Abstract: A constricting cord can be delivered to the vicinity of an annulus using an apparatus that includes a set of support arms, with a respective anchor launcher supported by each of the support arms. An inflatable first balloon is configured to push the support arms away from each other when the first balloon is inflated. An inflatable second balloon is mounted to a shaft and is configured for inflation when the second balloon is disposed distally beyond the first balloon. In some embodiments, the distal balloon is inflated while it is in a ventricle. In some embodiments, the distal balloon is inflated while it is in a pulmonary artery.

Abstract: Dislodgment of a constricting cord from an annulus can be prevented by delivering the distal loop portion of the constricting cord to the annulus using a percutaneous delivery tool, and launching anchors into the annulus so as to affix the distal loop portion of the constricting cord to the annulus. The percutaneous delivery tool is withdrawn in a proximal direction after the anchors have been launched. A pushing member is pressed in a distal direction so that the pushing member holds a portion of the constricting cord against the annulus with enough pressure to prevent dislodgment of any of the anchors during the withdrawal of the percutaneous delivery tool.

Abstract: Dislodgment of a constricting cord from an annulus can be prevented by delivering the distal loop portion of the constricting cord to the annulus using a percutaneous delivery tool, and launching anchors into the annulus so as to affix the distal loop portion of the constricting cord to the annulus. The percutaneous delivery tool is withdrawn in a proximal direction after the anchors have been launched. A pushing member is pressed in a distal direction so that the pushing member holds a portion of the constricting cord against the annulus with enough pressure to prevent dislodgment of any of the anchors during the withdrawal of the percutaneous delivery tool.

Abstract: A cardiac valve annulus may be constricted by using an apparatus to deliver a cord to the annulus, affixing the cord, and subsequently tightening that cord. In some embodiments, this apparatus includes a housing, a spool, and an elongated core with lumens that run through the core. The lumens are dimensioned to slidably accommodate portions of the cord. The cord, the lumens, and the spool are configured so that after a distal loop portion of the cord is anchored to the annulus, movement of the housing in a proximal direction will (a) cause the core to progressively move in a proximal direction with respect to portions of the cord and (b) cause extension sections of the cord to progressively unwind from the spool and be progressively drawn into the lumens.

Abstract: A device can be introduced into the right atrium of a subject's heart by introducing the distal end of a hollow, straight, and stiff shaft into the subject's right internal jugular vein, and advancing the distal end of the shaft into the right atrium via the superior vena cava. The position of the distal end of the shaft is adjusted by manipulating a handle affixed to a portion of the shaft that remains outside the subject's body. The handle can be used to rotate the shaft about its longitudinal axis, rotate the shaft about an anterior-posterior axis, rotate the shaft about a medial-lateral axis, and/or advance the shaft in the caudal direction. A device is advanced through the interior of the shaft until the device extends beyond the distal end of the shaft and into the right atrium.

Abstract: A heart valve annulus repair device having a tissue engaging member and a plurality of anchors. The tissue engaging member includes a loop of wire. Each of the anchors has a pointy front end and a back end and a slot that runs in a front-to-back direction. The anchors are distributed about the loop of wire with the front ends of the plurality of anchors facing the heart valve annulus and with the loop of wire passing through the slots. The device further includes means for implanting the anchors into the heart valve annulus tissue so that the tissue engaging member becomes affixed to the heart valve annulus.

Abstract: A device (e.g., an annulus-constricting device) with N anchors may be affixed to a cardiac valve annulus as follows. First, the device is delivered to the vicinity of the annulus via a catheter. Next, the position and layout of the device is adjusted via the catheter. Next, only those anchors which are properly positioned are driven into the annulus or tissue adjacent to the annulus. The remaining anchors remain unlaunched at this point. The unlaunched anchors are subsequently moved into a good position using either a manipulating tool or catheter-steering techniques, after which they are driven into the annulus or tissue adjacent to the annulus.

Abstract: A device can be introduced into the right atrium of a subject's heart by introducing the distal end of a hollow, straight, and stiff shaft into the subject's right internal jugular vein, and advancing the distal end of the shaft into the right atrium via the superior vena cava. The position of the distal end of the shaft is adjusted by manipulating a handle affixed to a portion of the shaft that remains outside the subject's body. The handle can be used to rotate the shaft about its longitudinal axis, rotate the shaft about an anterior-posterior axis, rotate the shaft about a medial-lateral axis, and/or advance the shaft in the caudal direction. A device is advanced through the interior of the shaft until the device extends beyond the distal end of the shaft and into the right atrium.

Abstract: A heart valve annulus repair device having a tissue engaging member and a plurality of anchors. The tissue engaging member includes a loop of wire. Each of the anchors has a pointy front end and a back end and a slot that runs in a front-to-back direction. The anchors are distributed about the loop of wire with the front ends of the plurality of anchors facing the heart valve annulus and with the loop of wire passing through the slots. The device further includes means for implanting the anchors into the heart valve annulus tissue so that the tissue engaging member becomes affixed to the heart valve annulus.

Abstract: A cord that has been previously affixed around an annulus can be fastened with a fastener that is movable from a first state in which the cord is free to slide to a second state in which the cord is locked in place. After the fastener is moved to the second state, a cutting element with a slit shaped distal portion oriented in the distal-to-proximal direction with sharp edges slides with respect to a shelf and cuts off portions of the cord that are proximal with respect to the two locked parts.

Abstract: An enlarged cardiac valve annulus can be reduced in diameter using a cord that is affixed to the annulus by a set of anchors. A knot or fixed loop is disposed at a first end of the cord, and the body of the cord passes through the knot or fixed loop so as to form (a) a loop portion positioned distally beyond the knot or fixed loop and (b) a second portion that runs between the knot or fixed loop and the second end. The body of the cord can slide with respect to the knot or fixed loop. After the anchors are implanted and a bond between the anchors and the annulus is sufficiently strong, pulling the second portion in a proximal direction while holding the knot or fixed loop in place will reduce the circumference of the annulus.

Abstract: A loop of material can be affixed to a cardiac annulus using a plurality of anchors. Each of these anchors is launched into the annulus by a respective anchor launcher, and each of these anchor launchers is triggered by pulling on a respective pull wire. This application is directed to methods and apparatuses that automate the pulling of these pull wires using a plurality of actuators. Each actuator includes a channel with a compressed spring disposed in a distal portion of the channel. A tab is affixed to the proximal end of the spring. When the tab is moved from a first position to a second position, the spring becomes free to expand. The expanding springs pull the pull wires in a proximal direction, which triggers the anchor launchers.

Abstract: A cord that has been previously affixed around an annulus can be fastened using a sliding member that locks into a housing. Before those two parts are locked together, the cord is free to slide through a channel in the sliding member, and a shear pin prevents the sliding member from moving. After those two parts are locked together, portions of the cord are squeezed between the upper surface of the sliding member and one wall of the housing, and other portions of the cord are squeezed between the lower surface of the sliding member and another wall of the housing, so that the cord can no longer slide. After locking, a sliding cutting element can be actuated to cut off portions of the cord that are proximal with respect to the two locked parts.

Abstract: A cardiac valve annulus may be constricted by using an apparatus to deliver a cord to the annulus, affixing the cord, and subsequently tightening that cord. In some embodiments, this apparatus includes an elongated core with a main channel, a set of first channels, and at least one second channel, all of which run through the core. The first channels accommodate pull wires for triggering the anchor launchers, and the second channels accommodate portions of the cord. Support arms extend distally beyond the core, and anchor launchers are mounted to each of these support arms. The support arms hold the distal ends of the anchor launchers at positions distributed about the annulus. The anchors are launched to affix the cord, and the cord is tightened in a subsequent procedure.

Abstract: A constricting cord can be delivered to the vicinity of an annulus using an apparatus that includes a set of support arms, with a respective anchor launcher supported by each of the support arms. An inflatable first balloon is configured to push the support arms away from each other when the first balloon is inflated. An inflatable second balloon is mounted to a shaft and is configured for inflation when the second balloon is disposed distally beyond the first balloon. In some embodiments, the distal balloon is inflated while it is in a ventricle. In some embodiments, the distal balloon is inflated while it is in a pulmonary artery.

Abstract: An annulus ring or a constricting cord may be delivered to the vicinity of a cardiac annulus using a set of anchor launchers, with each of the anchor launchers being supported by a respective support arm. An inflatable balloon is disposed between the support arms, and the balloon is configured so that when the balloon is inflated, the balloon will push the support arms away from each other. At least one retainer cord is connected to the support arms and is arranged with respect to the support arms to encompass the balloon and prevent the balloon from slipping out between the support arms.

Abstract: A constricting cord can be delivered to the vicinity of an annulus using an apparatus that includes a set of support arms, with a respective anchor launcher supported by each of the support arms. An inflatable first balloon is configured to push the support arms away from each other when the first balloon is inflated. An inflatable second balloon is mounted to a shaft and is configured for inflation when the second balloon is disposed distally beyond the first balloon. In some embodiments, the distal balloon is inflated while it is in a ventricle. In some embodiments, the distal balloon is inflated while it is in a pulmonary artery.

Abstract: Tissue ingrowth on the distal loop portion of a constricting cord can dramatically improve the bond between the constricting cord and a cardiac valve annulus. But tissue ingrowth on the proximal portions of the constricting cord can interfere with the constricting action of the cord. This problem can be addressed by covering the proximal portions of the constricting cord with a material that resists tissue ingrowth, and waiting for tissue ingrowth to strengthen the bond between the distal loop portion of the constricting cord and the annulus. The reduced ingrowth on the proximal portions of the constricting cord make it easier to constrict the annulus when the constricting operation is eventually performed.

Abstract: Dislodgment of a constricting cord from an annulus can be prevented by delivering the distal loop portion of the constricting cord to the annulus using a percutaneous delivery tool, and launching anchors into the annulus so as to affix the distal loop portion of the constricting cord to the annulus. The percutaneous delivery tool is withdrawn in a proximal direction after the anchors have been launched. A pushing member is pressed in a distal direction so that the pushing member holds a portion of the constricting cord against the annulus with enough pressure to prevent dislodgment of any of the anchors during the withdrawal of the percutaneous delivery tool.

Abstract: Dislodgment of a constricting cord from an annulus can be prevented by delivering the distal loop portion of the constricting cord to the annulus using a percutaneous delivery tool, and launching anchors into the annulus so as to affix the distal loop portion of the constricting cord to the annulus. The percutaneous delivery tool is withdrawn in a proximal direction after the anchors have been launched. A pushing member is pressed in a distal direction so that the pushing member holds a portion of the constricting cord against the annulus with enough pressure to prevent dislodgment of any of the anchors during the withdrawal of the percutaneous delivery tool.