Abstract: Apparatus is provided that includes an implant structure, which includes a contracting mechanism, which includes a rotatable structure, arranged such that rotation of the rotatable structure contracts the implant structure. A longitudinal member is coupled to the contracting mechanism. A tool for rotating the rotatable structure is configured to be guided along the longitudinal member, to engage the rotatable structure, and to rotate the rotatable structure in response to a rotational force applied to the tool. Other embodiments are also described.

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: 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 for use with a prosthetic valve for implantation at a native valve of a subject, the native valve including at least one native leaflet, the apparatus including (1) a prosthetic valve support, including (a) an upstream support portion, being configured to be placed against an upstream side of the native valve, and having an inner perimeter that defines an opening that is configured to receive the prosthetic valve, and (b) at least one clip (i) comprising at least two clip arms and a clip-controller interface, the clip-controller interface being coupled to at least one of the clip arms, and (ii) being configured to be coupled to a native leaflet of the native valve; and (2) at least one clip controller, reversibly couplable to the clip-controller interface, and configured to facilitate opening and closing of the clip. Other embodiments are also described.

Abstract: Apparatus is provided, including: (A) a valve body (204) including a first frame (206) shaped to define a lumen therethrough, and a valve member (205) disposed within the lumen, (B) an upstream support (210), configured to be placed against an upstream surface of a native heart valve, and (C) a flexible sheet (214) that couples the upstream support to the valve body. The valve body has a compressed state in which the first frame has a first diameter, and an expanded state in which the first frame has a second diameter that is greater than the first diameter. The support includes a second frame (212) that has a compressed state, and an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter. 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: 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: A method includes positioning an anchor deployment manipulator at least partially within a lumen of a sleeve of an annuloplasty ring, the sleeve having a lateral wall shaped to define the lumen, and the lumen extending longitudinally along a length of the sleeve. A portion of the sleeve that contains a distal end of the deployment manipulator is placed into an atrium in a vicinity of an annulus of an atrioventricular valve. An anchor is deployed from the distal end of the deployment manipulator through the lateral wall of the sleeve into cardiac tissue, while the distal end of the deployment manipulator is positioned such that a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the lateral wall of the sleeve at a point at which the anchor penetrates the lateral wall.

Abstract: Apparatus and methods are described including a prosthetic valve support (40) configured to be placed at a patient's native atrioventricular valve annulus. The valve support defines an annular element (44) that defines an inner cross-sectional area thereof. An expandable prosthetic valve (80) is placed into the patient's ventricle, the prosthetic valve including an expandable frame (79) and prosthetic valve leaflets (82) coupled to the frame. When the frame is in a non-constrained state thereof, a cross-sectional area of the frame, along at least a given portion L of the frame's length, is greater than the cross-sectional area defined by the annular element. The prosthetic valve is couplable to the prosthetic valve support at any location along the portion, by the frame being expanded when the location along the portion is aligned with the annular element. Other applications are also described.

Abstract: A method is provided, including introducing into a heart atrium, an annuloplasty structure having a sleeve with an elongated tubular side wall and at least one distal end wall having a surface substantially transverse to a lateral surface of the tubular side wall. A first tissue anchor is deployed through the surface of the end wall of the sleeve and into a first portion of annulus tissue. A second tissue anchor is deployed through a portion of the tubular side wall and into a second portion of annulus tissue, such that the first tissue anchor and the second tissue anchor are both deployed consecutively, to extend in a substantially same direction and into a common, substantially planar surface of a valve annulus, the common, substantially planar surface including the first and second portions of the annulus tissue. Other applications are also described.

Abstract: Apparatus and methods are described including a prosthetic valve support (40) configured to be placed at a patient's native atrioventricular valve annulus. The valve support defines an annular element (44) that defines an inner cross-sectional area thereof. An expandable prosthetic valve (80) is placed into the patient's ventricle, the prosthetic valve including an expandable frame (79) and prosthetic valve leaflets (82) coupled to the frame. When the frame is in a non-constrained state thereof, a cross-sectional area of the frame, along at least a given portion L of the frame's length, is greater than the cross-sectional area defined by the annular element. The prosthetic valve is couplable to the prosthetic valve support at any location along the portion, by the frame being expanded when the location along the portion is aligned with the annular element. Other applications are also described.

Abstract: A method is provided, including, delivering into a heart of a patient an annuloplasty ring structure including a body portion and an adjusting mechanism configured to adjust a size of the body portion of the annuloplasty ring structure, the adjusting mechanism including a housing, and following the delivering, moving the housing with respect to the body portion. Other applications are also described.

Abstract: Apparatus and methods are described, including one or more valve support guide members that are delivered to one or more commissures of a native atrioventricular valve of a patient. A prosthetic valve support is advanced toward the native valve along the one or more valve support guide members and placed at the native valve. A prosthetic valve is coupled to the valve support. One or more sealing elements facilitate sealing of an interface between the prosthetic valve support and the native valve. Other applications are also described.

Abstract: Apparatus is provided including an implant structure (22, 122, 1122), a rotatable structure (2900) coupled to the implant structure (22, 122, 1122) in a vicinity of a first portion thereof, and a flexible member (30). At least a first portion of the 5 flexible member (30) is disposed in contact with the rotatable structure (2900), and at least one end portion of the flexible member (30) is not disposed in contact with the rotatable structure (30). In response to rotation of the rotatable structure (2900) in a first direction thereof, successive portions of the flexible member (30) contact the rotatable structure (2900) to pull the at least one end portion of the flexible member 0 (30) toward the first portion of the implant structure (22, 122, 1122), and responsively to draw the first and second portions of the implant structure (22, 122, 1122) toward each other. Other applications are also described.

Abstract: An anchor driver is provided that includes a driver head having a flexible ring. An anchor is provided that includes a coupling head, which is shaped so as to define: (a) one or more mating elements that engage mechanical coupling elements of the driver head such that rotation of the mechanical coupling elements rotates the mating elements, which in turn rotate the coupling head, and (b) an outer coupling surface, sized to be inserted into and engage the flexible ring. The anchor also includes a tissue coupling element fixed to the coupling head. The rotation of the mechanical coupling elements causes the tissue coupling element of the anchor to screw itself into tissue, thereby causing separation of: (a) the outer coupling surface of the coupling head from the flexible ring, and (b) the mating elements of the coupling head from the corresponding mechanical coupling elements. Other embodiments are also described.

Abstract: Apparatus is provided that includes an annuloplasty system for use on a subject. The system includes an annuloplasty ring, which includes a sleeve having a lumen, and at least one anchor, shaped so as to define a coupling head and a tissue coupling element, which tissue coupling element is shaped so as to define a longitudinal axis, and is configured to penetrate cardiac tissue of the subject in a direction parallel to the longitudinal axis. The system further includes an anchor deployment manipulator, configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the tissue coupling element from a distal end of the deployment manipulator through a wall of the sleeve into the cardiac tissue in the direction parallel to the longitudinal axis of the tissue coupling element and parallel to a central longitudinal axis through the distal end of the deployment manipulator.

Abstract: Apparatus is provided for use with a native valve of a heart of a subject, the apparatus including (1) an annular upstream support portion, configured to be transluminally placed against an atrial surface of the native valve; (2) a tissue-engaging element that includes a coupling portion configured to be transluminally coupled to tissue in a ventricle of the heart; (3) an elastically-stretchable holding element, configured to secure the upstream support portion against the atrial surface by elastically coupling the coupling portion to the upstream support portion; and (4) a prosthetic valve, configured to be transluminally delivered to the native valve and intracorporeally coupled to the upstream support portion subsequently to the securing of the upstream support portion against the atrial surface. Other embodiments are also described.

Abstract: Apparatus and methods are described, including apparatus for puncturing a fossa ovalis of a heart. The apparatus comprises a catheter shaped to define a catheter lumen. A puncturing element is slidably disposed within the catheter lumen and configured to (a) be deployed from a distal portion of the catheter, and (b) puncture the fossa ovalis. A balloon is configured to be deployed from the distal portion of the catheter, be radially expanded, and upon being deployed and expanded, facilitate positioning of the puncturing element, by contacting at least a portion of the fossa ovalis. Other applications are also described.

Abstract: Apparatus and methods are described, including apparatus for puncturing a fossa ovalis of a heart. The apparatus includes a catheter shaped to define a catheter lumen. A puncturing element is slidably disposed within the catheter lumen, and is deployed from a distal portion of the catheter and to puncture the fossa ovalis. A probing element is deployed from the distal portion of the catheter. Upon being deployed, the probing element probes tissue near the fossa ovalis, the probing element having a first configuration thereof upon probing the tissue near the fossa ovalis. Upon probing tissue of the fossa ovalis, the probing element facilitates positioning of the puncturing element, by automatically adopting a second configuration thereof that is different from the first configuration. Other applications are also described.

Abstract: Apparatus is described for use with a native heart valve of a subject, the apparatus including (1) a prosthetic valve support, comprising an upstream support portion, the upstream support portion having (a) a compressed configuration and an uncompressed configuration in which the upstream support portion has an inner perimeter that defines an opening; and (2) a prosthetic valve, advanceable into the opening defined by the upstream support portion, and intracorporeally couplable to the upstream support portion by being expanded within the opening defined by the upstream support portion, the apparatus being configured such that, when the prosthetic valve is expanded within the opening defined by the upstream support portion, the expansion of the prosthetic valve is restricted by the inner perimeter of the upstream support portion, without causing the prosthetic valve support to apply a radially-expansive force to the native annulus. Other embodiments are also described.