Kit for transvenously accessing the pericardial space via the right atrium

• US 20040215168A1
• Filed: 01/23/2004
• Published: 10/28/2004
• Est. Priority Date: 04/30/1997
• Status: Abandoned Application

• Current Assignee: BETH Israel Deaconess Medical Center (Caregroup Incorporated)
• Original Assignee: BETH Israel Deaconess Medical Center (Caregroup Incorporated)
• Inventors: Waxman, Sergio, Verrier, Richard L.
• Application Number:
  US10/762,575
• Publication Number:
  US 20040215168A1
• Time in Patent Office: Days
• US Class Current: 604/528
• CPC Class Codes: A61M 2025/0089 Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
• CPC Class Codes: A61M 25/0105 Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/0662 Guide tubes

Abstract

A method and kit for accessing the pericardial space take advantage of the fact that the right auricle is a thin-walled, low-pressure structure which can be readily penetrated without damaging the pericardium or the epicardium. The method includes the step of passing a guide catheter through a selected peripheral vein to establish a transvenous route to the right auricle of the heart. An infusion guide wire and a leading guide wire are passed through the guide catheter and into the right auricle so that a distal end of the leading guide wire is positioned against a wall of the right auricle. The leading guide wire is located within a lumen of the infusion guide wire and protrudes outward, preferably about 2 mm, from a distal end of the infusion guide wire. The wall of the right auricle is then pierced with the distal end of the leading guide wire. After the wall of the right auricle is pierced, at least one of the infusion guide wire and the leading guide wire are advanced into the pericardial space. Once in position, the infusion guide wire and/or the leading guide wire can be used as a conduit over which a desired catheter may be introduced for performing a specific medical procedure. Alternatively, the infusion guide wire and/or the leading guide wire can be used to perform a specific medical procedure without the introduction of an additional device into the pericardial space.

Claims

1. A kit for transvenously accessing the pericardial space between a heart and its pericardium to perform a medical procedure on the heart, the kit comprising:

a guide catheter;

an infusion guide wire coaxial with the guide catheter substantially throughout a length of the guide catheter; and

a leading guide wire for entering the heart transvenously in combination with the infusion guide wire, the leading guide wire being coaxial with the infusion guide wire and having a diameter sufficiently small for passing through a lumen of the infusion guide wire, the leading guide wire having a sufficient length for passing through and protruding from a distal end of the infusion guide wire, the leading guide wire having a distal end for penetrating a wall of a right atrium of the heart; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire, wherein the infusion guide wire and the leading guide wire both have sufficient flexibility for simultaneously passing transvenously through the guide catheter into the right atrium.

2. The kit of claim 1, wherein the infusion guide wire has a diameter sufficiently small for passing through a lumen of the guide catheter, the infusion guide wire having a sufficient length for passing through the guide catheter into the right atrium via a transvenous route.

3. The kit of claim 1, wherein the guide catheter has sufficient length and flexibility for transvenous insertion into the right atrium.

4. The kit of claim 1, wherein the infusion guide wire has sufficient flexibility for conforming at least partially to a contour of the heart when the infusion guide wire is extended outward from a distal end of the guide catheter and into the pericardial space.

5. The kit of claim 4, wherein the infusion guide wire functions as an aspiration catheter having a lumen of sufficient diameter for passing the infusion guide wire over the leading guide wire and into the pericardial space for removal of fluid from the pericardial space for treating cardiac tamponade.

6. The kit of claim 1, wherein the leading guide wire has sufficient flexibility for conforming at least partially to a contour of the heart when the leading guide wire is extended outward from a distal end of the guide catheter and into the pericardial space.

7. The kit of claim 6, wherein the infusion guide wire functions as an aspiration catheter having a lumen of sufficient diameter for passing the infusion guide wire transvenously over the leading guide wire and into the pericardial space for removal of fluid from the pericardial space for treating cardiac tamponade.

8. The kit of claim 1, wherein the leading guide wire has a diameter between 0.010 inches and 0.018 inches.

9. The kit of claim 1, wherein the leading guide wire has a diameter of about 0.014 inches.

10. The kit of claim 1, wherein the infusion guide wire further comprises a radiopaque marker on its distal end.

11. The kit of claim 1, wherein the guide catheter further comprises a radiopaque marker on its distal end.

12. The kit of claim 1, wherein the leading guide wire further comprises a radiopaque marker on its distal end.

13. The kit of claim 1, wherein the leading guide wire is steerable to any location within the pericardium.

14. The kit of claim 1, wherein the kit is adapted to perform a surgical procedure on the heart.

15. The kit of claim 1, wherein the kit is adapted for placing an implantable device into the pericardium.

16. The kit of claim 1, wherein the locking device fixes the leading guide wire so as to protrude approximately 2 mm from the infusion guide wire.

17. The kit of claim 1, wherein the infusion guide wire and the leading guide wire jointly have sufficient pushability for penetrating into the pericardial space through the wall of the right atrium without kinking.

18. The kit of claim 1, wherein the infusion guide wire has a lumen of sufficient diameter for passing a fiberoptic imaging probe into the pericardium.

19. The kit of claim 1, wherein the guide catheter further comprises a blood pressure monitor.

20. The kit of claim 1, wherein the guide catheter further comprises an ECG monitor.

21. The kit of claim 1, wherein the infusion guide wire further comprises at least one electrode.

22. The kit of claim 1, wherein the leading guide wire further comprises at least one electrode.

23. A kit for transvenously accessing a pericardial space between a heart and its pericardium to perform a medical procedure on the heart, the kit comprising:

a guide catheter for transvenous insertion into a right atrium of the heart;

an infusion guide wire within the guide catheter for transvenous insertion into the right atrium and having sufficient stiffness for transvenously traversing a patient'"'"'s anatomy;

a hollow leading guide wire for passing through a lumen of the infusion guide wire and for extending through the infusion guide wire; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire,

wherein the leading guide wire has sufficient length for passing through and protruding from a distal end of the infusion guide wire, and has a distal end for penetrating a wall of the right atrium, the leading guide wire being sufficiently flexible for passing through the guide catheter and into the right atrium via a transvenous route.

24. The kit of claim 23, wherein the leading guide wire has sufficient flexibility for conforming at least partially to a contour of the heart when the leading guide wire is extended outward from a distal end of the guide catheter and into the pericardial space.

25. A dual guide wire for transvenously accessing a pericardial space between a heart and its pericardium to perform a medical procedure on the heart comprising:

an infusion guide wire;

a leading guide wire for insertion through the infusion guide wire and having a diameter sufficiently small for passing through a lumen of the infusion guide wire, the leading guide wire having a sufficient length for passing through and protruding from a distal end of the infusion guide wire, the leading guide wire having a distal end for penetrating a wall of a right atrium of the heart; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire,

wherein the dual guide wire is sufficiently flexible for transvenously passing into the right atrium, and wherein the dual guide wire is sufficiently pushable for penetrating into the pericardial space through a wall of the right atrium without kinking.

26. The dual guide wire of claim 25, wherein the dual guide wire has sufficient pushability for penetrating into the pericardial space through the wall of the right atrium without kinking while being aligned tangential to the wall.

27. The dual guide wire of claim 25, wherein the infusion guide wire further comprises a radiopaque marker on its distal end.

28. The dual guide wire of claim 25, wherein the guide catheter further comprises a radiopaque marker on its distal end.

29. The dual guide wire of claim 25, wherein the leading guide wire further comprises a radiopaque marker on its distal end.

30. The dual guide wire of claim 25, wherein the locking device fixes the leading guide wire so as to protrude approximately 2 mm from the infusion guide wire.

31. The dual guide wire of claim 25, wherein the infusion guide wire has a lumen of sufficient diameter for passing a fiberoptic imaging probe into the pericardium.

32. The dual guide wire of claim 25, wherein the infusion guide wire has a lumen of sufficient diameter for aspiration of fluid from the pericardial space to treat cardiac tamponade.

33. The dual guide wire of claim 25, wherein the infusion guide wire is coaxial with a guide catheter upon insertion of the guide catheter into the right atrium.

34. The dual guide wire of claim 25, wherein the dual guide wire further comprises a radiopaque marker on its distal end.

35. The dual guide wire of claim 25, wherein the locking device fixes the leading guide wire so as to protrude approximately 2 mm from the infusion guide wire.

36. A dual guide wire for transvenously accessing a pericardial space between a heart and its pericardium for performing a surgical procedure on the heart comprising:

an infusion guide wire;

a leading guide wire for transvenous insertion into a right atrium of the heart through the infusion guide wire and for performing a surgical procedure on the heart, the leading guide wire having a distal end for penetrating a wall of the right atrium, wherein the infusion guide wire and the leading guide wire jointly have sufficient pushability for penetrating the wall of the right atrium into the pericardial space without kinking; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire.

37. The kit of claim 36, wherein the infusion guide wire and the leading guide wire jointly have sufficient pushability for penetrating into the pericardial space through a wall of the right atrium without kinking while being aligned tangential to the wall.

38. A dual guide wire for transvenously accessing a pericardial space between a heart and its pericardium comprising:

an infusion guide wire for transvenous insertion into the heart;

a leading guide wire for insertion into the heart through the infusion guide wire; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire,

wherein the dual guide wire has sufficient pushability for penetrating into the pericardial space through a wall of a right atrium of the heart without kinking, and has sufficient steerability for steering to any location within the pericardium.

39. A dual guide wire for transvenously accessing a pericardial space between a heart and its pericardium for aspiration of fluid from the pericardial space to treat cardiac tamponade comprising:

an infusion guide wire for aspiration of fluid from the pericardial space to treat cardiac tamponade;

a leading guide wire for transvenous insertion into the heart through the infusion guide wire and having a distal end for penetrating a wall of a right atrium of the heart; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire,

wherein the dual guide wire has sufficient pushability for penetrating the wall of the right atrium into the pericardial space without kinking.

40. A dual guide wire for transvenously accessing a pericardial space between a heart and its pericardium to implant a surgical device within the heart comprising:

an infusion guide wire for transvenous insertion into the heart; and

a leading guide wire for insertion into the heart through the infusion guide wire and having a distal end for penetrating a wall of a right atrium of the heart, wherein the infusion guide wire and the leading guide wire jointly have sufficient pushability for penetrating the wall of the right atrium into the pericardial space without kinking; and

a locking device to fix a position of the leading guide wire relative to the infusion guide wire,

wherein the dual guide wire is adapted for implantation of a surgical device within the heart.

41. The dual guide wire of claim 40, wherein the dual guide wire is adapted for implantation of the surgical device within a coronary artery of the heart.