Abstract: A method for measuring a mean visco-elasticity value for a soft material uses a single probe carrying at least one transducer. At least one burst of mechanical vibrations is induced in a constraint zone in order to generate internal shear waves in the tissue propagating from the constraint zone into the tissue. The transient tissue displacements are measured with a transducer in at least one first measurement zone in the tissue, the first measurement zone being located away from the constraint zone. A mean visco-elasticity of the region of the tissue situated between the constraint zone and the first measurement zone is estimated from the measured transient tissue displacements of the tissue in the first measurement zone.

Abstract: An ultrasonic diagnostic apparatus includes a Doppler processing circuitry, an image generating circuitry, and a control circuitry. The Doppler processing circuitry calculates a correlation matrix using a first data string that is a set of reflected wave data generated based on reflected waves that are generated by transmitting ultrasonic waves without making time intervals of transmission pulses uniform on an identical scan line. The Doppler processing circuitry calculates a filter coefficient based on a result of principal component analysis using the correlation matrix. The Doppler processing circuitry extracts a second data string that is included in the first data string, and that is a set of reflected wave data originated from reflected waves of the ultrasonic waves that are reflected on a moving object present on the identical scan line, using the filter coefficient. The Doppler processing circuitry estimates moving object information of the moving object based on the extracted second data string.

Abstract: An ultrasonic apparatus and method for controlling the same, by which whether a biopsy is required is determined based on X-ray and ultrasound images. An ultrasonic apparatus includes an image processing unit for matching or correlating an area of interest in an ultrasound image of a subject and an area of interest in a X-ray image of the subject; a controller for analyzing the matched or matching area of interest and determining whether a biopsy is required for the subject; and a display for displaying the determination as to whether the biopsy is required.

Abstract: An image processing apparatus obtains, in both a first image obtained by capturing an object and a predetermined space including the object, a corresponding feature part of the object, specifies a first point on the first image and a second point on the predetermined space, calculates a degree of matching between the first point and the second point, based on a positional relationship between the first point on the first image and the feature part of the object, and a positional relationship between the second point on the predetermined space and the feature part of the object on the predetermined space, and causes a display unit to display the calculated degree of matching.

Abstract: According to one embodiment, an ultrasound diagnostic apparatus comprises processing circuitry. The processing circuitry sets one of wavelengths of a plurality of light sources as a reference wavelength, normalize an intensity of light having a wavelength other than the reference wavelength, which is detected by a pair of each light irradiation unit and each optical detector, with an intensity of light having the reference wavelength, calculate a first value for each pair by nonlinear enhancement correction of a normalized light intensity, calculate a second value for the each pair by nonlinear reduction correction of an intensity of light having the reference wavelength detected by the each pair, and calculate an evaluation value based on a value obtained by multiplication of the first value and the second value for the each pair.

Abstract: Devices, systems, and methods for treating damaged or diseased valves are disclosed. A representative embodiment includes an elongated shaft having a longitudinal axis, a proximal portion, and a distal portion, and a dissection arm at the distal portion. The dissection arm can have a longitudinal axis and be moveable between a low-profile state and a deployed state. In the deployed state, a portion of the arm can flex outwardly away from the longitudinal axis of the shaft. The arm is configured to be deployed within a space within a vessel wall such that, as the arm moves from the low-profile state to the deployed state, the arm pushes against vessel wall tissue at a periphery of the space, thereby separating tissue at the periphery to form a dissection pocket having a predetermined shape.

Abstract: An adhesive applicator includes a receiver having a tubular body with a closed first end and an opposed second end, the tubular body having a deformable wall, an adhesive composition contained within the tubular body, and an applicator tip mounted on the tubular body and comprising a foam material having an applicator external of the applicator for applying the adhesive, the applicator being such that deformation of the tubular body causes the adhesive to be expressed through the applicator tip. The foam material is a reticulated foam felt and allows for relatively constant flow of the adhesive through the foam felt and to the applicator surface thereof over a wide range of viscosity conditions of the adhesive and pressure applied to the deformable body of the applicator.

Abstract: A medical device for reducing the volume of a left atrial appendage (LAA) may include an elongate shaft having a distal portion, and a volume-reducing means expandable from a collapsed to an expanded state, the volume-reducing means being releasably attached to the distal portion. The volume-reducing means may include an actuatable frame and an impermeable covering disposed over the frame. The volume-reducing means may be sized to fit within the LAA in the expanded state while maintaining an open fluid flow path from a distal region through the ostium of the LAA. A medical device may include a second volume-reducing means to be placed within and substantially occlude a distalmost region of the LAA. A method may include inserting a volume-reducing means into the LAA, expanding the volume-reducing means, and positioning the volume-reducing means such that an open fluid flow path is maintained through an entire cycle of the heart.

Abstract: Disclosed herein are devices and methods for closing a hole in the wall of a cardiovascular structure from the inside using a self-assembling closure device. The closure device can be delivered to the subject hole from the inside of the cardiovascular chamber using a transcatheter approach. Disclosed techniques involve deploying the closure device from the delivery device such that an endo-cameral portion of the closure device self-expands first to cover the hole from the inside, and then extra-cameral arms of the device are released to self-deploy against the outside of the wall by withdrawal of a retaining element, such as a guidewire, to secure the closure device to the wall.

Abstract: A device for closing at least one opening leading to an anatomical cavity is delivered via a catheter positioned in a first opening leading to the anatomical cavity. An orientation control unit is positioned within the anatomical cavity. The orientation control unit defines an orientation of a portion of a tissue surface within the anatomical cavity that is skewed with respect to the first opening and orients a closure member of the device with the tissue surface. An occluding member and a constricting unit of the device are positioned within the anatomical cavity with the occluding member blocking a portion of an opening that is constricted by the constricting unit. An intermediate member of the device is positioned within the anatomical cavity and a closure unit employing at least one piercing element pierces through the intermediate member into a tissue wall surrounding the anatomical cavity.

Abstract: The invention relates to a device for reducing the retraction of the edges (4.1) of an opened fascia (4) of a patient (1) having an open soft tissue defect, in particular having an open abdominal wall (2) or an open soft tissue defect on the back, via which a tensile force (A, B) can be applied to the edges (4.1) of the fascia (4) by a force component (A1, B1) directed away from the body of the patient (1), such that the device (11) holds the edges (4.1) of the fascia (4) under tension and spaced apart from each other and that furthermore there is an open soft tissue defect, in particular an opened abdominal wall (2), or an open soft tissue defect on the back.

Abstract: In general, devices, systems, and methods for relocating tissue during surgeries are provided. In one embodiment, a surgical apparatus is provided that includes a needle, a hook movably disposed in the needle, an actuator, and a slidable member. The needle can be percutaneously advanced through skin of a patient. The actuator can move the hook between two orientations, one being disposed entirely within the needle and another extending from the needle. The slidable member can slide along the needle and abut an exterior surface of the skin of the patient through which the needle is advanced. In use, the hook can engage tissue within the body of the patient when the hook extends from the needle. The surgical apparatus can then move the engaged tissue within the body of the patient, and the engaged tissue can be locked in position relative to the skin.

Abstract: A surgical rib retractor has a housing having a first shoulder. The surgical rib retractor also has a body pivotably coupled to the housing and having a second shoulder. The retractor further has a first arm unit pivotably coupled to the first shoulder and configured to receive one rib. The surgical rib retractor also has a second arm unit pivotably coupled to the second shoulder and configured to receive another rib. The surgical rib retractor also has a first arm actuator constrained to be rotatable relative to the first shoulder and coupled to the first arm unit to pivot the first arm unit as the first arm actuator is rotated. The surgical rib retractor further has a second arm actuator constrained to be rotatable relative to the second shoulder and coupled to the second arm unit to pivot the second arm unit as the second arm actuator is rotated.

Abstract: Retractor blade assemblies, retractors, kits, and methods of using the same. The retractor blade assembly may include a retractor blade, a pedicle screw, and a shim that connects the pedicle screw to the retractor blade. The retractor blade may have a proximal end configured to engage a retractor body and a distal end configured to retract soft tissue. The pedicle screw may have a head portion removably connected to the distal end of the retractor blade and a shaft portion configured to engage the pedicle of a vertebra. The shim couples the pedicle screw to the retractor blade. For example, the shim may include an extension portion configured to engage the retractor blade and a connection portion configured to receive and temporarily lock the pedicle screw to the retractor blade.

Abstract: An instrument for crimping a suture fastener to a surgical suture is disclosed. The instrument has a shaft and an expanded receiving face configured to receive the suture fastener and to provide a smoothing radius for a distal end of the shaft. The instrument also has an anvil in the distal end of the shaft. The instrument further has a hammer in the distal end of the shaft and moveable relative to the anvil for crimping the suture fastener therebetween and received in the expanded receiving face. The instrument also has a pusher moveable in a direction substantially parallel to a longitudinal axis of the shaft and configured to engage at least one of the hammer and the anvil for urging the hammer and the anvil together.

Abstract: Finger traps for collapsible suture loops are provided. In general, a suture coupled to an implant can be tensioned to facilitate desirable positioning of the implant relative to tissue in a patient's body. The suture can include a finger trap and a knot. In general, the finger trap is a hollow area of the suture through which the suture passes through itself and is configured to slide in a single direction when under tension. In an exemplary embodiment, the knot is located along a length of the suture that is closer than the finger trap to a tail of the suture that is being pulled to tension the suture.

Abstract: A method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. A bone engaging fastener is coupled to bone. A second fastener is coupled to a suture construction. The second fastener is coupled to the first fastener. Soft tissue is coupled to the suture construction.

Abstract: In one embodiment, a medical device includes a tissue anchor has a first portion and a second portion. The tissue anchor is configured to be placed within bodily tissue of a patient. The first portion of the tissue anchor includes an extension member configured to engage the bodily tissue to help retain the tissue anchor within the bodily tissue. The first portion has an inner surface and defines a cavity. The second portion of the tissue anchor has a helical ridge. The helical ridge is configured to engage the inner surface of the first portion of the tissue anchor to movably couple the second portion of the tissue anchor to the first portion of the tissue anchor.

Abstract: A suturing device for minimally invasive surgery is disclosed. The device has at least one ferrule holder. The device also has a latch spring comprising at least one latch biased to cover the at least one ferrule holder. The device further has a needle comprising one or more curved needle arms. The device also has a needle control wire coupled to the needle for moving the one or more curved needle arms on an arcuate path through a tissue gap. The device further has a cam coupled to the needle control wire for selective engagement with a follower region on the latch spring.

Abstract: An apparatus including a suture instrument including a handle and a post extending from the handle, the handle including a cavity; a cover slidably attached to the handle to cover the cavity; a post extending upward from a bottom surface of the cavity; and a suture spool removably positioned over the post; wherein the post includes a force member configured to provide upward force on the spool when the cover is slid off of the spool.

Abstract: Systems, devices and methods to improve safety and efficiency in an operating room comprise providing a suture package that holds new suture needles and needle receptacles for storing used needles. The devices can be safely worn for the surgeon to self-dispense new suture needles in the near surgical field and to secure the used needles into a needle trap or a needle retainer located on his extremity, on his operative instruments or on the surgical drapes. The device may provide automated and/or simplified needle counting both during use and after removal from the surgical field. The device may be configured for ergonomic and efficient use so as to minimize the actions and motions of the surgeon to dispense and secure the needle.

Abstract: An end effector includes an anvil and a cartridge assembly having a plurality of surgical staples disposed in a cavity defined therein. The cartridge assembly may include a movable driver or sled configured to deploy the surgical staple from the cavity into tissue. The surgical staple may include a linear leg and an arcuate leg extending therefrom. The linear leg may include a protruding portion to provide pressure to tissue captured by the surgical staple. A three-dimensional and/or self-supporting surgical staple may interlock its two legs upon deployment thereof.

Abstract: A surgical loading unit includes an elongate body, an end effector pivotably coupled to the elongate body, and a flexible knife bar extending through a distal portion of the elongate body and a proximal portion of the end effector. Articulation of the end effector relative to the elongate body in a first direction moves a first segment of the knife bar in the first direction and moves a second segment of the knife bar in a second direction, opposite the first direction.

Abstract: A surgical tool assembly that includes a elongate shaft assembly that defines a shaft axis. A surgical end effector is movably coupled to the elongate shaft assembly by a distal support link that is pivotally coupled to the surgical end effector to define an articulation axis that is transverse to the shaft axis. The distal support link is pivotally and axially movably coupled to the elongate shaft assembly to facilitate selective articulation of the surgical end effector relative to the elongate shaft assembly about the articulation axis between a first unarticulated position and articulation position located on one side of the shaft axis.

Abstract: A surgical device comprising a first jaw member, a second jaw member, a clamping member and a clamp apparatus is disclosed. The clamping member is slidably positioned to translate at least partially through the first jaw member. The clamping member engages the first jaw member and the second jaw member, and has a knife blade for cutting tissue. A flange of the clamping member is configured to engage a cam surface to pivot the second jaw member with respect to the first jaw member from an open position toward an approximated position. The clamp apparatus is movable from a retracted position to an advanced position for preventing a gap between proximal portions of the first jaw member and the second jaw member from exceeding a predetermined distance. The clamping member and the clamp apparatus are separately movable.

Abstract: A surgical clip applier includes a housing, a channel assembly, jaw assembly, and a first insert. The channel assembly extends distally from the housing and the jaw assembly is disposed at the distal end of the channel assembly. The jaw assembly includes a first and second jaws constructed of a first material. Each of the jaws defines a recess extending longitudinally along opposing inner surfaces thereof. The first insert is disposed in the recess of at least one of the first or second jaws. The first insert is constructed of a second material different from the first material.

Abstract: A staple cartridge assembly is disclosed comprising, one, a plurality of staples removably stored within a surgical staple cartridge and, two, an implantable adjunct. The implantable adjunct is configured to be progressively released from the surgical staple cartridge during a firing progression of a firing assembly configured to travel through the surgical staple cartridge.

Abstract: Described here are devices and methods for treating hypertension by forming a fistula between two blood vessels to reduce blood pressure of a patient. The fistula may be formed using a catheter having an electrode that is placed in a first blood vessel. In some instances, a desired amount of blood pressure is determined. In other instances, the hypertension is drug resistant hypertension.

Abstract: An apparatus includes a body, a shaft assembly, a stapling head assembly, and an anvil. The stapling head assembly includes a deck member, a plurality of staples, and a driver. The deck member includes a first deck surface, a second deck surface, an outer annular array of staple openings formed through the deck surfaces, an inner annular array of staple openings formed through the deck surfaces, and a plurality of stand-off features extending distally from the second deck surface. The second deck surface is recessed relative to the first deck surface. The driver is operable to drive the staples through the staple openings. The anvil is operable to compress tissue against the deck surface.

Abstract: A circular stapler including a cartridge assembly and an anvil assembly is provided. The cartridge assembly includes a rotatable drive shaft and the anvil assembly includes first and second pull cables. When the anvil assembly engages the cartridge assembly, retraction of the first pull cable effects clamping of tissue between the anvil assembly and the cartridge assembly, and retraction of the second pull cable effects stapling and cutting of the clamped tissue.

Abstract: An occlusion device for a vascular or biological lumen includes a plurality of coiling members held together at both the proximal and distal ends by retaining features. A restraining loop can hold coiling members together at a point along a length of the coiling members. The coiling members are delivered simultaneously to form a coil pack to occlude a target location in the lumen. One or more of the coiling members has at least a portion with a larger curl diameter than other coiling members to secure the occlusion device against lumen walls at the target location. The coil members may have different or varying material moduli. The device may be used, for example, for occluding a vessel to block blood flow to an artery supplying blood liver (hepatic artery), kidney (renal artery), spleen (splenic artery) or intestines (mesenteric artery).

Abstract: A surgical instrument for treating tissue during use of a diagnostic scanning device. The surgical instrument includes a housing, an actuating mechanism and an end effector assembly. The actuating mechanism is configured to activate the end effector assembly to treat tissue. At least a portion of the end effector is made of a material that is compatible with the diagnostic scanning device and allows a user to insert and activate the end effector to treat tissue at a surgical site within a patient while the surgical site is monitored during diagnostic scanning device.

Abstract: A tourniquet for occluding the flow of blood in an injured limb, and methods of use and construction thereof is provided. The tourniquet includes a strap of inelastic material having an annulus at a first end and a fastener assembly a second end. The fastener assembly is extendible through the annulus, and the strap has a hook or loop fastener portion on at least one side. The fastener assembly includes first and second fastener portions. The first fastener portion is releasably fixable to the hook or loop fastener portion on the strap and is separable from the hook or loop fastener portion under a first tensile force. The second fastener portion is fixable to the hook or loop fastener portion on the strap and is separable from the hook or loop fastener portion under a second tensile force, wherein the second tensile force is greater than the first tensile force.

Abstract: A bone cutting guide may include a support that contains a shaft movable relative to the support. The shaft may carry a guide member having one or more cut guides through which a clinician inserts a cutting member to cut bone positioned under the guide cut guides. In operation, a clinician may fixate the support of the bone cutting guide to a bone and translate the guide member until the one or more cut guides are positioned at a desired cut location. The clinician may then perform a cut through the cut guide. In some examples, the bone cutting guide includes additional components, such as bridging member or secondary cut guide, to provide additional functionality.

Abstract: A system for cutting a bone of a patient may include a motor; a rotating shaft drivingly coupled to the motor; a support tube positioned around the rotating shaft and supporting the rotating shaft at a plurality of locations; a plurality of steering wires coupled to the support tube; and a bone cutter at a distal end of the rotating shaft.

Abstract: A laminectomy forceps having a cutting unit with a fixed beak and a sliding tray slidingly mounted on the fixed beak, an actuation lever to actuate the sliding tray, a handle in opposed position to the actuation lever and joined to an external frame joined to the fixed beak, a lever mechanism connected to the actuation lever and to the sliding tray, the lever mechanism including a first lever shaped as a straight bar, a second lever shaped as a straight bar and having a first arm between a fulcrum and a first end and a second arm between the fulcrum and a second end and a third lever shaped as a straight bar connected to a stem intended to push the sliding tray.

Abstract: A drill tool for implant surgery including a first drill part having a first, smaller diameter for drilling a recess for an implant post and a second drill part having a second, larger diameter for drilling a recess for an implant hat is disclosed. The second drill part has one or more shape cutting edges and one or more sharp pre-cutting edges extending beyond said one or more shape cutting edges.

Abstract: A motor-driven orthopedic impacting tool is provided for orthopedic impacting in the hips, knees, shoulders and the like. The tool is capable of holding a broach, chisel, or other end effector, which when gently tapped in a cavity with controlled percussive impacts, can expand the size or volume of an opening of the cavity or facilitate removal of the broach, implant, or other surgical implement from the opening. A stored-energy drive mechanism stores potential energy and then releases it to launch a launched mass or striker to communicate a striking force to an adapter in either a forward or reverse direction. The tool may further include a combination anvil and adapter and an energy adjustment mechanism to adjust the striking force the launched mass delivers to the adapter in accordance with a patient profile.

Abstract: The invention provides a method for creating a curvilinear void created in a bony structure. The method includes inserting a distal end of a reamer device through a cannula and into a curvilinear void created in a bony structure, the reamer device having a flexible reamer shaft assembly which includes (i) a pivotable reaming element at a distal end thereof, and (ii) a mechanism for pivoting adjustably the reaming element. The method also includes deploying the reaming element within the curvilinear void and manipulating the reaming element to enlarge the curvilinear void.

Abstract: An orthopedic bone cutter for cutting bone and tissue is described. The cutting device comprises a plurality of radially extending struts that form a frame to which a base is connected thereto. Each of the struts that form the frame comprise sidewalls having left and right sidewall portions that are positioned at an angular relationship with respect to a primary strut sidewall portion. A plurality of cutting teeth reside along each of the struts have a tissue cutting surface that is raised above the exterior strut surface. The base of the orthopedic bone cutter may comprise a cross bar or bar and boss interface which secure bone cutter to a drive shaft.

Abstract: A method of preparing a shoulder to receive a glenoid component includes accessing a glenoid of a shoulder, rotationally coupling a distal portion of a combination device to an instrument, applying a torque to a proximal portion of the combination device, transferring the applied torque from the proximal portion to the distal portion through a pivotable connection, rotating the instrument using the transferred applied torque, and reaming a portion of the glenoid with a rotating reaming section of the instrument using the transferred applied torque.

Abstract: Disclosed herein is a parallel spacer for parallel spacing of a guide wire/pin during surgery. The parallel spacer includes a parallel spacer body having a top surface and a bottom surface. The parallel spacer also includes a first aperture extending through the body and defined by one or more internal walls that extends to the opening in the top surface. The aperture is sized to receive a first guide and hold the first guide in a first orientation. A second aperture extends between a second opening in the top surface and a second opening in the bottom surface. The second aperture is defined by one or more walls located within the spacer body. The one or more walls connect the second opening in the top surface to the second opening in the bottom surface. The aperture is sized to receive another guide and hold the other guide in a parallel orientation to the first orientation at a first distance from the first aperture.

Abstract: A system for performing a fusion procedure on a sacroiliac joint defined between a sacrum and an ilium. The system may include a working cannula including a proximal end, a distal end, a tubular body extending between the proximal and distal ends, a cannula passageway defined within the tubular body and having a cannula axis extending there through, a pair of prongs coupled to the tubular body and extending distally there from, an anchor arm engagement structure coupled to the tubular body, and a pin guide coupled to the tubular body and defining a pin passageway having a guidance axis there through that is generally parallel with the cannula axis.

Abstract: Patient specific implant technology, in which an outline representation of a portion of an outer surface of a periphery of a bone volume is determined and the outline representation is used in operations related to implant matching. In addition, an instrument may be made to match a perimeter shape of a Patient Specific Knee Implant with features for locating holes in a distal femur such that posts or lugs in a femoral implant locate the femoral implant centered medial-laterally within an acceptable degree of precision to prevent overhang of either the side of the femoral implant over the perimeter of the distal femur bone resections. Further, a two-dimensional outline representation may be segmented into segments that correspond to resection cuts used in fitting an implant on a portion of a bone and operations related to implant matching may be performed based on the segments.

Abstract: A sterilizable disposable surgical instrument is formed by an implant for bone fusion as well as an implant sleeve surrounding the implant for bone fusion. The implant has a distal implant section, a proximal implant section, and a coupling section with a polygonal cross-section profile between the distal and proximal implant section. The implant sleeve has a protective cap and a handle, which can be connected to one another. A first bore is configured in the protective cap in the longitudinal direction and receives the proximal implant section of the implant. A second bore is configured in the handle running in the longitudinal direction and receives the distal implant section of the implant for bone fusion. A coupling region having a through-opening is configured in the second bore in the handle, into which the coupling section of the implant for bone fusion engages in an integral and force-locking manner.

Abstract: Electrohydraulic lithotripters comprising a plurality of electrohydraulic probes are disclosed. Each probe of the plurality of probes comprise a first electrode and a second electrode positioned at a distal end of the probe such that when the probe is discharged, an electric arc between the first electrode and the second electrode produces a shockwave that radiates from the distal end of the probe. A first probe and a second probe of the plurality of probes may be configured to discharge simultaneously or sequentially.

Abstract: Disclosed embodiments include devices and methods for shaping, bending, and/or volumetrically reducing rigid cartilaginous structures, such as hyaline cartilage in the septum. In the case of septal cartilage, shaping, bending, or reducing the cartilage would be useful for reducing nasal obstruction or to improve the cosmetic appearance of the nose.

Abstract: Attachment assemblies for oral hygiene devices and, in particular, attachment assemblies having improved designs to more effectively clean an individual's tongue or other inter-oral surface are described herein. These improved attachment assembly correspond, amongst other aspects, to improved fluid chamber configurations, improved fluid channel configurations, improved fluid exit hole configurations, improved air inlet hole configuration, and air channel features. Furthermore, these improvements to attachment assemblies are capable of being implemented separately from, or in combination with, one another.

Abstract: Provided is a forceps device including: an elongated body portion; a pair of gripping pieces that are provided at a distal end of the body portion, at least one of which possesses conductivity; a motive-power output portion that is provided at a base end of the body portion; a motive-power converting mechanism that connects the pair of gripping pieces and the motive-power output portion, and that converts motive power output by the motive-power output portion into relative opening/closing motions of the pair of gripping pieces; and an insulating member that is provided in a pathway connecting the pair of gripping pieces and the motive-power output portion via the motive-power converting mechanism.

Abstract: Pericardial modification devices and methods can be used for the treatment of heart conditions. For example, this document describes devices and methods for treating heart failure with preserved ejection fraction, including diastolic heart failure, by performing a pericardial modification procedure. In one example embodiment, a method for treating diastolic heart failure includes creating an opening in a patient's pericardial tissue, or removing a portion of the patient's pericardial tissue. The creation of the opening or the removing of the pericardial tissue reduces pressure exerted by the pericardial tissue on the patient's heart. The pericardial modification procedures are performed while avoiding trauma to the epicardial surface of heart as well as the phrenic nerves.