Abstract: Apparatus for regulating blood flow of a subject is provided, the apparatus comprising a prosthetic valve (20) that comprises a tubular element (22), shaped to define a lumen (23) therethrough, and a valve member (24), configured to be coupled to the tubular element (22) and to be disposed within the lumen (23). The prosthetic valve (20) has (1) a compressed configuration in which the lumen (23) has a compressed width, the valve member (24) is generally cylindrical, and the prosthetic valve (20) is configured to be percutaneously delivered into the subject, and (2) an expanded configuration in which the lumen (23) has an expanded width that is greater than the compressed width, and the valve member (24) is generally disc-shaped, is coupled to the tubular element (22), and is disposed within the lumen (23). Other embodiments are also described.

Abstract: Apparatus is provided, including an intracardiac annuloplasty structure configured for placement on an annulus of a heart valve, a first rotatable ring coupled to the annuloplasty structure and a second rotatable ring coupled to the annuloplasty structure. The first and second rotatable rings are arranged such that the first rotatable ring is rotatable to contract the annuloplasty structure while the second rotatable ring remains stationary, and the second rotatable ring is rotatable to contract the annuloplasty structure while the first rotatable ring remains stationary. Other embodiments are also described.

Abstract: Apparatus is provided, including a first catheter having a distal end portion transluminally advanceable to a vicinity of an anatomical site, a second catheter having a distal end portion advanceable through a first lumen and out of the first lumen, and a longitudinal implant, advanceable through the second lumen and out of the second lumen. The first and second catheters are assembled to facilitate sliding of the first and second catheters and of the implant, to configure them to assume a multi-bend formation having first and second bends separating first, second, and third domains. The first domain includes parts of the first and second catheters. The second domain includes the distal end portion of the second catheter, part of the implant, and none of the first catheter. The third domain includes part of the implant and none of the first nor second catheters. Other embodiments are also described.

Abstract: A catheter (14), advanced toward an anatomical site, has a proximal end and a steerable distal end. An anchor (32, 2332) is advanced through the catheter. An anchor driver (36) drives the anchor out of the catheter's distal end (104), anchoring the anchor at the site. A first constraining member (1602, 1652) engages tissue, and inhibits, after the anchor has been driven out of the catheter and before the anchoring, movement of at least the anchor driver's distal end, on a first axis between the anchor driver's distal end and a site at which the first constraining member engages the tissue. A second constraining member (26) inhibits, after the anchor has been driven out of the catheter and before the anchoring, movement of at least the anchor driver's distal end, on a second axis. Other embodiments are also described.

Abstract: An anchor deployment tool is provided that includes a flexible tube, which defines an anchor storage area in which tissue anchors are stored before deployment, and a distal anchor manipulation area that has a length of at least 3 cm. The tool also includes a rotating deployment element, which is positioned within the flexible tube, and is configured to, while the distal anchor manipulation area is disposed within a lumen defined by a wall of a sleeve, (i) directly engage the anchors in the anchor storage area a single one at a time, (ii) advance each of the anchors, while thus directly engaged, in a distal direction into the anchor manipulation area, and (iii) anchor the sleeve to tissue of a subject by deploying each of the tissue anchors through a distal end of the flexible tube, through the wall of the sleeve, and into the tissue.

Abstract: A method is provided, which includes providing an annuloplasty ring, which comprises (a) a flexible sleeve, and (b) a contracting assembly. During a percutaneous transcatheter procedure, the flexible sleeve is placed entirely around an annulus of a mitral valve of a subject in a closed loop. The sleeve 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 an anterior portion of the annulus between left and right fibrous trigones of the annulus. Thereafter, a longitudinal portion of the sleeve is contracted. Other embodiments are also described.

Abstract: Apparatus is provided, including a plurality of helical tissue anchors and an intracardiac annuloplasty structure defining a plane for placement on a heart valve annulus. The annuloplasty structure includes a plurality of compressible subunits, and a plurality of anchor mounts alternately disposed with respect to the plurality of compressible subunits. Each anchor mount (a) defines at least one opening for passage therethrough of a respective helical tissue anchor, (b) defines a path for passage therethrough of the helical tissue anchor, the path being aligned along an axis that is at a non-zero angle with respect to the plane of the annuloplasty structure, and (c) provides a structural element in the path for corkscrewing a distal portion of the helical tissue anchor therearound. Other embodiments are also described.

Abstract: Apparatus is provided, including an intracardiac annuloplasty structure. A first adjustment member has an end at a first location at first portions of the annuloplasty structure that are opposite each other. A second adjustment member has an end at a second location at the second portions of the annuloplasty structure that are opposite each other. The annuloplasty structure, the first-adjustment-member end, and the second-adjustment-member end are disposed within a catheter during delivery. After delivery, the first-adjustment-member end is moveable with respect to the annuloplasty structure toward and away from a plane of the annuloplasty structure to adjust a relative disposition of the first portions, and the second-adjustment-member end is moveable independently of the first-adjustment-member end and with respect to the annuloplasty structure toward and away from the plane to adjust a relative disposition of the second portions. 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: 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 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: 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 includes an annuloplasty structure, including: (i) a tubular body portion that is configured to be disposed at an annulus of a valve of a heart, and is shaped to define a perimeter; (ii) a flexible member, disposed within the tubular body portion; (iii) a first adjustment mechanism, attached to the tubular body portion and to the flexible member such that reversible actuation of the first adjustment mechanism reversibly adjusts a first dimension of the body portion by adjusting tension of the flexible member; (iv) a second adjustment mechanism, coupled to the tubular body portion, and reversibly actuatable to reversibly adjust a second dimension of the body portion. The apparatus further includes one or more elongate tools, reversibly couplable to the first and second adjustment mechanisms, and configured to independently actuate the first and second adjustment mechanisms by applying force thereto while the heart is beating.

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, comprising: (i) a catheter (64); (ii) an implant (100), comprising a flexible longitudinal member (102), and a linking member (104) that extends from a first linking site (106a) of the longitudinal member to a second linking site (106b) of the longitudinal member, the implant having: (a) a delivery state in which the longitudinal member is coaxial with the catheter, and at least a portion of the linking member is disposed alongside the longitudinal member, and (b) an implanted state in which a first distance between the first linking site and the second linking site, measured along the longitudinal member, is greater than a second distance between the first linking site and the second linking site, measured along the linking member; and (iii) a plurality of tissue anchors (46), slidable through the catheter and with respect to the longitudinal member. Other embodiments are also described.

Abstract: Apparatus for percutaneous access to a patient's body comprising a first steerable tube (12), shaped to define a first lumen, and a first coupling (152) at a longitudinal site of the first tube; and a second steerable tube (14), shaped to define a second lumen and a second coupling (154), the second coupling being intracorporeally couplable to the first coupling, the apparatus having (A) an unlocked state in which the second tube is rotatable within the first lumen, and (B) a locked state in which the second coupling is coupled to the first coupling, and rotation of the second tube is inhibited. The apparatus is configured such that when the second coupling becomes disposed at the longitudinal site in a given rotational orientation of the second tube, the apparatus moves into the locked state by the second coupling automatically coupling to the first coupling. Other embodiments are also described.

Abstract: Apparatus is provided including an annuloplasty ring structure configured to be implanted in a body of a patient. The annuloplasty ring structure includes a flexible body portion and an adjusting mechanism configured to adjust a size of the body portion of the annuloplasty ring structure. The adjusting mechanism includes a housing. A coupling is attached to the housing and to the body portion and is configured to couple the housing to the body portion in a manner in which the housing is moveable with respect to the body portion. Other embodiments are also described.

Abstract: A method is provided, including positioning an annuloplasty structure along an annulus of an atrioventricular valve of a subject, the annuloplasty structure including a sleeve having a lumen. The annuloplasty structure is fastened to the annulus. Thereafter, an elongate member is advanced into the lumen, such that an elongate contraction-restricting element of the elongate member occupies a longitudinal contraction-restricted portion of the sleeve. Thereafter, a contractible portion of the sleeve is contracted, while the contraction-restricting element restricts contraction of the contraction-restricted portion of the sleeve.

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: Apparatus is provided, including a locking mechanism, an implant, and a flexible strip within the implant having a plurality of recesses. A perimeter of the strip shortens and expands when the first end of the strip is advanced bidirectionally with respect to a second end of the strip. The locking mechanism includes a moveable recess-engaging portion, a mechanical support removably coupled to the recess-engaging portion, and a force applicator which maintains the recess-engaging portion in a position in which the recess-engaging portion is not disposed in any of the recesses. Upon decoupling of the mechanical support from the recess-engaging portion, the force applicator restricts motion of the plurality of recesses of the strip with respect to the second end of the strip, by facilitating positioning of the recess-engaging portion in one of the plurality of recesses. Other embodiments are also described.