Method for treatment of ischemic heart disease by providing transvenous myocardial perfusion

• US 5,655,548 A
• Filed: 09/16/1996
• Issued: 08/12/1997
• Est. Priority Date: 09/16/1996
• Status: Expired due to Term

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: Circulation, Inc. (ModivCare, Inc.)
• Inventors: Shmulewitz, Ascher, Nelson, James A.
• Primary Examiner(s): Millin, V.
• Assistant Examiner(s): O'Hara, K.
• Application Number:
  US08/714,466
• Time in Patent Office: 330 Days
• Field of Search: 128/898, 604/96, 604/49, 606/194, 623/3
• US Class Current: 128/898
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take 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 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/2493 Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/94 Stents retaining their form, i.e. not being deformable, after placement in the predetermined place
• CPC Class Codes: A61F 2220/0016 with sharp anchoring protrusions, e.g. barbs, pins, spikes
• CPC Class Codes: A61M 25/0021 characterised by the form of the tubing A61M25/0054 takes precedence
• CPC Class Codes: A61M 25/0075 Valve means

Abstract

Methods are provided for use in open surgical and transluminal methods for supplying long-term retrograde perfusion of the myocardium via a conduit disposed between the left ventricle and the coronary sinus. In a first method, an opening is formed between the left ventricle and the coronary sinus, and the coronary ostium is partially occluded using a stent that prevents the pressure in the coronary sinus from exceeding a predetermined value. In an alternative method, a first end of a conduit is inserted transeptally through the right atrium and obliquely into the posterior septal endocardium of the left ventricle via the posterior pyramidal space, while a second end of the conduit is inserted into the coronary sinus via the coronary ostium. A pressure-limiting valve is included in the conduit. In either method, the outlet from the left ventricle to the coronary sinus may include a one-way valve to prevent backflow from the coronary sinus into the left ventricle during cardiac diastole.

Claims

1. A method of treating ischemic heart disease by providing long-term retrograde transvenous myocardial perfusion, the method comprising steps of:

creating a conduit between a patient'"'"'s left ventricle and coronary sinus, so that blood flows through the conduit from the left ventricle to the coronary sinus during cardiac systole;

partially occluding the patient'"'"'s coronary ostium; and

limiting a peak pressure attained within the coronary sinus by venting blood received from the left ventricle into the patient'"'"'s right atrium when the pressure attained within the coronary sinus exceeds a predetermined value.

2. The method as defined in claim 1 wherein the step of creating the conduit comprises steps of:

inserting a cutting instrument into the coronary sinus via the coronary ostium; and

actuating the cutting instrument to bore through a wall of the coronary sinus, through the patient'"'"'s epicardium, myocardium and endocardium to create a passageway between the left ventricle and the coronary sinus.

3. The method as defined in claim 2 wherein the step of creating the conduit further comprises steps of:

transluminally inserting a catheter carrying a stent into the coronary sinus via the coronary ostium; and

deploying the stent in the passageway.

4. The method as defined in claim 3 further comprising a step of providing a stent having a one-way valve that prevents backflow of blood from the coronary sinus to the left ventricle.

5. The method as defined in claim 1 wherein the step of limiting a peak pressure comprises steps of:

providing a plug having a pressure sensitive valve, the pressure sensitive valve opening when the pressure exceeds the predetermined value;

transluminally inserting a catheter carrying the plug into the coronary ostium; and

deploying the plug in the coronary ostium.

6. The method as defined in claim 1 wherein the step of creating the conduit comprises steps of:

providing a device having a first end, a second end, and a lumen extending therebetween;

inserting a cutting instrument into the right atrium;

actuating the cutting instrument to create a passageway through the right atrial endocardium and into the left ventricular septal endocardium, the passageway extending through the posterior pyramidal space;

implanting the first end of the device in the passageway; and

implanting the second end of the device into the coronary ostium.

7. The method as defined in claim 6 wherein the step of creating the conduit further comprises steps of:

inserting the device into a catheter;

transluminally inserting the catheter into the right atrium; and

deploying the first end of the device in the passageway.

8. The method as defined in claim 7 wherein the step of creating the conduit further comprises steps of:

transluminally inserting a second catheter into the right atrium;

capturing the second end of the device with the second catheter; and

implanting the second end of the device in the coronary ostium.

9. The method as defined in claim 6 wherein the step of providing a device further comprises providing a device having a one-way valve that prevents backflow of blood from the coronary sinus to the left ventricle.

10. The method as defined in claim 6 wherein the step of limiting a peak pressure comprises a step of:

during the step of providing a device, providing a pressure sensitive valve that opens into the right atrium when the pressure exceeds the predetermined value.