Abstract: Apparatus is provided for adjusting at least one dimension of an implant. The apparatus includes a rotatable structure having a channel extending between first and second openings of the rotatable structure. The channel is configured for passage therethrough of an elongate tool. The rotatable structure has a lower surface that is shaped to define a first coupling. The apparatus includes a mechanical element having a surface coupled to the lower surface of the rotatable structure. The mechanical element is shaped to provide a second coupling configured to engage the first coupling during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure. The mechanical element has a depressible portion that is disposed in communication with the second opening, and is configured to disengage the first and second couplings in response to a force applied thereto by the elongate tool.

Abstract: An implant having an implant body, a gripper, an elastic pouch, and an elongate member. The pouch can be coupled to the gripper, can have a first part and a second part, can have a contracted state toward which the pouch is elastically biased, and can be reversibly stretchable into a stretched state. The elongate member can have a first end portion coupled to the implant body, a second end portion fastened to the second part of the pouch, and a mid-portion extending (i) from the second end portion, through the pouch to the first part of the pouch, and (ii) out of the pouch to the first end portion. In at least one state of the gripper, the mid-portion can be slidable through the gripper and into the pouch. Other embodiments are also described.

Abstract: A method is provided, including, during a percutaneous transcatheter procedure, placing an annuloplasty device entirely around an annulus of a mitral valve of a subject in a closed loop. The annuloplasty device includes a flexible sleeve, which is fastened to the annulus by coupling a plurality of tissue anchors to a posterior portion of the annulus, without coupling any tissue anchors to any anterior portion of the annulus between left and right fibrous trigones of the annulus. After (a) placing the annuloplasty device entirely around the annulus in the closed loop and (b) fastening the flexible sleeve to the annulus, a longitudinal portion of the flexible sleeve is longitudinally contracted. Other embodiments are also described.

Abstract: Apparatus is provided including a percutaneously-implantable implant and an adjustment device. The adjustment device can comprise an adjustment mechanism, coupled to the implant, and configured to change a dimension of the implant upon actuation of the adjustment mechanism and a lock. The adjustment device can have a locked state in which the lock inhibits actuation of the adjustment mechanism and an unlocked state in which the adjustment mechanism is actuatable. The adjustment device can be reversibly movable between the locked state and the unlocked state. The apparatus can include a longitudinal guide member and an adapter. An unlocking mechanism can be configured such that, while the adapter is coupled to the adjustment device, actuation of the unlocking mechanism moves the lock between the locked state and the unlocked state. Other applications are also described.

Abstract: A tissue-engaging element has a distal portion configured to engage a portion of tissue of the heart. A guide member is reversibly coupled to the tissue-engaging element. An artificial chorda tendinea has a distal end and a proximal end, at least the distal end being slidably coupled to the guide member. A tool is slidable along the guide member distally toward the tissue-engaging element while (i) the tool is coupled to at least the distal end of the chorda tendinea, and (ii) the guide member is coupled to the tissue-engaging element, such that sliding of the tool along the guide member distally toward the tissue-engaging element while (i) the tool is coupled to at least the distal end of the chorda tendinea, and (ii) the guide member is coupled to the tissue-engaging element, slides at least the distal end of the chorda tendinea toward the tissue-engaging element.

Abstract: Apparatus for facilitating anchoring of an anchor to a papillary muscle of a heart of a subject, the apparatus can include: (1) a housing, percutaneously deliverable to the heart, slidable along a guidewire, and shaped to define at least one opening; (2) a guide member, percutaneously deliverable to the heart, percutaneously removable from the subject, couplable to the housing, and having (a) a distal portion, including a chord-engaging element, configured to be percutaneously slidably coupled to at least one chorda tendinea of the heart, and decouplable from the at least one chorda, and (b) a proximal portion, including a longitudinal element; and (3) a deployment tool, configured (a) to be reversibly coupled to the anchor, (b) to be slidably coupled to the longitudinal element, and (c) to anchor the anchor to the papillary muscle. Other embodiments are also described.

Abstract: An apparatus can include: (1) a steerable tube, having a proximal section, a distal section, and a central longitudinal axis, the tube defining a primary lumen and two secondary lumens; (2) two wires, each extending from the distal section proximally through a respective secondary lumen; (3) a handle, coupled to the proximal section, and including a steering knob that is coupled to the wires such that rotation of the knob adjusts a degree of tension in the wires; (4) a pull ring coupled to the distal section of the tube such that the pull ring circumscribes the longitudinal axis at the distal section of the tube, and defining two recesses, a distal end portion of each wire being disposed in a respective one of the recesses; and (5) at least one cap, bridging the recesses and the distal end portion of the wires. Other embodiments are also described.

Abstract: A method for treating a heart valve of a patient includes inserting into a heart and in contact with a valve surface, an implant including an elongate element and a locking mechanism coupled to the elongate element. The locking mechanism has a resting position that provides a locked state preventing movement of the elongate element with respect to the locking mechanism. The heart valve is treated by facilitating movement of the elongate element with respect to the locking mechanism by maintaining application of a force to the locking mechanism using a tool, and thereby maintaining the locking mechanism in an unlocked state during the facilitating of the movement of the elongate element with respect to the locking mechanism. Subsequently, the locking mechanism is transitioned to the resting position by decoupling the tool from the locking mechanism.

Abstract: An implant structure includes a contracting mechanism, including a rotatable structure for contracting the implant structure, and a locking mechanism. A rotation tool is configured to engage and rotate the rotatable structure. A longitudinal guide member is removably coupled to the contracting mechanism, configured to guide the rotation tool to the rotatable structure, and includes a distal force applicator. The rotation tool is axially moveable with respect to the guide member. The contracting mechanism is arranged such that the locking mechanism is (a) unlocked when the guide member is coupled to the contracting mechanism in a first state, thereby allowing the rotatable structure to rotate, and (b) locked when (i) the guide member is coupled to the contracting mechanism in a second state, thereby restricting the rotation of the rotatable structure, and (ii) the guide member is not coupled to the contracting mechanism, thereby restricting the rotation of the rotatable structure.

Abstract: Apparatus includes a tube and an implant moveable at least in part through a lumen of the tube. The implant includes a longitudinal member and a locking mechanism coupled to the longitudinal member. The locking mechanism has (i) an unlocked state in which the locking mechanism is configured to facilitate adjustment of tension of the longitudinal member, and (ii) a locked state in which the locking mechanism is configured to restrict adjustment of the tension of the longitudinal member. A tool maintains the locking mechanism in the unlocked state via contact of the tool with the locking mechanism in the heart, and moves the locking mechanism into the locked state. The locking mechanism is disposed distally to the distal end of the tube while the longitudinal member is disposed entirely within the tube. Other applications are also described.

Abstract: A method is provided including inserting into a heart a tissue-adjusting member selected from the group consisting of: one or more artificial chordae tendineae and an annuloplasty ring structure. An adjusting mechanism of the tissue-adjusting member adjusts tension of the tissue-adjusting member. The adjusting mechanism: (a) includes a locking mechanism configured to restrict adjusting of the tissue-adjusting member by the adjusting mechanism, and (b) is shaped to define a first coupling. The method further includes, using a tool reversibly coupled to the adjusting mechanism, restricting the adjusting of the tissue-adjusting member by the adjusting mechanism, by facilitating movement of the locking mechanism into a locked state. The tool is shaped to define a second coupling that mates with the first coupling of the adjusting mechanism. The first and second couplings are coupled together and remain mated during the restricting of the adjusting of the tissue-adjusting member.

Abstract: During a percutaneous procedure, a flexible sleeve of an annuloplasty structure is introduced into an atrium and arranged completely around an annulus as a closed loop, such that none of one or more longitudinal contracting members thereof is positioned along an anterior portion of the annulus between fibrous trigones of the valve. The annuloplasty structure is fastened to the annulus. At least a portion of a posterior portion of the annulus is tightened, while preserving a length of an anterior portion of the annulus between fibrous trigones of the valve, by contracting, using the one or more longitudinal contracting members, a longitudinal portion of the sleeve not positioned along the anterior portion of the annulus between the fibrous trigones of the valve. Thereafter, the one or more longitudinal contracting members are locked.

Abstract: Apparatus for use with a guidewire is provided, the apparatus including (1) a first housing, shaped to define a first channel through which the guidewire is slidable; (2) a second housing, shaped to define a second channel through which the guidewire is slidable in at least a first direction toward the first housing; (3) a guidewire-engaging element, disposed within the second housing, and configured to inhibit the guidewire from sliding through the second channel in a second direction away from the first housing; and (4) a tubular member, (a) shaped to define a lumen therethrough, through which the guidewire is slidable, and (b) coupled to the second housing and slidably coupled to the first housing. Other embodiments are also described.

Abstract: A first element (91) includes a first arm (92) and a second arm coupled thereto and having a concavity (103) facing the first arm and defining a space (96). In an open state, a tissue anchor portion (46) moves into the space through a gap between distal portions (94) of the first and second arms. In the closed state, the anchor portion is not movable through the gap. A second element (82) is movable with respect to the first element, such that, while the portion (46) of the anchor (40) is within the space, and the first element is in the closed state, in a first position of the second element, the portion of the anchor is movable within the space, and in a second position of the second element, the second element applies torque to the anchor by rotating the second element. Other embodiments are also described.

Abstract: Apparatuses and devices usable for annuloplasty are provided. These can include a plurality of tissue anchors and an annuloplasty structure for placement on a heart valve annulus. The annuloplasty structure can include a plurality of compressible or adjustable subunits, and a plurality of anchor mounts alternately disposed with respect to the plurality of compressible/adjustable subunits. The anchor mounts are coupleable to the tissue anchors and can define a path for passage therethrough of a respective tissue anchor. The apparatuses and devices can be independently adjustable and can be adjustable for treating various sizes of patient annuli. Other embodiments are also described.

Abstract: A method is provided for use with an implant structure, a first tool, a second tool, and a longitudinal guide member. The implant structure is delivered to a heart of a subject, the implant structure including: (i) a first adjustment mechanism to which the first tool is coupled, and (ii) a second adjustment mechanism to which the longitudinal guide member is coupled. The implant structure is then coupled to tissue of the heart. Subsequently, the second tool is advanced along the longitudinal guide member to the second adjustment mechanism.

Abstract: Apparatuses and devices usable for annuloplasty are provided. These can include a plurality of helical tissue anchors and an annuloplasty structure for placement on a heart valve annulus. The annuloplasty structure can include a plurality of compressible or adjustable subunits, and a plurality of anchor mounts alternately disposed with respect to the plurality of compressible/adjustable subunits. The anchor mounts are coupleable to the helical anchors and can define a path for passage therethrough of a respective helical tissue anchor. The apparatuses and devices can be independently adjustable and can be adjustable for treating various sizes of patient annuli. Other embodiments are also described.

Abstract: Apparatus is provided, including an implant including a flexible longitudinal member extending along a longitudinal length of the implant, and a flexible contracting member extending alongside the longitudinal member and along the longitudinal length of the implant. The contracting member is configured to facilitate reduction of a perimeter of the implant by applying a contracting force to the longitudinal member in response to an application of force to the contracting member. The longitudinal member has first and second ends, and the first end is movable with respect to the second end responsively to the applying of the contracting force to the longitudinal member by the contracting member. The apparatus includes a lock coupled to the longitudinal member. The lock is engageable with the longitudinal member to restrict movement of the longitudinal member.

Abstract: Apparatus is provided, the apparatus comprising (i) a housing (22, 222), shaped to define a channel (24, 224) having an anchor-storage zone (26, 226) and an opening (28, 228) configured to provide access for an anchor driver (60) to the anchor-storage zone; (ii) a tissue anchor (40), stored in the anchor-storage zone and slidable through the channel; and (iii) a retaining member (30, 230). The retaining member (a) has a retaining state in which the retaining member is configured to retain the tissue anchor in the anchor-storage zone, and (b) is configured, by moving in response to a proximally-directed force applied to the tissue anchor, to allow the tissue anchor to leave the anchor-storage zone in response to the proximally-directed force. The proximally-directed force is greater than a pre-determined threshold force. Other embodiments are described.

Abstract: A method is provided including introducing into a heart atrium, an annuloplasty structure having a sleeve with an elongated tubular side wall, anchoring a first section of the sleeve by deploying a first tissue anchor through the first section and into a first portion of annulus tissue, and anchoring a second section of the sleeve by deploying a second tissue anchor through the second section and into a second portion of annulus tissue. A longitudinal portion of the tubular side wall is disposed between the first and second tissue anchors and has first and second lateral parts. The first lateral part is closer to the annulus than the second lateral part is to the annulus, and the second lateral part is opposite the first lateral part and has a larger degree of tension than a degree of tension of the first lateral part.