Methods and devices provide constriction of a heart valve annulus to treat cardiac valve regurgitation and other conditions. Embodiments typically include a device for attaching a cinching or tightening apparatus to a heart valve annulus to reduce the circumference of the annulus, thus reducing valve regurgitation. Tightening devices may include multiple tethered clips, multiple untethered crimping clips, stabilizing devices, visualization devices, and the like. In one embodiment, a plurality of tethered clips is secured circumferentially to a valve annulus, and the tether coupling the clips is cinched to reduce the circumference of at least a portion of the annulus. Methods and devices may be used in open heart surgical procedures, minimally invasive procedures, catheter-based procedures, and/or procedures on beating hearts or stopped hearts.

Devices and methods for heart valve repair

An apparatus for closing and sealing a vascular puncture is connected to an energy supply such that heat is generated in, or thermally conducted to, the tissue, thereby thermally fusing the vascular tissue together. The method for closing and sealing a vascular puncture comprises applying radio frequency or other energy to the tissue, the energy being sufficient to thermally fuse the tissue together, thus sealing the puncture. Embodiments of depth finding and guiding devices, as well as blood vessel occluders, are also disclosed.

Apparatus and method for sealing vascular punctures

A laser surgical knife characterized by switches, which can adjust an output power within the safe scope from the output power preliminarily set for a laser oscillator, mounted on an attachment of said laser surgical knife which is held by an operating surgeon's hand in order to irradiate laser rays on the affected parts. The present invention can provide a laser surgical knife of which output power can be changed at one touch and in safe without interrupting surgical operations merely by a simple process in which an operating surgeon operates a handy switch for hinself.

Laser surgical knife

Ultrasound applicators able to both image a treatment site and administer ultrasound therapy include an array of transducer elements that can be focused. In several embodiments, an electronically phased array is used for controlling the focal point of an ultrasound beam. The ultrasound beam produced thereby can also be electronically steered. To reduce the quality factor or Q of the array when the array is used for imaging, an electronic switch is selectively closed, placing a resistance in parallel with each of the array elements. A flexible array is employed in several embodiments and is selectively bent or flexed to vary its radius of curvature and thus control the focal point and/or a direction of focus of the array. In another embodiment, each of the transducer elements comprising the array are individually mechanically pivotable to steer the ultrasonic beam produced by the transducer elements.

Ultrasound transducers for imaging and therapy

In some examples, nerves surrounding arteries or leading to organs are targeted with energy sources to correct or modulate physiologic processes. In some examples, different types of energy sources are utilized singly or combined with one another. In some examples, bioactive agents or devices activated by the energy sources are delivered to the region of interest and the energy is enhanced by such agents or the agents are enhanced by the energy sources.

Energetic modulation of nerves

Laser radiation is coupled to an optical instrument having a relatively narrow working edge from which the radiation is emitted in a relatively narrow zone of intense radiation leakage. The working edge is placed in contact with vascularized tissues, and the laser radiation emanating from the working edge in combination with the contact between the working edge and the tissues forms an incision, and the laser radiation photocoagulates tissue adjacent the incision. The contact between the working edge and the tissues accurately positions the laser radiation with respect to the tissue, places pressure on vessels to aid hemostasis, mechanically stresses the incision line and provides the surgeon with tactile feedback. Radiation propagates from a laser to the optical instrument through a low-loss flexible fiberoptic waveguide by means of multimode optical waveguide propagation. As the radiation reaches the working edge of the optical instrument the radiation is emitted from the instrument because the incident angles of individual modes fall below the critical internal reflection angle of the instrument. Radiation leakage is further increased by the presence of blood on the working edge. The frequency of the laser radiation is selected to achieve a desired penetration depth. Deeper penetration may be necessary under some circumstances to produce a clot of sufficient size to allow adequate coagulation. A power control mounted on the handle of the optical instrument or elsewhere allows the surgeon to adjust the intensity of the radiation.

Method for cutting and coagulating tissue

A Photocoagulating scalpel system including a scalpel having a sharp, transparent blade for forming an incision, and a laser optically coupled to the blade for coagulating blood adjacent the incision. Laser radiation is transported to the blade through a low-loss fiberoptic waveguide. The radiation propagates through the waveguide and blade by means of multimode optical waveguide propagation wherein each mode has a discrete angle of incidence with respect to the blade surface. As the radiation reaches the beveled cutting edge of the blade, the angle of the blade surface changes causing the radiation to be emitted from the blade because the incident angles of individual modes fall below the critical internal reflection angle of the blade. Radiation leakage is further increased by the presence of blood on the blade surface which increases the critical internal reflection angle of the blade. Higher order modes having angles of incidence less than the critical internal reflection angles of the waveguide and blade are restricted so that radiation does not leak from the waveguide or blade before reaching the cutting edge. The laser radiation is preferably from an argon laser since its radiation is at a wavelength which is readily absorbed by red hemoglobin while being reflected by white tissue so that the radiation coagulates blood without causing extensive necrosis of the incised tissue. A power control on the handle of the scalpel allows the surgeon to adjust the intensity of the radiation as required depending upon the quantity of blood to be coagulated.

Robert F. Rushmer

Papers

Method for cutting and coagulating tissue

Photocoagulating scalpel system