Apparatus and method for septal punch

Patent metadata

Field	Value
Publication number	US-2020246046-A1
Application number	US-202016858015-A
Country	US
Kind code	A1
Filing date	Apr 24, 2020
Priority date	Sep 24, 2018
Publication date	Aug 6, 2020
Grant date	—

Abstract

In some embodiments, a method includes a shaft having a side catheter guide attached thereto via a guide coupler into an inferior vena cava and a superior vena cava such that the guide coupler is disposed in a right atrium, and applying a distal force to a proximal portion of the side catheter guide such that a distal end of the side catheter guide deflects laterally about the guide coupler towards a septum. The method further includes extending a side catheter that is disposed within the side catheter guide distally from the side catheter guide towards and into contact with the septum. The method further includes, with the side catheter in contact with the septum, extending a septum penetrator that is slidably disposed within the side catheter distally from the side catheter such that the septum penetrator pierces the septum.

First claim

1 . An apparatus, comprising:
a shaft; a guide coupled and angularly deflectable relative to the shaft via a guide coupler, the guide configured to be transitioned between a delivery configuration and a deployed configuration in which a distal end of the guide points away from a centerline of the shaft when transitioned from its delivery configuration to its deployed configuration, the guide defining a lumen; an elongate member slidably disposable within the lumen of the guide and configured to extend distally relative to the distal end of the guide, the elongate member defining a lumen; and a puncture member slidably disposable within the lumen of the elongate member and configured to extend distally relative to a distal end of the elongate member, the puncture member being configured to puncture tissue of a patient.

2 . The apparatus of claim 1 , wherein:
the puncture member defines a lumen configured to slidably receive a guide wire.

3 . The apparatus of claim 1 , further comprising:
an end effector disposed about the elongate member, the end effector configured to transition between a delivery configuration in which the end effector has a first cross-sectional area and a deployed configuration in which the end effector has a second cross-sectional area that is greater than the first cross-sectional area.

4 . The apparatus of claim 1 , further comprising:
an end effector disposed about the elongate member and having a cross-sectional area greater than a cross-sectional area of the elongate member.

5 . The apparatus of claim 1 , wherein:
the guide coupler allows rotational movement of the guide relative to the shaft and limits relative linear movement between the guide coupler and the guide.

6 . The apparatus of claim 1 , wherein:
the guide extends proximally from its distal end across at least a portion the shaft, and beyond a side of the shaft, and then turns and extends proximally towards a proximal end of the shaft, when the guide is in its deployed configuration and the elongate member is at least partially disposed within the lumen of the guide.

7 . The apparatus of claim 1 , further comprising:
a handle operably coupled to the shaft and the guide, the shaft and the guide extending distally from the handle, a length of the guide disposed between a distal end of the handle and the guide coupler increases in response to the guide being transitioned from its delivery configuration to its deployed configuration.

8 . The apparatus of claim 1 , wherein:
the guide coupler is spaced proximally from a distal end of the shaft.

9 . The apparatus of claim 1 , wherein:
the shaft defines at least one lumen, the at least one lumen configured to receive a guide wire.

10 . The apparatus of claim 1 , wherein:
the guide is configured to be transitioned between its delivery configuration and its deployed configuration in response to relative movement between (1) a portion of the guide disposed proximal to the guide coupler and (2) the shaft.

11 . The apparatus of claim 1 , wherein the elongate member is a side catheter, and the guide is a side catheter guide.

12 . The apparatus of claim 1 , wherein the shaft defines at least one lumen, the at least one lumen configured to receive at least a portion of the guide,
the shaft defining a first lateral opening and a second lateral opening, the guide configured to extend through the first lateral opening when in the deployed configuration, the elongate member and the puncture member configured to extend through the second lateral opening when the guide is in the deployed configuration.

13 . The apparatus of claim 1 , wherein the guide coupler is disposed within a lumen defined by the shaft.

14 . The apparatus of claim 1 , wherein the puncture member defines a lumen configured to slidably receive a guide wire,
the lumen having a first internal diameter at a distal end portion thereof and a second internal diameter, greater than the first internal diameter, in a portion proximal to the distal end portion.

15 . The apparatus of claim 1 , further comprising an atraumatic member coupled to the shaft and spaced (1) distally from the guide and (2) proximally from a distal end of the shaft, the atraumatic member tapered such that it reduces in cross-sectional area from its proximal end to its distal end.

16 . The apparatus of claim 1 , further comprising an atraumatic member defining a lumen therethrough, a first lateral opening, and a second lateral opening,
at least a portion of the shaft and the guide being disposed within the lumen of the atraumatic member, a portion of the guide that is disposed proximal to the guide coupler is configured to extend through the first lateral opening when the guide transitions from the delivery configuration to the deployed configuration, the elongate member configured to extend distally through the second lateral opening when the guide is in the deployed configuration.

17 . A method, comprising:
inserting a shaft having a guide attached thereto via a guide coupler into a heart of a patient such that a distal end of the guide is disposed in the right atrium of the heart; deflecting the distal end of the guide about the guide coupler such that the distal end of the guide points towards a septum of the heart; extending an elongate member that is disposed within the guide distally from the guide and towards the septum; and extending a septum penetrator that is slidably disposed within the elongate member distally from the elongate member such that the septum penetrator pierces the septum, the septum penetrator defining a lumen configured to slidably receive a guide wire.

18 . The method of claim 17 , wherein the inserting the shaft includes inserting the shaft into an inferior vena cava (IVC) of the heart and a superior vena cava (SVC) of the heart such that the shaft is disposed in both the IVC and SVC,
the deflecting and the extending the elongate member occurring with the shaft disposed in both the IVC and the SVC.

19 . The method of claim 17 , wherein the extending the septum penetrator distally from the elongate member includes extending the septum penetrator distally from the elongate member such that the septum penetrator pierces a fossa ovalis of the heart.

20 . The method of claim 17 , wherein the extending the septum penetrator such that the septum penetrator pierces the septum includes extending the septum penetrator into a left atrium of the heart, the method further comprising:
with the septum penetrator disposed in the left atrium, extending distally a guide wire from within a lumen defined by the septum penetrator from the septum penetrator and into the left atrium.

21 . The method of claim 17 , wherein:
the deflecting including causing a length of the guide that is proximal to the guide coupler and disposed within the heart to increase.

22 . The method of claim 17 , wherein:
the guide coupler is a hinge rotatably coupled to the shaft to allow rotational movement of the distal end of the guide relative to the shaft and limit relative linear movement between the hinge and the distal end of the guide.

23 . The method of claim 17 , wherein the elongate member includes an end effector at its distal end,
the extending the elongate member distally from the guide towards the septum includes extending the elongate member distally from the guide into contact with the septum such that the septum is tented by the end

Assignees

• Univ Maryland
• Univ Of Maryland Medical System Llc
• Protaryx Medical Inc

Inventors

• Gammie James S
• Haarstad Philip J
• Blaeser David
• Bauer Ryan
• Roller Stephen
• Quinn Rachael
• Pasrija Chetan
• Hlavka Edwin

Classifications

• A61B2017/00336

  with a protective sleeve, e.g. retractable or slidable · CPC title

• A61B2090/0801

  Prevention of accidental cutting or pricking · CPC title

• A61B2017/00247

  Making holes in the wall of the heart, e.g. laser Myocardial revascularization · CPC title

• A61B2017/003

  Steerable · CPC title

• A61B2017/22061

  for spreading elements apart · CPC title