Implantation of repair devices in the heart
Apparatus is provided, including an intracardiac annuloplasty structure configured for placement on an annulus of a heart valve, a first rotatable ring coupled to the annuloplasty structure and a second rotatable ring coupled to the annuloplasty structure. The first and second rotatable rings are arranged such that the first rotatable ring is rotatable to contract the annuloplasty structure while the second rotatable ring remains stationary, and the second rotatable ring is rotatable to contract the annuloplasty structure while the first rotatable ring remains stationary. Other embodiments are also described.
1. Apparatus, comprising:
an intracardiac annuloplasty structure configured for placement on an annulus of a heart valve;
a first rotatable ring coupled to the annuloplasty structure; and
a second rotatable ring coupled to the annuloplasty structure,
wherein the first and second rotatable rings are arranged such that:
the first rotatable ring is rotatable around an axis of the first rotatable ring to contract the annuloplasty structure while the second rotatable ring remains rotationally stationary around an axis of the second rotatable ring, and
the second rotatable ring is rotatable around the axis of the second rotatable ring to contract the annuloplasty structure while the first rotatable ring remains rotationally stationary around the axis of the first rotatable ring.
2. The apparatus according to claim 1 , further comprising a contracting wire coupled to the first and second rotatable rings, wherein the first and second rotatable rings are arranged such that:
the first rotatable ring is rotatable to contract the annuloplasty structure by pulling the contracting wire, and
the second rotatable ring is rotatable to contract the annuloplasty structure by pulling the contracting wire.
3. The apparatus according to claim 1 , further comprising a ratchet coupled to the annuloplasty structure, wherein the ratchet maintains a perimeter of the annuloplasty structure following contracting of the annuloplasty structure.
4. The apparatus according to claim 1 , wherein the annuloplasty structure comprises a plurality of anchor mounts configured to facilitate anchoring of the annuloplasty structure to tissue of a patient, and wherein the annuloplasty structure comprises at least one anchor-restricting element configured to restrict motion of a portion of a tissue anchor beyond the anchor-restricting element.
5. The apparatus according to claim 1 , wherein the annuloplasty structure defines a plane of the annuloplasty structure for placement on the annulus of the heart valve, and wherein the annuloplasty structure comprises a plurality of anchor mounts configured to facilitate anchoring of the annuloplasty structure to tissue of a patient, the plurality of anchor mounts each defining (a) at least one opening for passage therethrough of a respective one of a plurality of tissue anchors, and (b) a path for passage therethrough of the respective one of the plurality of tissue anchors, the path being aligned along an axis that is at a non-zero angle with respect to the plane of the annuloplasty structure.
6. The apparatus according to claim 5 , further comprising the plurality of tissue anchors, each respective one of the plurality of tissue anchors being configured for passage through of a respective one of the plurality of anchor mounts.
7. The apparatus according to claim 6 , wherein the plurality of tissue anchors comprises a plurality of helical tissue anchors, each respective one of the plurality of helical tissue anchors being configured for passage through of a respective one of the plurality of anchor mounts.
8. The apparatus according to claim 7 , wherein a proximal portion of the respective one of the plurality of helical tissue anchors is shaped so as to restrict continued corkscrewing of the respective one of the plurality of helical tissue anchors into tissue.
9. The apparatus according to claim 7 , wherein each one of the plurality of anchor mounts provides a structural element in the path for corkscrewing a distal portion of the respective one of the plurality of helical tissue anchors therearound.
10. The apparatus according to claim 9 , wherein the structural element is configured to restrict continued corkscrewing of the respective one of the plurality of helical tissue anchors into tissue.
11. The apparatus according to claim 9 , wherein the at least one opening of each anchor mount defines first and second openings, and wherein each respective one of the plurality of helical tissue anchors is moveable through the first and second openings of each anchor mount.
12. The apparatus according to claim 11 , wherein the distal portion of the respective one of the plurality of helical tissue anchors is arranged to corkscrew around the structural element before moving through the second opening.
13. The apparatus according to claim 1 , further comprising one or more longitudinal members reversibly coupled to the annuloplasty structure at respective locations of the annuloplasty structure, wherein the one or more longitudinal members are arranged such that the one or more longitudinal members are moveable to adjust a configuration of respective parts of the annuloplasty structure at the respective locations of the annuloplasty structure.
14. The apparatus according to claim 13 , wherein the one or more longitudinal members comprise at least first and second longitudinal members coupled to the annuloplasty structure at respective first and second locations of the annuloplasty structure, wherein movement of the first longitudinal member moves a first part of the annuloplasty structure at the first location with respect to a second part of the annuloplasty structure at the second location.
15. A method, comprising:
positioning in a chamber of a heart of a patient an intracardiac annuloplasty structure, the annuloplasty structure being coupled to first and second rotatable rings, wherein the first and second rotatable rings are arranged such that:
the first rotatable ring is rotatable around an axis of the first rotatable ring to contract the annuloplasty structure while the second rotatable ring remains rotationally stationary around an axis of the second rotatable ring, and
the second rotatable ring is rotatable around the axis of the second rotatable ring to contract the annuloplasty structure while the first rotatable ring remains rotationally stationary around the axis of the first rotatable ring;
using the first rotatable ring coupled to the annuloplasty structure, contracting the annuloplasty structure while the second rotatable ring remains rotationally stationary around the axis of the second rotatable ring; and
using the second rotatable ring coupled to the annuloplasty structure, contracting the annuloplasty structure while the first rotatable ring remains rotationally stationary around the axis of the first rotatable ring.
16. The method according to claim 15 , wherein contracting the annuloplasty structure comprises pulling a portion of a contracting wire coupled to the annuloplasty structure.
17. The method according to claim 15 , further comprising following the contracting, maintaining a perimeter of the annuloplasty structure using a ratchet coupled to the annuloplasty structure.