the surface of the balloon by alternatively positioning the ECG lead electrodes in pairs, thereby to automatically position the bronchial ECG lead electrodes on the anatomically prescribed locations on the inernal surface of the trachea or bronchus.
As is apparent from the description given in detail above, according to this invention, by inserting the intrabronchial catheter into the trachea or bronchus and supplying air to the balloon through the air tube to inflate the balloon in the trachea or bronchus, the bronchial ECG lead electrodes can easily be secured stably in close contact with the internal wall surface of the trachea or bronchus. Besides, by releasing the air from the inflated balloon, the ECG lead electrodes can safely be pulled out from the trachea or bronchus with ease.
Thus, the present invention enables the intrabronchial catheter of this invention to be easily inserted into the trachea or bronchus and the bronchial ECG lead electrodes to be reliably positioned the anatomically prescribed locations in the trachea or bronchus near the heart, and proves advantageous in monitoring bronchial electrocar-diogram. Since the bronchial ECG lead electrodes can be ~0 secured close to an atrium of the heart, the apparatus of this invention can be efficiently used for not only detecting an ECG lead current for an electrocardiogram, but also effecting atrial pacing.
Furthermore, since the intrabronchial catheter of this invention can be used as a tube for general anesthesia or artificial respiration, it is convenient from the standpoint of medical treatment to effect the general anesthesia or artificial respiration while observing an electrocardiogram.
As described above, since the apparatus for monitoring bronchial electrocardiogram according to this invention can be effectually applied for not only intrabronchial electrocardiography, but also atrial pacing, various cardiac information for diagnosing possible heart disorders such as supraventricular tachyarrhythmia and distinguishing supraventricular tachyarrhythmia from ventricular tachycardia can be reliably obtained with ease.
It is further understood by those skilled in the art that the foregoing description is a preferred embodiment of the disclosed device and that various changes and modifications may be made in the invention without departing from the spirit and scope thereof.
APPARATUS FOR MONITORING BRONCHIAL ELECTROCARDIOGRAM
This invention relates generally to an apparatus for monitoring bronchial electrocardiogram, and more particularly to an intrabronchial catheter for use in the bronchial electrocardiographic monitoring apparatus, which is inserted into the trachea or bronchus of a human body and provided at the leading end portion thereof with a balloon having electrocardiographic lead electrodes, '0 capable of being inflated within the trachea or bronchus of the human body so as to bring the lead electrodes in close contact with the internal surface of the trachea or bronchus.
An electrocardiogram is essential to diagnose possible heart disorders such as arrhythmia and ischemia. There are commonly known body-surface electrocardiography as the most popular electrocardiography widely practiced at present, transesophageal lead electrocardiography capable of precisely diagnosing the cardiac function, intracardiac 20 lead electrocardiography, and intrabronchial electrocar-diography.
As known, in the body-surface electrocardiography, electrocardiographic (ECG) lead electrodes are located at icanatomically prescribed locations (usually, twelve regions) on the surface of the human body in order to detect an ECG lead current generated by the heart. This 2~~~5~-medical method is convenient because it can be easily effected by merely attaching the ECG lead electrodes to the surface of the human body. However, since the ECG
lead electrodes are positioned at the locations far from the heart, the ECG lead current cannot sufficiently be detected. Particularly, this medical method is not applicable for searching for a location causing cardiac insufficiency.
The transesophageal lead electrocardiography is effected by inserting a catheter provided at its leading end portion with ECG lead electrodes into the esophagus through the oral cavity or nasal cavity and bringing the lead electrodes into contact with the internal surface of the esophagus so as to detect the ECG lead current.
Though this medical method enjoys an advantage in that the lead electrodes can be positioned near the heart, especially, the posterior wall of the left atrium of the heart, thereby obtaining more reliable cardiac information compared with the aforenoted the body-surface electrocar-diography. However, this medical method demands skill in inserting the catheter into the esophagus and attaching the lead electrodes to the internal wall of the esophagus.
Accordingly, this medical method cannot easily be practiced.
On the other hand, the intracardiac lead electrocar-diography uses a catheter with ECG lead electrodes which is introduced into the heart through thick blood vessels and secured onto the internal wall of the heart in order to directly pick up a lead current. Thus, this is looked on as a medical method capable of obtaining most precise cardiac information. However, this medical method entails a disadvantage such that it cannot easily be effected since it requires remarkably high-level surgical skill for inserting the catheter with the lead electrodes into the heart while applying the X-ray to the human body to secure 10 the lead electrodes onto the anatomically prescribed locations in the heart with a high accuracy.
In the intrabronchial electrocardiography similar to the transesophageal lead electrocardiography, a catheter with ECG lead electrodes is inserted into the trachea or bronchus in place of esophagus to detect the ECG lead current from the trachea or bronchus. This medical method is effected by positioning the ECG lead electrodes mounted on the leading end portion of the catheter at the bifurcation or the internal surface of at least one of the 20 left and right bronchi in order to detect the ECG lead current near the heart. This intrabronchial electrocar-diography also suffers a disadvantage such that, though the X-ray must be irradiated in inserting the lead electrodes into the trachea and bronchus, the lead electrodes disposed on the leading end portion of the catheter cannot easily be secured in position on the anatomically prescribed locations in the trachea or bronchus. The fact of the matter is that the catheter can be inserted into the trachea with relative ease because the trachea is hollow at all times, whereas the work of stably positioning the lead electrodes at the optimum locations in the trachea or bronchus often becomes much harder and more time-consuming, and besides, possibly entails the risk of causing a patient pain. Under these circumstances, this medical method is little available 10 clinically.
As noted above, various medical method for obtaining an electrocardiogram have been so far proposed and applied practically, but as is also apparent from the foregoing, the body-surface electrocardiography makes it impossible to obtain precise cardiac information for diagnosing possible heart disorders, and the transesophageal electrocardiography, intracardiac electrocardiography and intrabronchial electrocardiography disadvantageously call for high-level surgical skill and specificmedical 20 equipment and the work of inserting the lead electrodes which consumes much time and labor. However, a need has been earnestly felt for easy and reliable electrocar-diography capable of obtaining precise cardiac information for making a diagnosis of heart disorders such as arrhythmia.
In the light of the present circumstances, the inventors of this invention have studied the intra-bronchial electrocardiography and eventually could developed new intrabronchial electrocardiography capable of being practiced easily and reliably.
As described above, the intrabronchial electrocar-diography suffers from the defect that the lead electrodes cannot easily and stably be positioned at the anatomically prescribed locations in the trachea or bronchus. In particular, the lead electrodes should be kept in close contact with the internal surface of the trachea or bronchus in order to measure a precise electrocardiogram, whereas the conventional intrabronchial electrocar-diography has not employed means for stably retaining the lead electrodes at the suitable locations on the internal surface of the trachea or bronchus for effectively picking up the ECG lead current. Moreover, it is inadmissible to dislocate the lead electrodes in the trachea or bronchus, and thus, there has been a great need for a safe, reliable and handy intrabronchial catheter which can be suitably 20 applied for intrabronchial electrocardiography and has ECG
lead electrodes capable of being secured reliably onto the anatomically prescribed locations in the trachea or bronchus.
To overcome the drawbacks of the conventional apparatus for monitoring bronchial electrocardiogram applicable for intrabronchial electrocardiography, this - 6 - ~~~4~4~
invention has an object to provide an apparatus capable of stably and reliably monitoring bronchial electrocardiogram with a high accuracy, which has a structure capable of securely and easily retaining ECG lead electrodes at anatomically prescribed locations in the trachea or bronchus, and effectively detecting an ECG lead current.
Another object of this invention is to provide an apparatus for monitoring bronchial electrocardiogram, which has a catheter capable of being safely and easily 10 inserted into and pulled out from the trachea or bronchus without causing a patient pain.
A further object of this invention is to provide an apparatus for monitoring bronchial electrocardiogram, which is effectually applicable for not only intra bronchial electrocardiography, but also atrial pacing so as to obtain various cardiac information for diagnosing possible heart disorders such as supraventricular tachyarrhythmia and distinguishing supraventricular tachyarrhythmia from ventricular tachycardia while 20 effecting the atrial pacing.
To attain the aforementioned objects according to this invention, there is provided an apparatus for monitoring bronchial electrocardiogram, which comprises an elastic intrabronchial catheter to be inserted into the trachea or bronchus, at least one inflatable balloon disposed around the outer periphery at the leading end portion of the ~~4~~~
_~_ intrabronchial catheter, and one or more bronchial ECG lead electrodes mounted on the balloon.
The invention in one broad aspect provides apparatus for obtaining a bronchial electrocardiogram and effecting cardiac pacing. The apparatus comprises an elastic hollow intrabronchial catheter capable of being inserted into the trachea or bronchus, the catheter having a leading end portion. The apparatus also comprises an electrically non-conductive inflatable balloon disposed at the leading end portion of the intrabronchial catheter. Two pairs of bronchial ECG
electrodes are provided which detect an ECG lead current and effect cardiac pacing, respectively. Two of the bronchial ECG lead electrodes are mounted on an inflatable portion of the balloon so as to move outwardly away from the catheter as the balloon is being inflated; the other two bronchial ECG lead electrodes are also mounted to the balloon. An air tube extends along the catheter and has a leading end connected to the balloon such that air can be introduced into the balloon from the tube. The balloon is inflatable to a degree at which the balloon can contact an inner wall portion of the trachea or bronchus so that the ECG electrodes can be brought to anatomically prescribed locations on the inner wall portion when the catheter is inserted into the trachea or bronchus and the balloon is inflated to the degree.
This invention will become more fully understood from the detailed description given hereinbelow and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the present invention, and wherein:
Figure 1 is a partially sectioned side view showing _ g _ one embodiment of an apparatus for monitoring bronchial electrocardiogram according to this invention, Figure 2 is an explanatory diagram of the apparatus in use, Figure 3 is an enlarged view showing another embodiment having four ECG lead electrodes mounted in line on one peripheral side of a balloon, Figure 4 is an enlarged view showing still another embodiment having two ECG lead electrodes mounted on one peripheral side of a balloon, Figure 5 is an enlarged view showing yet another embodiment having four ECG lead electrodes mounted on the other peripheral side of a balloon, Figure 6 is a partially sectioned side view showing a further embodiment of an apparatus according to this invention, having an a~iliary balloon, and Figure 7 is an enlarged view showing the principal portion of Figure 6.
The presnet invention will become more fully understood from the detailed description given hereinbelow and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the 20 present invention.
The apparatus for monitoring bronchial electrocar-diogram according to this invention is shown in Figures 1 and 2 as one example and basically comprises an intrabronchial catheter 1 to be inserted into the trachea or bronchus, and an inflatable balloon 2 disposed around the outer periphery at the leading end portion of the _ g _ intrabronchial catheter 1, an air tube 3 for supplying air to the balloon 2 therethrough, and bronchial ECG lead electrodes 4a and 4b mounted on the balloon 2.
The intrabronchial catheter 1 is made from an elastic material such as synthetic resins. In this embodiment, a tube to be inserted into the trachea T for the purpose of general anesthesia or artificial respiration may be substituted for the intrabronchial catheter 1. Therefore, the catheter 1 is provided at the tail end portion thereof 10 with a connector 5 which is generally utilized in an air supply tube connected to an artificial respirator.
The balloon 2 mounted on the leading end portion of the catheter 1 is made of a thin membrane of synthetic resins or rubber, and shaped in a bag enveloping the leading end portion of the catheter I. The balloon 2 assumes a deflated state in its normal condition and is inflated by being supplied with air when the catheter 1 is completely inserted into the trachea as illustrated in Figure 2.
20 The balloon 2 mounted on the catheter 1 has a function of not only fixedly retaining the leading end portion of the catheter 1 at a prescribed location in the trachea T, but also preventing the air introduced into the lungs through the outside periphery of the catheter 1 from leaking out. Therefore, the balloon 2 is designed so that the outer surface thereof comes into tight contact with - l~ -the internal wall surface of the trachea or bronchus when being inflated with supply of air.
The air tube 3 enters inside the catheter 1 from the middle portion of the catheter and extends toward the leading end portion of the catheter along the internal surface of the catheter. Where the air tube 3 reaches the balloon 2, the air tube 3 pierces the wall of the catheter to be connected to the balloon. The air tube 3 is provided at the tail end thereof with a check valve 6 through which it is connected to an air pump 7 so as to supply the air to the balloon 2. Though the air pump 7 fundamentally serves to supply the air to the balloon 2, it may possess a function of releasing the air in the balloon 2 by force to deflate the balloon.
The bronchial ECG lead electrodes 4a and 4b are secured on the surface of the balloon 2 at a prescribed interval. The ECG lead electrodes are connected to respective lead wires 8 extending along the internal wall surface of the catheter 1 in the same manner as the air tube 3. The tail ends of the ECG lead electrodes have external terminals 9a and 9b connected to a not-shown electrocardiograph.
The locations at which the bronchial ECG lead electrodes 4a and 4b are attached to the balloon 2 are variously determined in accordance with the material of the balloon. In a case of using the balloon of non-conductive material such as rubber, the ECG lead electrodes may be attached to the outside of the membrane of the balloon. However, the ECG lead electrodes may be arbitrarily disposed on either side of the membrane of the balloon. In either case, the ECG lead electrodes must be secured so as not to fall away from the balloon when inserting the catheter into the trachea. Therefore, it is preferable to partially bury each electrode in the membrane of the balloon so as to expose a part of the 10 electrode outside to ensure an electrical connection of the electrode to the internal wall surface of the trachea.
The aforementioned intrabronchial catheter 1 is applied practically in performing general anesthesia or inserted into the trachea T through the oral cavity or nasal cavity as illustrated in Figure 2. The intra-bronchial catheter 1 is introduced until the leading end thereof reaches the bifurcation Y of the trachea in the same way as a tube for general anesthesia. The bronchial 20 ECG lead electrodes can easily be inserted into the trachea and located at the anatomically prescribed position on the bifurcation Y of the trachea by a person who has some experience of practicing medicine. When the leading end of the catheter reaches the anatomically prescribed location on the bifurcation Y of the trachea, air is supplied to the balloon 2 through the air tube 3 to inflate the balloon.
As mentioned above, the balloon 2 is inflated with air in the trachea, thereby bringing the outer surface of the balloon in tight contact with the internal wall surface of the trachea. Consequently, the ECG lead electrodes 4a and 4b are stably fixed in the state closely contacted with the internal wall surface of the trachea, to thereby enable the ECG lead current to be detected through the lead wires 8.
10 When taking off the catheter 1 from the trachea, the air in the balloon 2 is released through the air tube 3 by operating the air pump, thereby deflating the balloon.
In the illustrated embodiment, the catheter 1 has the connector 5 at the tail end thereof because of using a common tube for general anesthesia or artificial respiration as the catheter 1, but the connector 5 is by no means necessary to this invention.
Furthermore, the balloon 2 may be provided with only a single bronchial ECG lead electrode or a plurality of ECG
20 lead electrodes. When using the single bronchial ECG lead electrodes, a counterpart ECG lead electrode may be attached onto the surface of the human body. When using the plurality of ECG lead electrodes, the electrodes are arranged on the membrane of the balloon at intervals.
Also, when using the plurality of ECG lead electrodes, the electrodes must fundamentally be disposed in pairs, but _ 13 _ ~, ~ '' the number of the electrodes should not be understood as limitative.
Figure 3 through Figure 5 illustrate other embodiments of modified catheters each having additional bronchial ECG
lead electrodes 4c and 4d on the balloon 2. These catheters can be applied for not only monitoring bronchial electrocardiogram, but also effecting cardiac pacing.
In the embodiment shown in Figure 3, four bronchial ECG lead electrodes 4a, 4b, 4c and 4d are arranged on the 10 left side portion of the membrane of the balloon 2 in line in the lengthwise direction of the catheter. It is possible to use the pair of ECG lead electrodes 4a and 4c used for monitoring an electrocardiogram, and the pair of ECG lead electrodes 4b and 4d for cardiac pacing. The two pairs of ECG lead electrodes are arranged in line alternatively at regular intervals so as to ensure a sufficient distance between the paired electrodes for effectively detecting the ECG lead current. Thus, when practicing cardiac pacing, the ECG lead electrodes 20 sufficiently separated can be applied to detect a faint pacing current, and therefore, a patient will little feel an unpleasant sensation such as a cauterized feeling. The ECG lead electrodes arranged in line in this embodiment are separated by a distance of about 20 mm so as to leave a distance of 40 mm between the electrodes 4a-4c and 4b-4d which are substantially paired off.
2~g~~45 In the embodiment shown in Figure 4, two bronchial ECG
lead electrodes 4a and 4b are attached to the peripheral side surface of the balloon 2, and another set of two bronchial ECG lead electrodes 4c and 4d are attached to the front surface of the balloon. The embodiment shown in Figure 5 has four bronchial ECG lead electrodes 4a, 4b, 4c and 4d arranged in line on the right side surface of the balloon 2.
These embodiments having the different arrangements of the ECG lead electrodes are expected to undergo a change in electrocardiogram. Then, the inventors experimentally produced some intrabronchial catheters based on these embodiments for ascertaining the cardiac pacing performance, but the difference among them was not noticeable even on careful observation.
As was touched on earlier, the bronchial ECG lead electrodes can easily be inserted into the trachea and located at the anatomically prescribed position on the bifurcation Y of the trachea by a person skilled in practicing medicine. However, if the inflated balloon 2 slightly deviates from the prescribed position on the bifurcation Y, thereby separating the ECG lead electrodes from the anatomically prescribed locations in the trachea or bronchus, an electrocardiogram is not affected too much.
Next, a modified embodiment of the apparatus for monitoring bronchial electrocardiogram according to this invention will be described with reference to Figure 6 and Figure 7. The apparatus in this embodiment has an auxiliary balloon 11 for supporting the intrabronchial catheter 1 in addition to the balloon 2 with the ECG lead electrodes 12a and 12b. The auxiliary balloon 11 is disposed distant from the primary balloon 2 at the leading end portion of the catheter 1 by a suitable distance.
The auxiliary balloon 11 is connected to an air tube ?0 13 which extends along the internal surface of the catheter 1 in the same manner as the air tube 3 connected to the primary balloon 2. Similarly to the air tube 3 with the check valve 6, the air tube 13 is also provided at the tail end thereof with a check valve 14 through which the air tube 13 is connected to an air pump. By selectively operating the air pumps, the balloons 2 and 11 can be optionally inflated or deflated.
The ECG lead electrodes 12a and 12b in this embodiment are connected to external terminals 9a and 9b through lead 20 wires 8 extending along the internal surface of the catheter 1.
The ECG lead electrodes 12a and 12b are disposed one on either side of the outer surface of the balloon 2, and can be used as electrodes for electrocardiogram or cardiac pacing.
In the illustrated embodiment, reference numeral 17 denotes vent holes formed in the leading end portion la of the catheter 1 between the balloons 2 and 11.
The intrabronchial catheter 1 in this embodiment is inserted into the trachea until the balloon 2 reaches the bifurcation Y of the trachea, and thereafter, both the balloons 2 and 11 are inflated by being supplied with air through the respective air tubes. The balloon 2 may be inserted into the right or left bronchus B1 or B2. In Figure 7, the balloon 2 is inserted into the left bronchus 10 H2 and inflated with air, thereby bringing the ECG lead electrodes 12a and 12b into close contact with the internal wall surface of the bronchus.
The vent holes 17 serves as paths for permitting air to flow into the right bronchus B1 therethrough.
The intrabronchial catheter 1 in this embodiment is inserted across the bifurcation Y of the bronchus B2 so that the ECG lead electrodes 12a and 12b can be brought further close to the heart. Therefore, precise cardiac measurement or cardiac pacing can be effected with ease.
20 To facilitate the insertion of the intrabronchial catheter into the trachea and further into the bronchus having a smaller inner diameter than the trachea, it is desirable to made the balloon 2 smaller in diameter when being inflated than the inflated balloon 11, and the part la of the intrabronchial catheter between the balloons 2 and 11 may preferably be made rather small in diameter.
2~8~5~~
As is described above, though the apparatus according to this invention was fundamentally developed for the purpose of monitoring bronchial electrocardiogram for diagnosing the cardiac function, this apparatus can be effectively applied to transbronchial atrial pacing which is effected by inserting the intrabronchial catheter into the bronchus near the atrium of the heart in the manner identical to transesophageal atrial pacing which is effected by inserting pacing electrodes into the esophagus. When practicing the transbronchial atrial pacing by using the apparatus according to this invention, the connection of the bronchial ECG lead electrodes mounted on the balloon in this invention may be switched from an electrocardiograph to a pacing device for imparting electrical stimulation to the heart. However, since the atrial pacing which is generally effected while monitoring the cardiac function requires plural sets of the bronchial ECG lead electrodes, namely, at least four ECG lead electrodes are necessary. Also, the ECG lead electrodes are required to be arranged at regular intervals as described above. In this respect, the apparatus of this invention has a rational structure capable of arranging the ECG lead electrodes at regular intervals on the surface of the balloon by alternatively positioning the ECG lead electrodes in pairs, thereby to automatically position the bronchial ECG lead electrodes on the anatomically prescribed locations on the inernal surface of the trachea or bronchus.
As is apparent from the description given in detail above, according to this invention, by inserting the intrabronchial catheter into the trachea or bronchus and supplying air to the balloon through the air tube to inflate the balloon in the trachea or bronchus, the bronchial ECG lead electrodes can easily be secured stably in close contact with the internal wall surface of the trachea or bronchus. Besides, by releasing the air from the inflated balloon, the ECG lead electrodes can safely be pulled out from the trachea or bronchus with ease.
Thus, the present invention enables the intrabronchial catheter of this invention to be easily inserted into the trachea or bronchus and the bronchial ECG lead electrodes to be reliably positioned the anatomically prescribed locations in the trachea or bronchus near the heart, and proves advantageous in monitoring bronchial electrocar-diogram. Since the bronchial ECG lead electrodes can be ~0 secured close to an atrium of the heart, the apparatus of this invention can be efficiently used for not only detecting an ECG lead current for an electrocardiogram, but also effecting atrial pacing.
Furthermore, since the intrabronchial catheter of this invention can be used as a tube for general anesthesia or artificial respiration, it is convenient from the standpoint of medical treatment to effect the general anesthesia or artificial respiration while observing an electrocardiogram.
As described above, since the apparatus for monitoring bronchial electrocardiogram according to this invention can be effectually applied for not only intrabronchial electrocardiography, but also atrial pacing, various cardiac information for diagnosing possible heart disorders such as supraventricular tachyarrhythmia and distinguishing supraventricular tachyarrhythmia from ventricular tachycardia can be reliably obtained with ease.
It is further understood by those skilled in the art that the foregoing description is a preferred embodiment of the disclosed device and that various changes and modifications may be made in the invention without departing from the spirit and scope thereof.
Claims (12)
PROPERTY OF PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. Apparatus for obtaining a bronchial electrocardiogram and effecting cardiac pacing, said apparatus comprising:
~ an elastic hollow intrabronchial catheter capable of being inserted into the trachea or bronchus, said catheter having a leading end portion, ~ an electrically non-conductive inflatable balloon disposed at the leading end portion of said intrabronchial catheter;
~ two pairs of bronchial ECG electrodes which detect an ECG lead current and effect cardiac pacing, respectively, ~ two of said bronchial ECG lead electrodes being mounted on an inflatable portion of said balloon so as to move outwardly away from said catheter as the balloon is being inflated;
~ the others of said bronchial ECG lead electrodes also being mounted to said balloon;
~ an air tube extending along said catheter and having a leading end connected to said balloon such that air can be introduced into said balloon from said tube; and ~ said balloon being inflatable to a degree at which said balloon can contact an inner wall portion of the trachea or bronchus such that said ECG electrodes can be brought to anatomically prescribed locations on the inner wall portion when the catheter is inserted into the trachea or bronchus and the balloon is inflated to said degree.
~ an elastic hollow intrabronchial catheter capable of being inserted into the trachea or bronchus, said catheter having a leading end portion, ~ an electrically non-conductive inflatable balloon disposed at the leading end portion of said intrabronchial catheter;
~ two pairs of bronchial ECG electrodes which detect an ECG lead current and effect cardiac pacing, respectively, ~ two of said bronchial ECG lead electrodes being mounted on an inflatable portion of said balloon so as to move outwardly away from said catheter as the balloon is being inflated;
~ the others of said bronchial ECG lead electrodes also being mounted to said balloon;
~ an air tube extending along said catheter and having a leading end connected to said balloon such that air can be introduced into said balloon from said tube; and ~ said balloon being inflatable to a degree at which said balloon can contact an inner wall portion of the trachea or bronchus such that said ECG electrodes can be brought to anatomically prescribed locations on the inner wall portion when the catheter is inserted into the trachea or bronchus and the balloon is inflated to said degree.
2. The apparatus according to claim 1 wherein said bronchial ECG lead electrodes are arranged at prescribed intervals.
3. The apparatus according to claim 1, and further comprising an air pump connected to said balloon via said air tube, the pump supplying the air to inflate said balloon.
4. The apparatus according to claim 1, and further comprising an air pump and a check valve connected to said balloon via said air tube, said pump supplying the air to inflate said balloon.
5. The apparatus according to claim 1, wherein said intrabronchial catheter has a connector connectable to an air supply tube of an artificial respirator so that a patient can breath using an artificial respirator as the catheter is inserted into the trachea or bronchus and when the balloon is inflated in the trachea or bronchus.
6. The apparatus according to claim 1, and further comprising lead wires which extend along an internal wall surface of said catheter, and external terminals of an electrocardiograph, said lead wires being connected to said ECG lead electrodes which detect an ECG current and to said external terminals.
7. The apparatus according to claim 1, wherein said ECG lead electrodes are arranged in line at regular intervals.
8. The apparatus according to claim 7, wherein the ECG lead electrodes which detect an ECG lead current are alternately disposed with the ECG lead electrodes which effect cardiac pacing.
9. The apparatus according to claim 1, wherein said balloon has a side peripheral surface on which said two of the bronchial ECG lead electrodes are mounted and a front surface on which the others of said ECG lead electrodes are mounted.
10. The apparatus according to claim 9, wherein the ECG electrodes which detect an ECG lead current are mounted on said side peripheral surface and said front peripheral surface, respectively, and the ECG lead electrodes which effect cardiac pacing are mounted on said side peripheral surface and said front peripheral surface, respectively.
11. The apparatus according to claim 1 further comprising an auxiliary balloon disposed on said intrabronchial catheter distant from said balloon.
12. The apparatus according to claim 11, wherein said intrabronchial catheter has at least one vent hole extending therethrough at a location between said balloons.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP3-360403 | 1991-12-06 | ||
| JP36040391 | 1991-12-06 |
Publications (2)
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| CA2084545A1 CA2084545A1 (en) | 1993-06-07 |
| CA2084545C true CA2084545C (en) | 1999-11-02 |
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| CA002084545A Expired - Fee Related CA2084545C (en) | 1991-12-06 | 1992-12-04 | Apparatus for monitoring bronchial electrocardiogram |
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| US (1) | US5379765A (en) |
| EP (1) | EP0545739B1 (en) |
| AU (1) | AU669864B2 (en) |
| CA (1) | CA2084545C (en) |
| DE (1) | DE69228468T2 (en) |
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-
1992
- 1992-12-04 AU AU29884/92A patent/AU669864B2/en not_active Ceased
- 1992-12-04 CA CA002084545A patent/CA2084545C/en not_active Expired - Fee Related
- 1992-12-04 US US07/986,039 patent/US5379765A/en not_active Expired - Fee Related
- 1992-12-07 DE DE69228468T patent/DE69228468T2/en not_active Expired - Fee Related
- 1992-12-07 EP EP92311119A patent/EP0545739B1/en not_active Expired - Lifetime
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| AU669864B2 (en) | 1996-06-27 |
| DE69228468T2 (en) | 1999-06-17 |
| EP0545739A1 (en) | 1993-06-09 |
| CA2084545A1 (en) | 1993-06-07 |
| US5379765A (en) | 1995-01-10 |
| EP0545739B1 (en) | 1999-02-24 |
| AU2988492A (en) | 1993-06-10 |
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