FR2662074A1 - PROSTHETIC RING FOR MITRAL OR TRICUSPID ANNULOPLASTY. - Google Patents

Abstract

Prosthetic annulus (6, 7) for mitral or tricuspid annuloplasty, consisting of a core and cloth sheath as suture ring. The core makes a full ring with a rigid part (6a, 7a) to rest on the corresponding fibrous trigone (3a, 3b) and an elastic part.

Description

 1 invention relates to a prosthetic ring for mitral or tricuspid annuloplasty, intended for chi ru rgical reconstruction and defects of the mitral and tricuspid valves.

 Following insufficiencies of the heart valves due to various diseases, it is sometimes necessary to reconstruct the fibromuscular ring surrounding the valves to compensate for the deformation of the valve without having to remove it and replace it with a complete prosthesis.

The ring reconstruction rings currently used are essentially of two types
- rigid rings, open or closed (see for example FR-A- 2,031,699 and FR-A- 2,071,172
Carpentier),
- adjustable flexible rings like that described in US-A-4 290 151 from Eassana.

 Both types of rings have a textile element allowing their suturing.

 Carpentier's mitral ring has its possible open part located on the substantially rectilinear part of the generally bean-shaped ring, rectilinear part resting on the fibrous trigone.

 Massant's flexible rings are adjustable using the free ends of a wire folded over itself to allow the size of the ring to be adapted on site to the shape of the ring to be reconstructed.

 The common disadvantage of these two types of rings is that once in place (sutures to the natural valve ring), they are no longer extensible or flexible and maintain a constant dimension and rigidity, which does not allow them to follow all the movements of the heart.

 The invention overcomes this drawback by providing a prosthetic ring for mitral and tricuspid annuloplasty, of the type comprising a core and a textile sheath constituting a suturing means, characterized in that the core forms a complete ring comprising a rigid part intended to come in contact with the corresponding fibrous trigone, the rest of the core of the ring being made of an elastic material.

In the case of mitral annuloplasty, the rigid part of the core corresponds to the implantation of the anterior mitral valve, against the fibrous (rigid) trigone and therefore corresponds approximately to the substantially rectilinear part, and sometimes absent from the rigid ring of
Carpenter mentioned above. The elastic part corresponds to the implantation of the posterior mitral valve, against a contractile part of the heart.

 Similarly, for a reconstruction ring of the tricuspid valve, the rigid part of the prosthetic ring is located opposite the septal valve (corresponding to the fibrous trigone) while the elastic part is opposite the implantation of the anterior valves. and later.

The invention will now be described in more detail with reference to the accompanying drawings in which
Figure 1 is a schematic representation of the heart showing the location of the mitral and tricuspid valves.

FIG. 2 is a plan view of a prosthetic ring for a mitral valve and
Figure 3 is a plan view of a prosthetic ring for a tricuspid valve.

 Figure 1 shows the anatomy of the heart at the mitral and tricuspid valves. The mitral valve 1, composed of the anterior valve 1a and the posterior valve 1b, is surrounded on the side of the posterior valve 1b of the mitral ring 2 and is delimited from the side of the anterior valve by the right fibrous trigons 3a and left 3b and it is the part corresponding to the posterior valve which distends.

 The tricuspid valve 4 is divided into three, the septal valve 4a, the anterior valve 4b and the posterior valve 4c. Only the septal valve 4a is in contact with the left fibrous trigone 3b. The ring of the tricuspid valve is shown in 5 but does not constitute a well defined continuous fibrous ring and the anterior and posterior valves are inserted on the myocardium.

It is therefore most often in this region that the tricuspid ring distends, causing valve insufficiency.

 Figures 2 and 3 show schematically and respectively a mitral reconstruction ring 6 and a tricuspid reconstruction ring 7. Each of these rings has a core of elastic material but has a rigid insert 6a, 7a, placed in the ring where it once in place, will be in contact with the corresponding fibrous trigone. The area of the fibrous trigone is non-contractile and the reconstruction ring can be rigid there. On the other hand, the rest of the ring in contact with contractile areas of the heart is elastic to adapt to the contraction movements of the heart.

 The rings according to the invention comprise around their core a tubular sheath of woven textile material which allows their suturing to the natural valve ring.

Such a tubular sheath is known per se and has not been shown in the figures.

 The elastic part of the rings is made of textile or elastomer or the like with regard to elasticity, for example made of silicone rubber or another elastomer, while the rigid part is made of any rigid material, for example of titanium or a alloy of titanium, advantageously coated with a silicone sheath.

 The elastic part and the rigid part can be joined together by any suitable means assembly by interlocking of the respective ends, held in place by a common sheath (in addition to the textile sheath) for example made of silicone, welding or bonding of the flexible part on the ends of the rigid part fully coated with a layer of the same material as that which constitutes the elastic part, etc.

 To take account of the morphological variations of the natural rings to be reconstructed, the rings according to the invention are provided with several sizes of the rigid part. During the operation, the surgeon will determine the appropriate ring by measuring the distance separating the two commissures in the case of the mitral valve and the distance between the anteroseptal commissure and the posteroseptal commissure in the case of the tricuspid valve and then choose a ring comprising a rigid part of dimension corresponding to this distance. The measurement is made by introducing a template.

Claims (6)

 1.- Prosthetic ring for mitral and tricuspid annuloplasty, of the type comprising a core and a textile sheath constituting a suturing means, characterized in that the core forms a complete ring comprising a rigid part (6a, .7a) intended to come in contact with the corresponding fibrous trigone, the remainder C6, 7) of the core of the ring being made of an elastic material.  2. Prosthetic ring according to claim 1, for mitral annuloplasty, in which the core comprises a rigid part (#a) in the zone corresponding to the implantation of the anterior mitral valve, and an elastic part (6) in the zone corresponding to the posterior mitral valve  3. Prosthetic ring according to claim 1, for tricuspid annuloplasty, in which the core comprises a rigid part <7a) corresponding to the implantation of the septal valve and an elastic part (7a) corresponding to the implantation of the anterior valves. and posterior of the tricuspid valve.  4. Prosthetic ring according to any one of claims 1 to 3, wherein the rigid part of the core and the flexible part of the core are held together by a sheath of flexible plastic.  5. Prosthetic ring according to any one of claims 1 to 3, in which the rigid part of the core is covered, ends included, with a layer of plastic material allowing its assembly by gluing or welding at the ends of the part. elastic.  6. A prosthetic ring according to any one of claims 1 to 5, in which the rigid part is made of titanium alloy and the elastic part is made of silicone rubber.