U.S. patent number 3,667,474 [Application Number 05/000,728] was granted by the patent office on 1972-06-06 for dilator for performing mitral and tricuspidal commissurotomy per atrium cordis.
Invention is credited to Vladimir Ilich Goloviznin, Konstantin Vasilievich Lapkin, Lev Mikhailovich Popov, Georgy Fedorovich Romanov.
United States Patent |
3,667,474 |
Lapkin , et al. |
June 6, 1972 |
DILATOR FOR PERFORMING MITRAL AND TRICUSPIDAL COMMISSUROTOMY PER
ATRIUM CORDIS
Abstract
A dilator for performing mitral and tricuspidal commisurotomy
per atrium cordis, comprising a working head with jaws and a jaw
actuating mechanism, the working head being associated with a
hand-operated drive through a flexible base. The working head of
the dilator has a relatively rigid portion which enables the
surgeon to easily pass the working head with finger guidance
through tracts of any curvature, i.e., to utilize the dilator in
all current methods of instrumental commissurotomy performed per
atrium cordis. The working head of the dilator is distinguished by
its high rigidity and strength.
Inventors: |
Lapkin; Konstantin Vasilievich
(Moscow, SU), Romanov; Georgy Fedorovich
(Kirovo-Chepetsk, SU), Goloviznin; Vladimir Ilich
(Kirovo-Chepetsk, SU), Popov; Lev Mikhailovich
(Kirovo-Chepetsk, SU) |
Family
ID: |
21692760 |
Appl.
No.: |
05/000,728 |
Filed: |
January 5, 1970 |
Current U.S.
Class: |
606/198 |
Current CPC
Class: |
A61M
29/02 (20130101); A61B 2017/22097 (20130101) |
Current International
Class: |
A61M
29/00 (20060101); A61B 17/22 (20060101); A61m
029/00 () |
Field of
Search: |
;81/72
;128/242,243,244,345 ;294/16,93 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Pace; Channing L.
Claims
What is claimed is:
1. A dilator for performing mitral and tricuspidal commissurotomy
per atrium cordis, said dilator comprising a working head including
trough-shaped jaws, a lever mechanism coupled to said jaws for
opening and closing said jaws, said lever mechanism including two
groups of levers, the levers of one of the groups being articulated
to one end of said jaws, the levers of the other group being freely
slidable along the inner lateral surfaces of said jaws adjacent the
other end of said jaws, serving as guideways for said levers, a
hand-operated drive means coupled to said lever mechanism to
operate the same, a flexible base connecting the other ends of the
levers of said one group to said hand-operated drive means, a
flexible link accommodated inside said flexible base and connecting
the other ends of the levers of said other group with said
hand-operated drive means, and elongated spring elements connected
at one end thereof to the jaws and at the other end thereof to the
flexible base, one lever of each group being pivotally connected to
a lever of the other group intermediate the ends thereof.
2. A dilator as claimed in claim 1 wherein said spring elements are
connected to the jaws at the ends thereof remote from the ends at
which said one group of levers are connected to said jaws.
3. A dilator as claimed in claim 2 wherein said protective elements
are connected to the jaws proximate the said guideways.
4. A dilator as claimed in claim 1 wherein said jaws have a
longitudinal plane of symmetry and said two groups of levers are
symmetrically disposed with respect to said plane.
5. A dilator as claimed in claim 4 wherein said one group of levers
include arms straddling the levers of said other group.
6. A dilator as claimed in claim 1 wherein said trough-shaped jaws
are hollow and when closed are in contact with one another and
define an enclosure in which the lever mechanism is completely
enclosed.
7. A dilator as claimed in claim 1 wherein said spring elements are
constituted as coiled extension springs.
Description
This invention relates to medical apparatus and particularly to the
design of dilators used in performing mitral and tricuspidal
commissurotomy per atrium cordis.
Widespread use is made in present-day cardiac surgery--of dilators,
comprising a working head that consists of two jaws with a
mechanism for bringing said jaws apart which, for the sake of
brevity, will hereinafter be referred to as a jaw actuating
mechanism, said working head being mounted on a rigid base secured
to a hand-operated drive. The rigid base is essentially a tubular
structure inside which a rod or link is passed to connect the jaw
actuating mechanism with the hand-operated drive.
While in operation-- , the working head of said dilator is
introduced into the cardiac mitral orifice via an operational
incision in the left ventricle under the control of a finger passed
through the auricular appendage of the atrium cordis sinistrum.
However, such an operational technique involves operational
incisions in the heart in two zones, i.e., the left ventricle and
the auricular appendage of the atrium cordis sinistrum.
Such an operation can cause hemorrhage, thromboembolism, reflex
cardiac arrest and other complications.
Known in the surgical art are also dilators for "per atrium cordis"
commissurotomy of the mitral and tricuspid valves, wherein their
working head is made fast to the hand-operated drive by means of a
flexible base which accommodates a flexible rod or link connecting
the jaw actuating mechanism with said hand-operated drive. Such a
dilator due to its flexible base enables its working head to be
introduced under finger guidance into the heart being operated and,
unlike dilators featuring a rigid base, it involves only
cardiotomic operation per atrium cordis and only within a single
cardiac zone, which is conducive to minimize loss of blood during
operation, precludes and or substantially diminishes the risk of
such complications as primary cardiac arrest, valvulorrhexis, and
thromboembolisms.
The above-described dilator with a flexible base, however, features
a relatively longer rigid portion thereof when in a closed state
which depends upon the length of the jaws and protective elements,
said elements being essentially guard strips interconnecting the
ends of jaws with the flexible base, which makes it impossible to
successfully employ the dilator to gain access to the cardiac valve
involved via the auricular appendage of the atrium cordis
sinistrum, this technique being practised by a great and
overwhelming majority of surgeons in performing mitral
commissurotomy, since the operational tract along which the dilator
working head is to be introduced, is of considerable curvature.
A reduction of the length of the rigid portion of the dilator
cannot be obtained by merely decreasing the length of the jaws and
guard strips which constitute the overall length of the dilator
rigid portion, since the size of said strips and the length of jaws
depend upon the length of the arms of the jaw actuating mechanism,
while the shortening of said arms will result in a decreased span
or amount of jaw opening which is not permissible.
On the other hand, to make said guard strips flexible in the
afore-described dilator is not permissible since due to the fact
that the arms of the jaw actuating mechanism are articulately
connected at the rear ends of the jaws, the pathways of the
articulated joints of the guard strips when moving towards the jaws
are so directed that the opposite ends of said strips should slide
along the flexible base, whereas the guard strips should on the
same account work in compression in order to overcome forces of
friction against said flexible base.
Furthermore, the working head of the construction adopted in the
known dilator possesses but inadequate rigidity and strength.
It is an object of the present invention to provide such a dilator
for performing mitral and tricuspidal commissurotomy per atrium
cordis that has a minimized length of the rigid portion of its
working length, whereas its jaw actuating mechanism possesses a
sufficient strength and rigidity, whereby the dilator is suitable
for preforming safe and effective operations of commissurotomy with
all possibilities of utilizing all hitherto known ways of gaining
peratrial access to the mitral and tricuspid valves (viz. through
the auricular appendage, left wall of the atrium cordis or via the
interatrium septum).
To accomplish this object, in a dilator for performing mitral and
tricuspidal commissurotomy per atrium cordis, comprising a working
head having jaws of a trough-like shape with protective elements
and an articulated linkage of the jaw actuator, said working head
being interconnected with a hand-operated drive through a flexible
base and an elastic link or rod accommodated thereinside, according
to the invention the interior lateral areas of the jaws serve as
guideways for the arms of the jaw actuating mechanism, while the
articulated joint of the arm of said jaw actuating mechanism in
each of the jaws is located in its front portion and said
protective elements are made flexible and fixed with their ends to
said flexible base.
Said protective elements are preferably made as coiled springs
working in tension.
Said arms of the jaw actuating mechanism are preferably arranged
symmetrically with respect to the plane in which the jaws are
brought apart and which passes through a longitudinal axis of the
working head.
In what follows the invention is made more evident from a
consideration of a description of embodiments thereof with due
reference to the accompanying drawings, wherein:
FIG. 1 is an elevation view of a dilator for performing mitral and
tricuspidal commissurotomy per atrium cordis, according to the
invention;
FIG. 2 is a sectional view of the working head of the dilator when
open, taken on enlarged scale;
FIG. 3 is a section taken along line III--III of FIG. 1 on an
enlarged scale; and
FIG. 4 illustrates in elevation view an embodiment of the
hand-operated drive for the dilator of the invention.
Now referring to FIG. 1, the dilator of the invention comprises a
working head 1 associated through a flexible base 2 with a
hand-operated drive 3. As can be seen from FIG. 1 jaws 4 and 5 of
the working head 1 when closed, contact each other to form an
enclosure or casing for a jaw actuating mechanism 6 (FIG. 2). The
mechanism 6 comprises arms or links 7, 8, 9 and 10. The arms 7 and
8 are attached to a sleeve 13 by means of articulated joints 11 and
12, and to the jaws 4 and 5 through articulated joints 14 and 16.
The arms 9 and 10 are attached to a slide member 16 by means of
articulated joints 17 and 18, while their respective ends 19 and 20
are free to slide along the inner surfaces of the jaws 4 and 5 so
that the lateral walls of the jaws serve as guideways for the arms
9 and 10. The arms 7 and 8 are constituted as double levers (FIG.
3) which straddle the arms 9 and 10 in such a way that the arms of
the jaw actuating mechanism 6 are arranged symmetrically with
respect to the plane A--A (FIG. 3) in which the jaws are brought
apart and which passes through the longitudinal axis of the working
head, whereby the jaw actuating mechanism acquires rigidity and
strength.
Slots 21 and 22 are provided in the jaws 4 and 5 (FIG. 2) to serve
as guideways for the arms 9 and 10 as well. Connected to the jaws 4
and 5 and to the flexible base 2 are elastic protective elements 23
which are essentially coiled extension springs adapted to protect
the working head 1 against possible catching on cardiac tissue when
it is being opened.
The flexible base 2 is secured in the sleeve 13. Extending inside
the flexible base 2 is a rod 24 which is fixed in place on in the
slide member 16. The opposite ends of the flexible base 2 and of
the rod 24 are secured to respective handles 25 and 26 (FIG. 1) of
the hand-operated drive 3.
The rod 24 may be made of an elastic steel wire or of a stranded
steel wire in dependence upon the required degree of its
elasticity. Thus, when introducing the dilator per the auricular
appendage of the atrium cordis sinistrum, use is made of a rod made
of stranded steel wire, whereas if the dilator is to be introduced
through the interatrium septum from the right (dextrolateral
access) use is made of a rod made of elastic steel wire.
The flexible base 2 is made of a wound spring-steel wire and is
provided with a locknut 27 at the place of its attachment to the
handle 25, whereby the working head 1 can be set in any plane with
respect to the hand-operated drive 3.
The hand-operated drive 3 is provided with a stop 28 for limiting
the degree of opening of the working head 1, an indicator 29 of the
degree of opening of the working head 1 and return springs 30.
The hand-operated drive 3, (FIG. 4) is more suitable for use when
performing mitral commissurotomy by the dextrolateral access. When
utilized in transauricular sinistrolateral access, use is made of
the hand-operated drive 3 represented in FIG. 1.
For tricuspidal commissurotomy, use can be made of any of the
above-stated hand-operated drives.
The dilator of the present invention is operated as follows.
When bringing the handles 25 and 26 together (FIG. 1) the rod 24
causes the slide member 16 (FIG. 2) to move towards the sleeve 13,
while the jaw actuating mechanism 6 brings the jaws 4 and 5 apart.
The degree of opening or span of the jaws 4 and 5 is monitored by
the indicator 29 associated with the handles 25 and 26 (FIG. 1).
Both jaws 4 and 5 are caused to return to their initial position
under the effect of the return springs 30.
While in operation the dilator functions as follows: in performing
mitral commissurotomy, the working head 1 is introduced into the
heart's interior under finger guidance on the side of the atrium
cordis sinistrum and is set under finger control in the mitral
orifice. Bringing of the handles 25 and 26 of the hand-operated
drive 3 together the working head 1 is caused to open which, in
turn, effects separation of the concreted cusps of the mitral
valve, i.e. in commissurotomy. Whenever necessary, the working head
1 of the dilator can be set in any plane with respect to and to
suit the position of the commissures to be operated. The operation
of commissurotomy with the use of the present dilator ensures an
adequate dilation of the valve orifice, minimizes the operational
trauma inflicted upon the cardiac valvular apparatus and the loss
of blood during operation.
In the case of tricuspidal commissurotomy, the dilator can be
introduced under finger guidance through the auricular appendage of
the atrium cordis dextrum and through the wall of the latter. The
elimination of the tricuspidal stenosis is similar to the mitral
commissurotomy.
The dilator disclosed herein is successfully applicable to all the
up-to-date methods of peratrial instrumental commissurotomy, this
being due to the fact that the dilator of the invention is
favorably compared to all hitherto known dilators as regards
minimum length of the rigid portion of its working head which
length depends only upon the length of the jaws; thus, the working
head can be easily introduced and passed under finger guidance
through tracts of any curvature.
The present dilator possesses a higher rigidity and sturdiness as
compared to the dilators used heretofore and can sustain a load of
up to 100 kg when in open state, whereas the maximum load for the
known dilator with the flexible base is not more 8 to 10 kg.
Furthermore, a tight and snug adherence of the arms of the jaw
actuating mechanism to the inner lateral surfaces of the jaws along
with a symmetrical arrangement of the arms of said mechanism with
respect to the plane in which the jaws are brought apart, ensure
minimum free play and an increased rigidity of the dilator working
head.
The herein-proposed dilator is of a sectionalized construction
which allows preventive maintenance and replacement of worn-out or
faulty components which, in turn, adds much to the service
life.
The present dilator has been made employed in performing 65
operations in patients afflicted with mitral stenosis with no
complications or fatal results. The obtained results enable the
dilator of the present invention to be regarded as a valuable
contribution to the sphere of surgical instruments used in cardiac
surgery.
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