Devices and methods for coronary sinus pressure relief

• US 10,568,751 B2
• Filed: 01/10/2014
• Issued: 02/25/2020
• Est. Priority Date: 11/07/2006
• Status: Active Grant

• Current Assignee: Corvia Medical, Inc.
• Original Assignee: Corvia Medical, Inc.
• Inventors: McNamara, Edward
• Primary Examiner(s): Preston, Rebecca S
• Application Number:
  US14/152,094
• Publication Number:
  US 20140194971A1
• Time in Patent Office: 2,237 Days
• 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 17/221 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 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00592 Elastic or resilient implements
• CPC Class Codes: A61B 2017/00597 Implements comprising a membrane
• CPC Class Codes: A61B 2017/00606 Implements H-shaped in cross-section, i.e. with occluders on both sides of the opening
• CPC Class Codes: A61B 2017/00623 Introducing or retrieving devices therefor
• CPC Class Codes: A61B 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/2215 having an open distal end
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/144 Wire
• CPC Class Codes: A61F 2/2403 with pivoting rigid closure members check valves with hinged closure members in general F16K15/03
• CPC Class Codes: A61F 2/2412 with soft flexible valve members, e.g. tissue valves shaped like natural valves check valves with flexible valve members in general F16K15/14
• CPC Class Codes: A61F 2/2418 Scaffolds therefor, e.g. support stents
• CPC Class Codes: A61F 2/2451 Inserts in the coronary sinus for correcting the valve shape
• CPC Class Codes: A61F 2/2478 Passive devices for improving the function of the heart muscle, i.e. devices for reshaping the external surface of the heart, e.g. bags, strips or bands
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/82 : Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/844 : folded prior to deployment
• CPC Class Codes: A61F 2/90 : characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/91 : made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
• CPC Class Codes: A61F 2/954 : for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2002/061 : provided with means for allowing access to secondary lumens
• CPC Class Codes: A61F 2002/821 : Ostial stents
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2220/0008 : Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2220/005 : using adhesives
• CPC Class Codes: A61F 2220/0058 : soldered or brazed or welded
• CPC Class Codes: A61F 2230/0017 : Angular shapes
• CPC Class Codes: A61F 2230/005 : Rosette-shaped, e.g. star-shaped
• CPC Class Codes: A61F 2230/0054 : V-shaped
• CPC Class Codes: A61F 2230/0067 : conical
• CPC Class Codes: A61F 2250/0067 : Means for introducing or releasing pharmaceutical products into the body
• CPC Class Codes: A61F 2250/0069 : Sealing means
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61L 31/022 : Metals or alloys
• CPC Class Codes: A61M 1/3613 : Reperfusion, e.g. of the coronary vessels, e.g. retroperfusion
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

A method and devices for relieving pressure in the left atrium of a patient'"'"'s heart is disclosed. The method includes using an ablative catheter in a minimally invasive procedure to prepare an opening from the coronary sinus into a left atrium of the patient'"'"'s heart. Once the opening is prepared, the opening may be enlarged by a technique such as expanding a balloon within the opening. A stent is then placed within the coronary sinus of the patient, with a transverse portion expanding within the opening, allowing blood to flow from the left atrium to the coronary sinus and then to the right atrium. Pressure within the left atrium is thus relieved.

Claims

1. A method for relieving intracardial pressure, the method comprising:

advancing a catheter into a coronary sinus;

delivering a stent through the catheter to an opening between the coronary sinus and a left atrium;

deploying the stent through the opening to place a first portion of the stent in the left atrium, a second portion of the stent in the opening, and a third portion of the stent in the coronary sinus; and

permitting blood to flow from the left atrium into the coronary sinus, with the coronary sinus emptying into the right atrium.

2. The method of claim 1, wherein the first portion of the stent comprises a plurality of flanges, the deploying step comprising extending the plurality of flanges from the opening along a wall of the left atrium.

3. The method of claim 2, wherein the extending step comprises extending the plurality of flanges 2-4 mm in a direction parallel to the coronary sinus.

4. The method of claim 2, wherein the extending step comprises extending the plurality of flanges 1-2 mm in a direction parallel to the coronary sinus.

5. The method of claim 1, further comprising extending the third portion of the stent from the opening along the coronary sinus.

6. A method for relieving elevated pressure in a left atrium of a patient'"'"'s heart, the method comprising:

percutaneously placing a bending catheter inside a coronary sinus with its distal tip facing a placement location inside the coronary sinus,

penetrating the wall between the left atrium and the coronary sinus at the placement location from inside the coronary sinus and thereby creating an opening;

delivering an expandable device through a catheter to the coronary sinus of the patient'"'"'s heart;

expanding a first portion of the device within the coronary sinus to bear against the coronary sinus and hold the device in place;

extending a second portion of the device through the opening in the wall between the coronary sinus and the left atrium to provide a blood flow path from the left atrium into the coronary sinus, the device comprising a flange at a distal end of the second portion, the extending step comprising extending the flange within the left atrium; and

maintaining regular blood flow inside the coronary sinus through the first portion of the stent while allowing blood to flow from the left atrium into the coronary sinus,

wherein the second portion is strong enough to maintain the patency of the opening and allow flow therethrough, and wherein an end of the second portion is joined around its circumference to a portion of the first portion.

7. The method of claim 6, wherein the step of extending the flange comprises extending the flange 1-4 mm is a direction parallel to the coronary sinus.

8. The method of claim 6, wherein the flange comprises a plurality of struts, the step of extending the flange comprising extending the struts within the left atrium.

9. A method for relieving intracardial pressure, the method comprising:

percutaneously placing a bending catheter inside a coronary sinus with its distal tip facing a placement location inside the coronary sinus;

penetrating a wall between a left atrium and the coronary sinus at the placement location from inside the coronary sinus, thereby creating an opening;

deploying a distal portion of a long portion of a stent inside the coronary sinus distal to the opening;

deploying a crown portion of the stent at the opening between the coronary sinus and the left atrium, wherein the crown portion is strong enough to maintain the patency of the opening and allow blood flow therethrough, and wherein an end of the crown portion is joined around its circumference to a portion of the long portion;

engaging a wall of the atrium with a flange of the stent;

deploying a proximal portion of the long portion of the stent inside the coronary sinus proximal to the opening;

maintaining regular blood flow inside the coronary sinus through the long portion of the stent; and

allowing blood to flow from the left atrium into the coronary sinus, thus relieving pressure.

10. The method of claim 9, further comprising engaging an inner surface of the coronary sinus using a close fit between the long portion of the stent and the coronary sinus.