with initial reference to fig1 a conduit 10 is shown in the form of an l - shaped tube . the conduit 10 may be formed of titanium or other biocompatible material . the material of the conduit 10 is preferably radially rigid material in order to withstand contraction forces of the myocardium . by way of non - limiting example , the tube will have an outside diameter d o of about 3 millimeters and an internal diameter d i of about 2 . 5 millimeters to provide a wall thickness of about 0 . 25 millimeters . the tube 10 has a coronary portion 12 sized to be received within the lumen of a coronary vessel such as the lumen 80 of a coronary artery 82 distal to an obstruction 81 as illustrated in fig1 . the conduit 10 has a myocardial portion 14 extending at a right angle to the axis of portion 12 . the myocardial portion 14 is sized to extend from the coronary artery 82 directly through the myocardium 84 and protrude into the left ventricle 83 of a patient &# 39 ; s heart . the coronary portion 12 has a first opening 16 . the myocardial portion 14 has a second opening 18 in communication with an interior 20 of the implant 10 . therefore , blood can freely flow through the implant 10 between the left ventricle 83 and the lumen 80 of the coronary artery 82 . blood flows axially out of opening 16 parallel with the axis of lumen 80 . the longitudinal axis of the coronary portion 12 is aligned with the axis of the lumen 80 . sutures 24 secure the artery 82 to the coronary portion 12 . the proximal portion 82 a of the coronary artery is ligated by sutures 85 . the coronary and myocardial portions 12 , 14 have an open lattice construction 12 a , 14 a to define a plurality of open cells 12 b , 14 b extending through the wall thickness of the implant 10 . preferably , the coronary and myocardial portions 12 , 14 are joined by a transition portion 13 in a 90 ° bend between portions 12 , 14 . while transition portion 13 can have an open lattice construction as portions 12 , 14 , transition portion 13 will preferably have smaller open areas in such an open construction or , as illustrated , will be of solid construction . such construction permits the transition portion to deflect high velocity blood flows from the myocardial portion 14 into the coronary portion 12 . a lattice construction with large open cells in the transition portion could result in the high velocity flow damaging tissue ( not shown ) overlying the transition portion . any one or all of the coronary portion 12 , transition portion 13 and myocardial portion 14 could be formed in final size as rigid units or could be formed in small diameter sizes which are subsequently expanded to full size . for example , fig3 illustrates a coronary portion 12 ′ which is formed tapering from the transition portion 13 ′ to a reduced diameter open end 16 ′. the taper permits ease of insertion into a coronary artery . following such insertion , the tapered coronary portion 12 ′ may be expanded to full size illustrated by the phantom lines in fig3 . such expansion can be performed using balloon - tipped catheters as is conventional in stent angioplasty . a collapsed and subsequently expanded implant 10 where all portions 12 , 13 and 14 are expanded can permit use as a percutaneously deployed implant . the present drawings illustrate a presently preferred surgically deployed implant . in the surgical application , the artery 82 is ligated . the implant 10 is passed through the epicardium and myocardium on a side of the artery 82 . [ 0022 ] fig5 illustrates a balloon 100 placed in a tapered coronary portion 12 . a lead 102 from the balloon 100 is passed through an opening 113 ′ in the transition portion 13 ′. the opening 113 ′ can be closed with a plug 115 ′ after the balloon 100 and lead 102 are withdrawn through the opening 113 ′. alternatively , in a transition portion 13 ″ with open cell construction ( fig4 ), the balloon lead can be passed through the openings of the transition portion 113 ″. fig6 illustrates passing the lead 102 through opening 18 of the myocardial portion . the lead 102 can be pulled upwardly from the exterior of the heart to remove the balloon 100 . alternatively , the lead 102 can be pulled through a catheter ( not shown ) adjacent end 18 in the left ventricle . in either percutaneous or surgical implants , a flexible transition portion 13 ( as would be achieved with a stent lattice construction ) permits relative articulation between the coronary and myocardial portions 12 , 14 to ensure the coronary portion is axially aligned with the lumen 80 . absent such articulation , such axial alignment is achieved by accurately controlling the position of the myocardial portion 14 such that the coronary portion 12 is axially aligned with the lumen 80 following implantation . the open cell construction of the coronary and myocardial portions 12 , 14 permit tissue growth through the open cells 12 c , 14 c following implant . the healing procedure in the coronary portion 12 is the same as that in coronary stents . vascular endothelial cells grow over to coat the structural material 12 a of portion 12 . in portion 14 , myocardial tissue , if not obstructed , will grow through the cells 14 c . furthermore , the myocardium is highly thrombogenic . therefore , uncontrolled contact between the myocardium 82 and the implant interior 20 can result in thrombosis of the implant 10 . further , it is believed that the epicardium ( i . e ., outer layer of the myocardium ) has a greater density of myocardial growth cells which contribute to healing . to control growth in the myocardial portion 14 , a liner 30 is provided in the myocardial portion 14 . the liner 30 is any porous material for accepting tissue growth and , preferably , is a polyester fabric ( e . g ., dacron ). the porous liner 30 has interstial spaces smaller than the open cells 12 c , 14 c . the liner 30 is shown on an interior of the myocardial portion 14 but could also or alternatively surround the exterior . the liner 30 has an upper end 32 secured through any suitable means ( e . g ., sutures not shown ) to the upper end of the myocardial portion 14 . a lower end 34 is folded over the opening of the myocardial portion 14 and secured to the exterior of the portion 14 by sutures 36 . the myocardial portion 14 is sized to protrude into the left ventricle 83 with only the folded over liner material exposed to the interior of the left ventricle 83 . the liner 30 acts as a porous substrate into which tissue may grow . to prevent thrombus , the liner 30 is impregnated with an agent for controlling coagulation cascade and platelet activation and adhesion . an example of such an agent is heparin but could be any anticoagulant or antiplatelet . also , an agent such as a basic fibroblast growth factor could be used to accelerate healing . the agent permits structural cells to grow on the liner by limiting thrombus formation which , uncontrolled , would occlude the implant . due to the open construction , the structural , healing cells of the epicardium can grow onto the liner . subsequently , endothelial cells can grow on the structural cells . 1 . the drug agents control healing by minimizing coagulation and platelet activation which would otherwise be stimulated by agents from the myocardium ; and 2 . structural cells grow into and on the liner 30 now lined with the thrombus to initially heal and form a vascular bed ; and in the transition portion 13 , an open cells structure will permit tissue growth as in the coronary portion 12 . such growth may also occur in the solid construction . alternatively , the liner 30 can be extended into the transition portion 13 . additionally , the open cell structure in the transition portion 13 can permit articulation between the coronary portion and the myocardial portion . such a structure is shown in fig4 . the open transition portion 13 ″ is formed by a coil 13 a ″ between the coronary portion 12 ″ and the myocardial portion 14 ″. this structure permits bending at the transition portion . as a result , the coronary portion can be axially aligned in the artery without first accurately positioning the myocardial portion . having disclosed the present invention in a preferred embodiment , it will be appreciated that modifications and equivalents may occur to one of ordinary skill in the art having the benefits of the teachings of the present invention . it is intended that such modifications shall be included within the scope of the claims appended hereto . for example , the liner 30 can take many constructions including ptfe , expanded - ptfe , polyurethane , polypropylene or any biologically compatible paving material or natural tissue . further , restenosis of the coronary portion 12 can be prevented with radioactivity therapy ( such as providing the coronary portion with a short half - life beta emitter ). also , the liner 30 may be either a resorbable or non - resorbable material . genetically engineered cells can be transformed to secrete anticoagulants and other agents to keep the blood fluid ( such as tissue plasminogen activator and smooth muscle cells altered to express nitric acid ).
a transmyocardial implant establishes a blood flow path through a myocardium between a heart chamber and a lumen of a coronary vessel residing on an exterior of the heart . the implant includes a coronary portion sized to be received within the vessel . a myocardial portion is sized to pass through the myocardium into the heart chamber . a transition portion connects the coronary and myocardial portions for directing blood flow from the myocardial portion to the coronary portion . the coronary portion and the myocardial portion have an open construction for permitting tissue growth across a wall thickness of the coronary portion and the myocardial portion . the myocardial portion includes an agent for controlling a coagulation cascade and platelet formation .