Implantable valve

Abstract

The invention relates to an implantable valve (1) for the treatment of hydrocephalus. The valve (1) comprises an inlet (21) and an outlet (22), a valve unit (23) for adjusting a flow parameter in a fluid, a fluid chamber (2) extending from the inlet (21) via the valve unit (23) to the outlet (22) and designed and configured to be filled with the fluid, and an adjustment chamber (3) in which a mechanical adjustment device (31) for adjusting the valve unit (23) is arranged. A first elastic wall section (32) and a second elastic wall section (33) are arranged between the fluid chamber (2) and the adjustment chamber (3), wherein the adjustment chamber (3) is fluid-tightly separated from the fluid chamber (2), and wherein the valve unit (23) can be adjusted for setting the flow parameter via the mechanical adjustment device (31).

Description

The invention relates to an implantable valve for the treatment of hydrocephalus. Hydrocephalus is a condition in which an excessive amount of cerebrospinal fluid (CSF) accumulates in the ventricles of the brain. In a healthy person, CSF is continuously produced and reabsorbed in a state of balance. This balance is disrupted in individuals with hydrocephalus, resulting in an imbalance in the production and reabsorption of CSF. This leads to increased pressure within the brain and enlargement of the ventricles. The condition can cause severe health problems, such as headaches, nausea, memory problems, and balance disorders; untreated hydrocephalus in childhood is associated with severe disabilities and is very likely to be fatal. The treatment of hydrocephalus aims to provide drainage for cerebrospinal fluid (CSF). Shunt systems are used for this purpose, in which a tube with a valve is implanted to drain excess CSF from the ventricles of the brain or from the spinal canal into another body cavity (e.g., the abdominal cavity). The valve serves to define a valve parameter, such as the minimum differential pressure across the valve or a flow resistance, over which the CSF is drained from the ventricles. This valve parameter can be adjustable and individually adapted to the patient. Typically, an adjustment mechanism is provided on the valve, allowing a physician to set the desired parameter value.The ability to adjust the adjustable parameters of the valves is essential for successful treatment, as adaptation to physiological changes, such as the growth of children, must be possible at any time. German patent DE 10 2008 061 639 A1 discloses a hydrocephalus valve and an associated implantable force transmission system for contactless valve adjustment. The force transmission system comprises an actuator and a permanent magnet, which is spatially separated from the actuator and can be moved by it. The position of the permanent magnet is linked to a valve position for setting a desired opening pressure. From DE 10 2020 134 312 B3, another implantable valve for the treatment of hydrocephalus is known. This valve is an implantable throttle. The throttle is designed to regulate the flow rate by adjusting the flow resistance. The effective length of a flow channel can be adjusted to achieve this flow resistance. A disadvantage of these valves is that their adjustability can sometimes become impaired over time. Consequently, intervention by a doctor is necessary, often involving surgery to replace the valve. The object of the invention is to provide an improved valve with improved long-term durability, in particular improved long-term durability of the adjusting device. This objective is achieved by a valve according to claim 1. Embodiments are given in the dependent claims. The invention provides for an implantable valve for the treatment of hydrocephalus. The valve comprises an inlet and an outlet, a valve unit for adjusting a flow parameter in a fluid, and a fluid chamber extending from the inlet, through the valve unit, to the outlet. This fluid chamber is designed and configured to be filled with the fluid, and contains a mechanical adjustment device for adjusting the valve unit. A first elastic wall section and a second elastic wall section are arranged between the fluid chamber and the adjustment chamber. The adjustment chamber is fluid-tight and separated from the fluid chamber. The mechanical adjustment device is adjustable via the valve unit to set the flow parameter. A first elastic wall section and a second elastic wall section are arranged between the fluid chamber and the adjustment chamber. The invention is based on the finding that the adjustment device frequently becomes clogged due to the formation of occlusions within it. This process involves the formation of an organic residue in the cerebrospinal fluid (CSF) contained within the adjustment device, particularly in areas with less fluid flow. This residue adheres to the device and blocks it. The idea behind the invention is to prevent cerebrospinal fluid (CSF) from coming into contact with components of the adjustment device. This also prevents the adjustment device from being blocked or impaired by occlusion, deposits, or contamination. To achieve this, the adjustment device is separated from the fluid chamber in a fluid-tight manner, for example, by sealing the adjustment chamber with a capsule or chamber, thus preventing the adjustment device from contacting the CSF. The flexible wall section allows a force or a change in position to be transmitted through it, despite the separation of the fluid and adjustment chambers. For example, a force can be applied to the adjustment device from the outside, or changes in the device's position can be transmitted to the outside. A valve is generally understood to be a mechanical device that controls the flow of fluids. A valve can open, close, or regulate the flow. A valve can define a specific flow parameter within a flow, such as an opening pressure or flow resistance. In this context, the term "valve" refers to the entire valve assembly, including the adjustment mechanism. The valve unit, on the other hand, is the component within the valve that regulates the flow parameter. A fluid-tight separation between the fluid chamber and the adjustment chamber is defined as a separation in which no fluid can flow between the chambers. This separation can generally be achieved through sealing or encapsulation. Optionally, the separation between the fluid chamber and the adjustment chamber can be hermetically sealed. In one embodiment of the invention, the adjustment space extends between the elastic wall sections. The elastic wall sections can, in particular, each be formed by a metal membrane, which is made, for example, of titanium. For example, the adjustment space can be designed to resemble the shape of a flat cylinder, as in a miniaturized, round cookie tin, where the top and bottom form the elastic wall sections and a rigid side wall extending in a circular arc extends along the sides. One embodiment of the invention provides that the valve comprises a housing with at least one flexible housing section, over which one of the elastic wall sections is deformable. The housing can be made of titanium, another metal, or plastic. The flexible housing section can be arranged over one of the elastic wall sections. Thus, one of the elastic wall sections can be indented by an operator pressing on the flexible housing section, thereby indenting the underlying elastic wall section. In a further embodiment, the mechanical adjustment device comprises a height-adjustable actuating element and a rotor mechanically coupled to the actuating element. A rotational position of the rotor correlates with a height position of the actuating element. The actuating element can, for example, be a titanium rod with a thread into which the rotor engages. Thus, rotation of the rotor shifts the height position of the actuating element. The thread is, for example, a steep thread. The actuator can be rigidly connected to one of the elastic wall sections, for example, by welding. Alternatively, the actuator can be rigidly connected to both elastic wall sections. The welding prevents the actuator from rotating, thus preventing it from rotating with the rotor. At the same time, the flexible wall section in the area of ​​the (welded) connection can move in accordance with the change in height. The rotor can have at least one magnet. The magnet allows the rotor's rotational position to be adjusted from outside the valve by an operator holding an external magnet against the valve, and the magnetic force can then rotate the rotor into the desired position. Preferably, the rotor has two magnets arranged opposite each other on the rotor and with opposite polarities. In a further embodiment, the mechanical adjustment device includes a rotor brake for locking the rotor's rotational position. When the rotor brake is activated, a braking force presses the rotor onto a rotor seat. The rotor seat can be part of the adjustment chamber. It is possible for the rotor seat to be formed by a side wall of the adjustment chamber. When the valve is implanted and operating normally, the rotor brake is intended to be activated so that the rotor's rotational position does not change. In a further embodiment of the invention, the flexible housing section is designed and configured such that the rotor brake can be released by pressing the flexible housing section. This embodiment is based on the principle that the rotor and the actuating element are connected. By pressing the flexible housing section, the actuating element can be pressed via the elastic wall section, thereby lifting the rotor out of the rotor seat against the braking force. To release the rotor brake, sufficient force must therefore be applied to press in the flexible housing section and the elastic wall section, and additionally to overcome the opposing braking force. In a further embodiment, a mechanical connection is arranged between the adjusting device and the valve unit. The mechanical connection comprises two coupling parts, wherein at least one of the first two coupling parts has an inclined contact surface designed and configured to redirect an adjusting force of the adjusting device. The mechanical connection can be configured, in particular, to redirect an adjustment of the height position of the adjusting element into an adjustment of a connecting arm in a transverse direction. It can be provided that a second of the two coupling parts has a circular contact surface designed to slide along the inclined contact surface. The principle is similar to that of a wedge, in which a vertical movement of the wedge is converted into a horizontal movement of a counterpart.During a vertical movement of the wedge, the counterpart slides along the inclined surface, causing a deflection. It is, in a sense, "pushed aside". Alternatively, a mechanical connection with a connecting arm can be arranged between the adjusting device and the valve unit, wherein the mechanical connection comprises a rotating body and a rod acting on an outer surface of the rotating body and is designed and configured to redirect an adjusting force of the adjusting device. This mechanical connection can also be configured, in particular, to redirect an adjustment of the height position of the adjusting element into an adjustment of a connecting arm in a direction transverse to it. For example, the rotating body can be a gear and the engaging rod a rack. Furthermore, the rotating body can be connected to another engaging rod. The two rods are positioned at an angle to each other. In this configuration, an adjustment of the rod is translated into a rotation of the rotating body, which in turn is translated into an adjustment of the other rod. In a further embodiment of the invention, the adjustment chamber comprises an evacuated chamber. This means that the chamber defining the adjustment chamber is at least partially evacuated, so that a negative pressure prevails inside the chamber compared to the external ambient pressure. The external ambient pressure refers to the pressure in the prevailing fluid space. It may be stipulated that the absolute pressure in the chamber is at least 0.1 mbar and at most 50 mbar. Alternatively, a maximum pressure of 100 mbar, 200 mbar, 350 mbar, 500 mbar or 750 mbar may be stipulated. It is possible for both flexible wall sections to have different surface areas. The formula F = P · A or A = F / P establishes a correlation between the area A and the ratio of the normal force F to the pressure P. If both flexible wall sections are connected to the actuator, opposing normal forces act on the actuator at each connection. Due to the different surface areas, these normal forces are of different magnitudes, resulting in a net force at the actuator that acts towards the smaller surface area. This net force is transmitted via the actuator to the rotor and constitutes the braking force that presses the rotor into the rotor seat. Alternatively, the chamber can be designed not to be evacuated. In this case, a spring force can be applied to the actuator. This spring force can be provided, for example, by a mechanical spring or by preloading an elastic wall section. The adjustment chamber can then be filled with any gas or liquid. In a further embodiment of the invention, the valve includes a pump device. The pump device serves to accelerate the fluid and to dislodge any blockages or deposits. It may also be possible to flush the valve at regular intervals or as needed using the pump device. The pumping device can include a pump chamber that is compressible via the flexible housing section. The pumping action is achieved by compressing the flexible housing section. This reduces the volume of the pump chamber, causing the fluid to flow out. The pump chamber can be arranged downstream of the valve unit in the direction of fluid flow, and the valve unit can be designed and configured to block fluid backflow when the pump chamber is compressed. This prevents loosened deposits from returning to the ventricle or flowing back into the valve during operation and causing blockages. The valve unit can, for example, be a ball valve that prevents backflow. The valve may be designed and configured so that, when the pump chamber is compressed, at least half of the fluid volume contained in the valve is forced out. This allows a relatively large amount of cerebrospinal fluid to be accelerated and a particularly effective flushing action to be achieved. The flushing effect can be enhanced by directing the cerebrospinal fluid accelerated from the pump chamber specifically over areas prone to adhesions and / or occlusion. This can be achieved using flaps or openings designed as check valves. These can be configured to allow flow in only one direction. For example, an arrangement is possible in which pumping creates a circulating flow within the valve. In one embodiment, the flow parameter is a pressure value or a flow resistance value of the fluid. Regulating a pressure value is advantageous for setting an optimal intracranial pressure in the patient. For example, the pressure value could be a differential pressure applied upstream and downstream of the valve. Regulating a resistance value can be implemented, for example, to prevent an excessively rapid outflow of cerebrospinal fluid. For this purpose, the valve unit could, for instance, be designed as a restrictor. The invention is explained in more detail below with reference to the figures of the drawing by means of several exemplary embodiments. The figures show: Fig. 1 a schematic representation of a valve, wherein a flow chamber is shown in a top view, the flow chamber comprising a ball valve and separated from an adjustment chamber; Fig. 2 a cross-sectional view of a valve from a side perspective, wherein an adjustment chamber has an evacuated chamber; Fig. 3 the evacuated chamber and a flexible housing section from Fig. 2, wherein a pressure force is applied to release a rotor from a rotor brake; Fig. 4 an embodiment of the invention of an evacuated chamber in a cross-sectional view showing a braking force for locking the rotor brake; Fig. 5 the evacuated chamber according to Fig. 4, in which the rotor is released from the rotor brake; Fig.Fig. 6 shows a variant of the invention of a valve in which the braking force for locking the rotor is achieved via a spring tension; Fig. 7 shows a further variant of the invention with a mechanical connection in which force is redirected for adjusting a valve unit via two coupling parts, the adjustment chamber not being shown; Fig. 8 shows the variant of the invention from Fig. 7 in a perspective view, which shows the mechanical connection between the adjustment chamber and the ball valve; Fig. 9 shows a top view of the embodiment from Figs. 7 and 8; Fig. 10 shows a further example of the invention for a valve, wherein the valve has a pumping mechanism with which deposits in a fluid chamber can be loosened; and Fig. 11 shows a view of the valve from Fig. 10 in which the pumping mechanism is actuated. Figure 1 shows a top view of an open valve 1. The valve 1 serves to drain cerebrospinal fluid. The valve 1 has a flow chamber 2. The flow chamber 2 is the area within the valve 1 through which cerebrospinal fluid can flow. The direction of flow of the cerebrospinal fluid is symbolized by arrows in the illustration. The cerebrospinal fluid (CSF) initially flows into the valve 1 via the valve inlet 21. The valve inlet 21 can be formed by an inlet nozzle to which a shunt can be connected. The CSF then flows through a ball valve 23. The ball valve 23 defines a maximum applied pressure by only opening when a specific opening pressure is present. The ball valve 23 has a valve spring 231 with a spring force that opposes the applied pressure and closes the ball valve 23. Only when a certain pressure differential is present across the ball valve 23 is the spring force overcome, allowing the ball valve 23 to allow fluid flow. The valve spring 231 thus defines the opening pressure of the ball valve 23. In alternative configurations not shown, it may be provided that the flow parameter to be defined is also a flow resistance and that the valve unit is formed by a throttle or that other types of valves are provided for setting an opening pressure instead of the ball valve 23. In the direction of flow downstream of the ball valve 23, the cerebrospinal fluid flows through an inner chamber 24 of the valve 1. The fluid flows around an adjustment chamber 3 to an outlet 22. The adjustment chamber 3 is fluid-tight and separated from the flow chamber 2. The outlet 22 can be formed by an outlet nozzle to which a further shunt can be connected for the drainage of the cerebrospinal fluid into a body cavity. Fig. 2 shows a cross-sectional view of a valve 1 from a side perspective. The cerebrospinal fluid flows through the inlet 21, through the ball valve 23, to the outlet 22. The valve 1 comprises a housing 4. The housing 4 forms an outer wall of the valve 1 and is cylindrical, with a flexible housing section 41 formed at the bottom of the housing 4. It should be noted that the directional terms "underside," "topside," "vertical," and "horizontal" refer to an orientation of the valve 1 in which the valve 1, with its flexible housing section 41, rests on a flat surface. The orientation of the valve 1 within a body is independent of this. Thus, the valve 1 can be implanted in any spatially possible orientation within the body. Preferably, the valve 1 is arranged after implantation such that the inlet 21, preferably vertically, is positioned above the outlet 22. The adjustment chamber 3 is located within the housing 4. Between the adjustment chamber 3 and the housing 4 is the inner chamber 24, through which cerebrospinal fluid can flow. The adjustment chamber 3 is bounded by flexible walls 32, 33, a rotor seat 38, and a side wall 39, which form a chamber and hermetically seal the adjustment chamber 3 against the inner chamber 24. The two flexible walls 32, 33 can be formed by a metal membrane made of titanium. The chamber can be bounded laterally by a rigid, L-shaped wall, the vertical part of which forms the side wall 39 and the horizontal part of which forms the rotor seat 38. The adjusting device 31 is arranged within the adjustment space 3. The adjusting device 31 can have a height-adjustable actuating element 34, the position of which defines the opening pressure of the ball joint 23. An upper extension 342 of the actuating element 34 projects from the upper wall 32 and is connected to a mechanical link 5. The height position of the actuating element 34 is transmitted to the ball joint 23 via the mechanical link 5 and defines the preload of the valve spring 231, as shown by way of example in Figs. 7, 8 and 9. A lower extension 343 of the actuating element 34 projects from the underside of the lower flexible wall 33 to the flexible housing section 41. The actuating element 34 is rigidly connected to both the upper wall 32 and the lower wall 33. The actuating element 34 including the respective extension 342, 343 can be made of titanium and welded to the walls 32, 33.It should be noted that the respective extensions 342, 343 are part of the actuating element 34 or are permanently connected to it. The actuating element 34 can be a vertically extending rod that can be coupled to a rotor 35. The rotor 35 can be arranged in a horizontal plane and rotatably around the actuating element 34, so that the actuating element 34 forms an axis of rotation. A vertical position of the actuating element 34 is coupled to a rotational position of the rotor 35 by connecting the two parts via a steep thread 341. Thus, the vertical position of the actuating element 34 can be adjusted by rotating the rotor 35. The rotor 35 can have two embedded magnets 351 for this purpose. An operator can hold an external magnet against the valve 1 and use the magnetic force to rotate the rotor 35 into the desired position. In this embodiment, the chamber is an air-evaporated chamber. Accordingly, the elastic upper wall 32 and the elastic lower wall 33 are curved inwards. An evacuated chamber means that the adjustment space 3 is at least partially evacuated of air, so that a negative pressure exists compared to the external ambient pressure. This pressure is at least 0.1 mbar and at most 50 mbar. Alternatively, a maximum pressure of 100 mbar, 200 mbar, 350 mbar, 500 mbar, or 750 mbar can be provided. To prevent accidental adjustment of the rotor position, the adjusting device can include a rotor brake. When valve 1 is implanted and operating normally, the rotor brake is intended to be activated so that the rotational position of rotor 35 cannot change. For this purpose, when the rotor brake is activated, rotor 35 is firmly seated in the rotor seat 38 and locked in place by it. Fig. 3 shows an enlarged view of the adjustment chamber 3 and the flexible housing section 41. It depicts a state in which the rotor brake is released. A pressure force 36 acts from below on the flexible housing section 41. This pressure force 36 is applied by an operator by pressing a finger on the corresponding area, causing the flexible housing section 41 to be depressed. The inner surface of the flexible housing section 41 then abuts the lower extension 343 of the actuating element 34 and pushes it upwards in the direction of the pressure force 36. This also pushes the actuating element 34 and the rotor 35 upwards, releasing the rotor 35 from the rotor seat 38. In this state, the rotor 35 is now freely rotatable and can be adjusted externally via the magnets 351. The actuating element 34 is mounted in a rotationally fixed manner, so that it does not rotate with the rotor 35, but merely moves up or down via the thread 341. Thus, the rotation of the rotor 35 changes the height position of the actuating element 34 relative to the rotor 35. When the rotor 35 has rotated into the desired position, the pressure force can be released, allowing the rotor 35 to lower back into the rotor seat 38 and the rotor brake to be activated. Due to the change in the height position of the actuating element 34 relative to the rotor 35, the height position of the actuating element 34 also changes when the rotor 35 rests in the rotor seat 38. A braking force 37, which is explained with reference to the following figures, ensures this lowering. Figures 4 and 5 show the rotor brake. The basic principle is that, to activate the rotor brake, a downward braking force 37 presses the rotor 35 into the rotor seat 38, thus locking it. However, the brake can be released if the rotor 35 is lifted out of the rotor seat 38 against the braking force 37, as explained in Figure 3. The braking force 37 results from the forces generated by the negative pressure in the adjustment chamber 3 and acting on the flexible walls 32, 33. In the illustrated embodiment, the area of ​​the upper wall 32 is larger than that of the lower wall 33. The formula F = P · A or A = F / P establishes the physical correlation between the area A and the ratio of the normal force F to the applied pressure P. Due to the negative pressure inside the adjustment chamber 3, the normal force is directed inwards. Since both flexible walls 32, 33 are connected to the actuating element 34, an inward-acting normal force arises at each connection between wall 32, 33 and actuating element 34, which is transmitted to the actuating element 34. These two forces are opposite and together result in a net force. Due to the larger flexible area of ​​the upper wall 32, the corresponding normal force is also greater.The force resulting from the two normal forces is therefore directed towards the smaller area, or in other words, downwards. This resulting force is transmitted via the actuating element 34 to the rotor 35 and presses it against the rotor seat 38 as a braking force 37. The two walls 32, 33 can be made of the same material, for example titanium, and have the same thickness. Figure 6 shows a further embodiment in which the braking force 37 is generated in an alternative manner and the adjustment chamber 3 does not include an evacuated chamber. The figure shows an embodiment of a valve 1 with an inlet 21, an outlet 22, a ball valve 23, and a fluid chamber 2, corresponding to the previous embodiments. The adjustment chamber 3 has a chamber that hermetically separates the adjustment device 31 from the fluid chamber 2. The chamber comprises the elastically formed upper and lower walls 33, with only the lower wall 33 being shown in this example. Furthermore, the chamber has the brake seat 38, into which the rotor is pressed. In this embodiment, the braking force 37 is not generated by a force resulting from a vacuum, but by a spring force that is transmitted to the actuating element 34 by a helical spring 371.The helical spring 371 is arranged between a fixed housing section 42 and the actuating element 34 and presses the latter downwards. In this case, the adjustment chamber 3 can be filled with any gas or liquid, and the pressure can be equal to the pressure in the fluid chamber, so that there is no pressure difference between the fluid chamber 2 and the adjustment chamber 3. Alternatively, instead of the helical spring 371, the upper elastic wall and / or lower elastic wall 33 (not shown) can be pre-tensioned and exert a downward force on the actuating element 34. In this case, the elastic wall itself would act as a spring. Figures 7 and 8 illustrate the connection between the height position of the actuating element 34 and the opening pressure of the ball valve 23 via a mechanical linkage 5. The adjusting device 31 is omitted from the illustrations. Only the actuating element 34, which is movable in its height position, is shown in an abstract form. The mechanical connection 5 comprises a connecting arm 51 for connecting the actuating element 34 to the ball valve spring 231. A coupling converts the vertical position of the actuating element 34 into a radial, horizontal movement of the connecting arm 51 relative to the actuating element. The connecting arm 51 can be pre-tensioned at its outer end 512 by the valve spring 231. Radial movement of the connecting arm 51 increases the pre-tension of the valve spring 231 and thus increases the minimum pressure on the ball valve 23, making it more difficult to open. For the coupling, a rounded end 511 of the connecting arm 51 can rest against an inclined contact surface of the upper extension of the actuating element 342. The end 511 of the connecting arm 51 and the extension of the actuating element 342 thus form two coupling parts. The end 511 of the connecting arm 51 can have a contact surface, preferably round, which is always in contact with the inclined contact surface and can slide along it. A leaf spring 52 can be provided to ensure continuous contact between the two coupling parts, pushing the connecting arm 51 continuously towards the actuating element 34. When the actuating element 34 is moved vertically, the end 511 of the connecting arm 51 slides along the inclined contact surface 342 and moves horizontally. The connecting arm 51 can be located in a guide that allows only horizontal movement. The operating principle of the coupling is similar to that of a wedge, where a vertical movement of the wedge is converted into a horizontal movement of a counterpart. During a vertical movement of the wedge, the counterpart slides along the inclined surface, causing a deflection. It is, in effect, "pushed aside." Figure 9 shows an embodiment of the preceding two figures in a top view. The valve 1 shown is designed to be implanted into a body such that the inlet 21 is located vertically above the outlet 22. The actuating element 34 is visible in the center, and its setting is transmitted via the mechanical connection 5 with the connecting arm 51 and the leaf spring 52 to one end of the valve ball spring 231. A counterweight may also be provided. The counterweight is coupled to the ball valve 23 and serves to provide different opening pressures for different spatial orientations. It is connected to the ball valve 23 via a rocker arm and pushes a valve ball 232 towards the inlet 21. The gravitational force of the ball thus provides an additional closing force for the ball valve 23.This additional closing force, however, depends on the spatial orientation of the valve 1. For example, if the valve is rotated by 90° so that the counterweight 231 hangs below the ball, it will exert a smaller or even no additional closing force on the valve ball 232. Thus, the valve 1 acts as a gravity valve. The orientation of the counterweight ensures that the opening pressure at the ball valve 23 is greater when a patient is in an upright position compared to a supine position. In an alternative embodiment (not shown), the coupling comprises a gear and two racks. In this example, the upper extension of the actuating element and the connecting arm are each designed as a rack. The connecting arm does not extend radially from the extension of the actuating element, but rather passes alongside it. An overlap of the two parts is symbolized accordingly. This coupling also serves to translate an adjustment of the height of the actuating element into an adjustment of the connecting arm in a horizontal plane. The gear is engaged with the connecting arm and the upper extension of the adjusting element. A height adjustment of the adjusting element is therefore transmitted as a change in the rotational position of the gear, which in turn is transmitted to the connecting arm and moves it in the horizontal plane. Figures 10 and 11 show a valve 1 with a pumping device 6 for accelerating cerebrospinal fluid to dissolve possible blockages or adhesions. The pumping device 6 comprises a pumping chamber 61, which is arranged between the flexible housing section 41 and the lower wall 33. The pumping chamber 61 is a space that, when the valve is in use, is filled with cerebrospinal fluid and is thus part of the fluid chamber 2. In Fig. 11, the path of the fluid is illustrated by arrows. Accordingly, it flows through the inlet 21 and the ball valve 23 into the pumping chamber 61 and can then flow out of the valve 1 via the outlet 22. To create a pumping action, the pump chamber 61 can be compressed, as shown in Fig. 11. The flexible housing section 41 can be pressed in, thus reducing the volume of the pump chamber 61. Consequently, the cerebrospinal fluid is accelerated towards the outlet 22. The accelerated fluid can loosen and transport away deposits, particularly occlusive deposits. Backflow is prevented by the ball valve 23. Compressing the pump chamber increases the internal pressure, causing the ball valve 23 to close. This prevents loosened deposits from flowing back into the ventricle or, during operation of the valve 1, from flowing back into the valve 1 and causing further blockages. The direction of cerebrospinal fluid flow is indicated by arrows in Fig. 11. The pump chamber is dimensioned such that, when the pump chamber 61 is compressed, at least half of the fluid volume contained in the valve 1 is forced out of the valve. This allows a relatively large amount of cerebrospinal fluid to be accelerated and a particularly effective flushing action to be achieved. It is also possible to prophylactically "flush" the valve by compressing the pump chamber 61 via the flexible housing section 41 at regular intervals. It should be noted that the pump device can be used in combination with any of the embodiments described above. In one embodiment (not shown), the cerebrospinal fluid accelerated from the pump chamber is directed over areas prone to occlusion. Flow elements, such as check valves or flaps, are provided to allow for a preferred flow direction. In particular, it can be provided that a circulating flow can be created within the valve via these flow elements. It is understood that the invention is not limited to the embodiments described above and that various modifications and improvements can be made without deviating from the concepts described herein. It is further noted that any of the described features can be used separately or in combination with any other features, provided they are not mutually exclusive. The disclosure extends to and includes all combinations and subcombinations of one or more features described herein. Where ranges are defined, these include all values ​​within those ranges as well as all sub-ranges that fall within a range.

Claims

An implantable valve (1) for the treatment of hydrocephalus, comprising: - an inlet (21) and an outlet (22); - a valve unit (23) for adjusting a flow parameter in a fluid; - a fluid chamber (2) extending from the inlet (21) via the valve unit (23) to the outlet (22), which is designed and configured to be filled with the fluid; and - an adjustment chamber (3) in which a mechanical adjustment device (31) for adjusting the valve unit (23) is arranged, - wherein a first elastic wall section (32) and a second elastic wall section (33) are arranged between the fluid chamber (2) and the adjustment chamber (3), - wherein the adjustment chamber (3) is fluid-tightly separated from the fluid chamber (2), and - wherein the valve unit (23) is adjustable for adjusting the flow parameter via the mechanical adjustment device (31). Valve (1) according to claim 1, characterized in that both flexible wall sections (32, 33) each have a different area size. Valve (1) according to claim 1 or 2, characterized in that the adjustment space extends between the elastic wall sections (32, 33). Valve (1) according to one of the preceding claims, characterized in that the valve (1) comprises a housing (4) with at least one flexible housing section (41) over which one of the elastic wall sections (32, 33) is deformable. Valve (1) according to one of the preceding claims, characterized in that the mechanical adjusting device (31) comprises a height-adjustable actuating element (34) and a rotor (35) mechanically coupled to the actuating element (34), wherein a rotational position of the rotor (35) correlates with a height position of the actuating element (34). Valve (1) according to claim 4 or 5, characterized in that the rotor (35) has at least one magnet (351). Valve (1) according to one of claims 4 - 6, characterized in that the mechanical adjusting device (31) has a rotor brake for locking the rotational position of the rotor (35), wherein, when the rotor brake is activated, a braking force (37) presses the rotor (35) onto a rotor seat (38). Valve (1) according to claim 7, insofar as it relates back to claim 4, characterized in that the flexible housing section (41) is provided and designed such that the rotor brake can be released by pressing in the flexible housing section (41). Valve (1) according to one of the preceding claims, characterized in that a mechanical connection (5) is arranged between the adjusting device (31) and the valve unit (23), wherein the mechanical connection (5) comprises two coupling parts (511, 342), wherein one of the two coupling parts (511, 342) has an inclined contact surface which is provided and designed to redirect an adjusting force of the adjusting device (31). Valve (1) according to one of claims 1 to 8, characterized in that a mechanical connection (5) with a connecting arm (51) is arranged between the adjusting device (31) and the valve unit (23), wherein the mechanical connection (5) comprises a rotating body (54) and a rod (342) acting on an outside of the rotating body (54), which is provided and designed to redirect an adjusting force of the adjusting device (31). Valve (1) according to one of the preceding claims, characterized in that the adjustment space (3) has an evacuated chamber. Valve (1) according to claim 11, characterized in that an absolute pressure of at least 0.1 mbar and at most 750 mbar prevails in the evacuated chamber. Valve (1) according to one of the preceding claims, characterized in that the valve (1) comprises a pumping device (6) which is provided and designed for this purpose. Valve (1) of claim 13, insofar as it relates back to claim 4, characterized in that the pumping device (6) comprises a pumping chamber (61) which is compressible via the flexible housing section (41). Valve (1) according to claim 14, characterized in that the pump chamber (61) is arranged in a flow direction of the fluid behind the valve unit (23) and the valve unit (23) is provided and designed such that, in the event of compression of the pump chamber (61), the valve unit (23) blocks a fluid backflow. Valve (1) according to claim 15, characterized in that the valve (1) is provided and designed such that, during compression of the pump chamber (61), at least half of the liquid volume contained in the valve (1) is forced out of the valve (1). Valve (1) according to one of the preceding claims, characterized in that the flow parameter is a pressure value or a flow resistance of the fluid.

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