Coronary sinus cannulation

• US 10,004,388 B2
• Filed: 08/30/2007
• Issued: 06/26/2018
• Est. Priority Date: 09/01/2006
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Inventors: Saadat, Vahid, Rothe, Chris A., Peh, Ruey-Feng, Tam, Edmund A.
• Primary Examiner(s): NGUYEN, HIEN NGOC
• Application Number:
  US11/848,207
• Publication Number:
  US 20080058650A1
• Time in Patent Office: 3,953 Days
• Field of Search: 600478
• CPC Class Codes: A61B 1/00089 Hoods
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• CPC Class Codes: A61B 1/0605 for spatially modulated illumination
• CPC Class Codes: A61B 1/0676 at distal tip of an endoscope
• CPC Class Codes: A61B 1/0684 using light emitting diodes [LED]
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/12045 double occlusion, e.g. during anastomosis
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2017/00221 with wireless transmission of data, e.g. by infrared radiation or radiowaves
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00778 Operations on blood vessels A61B2017/22097, A61B2017/320741 take precedence
• CPC Class Codes: A61B 2017/00884 enhancing wound closure
• CPC Class Codes: A61B 2017/00893 pharmaceutically effective
• CPC Class Codes: A61B 2017/00907 : for light
• CPC Class Codes: A61B 2017/00986 : Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/12127 : Double occlusion, e.g. for creating blood-free anastomosis site
• CPC Class Codes: A61B 2017/3484 : Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/373 : using light, e.g. by using optical scanners
• CPC Class Codes: A61B 5/0084 : for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/6853 : with a balloon
• CPC Class Codes: A61M 2025/0058 : having an electroactive polymer material, e.g. for steering purposes, for control of flexibility, for locking, for opening or closing
• CPC Class Codes: A61M 25/007 : Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
• CPC Class Codes: A61M 25/1002 : characterised by balloon shape A61M25/1006, A61M25/1009 take precedence

Abstract

Coronary sinus cannulation apparatus and methods relating to tissue visualization catheters that can locate and/or cannulate a morphological feature within a body lumen, such as the coronary sinus, are described. Such devices can also perform a variety of therapeutic tissue treatments under direct in vivo visualization thereafter. Moreover, such apparatus and methods may also be utilized with guidewires to facilitate delivery into the coronary sinus to eliminate repositioning of the device and/or repeating an entire sequence of operations, consequently improving procedure effectiveness and reducing procedure time.

Claims

1. A method of visually locating a vessel within a body lumen, comprising:

intravascularly advancing a deployment catheter towards a tissue region at a first location of a vessel of a subject;

expanding a fluid barrier to define an open area against or adjacent to the tissue region, the open area being created by expansion of the fluid barrier, wherein the open area is in fluid communication with an environment external to the fluid barrier;

displacing an opaque fluid with a transparent fluid from the open area defined by the fluid barrier and the tissue region such that the opaque fluid is displaced into the environment external to the fluid barrier;

visually assessing the tissue region at the first location through the transparent fluid by viewing the tissue region via an optical imaging element attached to an inner surface of the fluid barrier;

after visually assessing the tissue region and after expanding the fluid barrier, expanding a balloon positioned along the inner surface of the fluid barrier with a pressurized fluid to at least partially expand the balloon;

visually assessing the tissue region at the first location through the expanded balloon with the optical imaging element; and

repositioning the fluid barrier from the first location to a second location based upon a visual appearance of the tissue region at the first location over an ostium of the vessel.

2. The method of claim 1 wherein intravascularly advancing comprises advancing the fluid barrier into a left atrial chamber of a heart.

3. The method of claim 1 wherein expanding the fluid barrier comprises self-expanding the fluid barrier from a low-profile delivery configuration into an expanded deployed configuration.

4. The method of claim 1 wherein expanding further comprises stabilizing a position of the fluid barrier relative to the tissue region.

5. The method of claim 1 wherein displacing an opaque fluid comprises infusing the transparent fluid into the open area through a fluid delivery lumen defined through the deployment catheter through which the fluid barrier extends.

6. The method of claim 5 wherein infusing the transparent fluid comprises pumping saline, plasma, water, or perfluorinated liquid into the open area such that blood is displaced from therefrom.

7. The method of claim 1 wherein the optical imaging element comprises a CMOS imager, CCD imager, or optical fiber.

8. The method of claim 1 wherein visually assessing comprises assessing anatomical characteristics of the tissue region at the first location.

9. The method of claim 8 wherein anatomical characteristics comprise a color or surface feature of the tissue region at the first location.

10. The method of claim 1 wherein repositioning comprises moving the fluid barrier along the tissue region while visualizing through the transparent fluid.

11. The method of claim 1, further comprising illuminating the tissue region with an optical fiber or light emitting diodes.

15. The method of claim 1, further comprising articulating the optical imaging element to alter a field of view of the optical imaging element, while the fluid barrier is expanded.

12. A method of visually locating a vessel within a body lumen, comprising:

intravascularly advancing a deployment catheter towards a tissue region at a first location of a vessel of a subject;

expanding a fluid barrier defining an open area against or adjacent to the tissue region, the open area being created by expansion of the fluid barrier, where the open area is in fluid communication with an environment external to the fluid barrier;

displacing an opaque fluid with a transparent fluid from the open area defined by the fluid barrier and the tissue region such that the opaque fluid is displaced into the environment external to the fluid barrier;

visually assessing the tissue region at the first location through a balloon and the transparent fluid by visualizing the tissue region via an imaging element attached to an inner surface of the fluid barrier, while the balloon is in a collapsed state;

visually assessing the tissue region at the first location through the balloon with the imaging element attached to an inner surface of the fluid barrier, while the balloon is in an expanded state; and

repositioning the fluid barrier from the first location to a second location based upon a visual appearance of the tissue region at the first location over an ostium of the vessel.

13. The method of claim 12, further comprising visually assessing the tissue region at the first location through the transparent fluid by visualizing the tissue region through the fluid barrier via an imaging element attached to an inner surface of the fluid barrier.

14. The method of claim 12, wherein the imaging element comprises a CMOS imager, CCD imager, or optical fiber.