DE102008016775A1 - Device for correcting insufficiency of mitral valve between left atrium and left ventricle of heart, has cylindrical element comprising narrow through hole that is adapted for feeding neochordae filament - Google Patents

Abstract

The device has an elastic cylindrical shaped element (32) with two ends (33, 34). The element comprises a narrow through hole (36), where the hole runs in longitudinal direction from the end (33) to the end (34). The hole is adapted for feeding neochordae filament (40). The bore hole is connected with outer surface of the element by a narrow inlet. A central borehole (38) runs in longitudinal direction to the element from the end (33) to the end (34). Diameter of a central channel corresponds to diameter of the element. An independent claim is also included for a method for correcting insufficiency of mitral valve between a left atrium and a left ventricle of heart.

Description

The The present invention relates to a device for correcting the Insufficiency of the mitral valve between left atrium and left ventricle of a heart, where the mitral valve has a ring, two sails and Includes papillary muscles.

The Heart is generally divided into a right and a left half of the heart, each consisting of a chamber (ventricle) and an atrium (atrium) consist. The blood can only flow in one direction in the heart spaces between the forecourts and chambers and the vessels adjoining the heart chambers heart valves which work like valves. In the right atrium open the upper and lower vena cava, which is the deoxygenic (venous) blood from the big circle to the heart. Between the right atrium and the right ventricle is located the tricuspid valve, which acts like a valve during chamber contraction a return current of the blood in the atrium prevented. It comprises three components, the above chordae attached to the musculature of the chamber (hence, sail flap). About one common stem the two pulmonary arteries then leave the right Chamber. These lead the oxygen-poor blood to the pulmonary circulation too. Through the pulmonary veins flows then the oxygen-rich (arterial blood) from the pulmonary circulation to the left atrium too. From here it passes over another sail flap, the Mitral valve to the left ventricle. The outflow is done via the Aorta, which has a flap like the pulmonary artery (aortic valve).

The Mitral valve is located between left atrium and left ventricle of the heart. The mitral valve, which consists of the mitral ring, the mitral sails and the papillary muscles with the chorda tendiae (tendon threads), is because of the pressure differences between systole and diastole on the one hand and the left atrium and the left ventricle on the other hand a very huge Exposed to pressure.

Of the Mitral ring consists of compact connective tissue and connects the atrial myocardium with the chamber myocardium, and supports the mitral leaflets.

About the Papillary muscles are the two sails of the mitral valve with the chordae tendiae attached to the wall of the left ventricle. The majority of Chrodea tendiae are based on the papillary muscles, especially serve the train regulation of the chordae, creating an optimal flap closure allows becomes. Furthermore, the papillary muscles reduce mechanical stress the chordae tendiae.

at Mitral valve insufficiency is that between left atrium and left ventricle located heart valve, so the mitral valve, no longer able to completely close. Thereby flows while of the heartbeat a part of the blood from the left ventricle again back in the left atrium. This blood flows before the next heartbeat - together with the blood arriving from the lungs - again through the mitral valve in the left ventricle. As a result, it virtually shuttles between left Atrium and left ventricle back and forth, why on the one hand the capacity the left ventricle is restricted, and on the other hand, the left atrium by the blood flowing back and forth is stretched.

Also can be due to the larger amount of blood in the left atrium to back the blood to the lungs, where the blood pressure elevated and water from the blood is pressed into the lungs. The longer the increased There is blood pressure in the lungs and the more water in the lungs the harder it gets for the right ventricle, blood to pump into the lungs. As a result, the right ventricle is overloaded and there is a right heart failure.

easier Forms of mitral valve insufficiency usually cause no discomfort, because the extensible wall of the left atrium one for a long time can compensate for the increased burden. With progressive Illness can as symptoms heart rhythm disorders, Atrial fibrillation, shortness of breath and edema occur, as well as finally the accumulation of blood clots in the dilated left atrium, with the danger of these with the bloodstream reaching into the blood vessels of the brain get there and trigger a stroke there.

Cause of mitral valve insufficiency several diseases affecting the function of the valve in different Impair the way. So leads the myxoid degeneration of the valve connective tissue to elongation and / or to a demolition of the chordae tendiae of the mitral valve and to a successively resulting segmental prolapse of the valve leaflets.

For the repair of the modified Chordae tendiae are in the art several options available. In various surgical techniques, the Chordae tendiae be replaced with artificial chordae, which are then referred to as so-called "Neochordae". The most critical step in the surgical treatment of degenerative mitral regurgitation is to determine the length of these neochordae, which must ensure perfect apposition of the prolapsed segment to the opposite segment of the mitral valve leaflet. The central problem is that the optimal conditions for the determination of the Length of the Neochordae are in principle only given to the beating, normally loaded heart.

task It is therefore an object of the present invention to provide a device with which on the beating heart the length of the neochordae is safe and sound can be easily determined.

According to the present Invention, this object is achieved in that the initially mentioned device an elastic, cylindrical element having a first and a second end, wherein the cylindrical element in its longitudinal direction and from the first end to the second end extending through holes having a first diameter, which is the implementation of Neochordae threads are adjusted.

The The object underlying the invention is further by a method resolved to correct the insufficiency of the mitral valve of a heart in which a device is used, which is an elastic, cylindrical element having a first and a second end, wherein the cylindrical element in its longitudinal direction and from the first end to the second end extending through holes having a first diameter, which is the implementation of Neochordae threads are adjusted.

The The object underlying the invention is thus perfect solved.

With the device according to the invention can the length the Neochordae replacing the Chordea tendiae on the beating heart be determined exactly. For this purpose, first a heart-lung machine connected to the device in the papillary muscle either temporarily - namely for the duration the determination of neochordae length - or permanent to be able to use it stably in the papillary muscle. The through the punctures of the device running Neochordae then with their on the ventricular side emerging from the device Then end at the sail edges fixed. The other ends of the neochordae occur on the back wall of the ventricle and can For example, provided with tourniquets, influenced in their length and marked the desired length become.

Subsequently, will the connection to the heart-lung machine removed, leaving the Heart begins again, to beat yourself. The emerging at the rear wall ends of the Neochordae are then dressed, which is the decisive step represents this operation. By means of the device according to the invention can the length the Neochordae thus concluding be adjusted exactly. To fix the end of the neochordae, the exits at the rear wall, can, for example, a fuse attached be, preferably a button-shaped fuse.

The inventive device can then either be removed from the muscle or in the muscle remain. In the former case, therefore, the neochordae threads will follow the length determination directly through the muscle, in the second case, the threads run through the punctures of the device remaining in the muscle.

The inventive device can, for example, either over the posterior wall of the ventricle or beyond the papillary muscle become. In the latter case, it is preferable if the through holes not isolated, d. H. isolated from the outer longitudinal surface of the device run inside but over corresponding, also in the longitudinal direction running accesses from the outer surface of the Device can be reached. Thus, the holes are on your whole length, eg through access channels, In contact with the environment, so that the device from the muscle - and the Threads - removed can be, thereby reducing the threads but remain in the muscle.

One Advantage of the device according to the invention is thus that the length the neochordae can be accurately adjusted at the beating heart, what with the previously known in the art or Devices was not the case. The channel-like holes enable due to the adjustment of their diameter, performing the Neochordae in the longitudinal direction of the cylindrical one Element. The length the Neochordae is so chosen that the neochordae threads on both Ends of the cylindrical element emerge, in such a way that the threads with their end, the the intraventricular Side of the cylindrical Elements exits, at the sail edges can be fixed and with its extracardiac end from the posterior wall of the left ventricle escape. The diameter of the through holes of the cylindrical element is chosen allowing easy sliding of the neochordae threads within the channels and is therefore preferably slightly larger than the diameter of the guided through the holes Neochordae, for example Neochordae "CV4 Gore ".

Especially is preferred if in the cylindrical element at least two, preferably 3 to 5 channel-like holes are provided.

In this measure, it is advantageous that the number of perforations can be adapted to the number of Neochordae that can replace the Chordae tendiae. As needed, two or more chordae tendiae can be replaced the. The cylindrical element may be formed as a kind of "revolver", with the channel-like through holes in a circular arrangement over the cross-sectional area of the element. It is understood, however, that any other arrangement of the through holes can be provided, in which case an essential aspect is the adaptation to the respectively to be replaced Chordae tendiae.

at the device according to the invention is preferred if, furthermore, a longitudinal direction to the cylindrical element and from the first end to the second end extending central bore provided with a second diameter suitable for recording a guidewire is formed This measure has the advantage that the device simply over a guide wire into the heart, more precisely the papillary muscle, introduced can be. The guidewire can, for example, a Seldinger guide wire be over which the device is inserted into the papillary muscle can.

The introduction the device according to the invention takes place, for example, in that an insertion needle according to the Seldinger technique from the ventricular Side is introduced axially into the papillary muscle, so they in case of the anterior papillary muscle on the lateral wall, and in the case of the posterior papillary muscle on the posterior wall of the left ventricle exit. The introduction needle can, for example, length markings by which then the length of the in the papillary muscle to be introduced cylindrical element can be determined. Accordingly, depending on the patient / heart a suitable, d. H. in its length matching, cylindrical element selected and over the guidewire introduced into the papillary muscle. The Neochordae are then fixed on one side to the sail edges and on the extracardiac side, which is due to the punctures in the cylindrical Element and the running and sliding threads is possible.

there is particularly preferred when the cylindrical element on one of its Ends has a pointed attachment.

These measure has the advantage that thus the insertion of the device in the Papillary muscle is relieved overall. The cylindrical element is about the laid with an introducer needle guidewire guided, and can easily penetrate the papillary muscle with the tip. The tip points for this also a central through hole, in which at insertion of the device into the papillary muscle of the guidewire.

Of the tip-shaped Attachment is a separate element that is used to insert the cylindrical Elements is placed on this and thus a tip for the device forms. After insertion of the cylindrical one Elements in the papillary muscle, the attachment is removed, causing the neochordae threads come to lie extracardially.

there is particularly preferred when the length of the cylindrical element corresponds to a length, resulting from the length of the papillary muscle and the posterior wall of a ventricle of the heart of a patient to be treated.

at this embodiment will the length of the cylindrical Exactly measured elements, for example. Based on a length marker on the insertion needle. The length of the cylindrical one Elements is advantageous as long as the track, the from the site of the posterior wall of the left ventricle reaches, at the the introduction needle exit, to the tip of the papillary muscle in the ventricle. Thereby is guaranteed that the cylindrical Element completely spans the papillary muscle and the posterior wall of the ventricle and with its holes a way for the Neochordae threads through forming these tissues. Thereby have to the neochordae threads for your length determination not directly guided by the papillary muscle (s), and can rather about it out well in the through holes of the cylindrical element and by putting on in your length be set. The device can be made after fixation of the threads be removed from the muscle, or remain in the muscle permanently.

at a development of the device according to the invention is preferred if the neochordae threads have tourniquets on at least one of their first ends. Especially is preferred when tourniquets turn to the extracardiac lie next ends of Neochordae threads are. This embodiment has the advantage that the Neochordae threads - for example, after their one-sided intraventricular Fixation at the sail edges - over the extracardial Tourniquets tightened and fixed in their length can be.

In a still further embodiment is preferred when the cylindrical element to lie at his intraventricular coming end has a section that has a larger diameter as the remaining portions of the cylindrical member. It is further preferred if the section is integral with the cylindrical one Element is formed, or as a separate component.

This measure has the advantage that the portion with the larger diameter as a stop element in the introduction of the cylindrical Ele ment acts in the papillary muscle, so that it can be introduced into the papillary muscle, so to speak, until it stops, so long until the continuation of the element is stopped in the papillary muscle due to the larger end portion. This avoids that the cylindrical element slips further than desired in the papillary muscle, whereby the neochordae threads at least partially directly in the papillary muscle - and not in the "revolver" - run. With this embodiment, therefore, the device remains permanently in the papillary muscle.

In a further embodiment is preferred when the neochordae filaments comprise a material, that selected is selected from the group comprising polypropylene, polytetrafluoroethylene, Polyurethane, or mixtures thereof.

Further is preferred if the elastic cylindrical element, or all other components of the device, such as a sharpener section and an introduction element, a material, for example. Polyvinyl chloride or the like suitable materials.

The mentioned materials have the advantage that they are in the field of Medical technology has already been adequately tested and tested. A essential condition is their biocompatibility with human / animal Tissues, as well as their inertness and longevity. In particular, polytetrafluoroethylene (PTFE) has proven to be a material for Neochordae threads proved to be suitable.

In a further embodiment is preferred when introducing of the cylindrical one Elements further an insertion element is provided, which releasably connected to the cylindrical member for its introduction is.

These measure has the advantage that with the introduction element the device can be easily introduced into the papillary muscle and after its Placement can be removed.

• a) Einbringen einer Vorrichtung mit einem elastischen, zylinderförmigen Element, das kanalartige Durchbohrungen und darin verlaufende Neochordae-Fäden aufweist, nach der Seldinger Technik in den Papillarmuskel und die Hinterwand des linken Ventrikels,
• b) Befestigen des einen Endes der Neochordae-Fäden an den Rändern der Segel der Mitralklappe,
• c) Anziehen der Neochrodae-Fäden am anderen Ende bis zur gewünschten Einstellung des Abstandes zwischen Papillarmuskel und Mitralklappenring.

As already mentioned above, the present invention also relates to a method for correcting the mitral valve insufficiency between the left atrium and the left ventricle of a heart, the mitral valve comprising a ring, two leaflets and papillary muscles comprising the following steps:

• a) introducing a device with a resilient, cylindrical element having channel-like holes and neochordae threads extending therein, according to the Seldinger technique in the papillary muscle and the posterior wall of the left ventricle,
• b) attaching one end of the neochordae filaments to the edges of the mitral valve leaflets,
• c) Tighten the Neochrodae threads at the other end to the desired adjustment of the distance between papillary muscle and mitral valve annulus.

there is preferred when an embodiment the device according to the invention is used. By introducing the device via the Seldinger technique injuries the papillary muscle advantageously avoided. The introduction takes place for example, about the ventricular Side, with an insertion needle is introduced axially into the papillary muscle, so that it on the Lateral, posterior wall of the left ventricle emerges. For this Step is the patient connected to a heart-lung machine. These introducer may have, for example, length marks, based on which the length of the to be introduced cylindrical Elements, or the "revolver" determine leaves. The selected Revolver is then over a Seldinger guidewire introduced. Following that, the neochordae are using a conventional surgical needle fixed to the sail edges.

To this step can For example, also other conventional Procedures, such as, for example, an annuloplasty performed.

The Neochordae can For example, also have different colored markings and tourniquets be provided. With the color markers is the treating physician the possibility given that for the tightening of the chordae necessary echocardiographic image sequences, represent the individual parts of the mitral valve, with those at this Correcting segments anchored neochordae. The length of the Neochordae can by tightening the Neochordae threads on their End that emerges from the back wall, especially through the tourniquets, which are at this end, be influenced. The patient will be followed by the heart-lung machine disconnected, taking the heart back by itself begins to beat. The following decisive step, namely the Tightening the neochordae threads to the desired Length, is, for example, under transesophageal, controlled echocardiographic control. As completion of the operation can, for example, a button-shaped Closure or fuse attached to the place where the Neochordae emerge from the lateral / posterior wall of the ventricle. This can the predetermined length the neochordae are permanently fixed us stable.

With the method according to the invention is achieved that for the neochordae in the specific case required length exactly and can be determined by the beating heart.

It is understood that the above features and the to be explained below not only in the specified combination, but also in other combinations or alone, without to leave the scope of the present invention.

The The invention will become apparent from the following description and the accompanying drawings. It demonstrate:

1 a schematic representation of a cross section through a heart of a human;

2a a schematic, not to scale representation of an embodiment of the device according to the invention, with pre-assembled threads that serve as Neochordae;

2 B a not to scale cross-section through the cylindrical member of another embodiment of the device according to the invention;

3a a schematic, not to scale representation of an introducer needle with guide wire, which is inserted intraventricularly into the papillary muscle;

3b a schematic, not to scale representation of an embodiment of the device according to the invention, which is temporarily inserted into the papillary muscle;

3c an embodiment of the device according to the invention in the final position in the papillary muscle;

4a a schematic, not to scale representation of a composite device according to the invention, before its introduction, having a pointed portion and an introducer portion;

4b a cross-section of an embodiment of a as in 4a represented Introducer part.

5a a cross section through a two-part securing element, which is part of the device according to the invention in one embodiment; and

5b a plan view of a portion of the fuse element with indicated Neochordae.

For a better understanding, first of all 1 explains the general structure of a human heart. In 1 a schematic cross-section through the heart of a man shown, which with 10 is marked. Here, the left atrium (atrium) with 11 and the left ventricle with 12 designated, the right atrium (atrium) with 13 and the right ventricle with 14 , The oxygen-poor blood is through upper and lower vena cava 15 and 16 the right atrium 13 fed. The blood comes from the right atrium 13 via the tricuspid valve 17 in the right chamber 14 and from there via the pulmonary valve 18 into the pulmonary veins 19 , The oxygenated blood in the lungs is then transferred to the left atrium 11 and about the mitral valve 20 in the left chamber 12 directed where it passes through the aortic valve 22 into the aorta 24 is pumped.

In 2a is with 30 Overall, an embodiment of the device according to the invention, with a cylindrical element 32 with a first intraventricular end 33 and an extracardiac second end 34 , The cylindrical element 32 has punctures 36 on, extending through the entire body of the cylindrical element 32 pull, and the in 2 circular with respect to the cross section of the cylindrical element 32 are arranged. In the middle of the cylindrical element 32 is also a second through hole 38 provided, which is adapted to receive the guidewire.

Arriving at its intraventricular end 33 has the cylindrical element 32 a section 42 on, which has a larger diameter than the remaining portions of the element. The section 42 represents a kind of stop element or flange, with which is prevented that the cylindrical element 32 is pushed into the papillary muscle as necessary or desired, and is an optional element. If the device is to remain in the muscle, is the section 42 provided, in the other case, ie, when the cylinder is removed from the muscle, such a section is not provided. The punctures 36 also pass through the section 42 , so that Neochordae threads 40 can escape here. In the embodiment of 2a are the Neochordae threads 40 preassembled.

In 2 B is a cross section of a further embodiment of the device according to the invention, or the cylindrical element shown in FIG 2 B With 82 is designated. The cylindrical element 82 has punctures 86 on, extending through the entire body (not shown) of the cylindrical element 82 pull, and the in 2 B circular with respect to the cross section of the cylindrical element 82 are arranged. In the middle of the cylindrical element 82 is also a second through hole 88 provided, which is adapted to receive the guide wire (not shown). Via channel-like access 90 are the drillings 86 over the entire longitudinal direction of the cylindrical element 82 in contact with the environment or with the surface 83 of the cylindrical element 82 in connection. This embodiment is suitable, for example, to be removed after fixation of the threads from the papillary muscle.

The 3a to 3c show various sections of the insertion process of an embodiment of the inventive device 30 , where the same elements as in 2 have been provided with the same reference numerals.

In 3a is shown schematically as an insertion needle 50 with a Seldinger wire 52 from intraventricular to the papillary muscle 54 is introduced. The insertion needle 50 points in 3a marks 51 on, by means of which the length of the einzüh-generating cylindrical element 32 of the embodiment 2a can be determined. After determining the length of the cylindrical element 32 a matching element is selected and placed over the Seldinger wire 52 in the papillary muscle 54 introduced. The cylindrical element 32 It is just as long that the end 34 of the cylindrical element 32 on the side / posterior wall of the ventricle just emerges, or there an extracardiac exit for the Neochordae threads 40 forms, and that the end 33 of the cylindrical element 32 through the at this end 33 provided section 42 with wider diameter not further into the papillary muscle 54 can penetrate. As already mentioned above, in another embodiment, the portion with the wider diameter is not provided, which is the removal of the cylindrical element 32 relieved from the muscle.

The latter position is in 3b shown schematically: Here it is shown that the introduced device temporarily placed Tourniquets 56 which can be tightened later. In 3b is further shown that in the end 33 intraventricular escaping Neochordae threads on the sails 58 , or the sail edges, are attached.

In 3c is the last position of the insertion shown schematically: Here is the introduced device 30 shown in their final position, this also being a security element 60 that is in 3c is shown button-like designed. With this fuse element 60 can the neochordae threads 40 be stably and permanently fixed at their exit site on the side / rear wall of the ventricle in their length. The mitral valve is after insertion of the device according to the invention and after the length adjustment of Neochordae back in working condition. Depending on the use of a permanent or temporary cylindrical element, the neochordae threads can run either in the through-holes of the cylindrical element (permanent retention of the element in the muscle) or, after removal of the element, directly in the muscle.

4a shows a schematic, not to scale representation of a composite device according to the invention, in the state before its introduction into the papillary muscle. This has a pointed section 62 on, the insertion into the papillary muscle over the Seldinger wire 52 facilitated. Furthermore, the cylindrical element 32 shown by means of an insertion or Introducer-part 64 can be handled and introduced into the muscle.

The Neochordae threads 40 passing through the punctures 36 . 86 are guided, for example, on one in Einführstiel 64 provided groove 65 led, as in 4b is shown with reference to the cross section of an embodiment.

The provided at the ends of Neochordae threads (Seldinger) needles thereby introducing the device into the papillary muscle for Avoiding puncture injuries in a protective cover and / or a foam-like material recorded in the manner of a cushion be (not shown).

To the fixation of the threads becomes the insertion stem, the solvable with the cylindrical one Element connected, simply pulled out.

In 5 is an embodiment of the fuse element 60 shown in more detail, with elements already in the 1 to 4 are provided with reference numerals, in 5 are named with the same reference numerals. The fuse element 60 is formed in two parts in this embodiment, with a first part 90 and a second part 92 , The first part 90 has a central channel 93 on that in the in 5 shown throughout the first part 90 is formed, but this is not necessary. The diameter of this central channel 93 corresponds in the embodiment shown approximately to the external diameter of the cylindrical element 32 , From this central channel 93 branch channels 94 . 95 radially outward, ie to the periphery or to the edge of the first part 90 from, or the channels 94 . 95 stand with the central channel 93 in connection. In the in 5 the embodiment shown are the channels 94 . 95 in the interior of the first part 90 Slightly downwards led, but this is not mandatory. The diameter of these channels 94 . 95 is greater than or equal to the diameter of the neochordae 40 but at least in such a way that the Neochordae 40 can slide freely in it.

The first part 90 can have a total of a flat cylindrical shape, so that the first part 90 in plan view of that side which comes to rest extraventricularly, ie on the epicardium of the ventricle, is approximately circular. It will be understood, however, that any other shape may be suitable to suit the purpose and function of the part.

The first part 90 also has at its periphery a recess, whereby the peripheral edge 96 of the first part 90 forming a protruding bead-shaped edge slightly above the remaining part of the first part 90 survives. On the underside of the beaded edge 96 of the first part 90 is also in the in 5 embodiment shown a recess 97 provided in the direction of the central channel 93 is trained. It forms the counterpart to a corresponding to the recess 97 trained bulbous section 102 of the second part 92 , which will be further described below.

The first part 90 also has recesses in its body 98 . 99 on, starting from the bottom and thus on the side facing away from the epicardium of the first part 90 in the body of the first part 90 usher. These recesses are sufficient 98 . 99 each up to the radially extending channels 94 . 95 in the body of the first part 90 into which they communicate with them.

The shape of the recesses 98 . 99 corresponds in each case as surveys formed counterparts 103 . 104 on the second part 92 in such a way that they can be received in the recesses in the manner of a plug. The counterparts 103 . 104 to the recesses 98 . 99 thus form plug-like extensions on the second part 92 , The second part 92 also has a raised peripheral edge 100 with a bead-shaped section 102 on that when merging the two parts 90 . 92 in the circumferential recess 97 of the first part 90 can be locked. Furthermore, the second part 92 a the central channel 93 of the first part 90 corresponding counterpart 106 at least partially from below into this channel 93 can be introduced if the two parts 90 and 92 be put together. This counterpart, in one embodiment, may comprise a felt portion or other textile fabric or mixtures thereof to simultaneously seal any bleeding from the ventricular wall.

By putting the two parts together 90 and 92 will be in the central channel 93 and in the channels 94 . 95 guided Neochordae 40 fixed, there when mating the parts 90 . 92 on the one hand, the counter-attacks 103 . 104 into the channels 93 . 94 and thus to the Neochordae running in it 40 press, and there on the other hand, the peripheral edge portion 102 of the second part 92 in the corresponding circumferential recess 97 of the first part 90 is pressed and locked; this will make the Neochordae 40 in their position or length between the parts 90 . 92 clamped so that they can no longer slip and change in length.

In 5b has the second part 92 five counterparts 103 . 104 on, as elevations star-shaped around the central counterpart 106 around on the second part 92 are formed. It is understood that the number of formed as surveys counterparts 103 . 104 according to the number of channels 94 . 95 or the neochordae led there 40 In the first part 90 directed. It can also be provided in another embodiment that only the peripheral edge portion is used for fixing the Neochordae and on the counterparts 103 . 104 is waived.

Also the shape of the counterparts 103 . 104 is arbitrary, as long as they are at the corresponding recesses 98 . 99 are adjusted. In 5b they are elongated, but also, for example, a pin-shaped or other forms may be provided.

To introduce the device according to the invention, the papillary muscle 54 pierced outward with a Seldinger needle from the ventricle. Subsequently, the Seldinger wire is inserted and the needle from the papillary muscle 54 away. Based on the markings on the Seldinger needle, the pre-assembled cylindrical element, which resembles a revolver because of its special design, can be selected with the appropriate length. The cylindrical element 32 . 82 is introduced after that, and the style 64 as well as the thorn-shaped approach 62 away from the top.

The extracardiac ends of the Neochordae can also be provided with a kind of needles to a subsequent threading the Neochordae 40 in the radial channels 94 . 95 to facilitate.

The intraventricular ends of the neochordae 40 are further, as already described above, sewn to the edges of the mitral valve. The ends of the neochordae led out at the back wall 40 be in the radial channels 94 . 95 of the first part 90 of the fuse element 60 introduced, via the central channel 93 over the channels 94 . 95 outwards to the periphery of the part 90 , The latter is applied to the ventricular wall.

Claims (21)

Device for correcting the mitral valve insufficiency between the left atrium and the left ventricle of a heart, the mitral valve comprising a ring, two leaflets and papillary muscles, characterized in that the device comprises an elastic, cylindrical element ( 32 ; 82 ) with a first ( 33 ) and a second end ( 34 ), wherein the cylindrical element ( 32 ; 82 ) in its longitudinal direction and from the first end ( 33 ) to the second end ( 34 ) running, channel-like holes ( 36 ; 86 ) having a first diameter, which is suitable for carrying neochordae threads ( 40 ) are adjusted. Device according to claim 1, characterized in that it further comprises Neochordae threads ( 40 ) through the channel-like holes ( 36 ; 86 ) are passed. Apparatus according to claim 1 or 2, characterized in that at least two, preferably 3 to 7, channel-like holes ( 36 ; 86 ) are provided. Device according to one of claims 1 to 3, characterized in that the perforations ( 86 ) via channel-like accesses ( 90 ) with the outer surface ( 83 ) of the cylindrical element ( 82 ) are connected. Device according to one of claims 1 to 4, characterized in that further comprises a longitudinal direction to the cylindrical element ( 32 ) and from the first end ( 33 ) to the second end ( 34 ) extending central bore ( 38 ) is provided with a second diameter which is suitable for receiving a guide wire ( 52 ) is trained. Device according to one of claims 1 to 5, characterized in that the cylindrical element ( 32 ; 82 ) for its introduction at the second end ( 34 ), which comes to lie extracardially, a pointed attachment ( 62 ) having. Device according to one of claims 1 to 6, characterized in that the channel-like bores ( 36 ; 86 ) have a diameter which is greater than the diameter of the through the channel-like holes ( 36 ; 86 ) guided Neochordae threads ( 40 ). Device according to one of claims 1 to 7, characterized in that the length of the cylindrical element ( 32 ; 82 ) corresponds to a length resulting from the length of the papillary muscle ( 54 ) and the posterior wall of a ventricle of the heart of a patient to be treated. Device according to one of claims 1 to 8, characterized in that the first end ( 33 ) of the cylindrical element ( 32 ; 82 ), which comes to lie intraventricularly, a section ( 42 ), which has a larger diameter than the remaining portions of the cylindrical element ( 32 ; 82 ). Device according to one of claims 1 to 9, characterized in that the Neochordae threads ( 40 ) on at least one of its first ends temporary tourniquets ( 56 ) exhibit. Device according to one of claims 1 to 10, characterized in that the Neochordae threads ( 40 ) comprise a material selected from the group consisting of polypropylene, polytetrafluoroethylene, or mixtures thereof. Device according to one of claims 1 to 11, characterized in that it further comprises a securing element ( 60 ), with which one end of the neochordae ( 40 ) after insertion of the device into the papillary muscle ( 54 ) is fixable on the extraventricular side. Device according to claim 12, characterized in that the securing element comprises a first part ( 90 ) for the inclusion of Neochordae ( 40 ) and a second part ( 92 ), the first part ( 90 ) and the second part ( 92 ) can be connected to one another like a plug and, if necessary, can be detached again. Device according to claim 13, characterized in that the first part ( 90 ) a central channel ( 93 ) having. Device according to claim 14, characterized in that the central channel ( 93 ) has a diameter which corresponds to the outer diameter of the cylindrical element ( 32 ; 82 ) corresponds. Device according to one of claims 13 to 15, characterized in that the first part ( 90 ) from the central channel ( 93 ) branch off radially to the edge of the part ( 90 ) running channels ( 94 . 95 ) whose diameter is greater than or equal to the diameter of the neochordae ( 40 ). Device according to one of claims 13 to 16, characterized in that the first part ( 90 ) Recesses ( 96 ) for receiving projections ( 97 ) of the second part ( 92 ) having. Device according to one of claims 13 to 17, characterized in that by merging the parts ( 90 ) and ( 92 ) by the first part ( 90 ) recorded Neochordae ( 40 ) are fixable. Device according to one of claims 1 to 18, characterized in that for insertion of the cylindrical element ( 32 ; 82 ) an insertion element ( 64 ) provided with the cylindrical element ( 32 ; 82 ) is releasably connected to its introduction. Method for correcting the mitral valve insufficiency between the left atrium and the left ventricle of a heart, the mitral valve comprising a ring, two leaflets and papillary muscles, characterized in that it comprises the following steps: a) inserting a device with a resilient, cylindrical element ( 32 ; 82 ), the channel-like holes ( 36 ; 86 ) and Neochordae threads ( 40 ), according to the Seldinger technique in the papillary muscle ( 54 ) and the posterior wall of the left ventricle, b) attaching the one end of the neochordae threads ( 40 ) at the edges of the sails ( 58 ) of the mitral valve, c) tightening of the neochordae filaments ( 40 ) at the other end to the desired setting of the distance between papillary muscle ( 54 ) and mitral valve ring. Method according to claim 20, characterized in that a device according to one of claims 1 to 18 is used.