Apparatus and methods for coronary sinus access

• US 20060084839A1
• Filed: 11/08/2005
• Published: 04/20/2006
• Est. Priority Date: 05/30/2002
• Status: Active Grant

• Current Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford University)
• Original Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford University)
• Inventors: Mourlas, Nicholas J., Miller, David John, Leeflang, Stephen Arie, Nayak, Asha Shrinivas, Eversull, Christian Scott
• Granted Patent: US 8,016,748 B2
• Time in Patent Office: Days
• US Class Current: 600/116
• CPC Class Codes: A61B 1/00082 Balloons
• CPC Class Codes: A61B 1/00096 Optical elements
• CPC Class Codes: A61B 1/005 Flexible endoscopes
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/05 characterised by the image sensor, e.g. camera, being in the distal end portion
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61M 25/0147 with movable mechanical means, e.g. pull wires

Abstract

Apparatus and methods for locating morphological features within a body cavity using a catheter including proximal and distal ends, a transparent balloon carried on the distal end, and an optical imaging assembly carried on the distal end for imaging through the balloon. The balloon includes a channel extending therethrough to a lumen extending through the catheter. A guidewire or other localization member is received in the lumen that is extendable through the channel. During use, the catheter is inserted into a right atrium of a heart, and the balloon is expanded and placed against the wall of the heart to locate the coronary sinus. Sufficient force is applied to clear blood between the surface and the wall and clear the field of view of the imaging assembly. The catheter is manipulated to locate the coronary sinus, whereupon the localization member is advanced into the coronary sinus.

Claims

1. A method for accessing a body lumen, comprising:

inserting a distal end of a tubular member into a first body lumen, the tubular member comprising a substantially transparent expandable member thereon in a contracted condition;

expanding the expandable member within the first body lumen;

placing a surface of the expanded expandable member in contact with a wall of the first ( body lumen in order to image the wall through the expandable member;

manipulating the tubular member to move the expandable member along the wall, while imaging the wall through the expandable member, until a second body lumen is identified; and

advancing an instrument from the tubular member into the second body lumen.

2. The method of claim 1, wherein the first body lumen comprises a right atrium of a patient'"'"'s heart, and wherein the second body lumen comprises a coronary sinus ostium.

3. The method of claim 1, wherein the instrument is advanced into the second body lumen to stabilize the distal end of the tubular member.

4. The method of claim 1, wherein the instrument comprises at least one of a lead, a guide wire, a cannula, and a catheter.

5. The method of claim 1, wherein the instrument is advanced into the second body lumen through a channel extending through the expandable member that communicates with the second body lumen.

6. The method of claim 5, wherein the channel is disposed concentrically with a central axis of the tubular member, and wherein the tubular member is manipulated to align the channel with the second body lumen.

7. The method of claim 5, wherein the channel is parallel with a central axis of the tubular member, and wherein the tubular member is manipulated to align the channel with the second body lumen.

8. The method of claim 1, wherein the surface of the expanded expandable member is placed in contact with the wall of the first body lumen with sufficient force to at least partially clear fluid from between the surface and the wall to enhance imaging the wall.

9. The method of claim 1, further comprising delivering a fluid between the surface and the wall to at least partially clear bodily fluid from between the surface and the wall to enhance imaging the wall.

10. The method of claim 1, further comprising expanding an occlusion member on the tubular member to substantially seal the second body lumen from the first body lumen.

11. The method of claim 10, further comprising infusing fluid into the second body lumen.

12. The method of claim 11, wherein the fluid comprises contrast, the method further comprising obtaining a venogram of a location distal to the occlusion member.

13. The method of claim 11, wherein the fluid comprises a therapeutic agent.

14. The method of claim 10, further comprising aspirating fluid from the second body lumen.

15. A method for imaging a wall of a body cavity of a patient, comprising:

inserting a distal end of a tubular member into the body cavity, the tubular member comprising a substantially transparent expandable member thereon in a contracted condition;

expanding the expandable member within the body cavity;

placing a surface of the expanded expandable member in contact with a wall of the body cavity in order to image the wall through the expandable member;

applying sufficient force to at least partially clear fluid from between the surface and the wall to enhance imaging the wall; and

manipulating the tubular member to move the expandable member along the wall, while imaging the wall through the expandable member.

16. The method of claim 15, wherein the tubular member is manipulated by steering the distal end of the tubular member from a proximal end of the tubular member.

17. The method of claim 15, wherein the tubular member is manipulated to move the expandable member along the wall, while imaging the wall through the expandable member, until a desired body structure is identified.

18. The method of claim 17, wherein an instrument is advanced to the desired body structure through the tubular member, the instrument comprising at least one of a lead, a guide wire, a cannula, and a catheter.

19. The method of claim 17, wherein the desired body structure comprises a body lumen communicating with the body cavity, the method further comprising advancing an instrument from the tubular member into the body lumen.

20. The method of claim 19, wherein the tubular member is manipulated to position the body lumen in a field of view through the expandable member, thereby substantially aligning a channel through the expandable member with the body lumen.

21. The method of claim 20, wherein the instrument is advanced through the channel into the body lumen after the channel is substantially aligned with the body lumen.

22. The method of claim 19, wherein the body cavity comprises a right atrium of a patient'"'"'s heart, and wherein the body lumen comprises a coronary sinus ostium.

23. The method of claim 15, further comprising delivering a fluid between the surface and the wall to at least partially clear bodily fluid from between the surface and the wall to enhance imaging the wall.

24. A method for locating a coronary sinus communicating with a right atrium of a heart, comprising:

inserting a distal end of a tubular member into the right atrium; and

manipulating the distal end of the tubular member, while sensing oxygen content of blood within the right atrium to locate the coronary sinus.

25. The method of claim 24, further comprising advancing an instrument from the tubular member into the coronary sinus once the coronary sinus is located.

26. The method of claim 25, further comprising positioning the distal end of the tubular member adjacent the coronary sinus before advancing the instrument into the coronary sinus.

27. The method of claim 25, further comprising advancing the distal end of the tubular member into the coronary sinus.

28. The method of claim 24, further comprising deploying an array of oxygen sensors from the distal end of the tubular member.

29. A method for imaging a wall of a body cavity of a patient, comprising:

inserting a distal end of a tubular member into the body cavity, the tubular member comprising a substantially transparent expandable member thereon in a contracted condition;

expanding the expandable member within the body cavity;

placing a surface of the expanded expandable member in contact with a wall of the body cavity in order to image the wall through the expandable member;

substantially stabilizing the distal end of the tubular member relative to the wall of the body cavity; and

manipulating the tubular member to move the expandable member along the wall, while imaging the wall through the expandable member.

30. The method of claim 29, wherein the distal end of the tubular member is stabilized by applying a distal force to the tubular member to press the expandable member against the wall to stabilize the distal end of the tubular member.

31. The method of claim 30, wherein pressing the expandable member results in deformation of the expandable member, thereby substantially stabilizing the distal end of tubular member.

32. The method of claim 30, further comprising imaging one or more tissue structures through the expandable member while the distal end of the tubular member is stabilized.

33. The method of claim 30, wherein a portion of the expandable member is directed into a body lumen communicating with the body cavity when the distal force is applied to stabilize the distal end of the tubular member.

34. The method of claim 29, wherein the distal end of the tubular member is stabilized by advancing an elongate member from the tubular member.

35. The method of claim 34, wherein the elongate member is advanced from the tubular member into a body lumen communicating with the body cavity to stabilize the distal end of the tubular member.

36. The method of claim 34, wherein the elongate member is advanced from the tubular member to engage a morphological feature to stabilize the distal end of the tubular member.

37. The method of claim 36, wherein the body cavity comprises a right atrium of a heart, and wherein the elongate member is engaged with a trebaculae came on a wall of the heart to stabilize the distal end of the tubular member.

38. The method of claim 36, wherein the body cavity comprises a right atrium, and wherein the elongate member is used to straddle an eustation ridge on a wall of the right atrium to stabilize the distal end of the tubular member.

39. The method of claim 29, wherein the tubular member is manipulated while imaging the wall until a body lumen is located, the method further comprising advancing an instrument from the tubular member into the body lumen.

40. The method of claim 39, wherein the body cavity comprises a right atrium of a patient'"'"'s heart, and wherein the body lumen comprises a coronary sinus ostium.

41. A method for accessing a body lumen, comprising:

inserting a distal end of a tubular member into a first body lumen, the tubular member comprising a substantially transparent expandable member thereon in a contracted condition;

expanding the expandable member within the first body lumen;

placing a surface of the expanded expandable member in contact with a wall of the first body lumen in order to image the wall through the expandable member;

manipulating the tubular member to move the expandable member along the wall, while imaging the wall through the expandable member, until a second body lumen is identified; and

advancing the distal end of the tubular member into the second body lumen with the expandable member at least partially expanded.

42. The method of claim 41, wherein the size of the expandable member is adjusted to accommodate the second body lumen.

43. The method of claim 41, wherein the expandable member is partially deflated before advancing the distal end of the tubular member into the second body lumen.