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WO2006023538A2 - Derivation/valve medicale pour la regulation de liquides organiques - Google Patents

Derivation/valve medicale pour la regulation de liquides organiques Download PDF

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Publication number
WO2006023538A2
WO2006023538A2 PCT/US2005/029227 US2005029227W WO2006023538A2 WO 2006023538 A2 WO2006023538 A2 WO 2006023538A2 US 2005029227 W US2005029227 W US 2005029227W WO 2006023538 A2 WO2006023538 A2 WO 2006023538A2
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WO
WIPO (PCT)
Prior art keywords
fluid
piston
valve
shunt
body fluid
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2005/029227
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English (en)
Other versions
WO2006023538A3 (fr
Inventor
Joshua E. Medow
Christopher C. Luzzio
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Wisconsin Alumni Research Foundation
Original Assignee
Wisconsin Alumni Research Foundation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Wisconsin Alumni Research Foundation filed Critical Wisconsin Alumni Research Foundation
Publication of WO2006023538A2 publication Critical patent/WO2006023538A2/fr
Publication of WO2006023538A3 publication Critical patent/WO2006023538A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/22—Valves or arrangement of valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
    • A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
    • A61M27/006—Cerebrospinal drainage; Accessories therefor, e.g. valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/04—Liquids
    • A61M2202/0464—Cerebrospinal fluid

Definitions

  • This document concerns an invention relating generally to medical shunts for controlling the flow of body fluids, e.g., shunts for drainage of cerebrospinal fluid for treatment of hydrocephalus and similar conditions.
  • cerebrospinal fluid helps maintain their proper operation.
  • an imbalance occurs between the rate of fluid production and the rate of reabsorption. This can lead to hydrocephalus, a condition wherein the brain's ventricles become enlarged with cerebrospinal fluid, pressing brain tissue against the skull. This can lead to serious neurological problems, and potentially death.
  • the most effective treatment for hydrocephalus is surgical insertion of a shunt, a valve which vents excess cerebrospinal fluid from the brain.
  • a neurosurgeon makes an estimate of the amount of flow required to relieve hydrocephalus, and selects a shunt having the desired flow capacity.
  • a flap is cut in the scalp, a small hole is drilled in the skull, and a catheter is inserted to pass into a ventricle of the brain. The catheter is then connected to the shunt beneath the scalp.
  • Another catheter is attached to the outlet of the shunt and is usually tunneled into the skin, down the neck, and into the peritoneal (abdominal) cavity.
  • shunts operate in the manner of a common check valve, wherein their flow is dependent on the pressure difference across the valve between its inlet and outlet. When the pressure difference exceeds some threshold level, the valve opens to allow cerebrospinal fluid to drain from the brain.
  • This arrangement can lead to the problem of siphoning: since opening of the valve is in part dependent on the pressure at the valve outlet, low pressure on the outlet side may cause the valve to open even if the pressure on the inlet side is not indicative of excess cerebrospinal fluid pressure in the ventricles.
  • a shunt for use in the maintenance of proper pressure of cerebrospinal or other body fluids includes an inlet port, an outlet port, and a fluid passage therebetween.
  • a valve i.e., an openable and closable gate
  • a valve is situated between the inlet and outlet ports, thereby defining an upstream side of the fluid passage between the inlet port and the valve, and a downstream side of the fluid passage between the valve and the outlet port.
  • a movable valve actuating member (such as a piston) is provided, with the valve actuating member being biased by a closing force to urge the valve toward a closed state.
  • the valve actuating member has a face adjacent the upstream side of the fluid passage (and preferably isolated from the downstream side of the fluid passage), wherein fluid pressure in the upstream side exerts an opening force on the face and urges the valve toward an open state.
  • the opening force on the valve actuating member exceeds the closing force by some amount, the valve actuating member moves the valve to the open state, allowing fluid flow through the fluid passage between the inlet and outlet ports.
  • the valve actuating member is a piston having a piston face adjacent the upstream side of the fluid passage, the valve will open once some shunting pressure arises on the upstream side which is sufficient to overcome the closing force.
  • the valve actuating member preferably takes the form of a displaceable piston, wherein the piston may include a cutout (such as a through-hole or groove) which partially defines the valve: as the cutout moves into alignment with the fluid passage (e.g., with a drain port defined at the start of the downstream side of the fluid passage), the valve is switched to its open state and fluid may flow from the upstream side to the downstream side.
  • the cutout may be provided in a mask, such as an elastic membrane, which may be linked to the piston such that the piston moves the mask (and its cutout) into and out of alignment with the fluid passage to open and close the valve.
  • a flexible mask is particularly beneficial because it can conform to tightly seal the juncture between the upstream and downstream sides of the fluid passage unless the cutout is moved into alignment with the passage.
  • the mask is an elastic membrane situated between the upstream side of the fluid passage and a drain port on the downstream side
  • the fluid pressure on the upstream side may ordinarily push the membrane to bulge into the drain port (when its cutout is not aligned with the drain port), ensuring a tight seal against fluid leakage.
  • the closing force biasing the valve towards the closed state is preferably provided by an elastic diaphragm connected to the piston (and which may define at least a portion of the piston face), or by a mechanical spring (e.g., leaf or helical spring), pneumatic spring, or the like. If an elastic diaphragm is used, it may beneficially be bounded on one of its sides by a closed gas chamber containing compressible gas, whereby the pressure within the gas chamber contributes (along with the elasticity of the diaphragm) to the closing force.
  • the gas chamber is constructed so that it has selectively adjustable volume - as by defining it as a cylinder into which a cap may be screwed to reduce its volume - a user may selectively adjust the gas chamber volume to adjust the pressure of gas therein, and thereby adjust the closing force.
  • valve actuating member is provided by a displaceable piston which travels along a linear bore
  • the bore is preferably oriented at least substantially perpendicular to the direction in which fluid flows between the upstream and downstream sides of the flow passage.
  • FIG. 1 is a schematic cross-sectional view of a first exemplary shunt 100.
  • FIG. 2 is a schematic cross-sectional view of a second exemplary shunt 200.
  • FIGS. 3A and 3B are schematic cross-sectional views of a third exemplary shunt 300, wherein FIG. 3A depicts the closed shunt and FIG. 3B depicts the open shunt.
  • FIGS. 4A and 4B are schematic cross-sectional views of a fourth exemplary shunt 400, wherein FIG. 4A depicts the closed shunt and FIG. 4B depicts the open shunt.
  • FIG. 5 is a schematic cross-sectional view of a fifth exemplary shunt 500.
  • the shunt 100 includes an inner body 102 separated from an outer casing 104 by a gas chamber 106, with the inner body 102 being supported within the outer casing 104 by an inlet port 108 and an outlet port 110.
  • the inlet port 108 protrudes from the outer casing
  • a fluid passage 112 extends between the inlet port 108 and outlet port 110 to allow flow of cerebrospinal fluid therebetween.
  • a valve 114 i.e., an openable and closable gate
  • the valve 114 may be regarded as separating the fluid passage 112 into an upstream side 116 between the inlet port 108 and the valve 114, and a downstream side 118 between the valve 114 and the outlet port 110.
  • the valve 114 is defined in the fluid passage 112 by a piston 120 which slides linearly within a bore 122 defined in the inner body 102, with the bore 122 intersecting the fluid passage 112.
  • the piston 120 has a first end 124 and an opposing second end 126, with an intermediate length 128 extending therebetween.
  • This intermediate length 128 has a cutout 130 defined therein, with the cutout 130 taking the form of a through-hole, circumferential groove, or other discontinuity in the piston 120.
  • the cutout 130 allows cerebrospinal fluid to pass between the upstream side 116 and a drain port 132 at the outset of the downstream side 118 when the cutout 130 is aligned with the fluid passage 112.
  • the intermediate length 128 of the piston 120 blocks the fluid passage 112.
  • the piston 120 thus serves as a valve actuating member such that when the piston 120 is appropriately displaced within the bore 122, the valve 114 will change between open and closed states to allow or block passage of cerebrospinal fluid from the inlet port 108 to the outlet port 110.
  • a deformable elastic diaphragm 138 separates the first actuation chamber 134 (and any fluid therein) from the gas chamber 106, so that the diaphragm 138 has a fluid side 140 bounding the fluid in the first actuation chamber 134 and a gas side 142 bounding the gas in the gas chamber 106.
  • the first end 124 of the piston 120 is affixed to the diaphragm 138 in such a manner that flexure of the diaphragm 138 in directions generally parallel to the bore 122 will cause the piston 120 to translate within the bore 122.
  • a second fluid communication channel 144 also leads from the upstream side 116 of the fluid passage 112 to a second piston actuation chamber 146 onto which the bore 122 opens, with the piston second end 126 facing the second actuation chamber 146.
  • the piston 120 effectively has three faces (i.e., three surfaces upon which pressure may act to displace the piston 120 within its bore 122): two opening faces which may be driven to open the valve 114, a first opening face defined by the fluid side 140 of the attached diaphragm 138 and a second opening face defined by the piston second end 126; and one closing face which may be driven to close the valve, the gas side 142 of the attached diaphragm 138 (or viewed differently, the first end 124 of the piston 120 and the gas side 142 of the diaphragm 138 attached thereon).
  • the elasticity of the diaphragm 138, plus the gas pressure within the gas chamber 106 acting on the closing face 142 of the piston 120, will maintain the valve 114 in an ordinarily closed state.
  • the pressure in the upstream side 116 of the fluid passage 112 acts on the first and second opening faces 126 and 140 to overcome the opposing biasing force of the elastic diaphragm 138 and the opposing pressure in the gas chamber 106 on the closing face 142
  • the piston 120 may displace in the bore 122 to a sufficient extent that the cutout 130 aligns with the fluid passage 112, thereby allowing fluid flow between the upstream side 116 and a downstream side 118 of the fluid passage 112.
  • the opening of the valve 114 is wholly or largely decoupled from the pressure in the outlet port 110, and thus in the peritoneal cavity or other drainage location. Since the faces 126 and 140 of the piston 120 which are driven to open the valve 114 are solely exposed to the upstream side 116 of the fluid passage 112, the opening of the valve is dependent on the pressure at the inlet port 108 (and thus within the brain ventricles) and the valve opening force generated thereby, versus the valve closing force generated by the elasticity of the diaphragm 138 and the pressure within the gas chamber 106. Thus, appropriate choice of the elasticity of the diaphragm
  • FIG. 1 being a simplified schematic view of the exemplary shunt 100, does not illustrate convenient means by which the tension of the diaphragm 138 and the pressure of the gas chamber 106 may be varied. However, numerous means for allowing such variance can be provided.
  • shunts such as the shunt 100 can be manufactured with a variety of diaphragms 138 having different tensions (as by providing different diaphragm thicknesses).
  • Medical personnel may then choose a diaphragm 138 having a desired tension, its attached piston 120 may be slid into the bore 122, and the diaphragm may be fit atop the first actuation chamber 134 and have its edges folded about the edges of the inner body 102 and sealed thereon, as by fitting a rubber ring about the diaphragm 138 and inner body 102.
  • the gas pressure within the gas chamber 106 may be conveniently varied by providing a screw- on cap having a threaded engagement about an end of the outer casing 104, whereby screwing on the cap reduces the volume of the gas chamber 106 (and thereby increases the pressure therein).
  • some form of structure which may be adjustably extended from the exterior of the outer casing 104 to its interior may be adjusted to extend into the interior of the gas chamber 106 by a desired degree such that the gas pressure within the gas chamber 106 is set as desired.
  • the displacement of the valve actuating member i.e., the piston 120
  • the shunt 100 overcomes difficulties encountered in some prior shunts wherein their valves remain open even after some threshold opening pressure is relieved, thereby leaving their valves open at some undesirable range of lower pressures.
  • the shunt 200 also includes an inner body 202 and outer casing 204 spaced by a gas chamber 206.
  • the inner body 202 here includes an inlet port 208 and an outlet port 210 extending from one end of the casing 204, which can in some cases be a more convenient arrangement for installation in or on a body.
  • a fluid passage 212 extends between the inlet port 208 and outlet port 210, with a valve 214 separating the fluid passage 212 into an upstream side 216 between the inlet port 208 and the valve 214, and a downstream side 218 between the valve 214 and the outlet port 210.
  • the valve 214 is here partially defined by a mask 248 affixed to the intermediate length 228 of a piston 220, which slides linearly within a bore 222 defined in the inner body 202 and intersects the fluid passage 212.
  • the mask 248 is situated between the upstream side 216 of the fluid passage 212 and a drain port 232 defined at the outset of the downstream side 218, and it slides across the drain port 232 when the piston 220 is displaced.
  • the mask 248 is preferably formed of a flexible, deformable membrane which bears against and normally closes the drain port 232 from the upstream side 216 of the fluid passage 212.
  • the mask 248 bears a cutout 230 (such as a narrow slit) whereby the valve 214 opens when the cutout 230 aligns with the drain port 232 of the fluid passage 212.
  • a cutout 230 such as a narrow slit
  • valve leakage might be diminished because the mask 248 may be made to ordinarily bear on and seal the drain port 232, with its bearing force being enhanced by fluid pressure in the upstream side 216 of the fluid passage 212.
  • fluid will be allowed to pass when the cutout 230 and drain port 232 are aligned.
  • the piston 220 is then actuated in much the same manner as in the shunt 100 of
  • the piston 220 has a first end 224 extending into a first piston actuation chamber 234 and being affixed to a deformable elastic diaphragm 238, and a first fluid communication channel 236 connects the upstream side 216 of the fluid passage 212 to the first piston actuation chamber 234.
  • the opposing piston second end 226 rests adjacent a second piston actuation chamber 246 defined within the bore 222, and the second piston actuation chamber 246 is also connected to the upstream side 216 of the fluid passage 212 by a second fluid communication channel 244.
  • valve actuation is effected by actuation of the piston 220 in a direction perpendicular to fluid flow, thereby avoiding any tendency for the valve 214 to remain open once pressure at the upstream side 216 drops below the shunting pressure.
  • a third shunt is depicted generally by the reference numeral 300.
  • the shunt 300 which in some respects might be regarded as a simplified version of the shunt 100, includes a body 302 defining a fluid passage 304, with fluid ingress to the upstream side 306 of the fluid passage 304 at an inlet port 308, and fluid egress from the downstream side 310 of the fluid passage 304 at an outlet port 312. Fluid entering the upstream side 306 enters a first piston actuation chamber 314, which is bounded on opposing sides by an elastic diaphragm 316 and a piston 318.
  • the piston 318 has a first end 320 defining a piston head and an opposing second end 322 joined to the diaphragm 316, with the intermediate length 324 of the piston 318 allowing fluid flow about its circumference.
  • the diaphragm 316 effectively defines additional piston faces upon which pressure may act to displace the piston 318, with the diaphragm 316 having a first face 326 on the upstream side 306, and additionally a second face 328 in a second piston actuation chamber 330 which is in fluid communication with the downstream side 310. As depicted in FIG.
  • This shunt 300 differs from the prior shunts 100 and 200 in that it will open and close the valve 332 in response to the relative pressure difference between the upstream side 306 and the downstream side 310, rather than in response to the pressure at the upstream side 306 alone. Since the piston 318 and the diaphragm 316 have equal surface area exposed to the upstream side 310, and the diaphragm 316 effectively serves as a face of the piston 318 since it is attached thereon, the pressure of the upstream side 306 applies an equal force to both the diaphragm 316 and piston 318 and by itself will not effect any net movement of the piston 318 and the diaphragm 316. Similarly, the piston 318 and the diaphragm 316 both have equal area exposed to the downstream side 310, and the pressure of the downstream side 310 does not by itself effect any net movement of the piston 318.
  • the shunt 300 opens and closes in response to a sufficiently high pressure difference between the upstream side 306 and downstream side 310, siphoning (i.e., suction of fluid from the upstream side 306 owing to low pressure at the downstream side 310) is possible.
  • the shunt 300 is therefore useful either by itself in situations where siphoning is not a significant concern, or in combination with other shunts to protect against undesirable backflow.
  • the shunt 300 can be modified in a number of respects if desired. Initially, the pressure at which the valve 332 opens can be modified by changing the area of one or both of the piston 318 and the diaphragm 316, and/or by changing the elasticity of the diaphragm 316. If reversible flow is desired, the stops 334 can be removed, and/or the area of the piston 318 can be appropriately modified with respect to the area of the diaphragm 316.
  • a fourth shunt depicted at the reference numeral 400, represents a variation of the foregoing shunts.
  • the shunt 400 includes a body 402 defining a fluid passage 404, with fluid ingress to the upstream side 406 of the fluid passage 404 at an inlet port 408, and fluid egress from the downstream side 410 of the fluid passage 404 at an outlet port 412.
  • Fluid entering the upstream side 406 enters a first piston actuation chamber 414 bounded by an elastic diaphragm 416, with the diaphragm 416 being coupled to a piston 418 at a first face 420 on the upstream side 406, and with the opposing second face 422 of the diaphragm 416 being situated in a second piston actuation chamber 424 which is in fluid communication with the downstream side 410.
  • the piston 418 has a first end 426 defining a piston head, an opposing second end 428 joined to the first face 420 of the diaphragm 416, and an intermediate length 430 which extends through a bore 432 in the wall of the first piston actuation chamber 414.
  • the piston 418 is simply carried along with the diaphragm 416, and is not by itself actuated by the pressure of the upstream side 406, the downstream side 410, or the difference therebetween. Rather, the diaphragm 416 effectively defines the piston faces upon which pressure acts to displace the piston 418. As depicted in FIG.
  • the diaphragm 416 deforms as in FIG.4B and opens the drain port 436 to the downstream side 410, allowing fluid flow from the higher-pressure upstream side 406 to the lower-pressure downstream side 410.
  • the piston head 426 and drain port 436 thereby define a valve 438 which is actuated by the flexion of the diaphragm 416 in response to the pressure difference between the upstream side 406 of the fluid passage 404 and the downstream side 410.
  • the shunt 400 differs from the prior shunts 100 and 200 (and is similar to the shunt 300) in that it will open and close the valve 438 in response to the relative pressure difference between the upstream side 406 and the downstream side 410, rather than in response to the pressure at the upstream side 406 alone.
  • Backflow from a higher-pressure downstream side 410 to a lower-pressure upstream side 406 is prevented since the piston 418 will only move upwardly to open the valve 438 when the diaphragm 416 distends upwardly, which can only occur if the pressure of the upstream side 406 is greater than that of the downstream side 410.
  • the shunt 400 is useful (wither by itself or in combination with other shunts) in situations where backflow is undesirable, and where siphoning through shunt 400 is not a major concern (i.e., where flow from the upstream side 406 to the downstream side 410 may occur in response to low pressure at the downstream side 410, as opposed to being triggered by some high threshold pressure at the upstream side 406).
  • the shunt 400 can be modified to have its valve
  • FIG. 438 open at different pressures by changing the area of one or both of the piston 418 and the diaphragm 416, and/or by changing the elasticity of the diaphragm 416. If reversible flow is desired, the stop 434 can be removed, and/or the area of the piston 418 can be appropriately modified with respect to the area of the diaphragm 416. It is notable that the principles of the foregoing shunts can be extended to nonlinear piston/bore arrangements, for example, to rotary piston arrangements. To illustrate, FIG.
  • FIG. 5 illustrates a fifth version of a shunt, depicted generally by the reference numeral 500, wherein a generally semicylindrical casing 504 bears an inlet port 508 and an outlet port 510 with a fluid passage 512 extending therebetween.
  • a valve 514 which is part defined by a piston 520, divides the fluid passage 512 into an upstream side
  • valve 514 acts to selectively allow fluid flow from the inlet port 508 and upstream side 516 to the downstream side 518 and outlet port 510, but a somewhat different arrangement is used to effect such selective flow.
  • the piston 520 is more in the nature of a rotary piston, i.e., it is actuated via a pivoting or rotating motion.
  • the piston 520 has opposing faces 540 and 542, with the piston being pivotally movable about a fulcrum 550 situated between the faces 540 and 542 on one side and the faces 540 and 542 being bounded by an intermediate length 528 on the opposite side.
  • the intermediate length 528 has a curved profile conforming to a section of a cylinder, and it complementarily slides against a portion of the casing 504 and also against an inner guide wall 554, which has a drain port 532 defined adjacent the inlet port 508.
  • the piston 520 also includes a cutout 530 extending from its intermediate length 528 from a point adjacent face 540 to a point on face 540 adjacent the outlet port 510 and fulcrum 550, with the cutout 530 being unobstructed at the downstream side 518 of the fluid passage 512, and being normally obstructed (closed) at the upstream side 516 by the inner guide wall 554 unless the cutout 530 moves into alignment with the drain port 532 (in which case the valve 514 is placed in the open state to allow fluid flow between the upstream side 516 and downstream side 518).
  • the following arrangement is then used to pivot the piston 520 of the valve 514 between the open and closed states.
  • the piston 520 is connected by a flexible skirt 552 to define a gas chamber 506 bounded by the casing 504, the face 542 of the piston 520, and the skirt 552.
  • the pressure of the gas on the piston face 542 will normally bias the valve
  • Fluid entering the inlet port 508 may therefore flow into the piston actuation chamber 534, and if it reaches a shunting pressure, it may pivotally displace the piston 542 to such an extent that the cutout 530 is adjacent the drain port 532, thereby opening the valve 514 and allowing fluid flow between the upstream side 516 and downstream side 518. Otherwise, if the pressure at the inlet port 508 and upstream side 516 (and thus in the piston actuation chamber 534) is insufficient, the piston 520 is biased by the gas pressure and spring 538 force in the gas chamber 506 to maintain the drain port 532 obscured by the intermediate length 528 of the piston 520.
  • shunts are of course preferably formed of biocompatible materials, and are appropriately sized, shaped, and configured for implantation (if they are to be used after implantation). The appropriate choice of materials, sizes, configurations, etc. to be used in any given situation will be apparent to surgeons and other medical personnel who work with shunts, and to others who are familiar with shunts.
  • the diaphragm 138 could then be substituted with an inflexible wall, and a helical spring, leaf spring, elastomeric spring, or other biasing means could be interposed between the wall and the piston first end 124 to supply the closing force, and with fluid pressure on the piston first end 124 supplying the shunting force.
  • the diaphragm 138 could instead be replaced with an inflexible piston head which travels in the first piston actuation chamber 134 and which is subjected to shunting and closing forces at its fluid side 140 and gas side 142 without any contribution of elastic forces.
  • a helical spring or other biasing means in conjunction with a diaphragm 138, in which case the diaphragm 138 may supply negligible biasing force, or may supply any desired degree of biasing force in conjunction with the biasing means.
  • piston faces upon which the opening and closing pressures act need not be located at an end of the piston.
  • the piston 120 could have a shaft continuing beyond the gas side 142 of the diaphragm 138 to engage in a bore defined in the casing 104.
  • Such an arrangement would further support the piston 120, but the piston first opening face defined by the diaphragm fluid side 140 and the piston closing face defined at the diaphragm gas side 142 would no longer be situated at an end of the piston 120. (Note that the boundaries of the cutout 130 are not regarded to be piston faces, since fluid pressure on these boundaries does not effect displacement of the piston 120.
  • a "piston face" should be regarded as a surface of the piston whereupon fluid pressure may act to cause displacement of the piston.
  • the various shunts may also be used in conjunction with other types of valves (or entire shunts) situated upstream or downstream from the shunt.
  • some form of one-way valve might be situated at the outlet port to account for situations wherein pressure at the upstream side is sufficiently great to open the valve, but the pressure at the downstream side - which, again, has little or no effect on valve actuation - is even higher than the shunting pressure.
  • valve would open when the shunting pressure is reached at the upstream side, but would then remain open as cerebrospinal fluid flows from the outlet port to the inlet port and the pressure at the upstream side settles to some pressure above the shunting pressure. If a one-way flow valve is situated at the outlet port such that flow from the downstream side of the fluid passage to the upstream side is prohibited, this situation can be prevented or minimized.
  • shunts are designed (or may be designed) to incorporate numerous desired features which have not been emphasized in the foregoing discussion, e.g., the ability to set different shunting pressures before valve opening occurs; ports allowing attachment of ventricular and peritoneal catheters of different lengths; a completely enclosed design whereby tissue ingrowth/encapsulation is avoided or minimized; a completely nonmetallic design whereby imaging artifacts may be avoided; small size and low profile to avoid unnecessary protrusion, and erosion through the skin; a design wherein suture tabs/wings may be added to the casing (or other exterior of the shunt) to more easily allow it to be sutured in place (if desired) to avoid shunt migration; and a design allowing incorporation of radiopaque markers or other tags so that status checks may be performed via X-ray or other diagnostic imaging techniques.
  • the invention is not intended to be limited to the preferred versions of the invention described above, and the true scope of the invention will be defined by the claims included in any

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Abstract

L'invention a trait à des dérivations (valves) pour l'écoulement contrôlé de liquides organiques, tels que le liquide céphalo-rachidien, comportant un organe d'actionnement de valve (tel qu'un piston) entre les orifices d'entrée et de sortie. L'organe d'actionnement de valve est sollicité vers un état dans lequel la valve est fermée, et comporte une face adjacente au côté amont de la valve (et, de préférence, isolée du côté aval de la valve) permettant à la pression de liquide du côté amont d'exercer une force d'ouverture sur la face pour solliciter la valve vers un état d'ouverture. Lorsque la force d'ouverture sur l'organe d'actionnement de valve dépasse la force de fermeture dans une certaine quantité, l'organe d'actionnement de valve déplace la valve vers l'état d'ouverture, permettant l'écoulement de liquide à travers le passage de liquide entre les ports d'entrée et de sortie.
PCT/US2005/029227 2004-08-18 2005-08-17 Derivation/valve medicale pour la regulation de liquides organiques Ceased WO2006023538A2 (fr)

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US60274404P 2004-08-18 2004-08-18
US60/602,744 2004-08-18

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2025090925A1 (fr) * 2023-10-25 2025-05-01 The Cleveland Clinic Foundation Système de drainage ambulatoire

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US5192265A (en) * 1990-12-10 1993-03-09 Hsc Research & Development Limited Partnership Adjustable-resistance anti-siphon device
FR2698535B1 (fr) * 1992-11-30 1995-01-20 Drevet Jean Baptiste Dispositif de régulation et de contrôle de l'écoulement du liquide céphalo-rachidien dans un circuit de drainage.
US5980480A (en) * 1996-07-11 1999-11-09 Cs Fluids, Inc. Method and apparatus for treating adult-onset dementia of the alzheimer's type
US20030004495A1 (en) * 1996-07-11 2003-01-02 Eunoe, Inc. Apparatus and methods for volumetric CSF removal

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2025090925A1 (fr) * 2023-10-25 2025-05-01 The Cleveland Clinic Foundation Système de drainage ambulatoire

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