Apparatus and method for targeting a body tissue

• US 8,019,404 B2
• Filed: 10/05/2007
• Issued: 09/13/2011
• Est. Priority Date: 10/06/2006
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Kapadia, Samir
• Primary Examiner(s): Casler; Brian
• Assistant Examiner(s): LAMPRECHT, JOEL
• Application Number:
  US11/867,774
• Publication Number:
  US 20080249397A1
• Time in Patent Office: 1,439 Days
• Field of Search: 600/407, 600/410, 600/437, 600/443, 600/424, 600/439, 600433-435
• US Class Current: 600/433
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/00243 cardiac
• 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 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2017/3484 Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2090/3929 Active markers
• CPC Class Codes: A61B 2090/3958 emitting a signal
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61N 1/06 for high-frequency therapy

Abstract

An apparatus for targeting a desired target site on a body tissue that separates a first body cavity from a second body cavity of a patient includes a catheter having a longitudinally extending catheter lumen and adapted to provide access to the first body cavity. A framing member has a collapsed condition in which the framing member is adapted for insertion into the first body cavity through the catheter lumen and an expanded condition in which the framing member is adapted for placement within the first body cavity. The framing member has a framing member body. At least one target point is carried by the framing member and is adapted for placement adjacent the desired target site. At least one target wire is attached to at least one target point. At least a portion of the target wire extends through the catheter lumen. The target wire is substantially spaced apart from the framing member body. A method of using the apparatus is also described.

Claims

1. An apparatus for targeting a desired target site on a body tissue that separates a first body cavity from a second body cavity of a patient, the apparatus comprising:

a catheter having a longitudinally extending catheter lumen and adapted to provide access to the first body cavity;

a framing member having a collapsed condition in which the framing member is adapted for insertion into the first body cavity through the catheter lumen and an expanded condition in which the framing member is adapted for placement within the first body cavity, the framing member having a framing member body;

at least one target point carried by the framing member and adapted for placement adjacent the desired target site; and

at least one target wire attached to at least one target point, at least a portion of the target wire extending through the catheter lumen, and the target wire being substantially spaced apart from the framing member body.

2. The apparatus of claim 1, wherein a plurality of target points are arranged in a target grid carried by the framing member.

3. The apparatus of claim 1, wherein the target wire extends between an external power source and the target point and selectively provides at least one of an electrical and a mechanical signal to the target point to indicate a position of the target point relative to the body tissue in cooperation with an external imaging system.

4. The apparatus of claim 1, wherein the framing member includes at least one framing strand and the first body cavity has an interior first body cavity surface including a portion of the body tissue, the framing strand being adapted to exert positive pressure at a plurality of locations on the interior first body cavity surface to maintain a position of the at least one target point adjacent the body tissue.

5. The apparatus of claim 1, including a puncture needle adapted for insertion through the catheter lumen and into the first body cavity, the puncture needle having a first needle end operative to puncture the body tissue at the target site.

6. The apparatus of claim 1, including a puncture needle connectable to the target wire and adapted for insertion through the catheter lumen and into the first body cavity, the puncture needle having a first needle end operative to puncture the body tissue responsive to guidance by the target wire.

7. The apparatus of claim 1, wherein at least one target point has an associated radiopaque marker to indicate a position of the target point relative to the body tissue in cooperation with an external imaging system.

8. The apparatus of claim 1, wherein each of the first and second body cavities is at least one of a left atrium, a right atrium, a peritoneal cavity, a chest cavity, a left atrial appendage, a right atrial appendage, a left pulmonary vein, a blood vessel, a common iliac artery, a subintimal space, a portion of the heart, a gastrointestinal organ, a genitourinary organ, and a space external to the patient'"'"'s body.

9. The apparatus of claim 1, wherein the body tissue is at least one of an interatrial septum, a left atrial appendage wall, a right atrial appendage wall, a left pulmonary vein wall, a chest wall, an abdominal wall, a heart wall, a blood vessel wall, a common iliac artery wall, a gastrointestinal organ wall, a genitourinary organ wall, and a skin of the patient.

10. The apparatus of claim 1, wherein the target site is a void in the body tissue.

24. The apparatus of claim 1, wherein the target wire and framing member are not coaxial with one another.

26. The apparatus of claim 1, wherein the at least one target point to which at least one target wire is attached is calibrated to have an offset relationship with the desired target site such that a puncture needle connected to, and offset from, the target wire is guided to the desired target site by the target wire.

11. A method for puncturing a body tissue of a patient at a desired target site, the method comprising the steps of:

inserting a catheter having a longitudinally extending catheter lumen into the patient;

advancing the catheter into a first body cavity of the patient;

providing a framing member having a framing member body and carrying at least one target point, the target point adapted for placement adjacent the body tissue to indicate the desired target site;

providing at least one target wire attached to at least one target point, at least a portion of the target wire extending through the catheter lumen, and the target wire being substantially spaced apart from the framing member body;

inserting the framing member in a collapsed condition into the first body cavity through the catheter lumen;

expanding the framing member into an expanded condition within the first body cavity;

positioning the target point adjacent the desired target site;

inserting a puncture needle into the first body cavity through the catheter lumen;

connecting the puncture needle to the target wire;

guiding the puncture needle to the target point with the target wire; and

puncturing the body tissue with the puncture needle at the desired target site.

12. The method of claim 11, including the step of adjusting the position of the target point to position the target point adjacent the desired target site.

13. The method of claim 11, including the step of viewing the position of the at least one target point within the first body cavity using an external imaging system.

14. The method of claim 11, wherein the framing member carries a plurality of target points forming a target grid, the method including the steps of:

positioning the target grid adjacent the body tissue;

viewing the position of the target grid within the first body cavity using an external imaging system;

selecting a target point from the target grid, the selected target point being in a predetermined relationship with the desired target site; and

guiding the puncture needle to the selected target point.

15. The method of claim 11, wherein the first body cavity includes an internal first body cavity surface including a portion of the body tissue, and the step of positioning the target point adjacent the body tissue includes the steps of:

contacting a plurality of locations on the internal first body cavity surface with the framing member;

exerting positive pressure at the plurality of locations on the internal first body cavity surface with the framing member; and

maintaining a position of the target point adjacent the body tissue.

16. The method of claim 11, wherein the framing member is an elongated framing member having longitudinally spaced first and second framing member ends separated by the framing member body, the target point is affixed to the framing member body, the catheter has a catheter outlet end in fluid communication with the first body cavity, and the step of expanding the framing member into a second expanded condition within the first body cavity includes the steps of:

anchoring the first framing member end adjacent the catheter outlet end;

advancing the second framing member end toward the first body cavity; and

bowing the framing member body out into the first body cavity.

17. The method of claim 11, wherein the step of guiding the puncture needle to the target point with the target wire includes the steps of:

calibrating the target point to have an offset relationship with the desired target site to compensate for an offset distance between the target point and the puncture needle;

connecting the puncture needle to the target wire; and

guiding the puncture needle along the target wire to the target point.

18. The method of claim 13, wherein the step of viewing the position of the target point within the first body cavity using an external imaging system includes the steps of:

selectively providing at least one of an electrical and a mechanical signal through the target wire to the target point;

providing a visual signal with the target point; and

viewing the visual signal using the external imaging system.

19. The method of claim 18, wherein the framing member carries a plurality of target points making up a target grid, each target point has a target wire, and the step of viewing the position of the target point within the first body cavity using an external imaging system includes the steps of:

selectively providing at least one of an electrical and a mechanical signal through a selected target wire to a selected target point;

providing a visual signal with the selected target point; and

viewing the visual signal using the external imaging system.

20. The method of claim 11, wherein at least one target point has an associated radiopaque marker to indicate a position of the target point relative to the body tissue in cooperation with an external imaging system.

21. The method of claim 11, wherein each of the first and second body cavities is at least one of a left atrium, a right atrium, a peritoneal cavity, a chest cavity, a left atrial appendage, a right atrial appendage, a left pulmonary vein, a blood vessel, a common iliac artery, a subintimal space, a portion of the heart, a gastrointestinal organ, a genitourinary organ, and a space external to the patient'"'"'s body.

22. The method of claim 11, wherein the body tissue is at least one of an interatrial septum, a left atrial appendage wall, a right atrial appendage wall, a left pulmonary vein wall, a chest wall, an abdominal wall, a heart wall, a blood vessel wall, a common iliac artery wall, a gastrointestinal organ wall, a genitourinary organ wall, and a skin of the patient.

23. The method of claim 11, wherein the target site is a void in the body tissue.

25. The method of claim 11, wherein none of the puncture needle, the target wire, and the framing member are coaxial with one another.