DE102008013856A1 - Valvuloplasty catheter for treatment of heat valve stenosis, has catheter casing provided for surrounding catheter hollow space, dilatation balloon arranged at proximal end in proximity of head, and sensor arranged in area of head - Google Patents

Abstract

The catheter (2) has a catheter casing (4) surrounding a catheter hollow space (6), and a dilatation balloon (14) arranged at a proximal end (10) in the proximity of a catheter head (12). An image-giving sensor (18) e.g. ultrasonic sensor, is arranged in an area of the head and designed in such a manner that its visual field covers a space region lying around the balloon. The sensor is movable in a longitudinal direction of the catheter opposite to the casing and rotatable by a drive shaft that is guided in the hollow space, where a cyclic sampling of the sensor is executed by a multiplexer. Independent claims are also included for the following: (1) a medical examination and treatment device comprising a valvuloplasty catheter (2) a method for minimal-invasive treatment of a heat valve stenosis.

Description

The The invention relates to a valvuloplasty catheter for treatment of heart valve stenoses surrounding a catheter cavity flexible catheter sheath and one at the proximal end in near the catheter tip dilatation balloon having. The invention further relates to a medical examination and treatment device with such a valvuloplasty catheter.

To In the 1990s, heart valve disorders were usually Treated by surgical operations open heart. This was associated with high risks and long recovery times for the patient. For some years now there is the possibility of constrictions or stiffening of the heart valves, so-called heart valve stenoses, minimally invasive with the help of specially designed To treat catheters.

at this method, also called valvuloplasty, becomes thinner flexible hollow body or catheter, a so-called valvuloplasty catheter, from the groin or arm of the patient into the bloodstream (Vein or artery) introduced and advanced slowly so far, until the body-facing (proximal) end of the valvuloplasty catheter, speak the catheter tip, which reaches the heart valve to be treated. Subsequently is a arranged in the region of the catheter tip elastic Balloon, a so-called dilatation balloon, with the help of an expansion agent, the one about the catheter sheath enclosed Cavity is supplied from the outside, so far inflated, until a desired expansion of the heart valve is reached. After that the expansion agent is drained off, whereupon the dilatation balloon contracting, leaving the valvuloplasty catheter finally pulled back over the bloodstream and removed can. Often, a single application of the procedure is sufficient to achieve a lasting healing success.

A suitable for such procedures Valvuloplastik catheter is for example from the US 4,819,751 known.

Although the method of valvuloplasty contrasts a significant advance an open heart surgical procedure but still not negligible risks until towards the possible death of each such minimally invasive procedure. Object of the present invention is It therefore, a valvuloplasty catheter and an associated indicate medical examination and treatment facility, with which the risk of heart valve invasion is faced previously known and practiced concepts further lowered and increases the likelihood of comprehensive treatment success can be.

In With respect to the valvuloplasty catheter, the object according to the invention thereby solved that in the area of the catheter tip at least one imaging sensor is provided.

Conveniently, The Valvuloplastik catheter is part of a medical Examination and treatment facility, wherein the imaging Sensor via a signal line guided in the catheter cavity with an outside of the valvuloplasty catheter Picture editing and playback device is connected to and this real-time image information from the site of a valvuloplasty Intervention transmits.

The Invention is based on the consideration that a large Disadvantage of previous valvuloplasty catheters and their handling It is that these with the help of external fluoroscopy (Angiography) are applied in the heart, leaving the patient and the medical staff during this procedure x-rays are exposed. In addition, there is the disadvantage that in the X-ray image either the catheter or the Herklappenstenose (or both) relatively is hard to see, especially when using a cost-effective conventional X-ray method with two-dimensional Imaging characteristics. By injecting contrast agents can Although the heart valve region is shown more clearly and with more contrast but there are patients who are allergic to contrast medium react, leading to dangerous complications can. Due to the limited view in the angiographic X-ray control is the risk that the dilatation balloon is not placed properly and by the Dilation the heart valve is damaged.

To avoid such difficulties, it is now envisaged to arrange an imaging element in the anterior part of a valvuloplasty catheter in order to provide "live images" of the location of the valvuloplasty procedure, ie directly from the heart, to an externally mounted display device, e.g. B. a PC-based visualization system with connected monitor. With this imaging element, on the one hand, the insertion and passage of the valvuloplasty catheter through the vessels, heart chambers and heart valves can be followed, which in particular reduces the risk of a "puncture" through the vessel walls. On the other hand, the precise positioning of the dilation balloon in the heart valve to be treated as well as its subsequent expansion can be displayed, monitored and checked. An application of X-radiation, which is undesirable in particular in children and possibly harmful in the long term, can be dispensed with altogether.

advantageously, the imaging sensor is configured and aligned so that his field of vision is one around the dilatation balloon Room area covers. That is, the imaging sensor "looks" - related on the approximately cylindrical around a central axis arranged catheter sheath or the dilatation balloon - in about radially outward, depending on the specific arrangement and on the type and operating principle of the If necessary, through the dilatation balloon "through".

In alternative embodiment, it is provided that the field of view the imaging sensor above all lying in front of the catheter tip Covering space, so based on the insertion direction of the catheter forward "looks", which is particularly appropriate for monitoring the insertion process and the feed, z. B. through a heart valve, is.

optimally, the imaging sensor combines the two options mentioned, has a particularly wide field of vision both in radial as well as in the forward direction. Alternatively, if space permits, too several imaging elements or sensors may be provided, the different Cover viewing directions.

advantageously, is the imaging sensor opposite the catheter sheath displaceable in the longitudinal direction of the valvuloplasty catheter. For example, it may be provided that the sensor from a in near the dilatation balloon located "retracted" stop position in the forward direction from the outer catheter sheath to push out, so in the manner of an anticipatory Vorpostens to inspect the areas further ahead. To this end the imaging sensor z. B. at a relative to the outer Slidable catheter sleeve and arranged in the cavity Inner catheter or be arranged on an inner part.

Preferably the imaging sensor is an (acoustic) ultrasonic sensor, a magnetic resonance sensor or an optical image sensor.

The Ultrasound imaging (sonography) is performed after the so-called Echo pulse method. An electrical pulse of a high frequency generator is in the transducer of an ultrasonic transducer (usually a piezo-crystal, possible is also a silicon-based sensor) in one Sound pulse implemented and sent out. The sound wave is on the inhomogeneities of the tissue structure partially or completely scattered or reflected. A returning echo will In the transducer converted into an electrical signal and then in a connected electronic evaluation and display unit visualized, using a mechanical or electronic panning the sensor is a 2D or 3D scan of the examination area done can. Intervascular ultrasound imaging (IVUS) is especially for imaging deep tissue layers and Vascular structures suitable.

In a second advantageous variant is in the imaging Sensor around a so-called IVMRI sensor for intervascular Magnetic resonance imaging. In magnetic (nuclear) resonance tomography become the magnetic moments (nuclear spins) of the nuclei of the studied Tissue aligned in an external magnetic field and by radiated radio waves to a gyroscope movement (Präzesion) stimulated, whereby as a result of relaxation processes in one associated receiving coil an electrical magnetic resonance signal that is the basis for the image calculation represents.

Recently, it has been possible to miniaturize the magnetic field generating elements and the transmitting and receiving coils and to integrate in an imaging IVMRI sensor that an intracorporeal or intervascular application of the MRI method is possible, advantageously the required static magnetic field within the patient's body is generated or applied. Such a concept is z. B. in the US 6,600,319 described.

For this purpose, in the IVMRI sensor, a permanent magnet or an electromagnet for generating a static magnetic field and an equally effective as a transmitting and receiving coil coil integrated. The magnet generates field gradients of preferably 2 T / m to 150 T / m in the vicinity of the vessel or organ to be examined. Nearby means up to 20 mm away from the magnet. Depending on the strength of the magnetic field, radio waves in the frequency range from 2 MHz to 250 MHz can be coupled out via the coil to excite the surrounding body tissue. Higher static magnetic field strengths require higher frequencies at the excitation field. The coil advantageously also serves to receive the associated "response" of the body tissue. Alternatively, separate transmit and receive coils may be provided.

in the Unlike conventional MRI systems are the IVMRI sensor and the electronic signal processing and evaluation provided Circuits and digital evaluation advantageously designed so that they are synonymous with a comparatively inhomogeneous Working magnetic field with high local field gradients and generate corresponding magnetic resonance images. Since under these conditions the received echo signals in characteristic Way through the microscopic diffusion of water molecules is influenced in the examined tissue is usually an excellent representation and differentiation between different Soft tissues, z. Between lipid layers and fibrous tissue, allows. This is just what is now planned Field of application of valvuloplasty of particular interest.

alternative to the concept described here, the static magnetic field also be generated by external magnets. Unlike the conventional one MRI becomes the dynamic fields, i. H. the radio waves, as well in this embodiment expediently intervascular, d. H. by arranged on Valvuloplastik catheter Transmitter and receiver units generated.

Of Further, in alternative or additional embodiment an optical imaging element in the region of the catheter tip of the valvuloplasty catheter. For example, come one on the well-known CMOS technology (Complementary Metal Oxide Semiconductor-based optical semiconductor detector for detection of incident light into consideration. One such as "Active Pixel Sensor "known CMOS sensor is similar as well as the well-known from the field of digital photography CCD sensors (Charge-Coupled Device) on the internal photoelectric effect and has in addition to a low power consumption the advantage that he is particularly inexpensive to produce. For illumination the examination and treatment region, especially the respective one Heart valve, is appropriate in this variant of imaging Light source, z. B. an LED (Light Emitting Diode) in the field of Provide catheter tip, which has a through the catheter cavity guided electrical line supplied with power / voltage can be.

alternative The Valvuloplastik catheter can also be equipped with a sensor for optical Coherence tomography (OCT = Optical Coherence Tomography) be equipped.

The Optical coherence tomography imaging provides high-resolution Pictures, in particular, the structures near the Vessel surface comparatively accurate play. The principle of this procedure is based on that of Valvuloplasty catheter fed via a light guide Light, preferably infrared light, radiated into the vessel is, where the light reflected there again in the light guide coupled and guided to an evaluation. In the evaluation unit is - similar to a Michelson interferometer - the interference of the reflected Light with the reference light for image generation evaluated.

Whereas conventional interferometric apparatuses preferably work with laser light of a defined wavelength, which has a comparatively large optical coherence length, light sources with broadband radiation characteristics ("white light") and with comparatively short coherence length of the emitted light are used in so-called LCI (Low Coherence Interferometry) Commitment. Corresponding image sensors, which are now provided according to an advantageous embodiment of the invention for use in Valvulo plastic catheter are, for example, in the US 2006/0103850 described.

In an advantageous modification, it is also possible to provide an image sensor which is based on the so-called OFDI principle (Optical Frequency Domain Imaging). The method is related to OCT, but uses a wider frequency band. The operating principle is z. B. in the publication "Optical frequency domain imaging with a rapidly swept laser in the 815-870 nm range", H. Lim et al., Optics Express 5937, Vol. 13 described in more detail.

Finally, the valvuloplasty catheter may also include an imaging sensor mounted on the so-called "near infrared (NIR) Diffuse Reflectance Spectroscopy".

Further can also be combinations of at least two optical Sensors of the above type be present.

A tabular overview summarizes the strengths and weaknesses of the respective optical imaging techniques (from ++ = particularly good or suitable to - = poor or unsuitable): Comparison of the image sensors Close-resolution Remote-resolution Penetration of blood Optical (CMOS) + + - OCT ++ - - LCI + + + NIR - - +/- OFDI ++ - +

There the detectable or to be surveyed with the respective image sensor Solid angle is usually limited, it is particular in the already mentioned configuration with radial viewing direction (with respect to the central axis of the valvuloplasty catheter), when the imaging sensor is over in the catheter cavity guided drive shaft relative to the catheter sheath is rotatable. This makes it possible without the catheter sheath even turn against the vessel path to have a 360 ° view.

alternative It is also conceivable, a plurality of imaging sensors via the circumference of the catheter sheath distributed and opposite to arrange this fixed and a cyclic detection or To provide reading of the sensors via a multiplexer. That is, it is only one with this configuration Signal line inside the catheter sheath required over the image data of the various sensors in the manner of a serial Interface can be sequentially sent or queried. A small number of signal lines, preferably only a single, is for mechanical flexibility and flexibility of the valvuloplasty catheter.

By the (mechanical or electronic) rotation of the image sensor can with simultaneous withdrawal or advance by appropriate, in principle known from the prior art methods of signal processing and image calculation advantageously 3D images or volume data sets be generated.

In An advantageous development is in the region of the catheter tip arranged a number of position sensors or position sensors, by means of which the current position and preferably also the Orientation of the catheter tip can be determined. Preferably these are several, in particular three electromagnetic Transmit coils that are connected to a number of externally, d. H. outside the patient arranged receiving coils or signal detectors interact. In an alternative embodiment, the role the transmitting and receiving units also be reversed, d. h., the Reception coils are fixed on the catheter side, while the Transmitting coils are preferably arranged stationary in the room. The position information thus obtained on the one hand facilitate the safe Inserting the Valvuloplasty Catheter and Navigation to the target area, on the other hand, they support in an advantageous manner Make the construction of three-dimensional recordings from one Plurality of two-dimensional cross-sectional images. Furthermore, let the position data advantageous in the computational correction of motion artifacts and the like.

In further expedient embodiment can in the area the catheter tip at least one magnetic element for guidance of the valvuloplasty catheter by means of an external magnetic field be provided. In this so-called magnetic navigation Thus, the valvuloplasty catheter is driven by an external magnetic field controlled and driven. In the respective magnetic element it can be a permanent magnet or an electromagnet act.

As an alternative to guiding the valvuloplasty catheter by an external magnetic field, a mechanical navigation can be provided. For this purpose, in the valvuloplasty catheter expediently suitable mechanical elements, for. B. in the form of pull wires and the like, integrated by external tensile and compressive forces a temporary mechanical deformation, elongation and / or bending of the catheter or single allow, selectable catheter sections, in particular the catheter tip. The mechanical and / or magnetic guidance of the valvuloplasty catheter preferably takes place automatically with the aid of a computer-aided control and drive device.

Of Furthermore, it can be provided, the actual valvuloplasty catheter through an outer guide catheter through to the organ to be treated. For example can then, if advantageous for diagnostic purposes or useful, a valvuloplasty catheter with IVMRI imaging exchanged for a valvuloplasty catheter with optical imaging without the patient being re-invaded, say by a change or a movement or other manipulation of the outer guide catheter, loaded becomes. The replaced inner catheter does not have to be elaborate the target area is navigated and adjusted there again. Much more it is enough to him up to a stop position in the cavity of the outer catheter to be inserted during the procedure in its previously reached or ingested position remains in the vessel or in the heart.

• 1. Positionierung des Patienten auf dem Behandlungstisch
• 2. evtl. vorbereitende Röntgenuntersuchung und/oder extrakorporale Ultraschalluntersuchung
• 3. Einführung des Valvuloplastik-Katheters über venösen Zugang
• 4. Führung des Valvuloplastik-Katheters basierend auf der integrierten Bildgebung bis zu der zu behandelnden Herzklappe
• 5. Beobachtung der zu behandelnden Herzklappe mit der integrierten Bildgebung des Valvuloplastik-Katheters
• 6. Positionierung des Valvuloplastik-Katheters mit Unterstützung der integrierten Bildgebung
• 7. Dilatation der Klappenstenose mit dem Dilatationsballon
• 8. Kontrolle der Dilatationen durch die integrierte Bildgebung
• 9. evtl. abschließende Röntgenkontrolluntersuchung und/oder extrakorporale Ultraschalluntersuchung
• 10. Verlegung des Patienten

For example, a convenient workflow for using the valvuloplasty catheter with integrated imaging is as follows:

• 1. Positioning the patient on the treatment table
• 2. possibly preparatory X-ray examination and / or extracorporeal ultrasound examination
• 3. Introduction of the valvuloplasty catheter via venous access
• 4. Guide the valvuloplasty catheter based on the integrated imaging to the heart valve to be treated
• 5. Observation of the heart valve to be treated with the integrated imaging of the valvuloplasty catheter
• 6. Positioning of the valvuloplasty catheter with integrated imaging support
• 7. Dilatation of valve stenosis with the dilatation balloon
• 8. Control of Dilatations by Integrated Imaging
• 9. possibly final x-ray examination and / or extracorporeal ultrasound examination
• 10. Transfer of the patient

ever on the type of imaging and their ability to "penetrate" Blood may be useful during step # 5, the area to be observed with a saline solution rinse to temporarily displace the blood or to dilute. Furthermore, it may be useful to have a contrast agent to apply at the site of observation, in the case of IVMRI imaging z. B. based on gadolinium, or in an ultrasound imaging based on sulfur hexane fluoride. The injection advantageously takes place via a laid in the catheter cavity, in the region of the catheter tip an outlet opening having injection or like.

Summarized is above all with the valvuloplasty catheter described here an optimization of medical work processes in the Treatment of valve stenosis in the heart of a living thing allows. Such interventions can be done with a higher degree Patient safety and faster than previously completed become.

Various Embodiments of the invention will be described with reference to a Drawing explained in more detail. In it show in each case highly simplified and schematic representation:

1 a medical examination and treatment device with a valvuloplasty catheter shown in longitudinal section,

2 to 5 alternative embodiments of a valvuloplasty catheter,

6 a detailed representation of an integrated into a valvuloplasty catheter optical sensor with lateral / radial observation direction,

7 a detailed view of an integrated into a valvuloplasty catheter optical sensor with forward viewing direction,

8th a detailed view of a sensor head integrated in a valvuloplasty catheter for OCT or LCI imaging with lateral / radial observation direction,

9 a detailed view of a sensor head integrated into a valvuloplasty catheter for OCT or LCI imaging with a forward-looking direction,

10 a detailed view of an integrated sensor for IVMRI imaging with lateral / radial observation direction, and

11 a detailed view of an integrated sensor for IVMRI imaging with forward viewing direction.

Same Parts are provided with the same reference numerals in all figures.

The in 1 illustrated valvuloplasty catheter 2 is designed for the minimally invasive treatment of heart valve stenosis. It includes a thin flexible catheter sheath 4 for introduction into a blood vessel, not shown. The catheter sheath 4 surrounds a cylindrical catheter cavity 6 (Also referred to as lumens), in which an only schematically indicated expansion medium line 8th runs. About the expansion line 8th is a pressurized gaseous or liquid expansion agent at the proximal (bodyside) end 10 Valvuloplasty catheter 2 near the catheter tip 12 arranged dilatation balloon 14 deliverable by a temporary expansion of the dilatation balloon 14 to achieve a dilatation of a stenosed heart valve. To prevent inadvertent escape of expansion agent is between the dilatation balloon 14 and the catheter sheath 4 a sealing ring 16 arranged.

For optimal and lasting healing success and to minimize any risk of intervention, it is important that the dilatation balloon 14 is positioned as accurately as possible before its expansion at the correct or "fitting" position in the heart for the respective procedure, which has hitherto usually been carried out by angiographic X-ray control. For improved monitoring of catheter advancement and more accurate placement of the dilatation balloon 14 even without the use of ionizing X-radiation is the valvuloplasty catheter 2 according to 1 with an imaging sensor 18 in the area of the catheter tip 12 fitted. Depending on the type of sensor and other details of the embodiment, its "field of view" is preferably radially outwards (to the surrounding vessel wall, not shown here) and / or in the proximal direction to the front (ie in the direction of advance of the valvuloplasty catheter 2 ), as symbolically by the arrows 20 is indicated.

The imaging sensor 18 For example, it can be an optical, an acoustic (ultrasound) or a sensor based on the principle of magnetic resonance. The signal and supply lines required for its operation and transmission of the recorded image data 22 are inside the catheter sheath 4 to a body distal (distal) end of the valvuloplasty catheter 2 arranged connection coupling 24 guided. About the connection coupling 24 on the one hand, the pressure and / or fluid-carrying lines within the catheter sheath 4 mechanically connectable to external storage containers and the like. On the other hand are the connection coupling 24 the imaging electronic components of the valvuloplasty catheter 2 electrically with a signal interface indicated only schematically 26 connectable, which in turn with an external image editing and playback device 28 connected is. A non-illustrated monitor is used to reproduce the imaging sensor 18 intervascular or intracorporeal recorded and optionally subsequently computationally prepared "live images" from the treatment site.

To the imaging sensor 18 within the fixed catheter sheath 4 In order to rotate about its own axis, can also be a rotatable drive shaft in the catheter cavity 6 be arranged, however, in 1 is not shown in detail. The imaging sensor 18 , the signal lines 22 and optionally the drive shaft may be in the nature of one within the outer catheter sheath 4 arranged inner catheter combined into a compact unit and of an (inner) protective cover 30 be surrounded. In particular, when using interferometric imaging methods, optical fibers can also be laid in the inner catheter, via the incoming and outgoing light bundles to an externally mounted, via the connection coupling 24 connectable interferometer unit or the like. In the area of the imaging sensor 18 has the inner protective cover 30 , optionally also the outer catheter sheath 4 , Expediently a transparent window for the respective imaging process 32 , optionally also an optical lens.

Furthermore, (optionally) one or more lines 34 be provided for a rinsing liquid or a contrast agent, which has a near the Dilatationsballons 14 arranged outlet opening 36 injectable into the vascular or heart valve region to be examined / treated.

Finally, in the area of the catheter tip 12 , here in 1 in the immediate vicinity of the imaging sensor 18 , Position sensors 38 be provided, which in conjunction with a position outside the patient body position detection unit 40 according to the transmitter-receiver principle an accurate coordinate localization or localization of the catheter tip 12 enable. The position data obtained in this way can be used, for example, by the image processing and reproduction device 28 and be taken into account in the image reconstruction, especially in the artifact correction. The necessary signal lines 42 for the position sensors 38 can also inside the (inner) protective cover 30 essentially parallel to the signal lines 22 of the imaging sensor 18 be guided.

In 2 to 5 are each constructive modifications of the valvuloplasty catheter 2 shown.

For example, in 2 that the imaging sensor 18 supporting inner part 44 opposite the catheter sheath 4 forward (in the proximal direction) from an unspecified, the position in 1 corresponding retraction position displaceable in an upstream position and vice versa (indicated by the double arrow 46 ). That is, the imaging sensor 18 If required, it can be passed over the area of the catheter tip 12 with the transparent window 32 Push forward and has there completely undisturbed view. If necessary, it is then possible to completely dispense with a transparent window, as in FIG 3 is shown.

The embodiment according to 4 is essentially the same as 1 but the position sensor (s) is / are 38 in this variant now on the outer catheter sheath 4 arranged. In the variant according to 5 Finally, the displacement path of the imaging sensor 18 enlarged in the longitudinal direction and accordingly is a transparent window 32 provided with a larger spatial extent. The position sensors 38 are here also further to the body remote end of the valvuloplasty catheter 2 towards the back end of the dilatation balloon 14 appropriate. The distance to which the position sensors 38 opposite the catheter tip 12 are considered shifted in the determination of the actual peak position (by interpolation) are taken into account.

In the detail view according to 6 is the area of the catheter tip 12 with the imaging sensor 18 lifted out, wherein in the variant shown here, a CMOS-based optical sensor is used. A light source 48 here a high-performance micro-LED, which illuminates the valvuloplasty catheter in an approximately circular manner 2 and especially the imaging sensor 18 surrounding vessel wall 50 (emitted light 51 ). At the vessel wall 50 reflected light 53 falls through a lens 52 on a reflection mirror 54 (Or, for example, on a prism with analog operation or beam guidance) and from there to the actual CMOS image detector 56 , The arrangement according to 6 So is for a radial line of sight (relative to the central axis 58 Valvuloplasty catheter 2 ). Through one with the help of the drive shaft 59 accomplished rotational movement about the central axis 58 , indicated by the arrow 60 , the full 360 ° side-view field can be covered.

Alternatively, in 7 an example of a light source configuration 48 , Lens 52 and CMOS detector 56 shown, with the forward viewing is enabled, which during the advancement of the valvuloplasty catheter 2 is particularly useful through the blood vessels to the heart chambers and possibly through the heart valves. An obstacle lying in the forward direction, possibly obstructing the further feed 61 can be recognized this way. The two variants after 6 and 7 If desired, they can also be combined with one another in order to provide a particularly comprehensive field of vision in virtually all directions.

The observation directions mentioned, namely radially / laterally and forwards, can also be realized with other sensor types. For example, in 8th a configuration of an OCT or LCI sensor head 62 for radial radiation and reception and in 9 represents a forward-looking radiation and reception. More specifically, the reference numeral designates 62 only for the Lichtaus- and coupling into the light guide 64 responsible sensor part or sensor head; the actual interferometric evaluation and imaging takes place outside the valvuloplasty catheter 2 , Shown in each case by the reflection mirror 66 or lens 68 influenced beam path outcoupled and reflected light beams.

Similarly, an IVMRI sensor or IVUS sensor may be configured for either radial or forward radiation / reception, as in FIG 10 and 11 schematically for an IVMRI sensor 69 with permanent magnets 70 for the static magnetic field and transmitting / receiving coils 72 is shown.

at lateral radiation / reception may be particularly in the case of Ultrasonic sensors instead of a single rotating sensor be advantageous to provide an array of ultrasonic sensor elements with different "viewing directions", which, for example, is activated cyclically via a multiplexer, d. H. be excited and queried.

QUOTES INCLUDE IN THE DESCRIPTION

This list The documents listed by the applicant have been automated generated and is solely for better information recorded by the reader. The list is not part of the German Patent or utility model application. The DPMA takes over no liability for any errors or omissions.

Cited patent literature

• US 4819751 [0004]
• - US 6600319 [0017]
• US 2006/0103850 [0024]

Cited non-patent literature

• "Optical frequency domain imaging with a rapidly swept laser in the 815-870 nm range", H. Lim et al., Optics Express 5937, Vol. 13 [0025]

Claims (10)

Valvuloplasty Catheter ( 2 ) for the treatment of heart valve stenosis, comprising a catheter cavity ( 6 ) surrounding flexible catheter sheath ( 4 ) and one at the proximal end ( 10 ) near the catheter tip ( 12 ) arranged dilatation balloon ( 14 ), characterized in that in the region of the catheter tip ( 12 ) at least one imaging sensor ( 18 ) is provided. Valvuloplasty Catheter ( 2 ) according to claim 1, wherein the imaging sensor ( 18 ) is configured and oriented such that its field of vision extends around the dilatation balloon ( 14 ) covers around space area. Valvuloplasty Catheter ( 2 ) according to claim 1 or 2, wherein the imaging sensor ( 18 ) is configured and oriented so that its field of vision is one in front of the catheter tip ( 12 ) covering the area of space. Valvuloplasty Catheter ( 2 ) according to one of claims 1 to 3, wherein the imaging sensor ( 18 ) opposite the catheter sheath ( 4 ) in the longitudinal direction of the valvuloplasty catheter ( 2 ) is displaceable. Valvuloplasty Catheter ( 2 ) according to one of claims 1 to 4, wherein the imaging sensor ( 18 ) is an ultrasonic sensor, a magnetic resonance sensor or an optical sensor. Valvuloplasty Catheter ( 2 ) according to one of claims 1 to 5, wherein the imaging sensor ( 18 ) over one in the catheter cavity ( 6 ) guided drive shaft ( 59 ) opposite the catheter sheath ( 4 ) is rotatable. Valvuloplasty Catheter ( 2 ) according to one of claims 1 to 5, wherein a plurality of imaging sensors ( 18 ) over the circumference of the catheter sheath ( 4 ) and fixedly arranged opposite to it, wherein a cyclic detection or readout of the imaging sensors ( 18 ) is provided via a multiplexer. Medical examination and treatment device with a valvuloplasty catheter ( 2 ) according to one of claims 1 to 7, wherein the imaging sensor ( 18 ) over one in the catheter cavity ( 6 ) guided signal line ( 22 ) with an outside of the valvuloplasty catheter ( 2 ) image processing and playback device ( 28 ) and transmits to them in real time image information from the location of a valvuloplasty procedure. Method for the minimally invasive treatment of heart valve stenosis, in which a valvuloplasty catheter ( 2 ) with a dilatation balloon ( 14 ) and with one in the proximal end ( 10 ) of the valvuloplasty catheter ( 2 ) integrated imaging sensor ( 18 ) is guided through the blood vessels of a patient as far as a heart valve to be treated, wherein real-time images transmitted by the reproduction unit to a reproduction unit located outside the patient body are transmitted by the imaging sensor (FIG. 18 ), monitoring of the catheter advancement and a positional control of the dilatation balloon ( 14 ) is made. Method according to Claim 9, in which, on the basis of the real-time images, a control of a patient by expansion of the dilatation balloon ( 14 ) caused valvular dilatation is made.