U.S. patent application number 11/159705 was filed with the patent office on 2007-01-11 for method and system for accessing a pericardial space.
This patent application is currently assigned to Cardiac Pacemakers, Inc.. Invention is credited to Peter L. Callas, John S. Greenland, Gary L. Hague, Peter T. Kelley, Ted Schulte, Jason A. Shiroff, Bruce A. Tockman, David B. Yingling.
Application Number | 20070010793 11/159705 |
Document ID | / |
Family ID | 37619173 |
Filed Date | 2007-01-11 |
United States Patent
Application |
20070010793 |
Kind Code |
A1 |
Callas; Peter L. ; et
al. |
January 11, 2007 |
Method and system for accessing a pericardial space
Abstract
A device and method for accessing a pericardial space of the
heart includes a shaft having a cavity at a distal end, a suction
lumen terminating in a distal port within the cavity and a hollow
needle having a distal tip extending into the cavity. The cavity
may be a recess in the shaft into which the distal tip of the
needle fixedly protrudes. In other embodiments, the cavity is
formed by an inflatable member positioned at the distal end of the
shaft and the needle is slidable relative to the shaft. Suction is
applied at the cavity to draw a pericardial bleb. The needle
pierces the pericardial bleb for accessing the pericardial space
and also facilitates delivery of payloads into the pericardial
space.
Inventors: |
Callas; Peter L.; (Castro
Valley, CA) ; Hague; Gary L.; (Carlsbad, CA) ;
Greenland; John S.; (San Diego, CA) ; Tockman; Bruce
A.; (Scandia, MN) ; Kelley; Peter T.;
(Buffalo, MN) ; Shiroff; Jason A.; (Shoreview,
MN) ; Yingling; David B.; (Stillwater, MN) ;
Schulte; Ted; (Austin, TX) |
Correspondence
Address: |
FAEGRE & BENSON, LLP;BOSTON SCIENTIFIC PATENT DOCK
2200 WELLS FARGO CENTER
90 SOUTH SEVENTH STREET
MINNEAPOLIS
MN
55402-3901
US
|
Assignee: |
Cardiac Pacemakers, Inc.
St. Paul
MN
|
Family ID: |
37619173 |
Appl. No.: |
11/159705 |
Filed: |
June 23, 2005 |
Current U.S.
Class: |
604/500 ;
604/164.01 |
Current CPC
Class: |
A61B 2017/306 20130101;
A61B 17/3478 20130101; A61M 25/0084 20130101 |
Class at
Publication: |
604/500 ;
604/164.01 |
International
Class: |
A61M 31/00 20060101
A61M031/00 |
Claims
1. A device for accessing a pericardial space of a heart, the
device comprising: a shaft extending from a proximal end to a
distal end, the shaft defining a cavity disposed near the distal
end, and a suction lumen terminating in at least one distal suction
port located within the cavity; and a hollow needle extending
through the shaft and fixed in position relative to a longitudinal
axis of the shaft, the needle having a sharp distal end protruding
into the cavity downwardly toward a heart surface at an angle with
respect to a longitudinal axis of the shaft.
2. The device of claim 1 further comprising a guidewire adapted for
advancing through a bore of the needle.
3. The device of claim 1 wherein the suction lumen terminates in a
plurality of distal suction ports.
4. The device of claim 1 wherein the needle extends a distance of
from about 0.5 to about 3 mm into the cavity.
5. The device of claim 1 wherein the angle is between about 15 and
about 60 degrees.
6. The device of claim 1 wherein the angle is about 90 degrees.
7. The device of claim 1 wherein the cavity has a generally concave
configuration with respect to the heart surface.
8. The device of claim 1 further comprising a flange structure
formed on an inner wall of the shaft adapted to prevent
longitudinal movement of the needle relative to the shaft and
permit rotational movement of the needle relative to the shaft.
9. A device for accessing a pericardial space of a heart, the
device comprising: a shaft extending from a proximal end to a
distal end, the having a suction lumen terminating in at least one
distal suction port near the distal end and an inflation lumen; an
inflatable member positioned near a distal end of the shaft, the
inflatable member having a collapsed configuration and an inflated
configuration defining a cavity, the inflatable member in
communication with the inflation lumen; and a hollow needle adapted
for advancement through the shaft into the cavity.
10. The device of claim 9 further comprising a secondary lumen
terminating in an access port located within the cavity.
11. The device of claim 10 wherein the needle is adapted for
advancement through the secondary lumen.
12. The device of claim 9 wherein the inflatable member is ring or
toroidal-shaped.
13. The device of claim 9 wherein the inflatable member is
inflatable to at least a first intermediate configuration.
14. The device of claim 9 wherein the suction lumen terminates in a
plurality of suction ports.
15. The device of claim 9 wherein the shaft further defines a
recess adapted to hold the inflatable member while in the collapsed
configuration.
16. A method of accessing the pericardial space, the method
comprising: maneuvering a distal end of a shaft to the pericardial
surface; inflating an inflatable member disposed at the distal end
of the shaft to an inflated configuration defining a cavity
adjacent the pericardial surface; applying suction within the
cavity to draw the pericardium into the cavity and create an
enlarged region; piercing the pericardium within the cavity to
access the pericardial space; and inserting a payload through the
pierced pericardium and into the pericardial space.
17. The method of claim 16 wherein piercing the pericardium further
includes advancing a hollow needle having a sharp distal end
through the shaft to the cavity.
18. The method of claim 16 wherein inserting the payload further
includes advancing a guidewire through the needle and into the
enlarged region.
19. The method of claim 16 further comprising removing the suction
to release the pericardium from the cavity.
20. The method of claim 16 wherein inflating the inflatable member
further includes inflating the inflatable member to an intermediate
configuration.
Description
TECHNICAL FIELD
[0001] The present invention relates to medical devices and methods
for accessing an anatomical space of the body. More specifically,
the invention relates to devices and methods for accessing the
pericardial space of the heart in a minimally-invasive manner.
BACKGROUND
[0002] The human heart is enveloped within a tissue structure
referred to as the pericardium, which comprises two major parts.
The inner layer of the pericardium lies immediately over the
myocardium (heart muscle) and is referred to as the visceral
pericardium or epicardium. The outer layer, forming a sac around
the visceral pericardium, is referred to as the parietal
pericardium. Normally these two layers lie in close contact with
each other and are separated only by a thin layer of pericardial
fluid, which allows the heart to move within the parietal sac with
minimal friction. The potential space between the visceral and
parietal pericardia is referred to as the pericardial space. The
visceral pericardium is commonly referred to as the epicardium and
the parietal pericardium is commonly referred to as the
pericardium. This naming convention will be used herein.
[0003] Access to the pericardial space is necessary for a variety
of medical procedures, including treatment of infections, injuries,
and heart defects. For example, cardiac rhythm management systems
such as pacemakers, implantable pulse generators, and implantable
cardioverter defibrillators include electrode bearing leads for
sensing and stimulating the heart. These leads can be deployed from
inside or outside the heart. In the latter case, the pericardial
space is typically traversed to reach the epicardium for lead
implantation and attachment.
[0004] Part of the challenge in accessing the pericardial space
stems from its minimal thickness. When making an incision or
perforation in the pericardium, it is preferable to avoid also
puncturing the underlying epicardium and damaging the myocardium or
a coronary vessel. The close proximity of the epicardium to the
pericardium makes this difficult. Another important consideration
is the trend toward minimally-invasive surgical techniques, which
generally are associated with a host of advantages including lower
costs and fewer complications.
[0005] There is a need in the art for improved, efficacious methods
and devices for penetrating the pericardium and thereby accessing
the pericardial space, which minimize the risk of damaging other
heart tissues. There is a further need for such methods and devices
that are compatible with minimally-invasive surgical
techniques.
SUMMARY
[0006] According to one embodiment, the present invention is a
device for accessing a pericardial space of a heart. The device
includes a shaft that extends from a proximal end to a distal end
and defines a cavity disposed near the distal end. The shaft
further includes a suction lumen terminating in at least one distal
suction port located within the cavity. A hollow needle extends
through the shaft and is fixed in position relative to a
longitudinal axis of the shaft. The needle has a sharp distal end
protruding into the cavity toward a heart surface at an angle with
respect to a longitudinal axis of the shaft.
[0007] According to another embodiment, the present invention is a
device for accessing a pericardial space of a heart and includes a
shaft extending from a proximal end to a distal end, and having a
suction lumen terminating in at least one distal suction port near
the distal end and an inflation lumen. An inflatable member is
positioned near a distal end of the shaft and has a collapsed
configuration and an inflated configuration that defines a cavity.
The inflatable member is in communication with the inflation lumen.
Finally, the device includes a hollow needle adapted for
advancement through the shaft into the cavity.
[0008] According to still another embodiment, the present invention
is a method of accessing the pericardial space in which a distal
end of a shaft is maneuvered to the pericardial surface. An
inflatable member disposed at the distal end of the shaft is
inflated to an inflated configuration defining a cavity adjacent
the pericardial surface. Suction is applied within the cavity to
draw the pericardium into the cavity and create an enlarged region.
The pericardium within the cavity is pierced to access the
pericardial space and a payload is inserted through the pierced
pericardium and into the pericardial space.
[0009] While multiple embodiments are disclosed, still other
embodiments of the present invention will become apparent to those
skilled in the art from the following detailed description, which
shows and describes illustrative embodiments of the invention. As
will be realized, the invention is capable of modifications in
various obvious aspects, all without departing from the spirit and
scope of the present invention. Accordingly, the drawings and
detailed description are to be regarded as illustrative in nature
and not restrictive.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] FIG. 1 is a schematic view of a pericardial access system,
according to one embodiment of the invention, in relation to a
heart.
[0011] FIG. 2 is a side sectional view of a pericardial access
system, according to one embodiment of the invention, in relation
to the anatomic layers of the heart.
[0012] FIG. 3 is a flowchart detailing a method of accessing the
pericardial space using the pericardial access system of FIG.
2.
[0013] FIG. 4 is a side sectional view of the pericardial access
system of FIG. 2 in which negative pressure has been applied.
[0014] FIG. 5 is a side sectional view of the pericardial access
system of FIG. 2 in which the pericardium has been pierced.
[0015] FIG. 6 is a perspective view of the underside of a
pericardial access system in accordance with another embodiment of
the present invention.
[0016] FIG. 7 is a flowchart detailing a method of accessing the
pericardial space using the pericardial access system of FIG.
6.
[0017] FIG. 8 is a side sectional view of the pericardial access
system of FIG. 6 in relation to the anatomic layers of the heart in
which the inflatable member is deflated.
[0018] FIG. 9 is a side sectional view of the pericardial access
system of FIG. 8 in which the inflatable member is inflated.
[0019] FIG. 10 is a side sectional view of the pericardial access
system of FIG. 8 in which negative pressure has been applied.
[0020] FIG. 11 is a side sectional view of the pericardial access
system of FIG. 8 in which a needle has been advanced to pierce the
pericardium.
[0021] FIG. 12 is a side sectional view of the pericardial access
system of FIG. 8 in which a guidewire has been introduced into the
pericardial space.
[0022] FIG. 13 is a perspective view of a pericardial access system
in accordance with another embodiment of the present invention.
[0023] FIG. 14 is a side sectional view of the pericardial access
system of FIG. 13.
[0024] FIG. 15 is an end view of a shaft of the pericardial access
system of FIG. 13.
[0025] While the invention is amenable to various modifications and
alternative forms, specific embodiments have been shown by way of
example in the drawings and are described in detail below. The
intention, however, is not to limit the invention to the particular
embodiments described. On the contrary, the invention is intended
to cover all modifications, equivalents, and alternatives falling
within the scope of the invention as defined by the appended
claims.
DETAILED DESCRIPTION
[0026] FIG. 1 is a general schematic illustration of a pericardial
access device 10, in accordance with a first embodiment of the
present invention, in relation to a heart 20. As shown in greater
detail in the sectional side view of FIG. 2, the pericardial access
device 10 is positioned adjacent a pericardium 22 of the heart 20.
A pericardial space 24 lies opposite the pericardium 22 and is
bounded by an epicardium 26 on its far side. The epicardium 26
contacts a myocardium 28 on the side opposite the pericardial space
24. The pericardial access device 10 may be employed for accessing
the pericardial space 24 to facilitate a variety of procedures,
including those requiring a minimally invasive approach to the
heart 20. Such procedures include, for example, epicardial lead
placement, cellular myoplasty, transmyocardial revascularization,
epicardial ablation, closed chest coronary anastomosis,
epicardial/myocardial drug delivery, diagnoses and
pericardicentesis (draining pericardial fluid).
[0027] As shown in FIG. 2, the device 10 includes a shaft 12 and a
needle 14 fixed in relation to a longitudinal axis of the shaft 12
(i.e., the needle 14 is prevented from moving longitudinally within
the shaft 12). The shaft 12 extends from a proximal end (not shown)
to a distal end 16 provided with an atraumatic tip 17. The shaft 12
is sized so that the distal end 16 can be brought into proximity
with the pericardium 22 while the proximal end is accessible from
outside of the chest cavity. The shaft 12 includes a cavity or
recessed region 18 having a depth, d, disposed near the distal end
16, preferably somewhat proximal relative to the distal tip 17 of
the shaft 12. A suction lumen 30 extends from a proximal port (not
shown) near the proximal end of the shaft adapted for connecting to
a source of negative pressure to a suction port 32 disposed at the
recessed region 18 of the shaft 12. In other embodiments, the
cavity or region 18 includes a plurality of ports 32 distributed at
various locations to optimize the suction force applied to the
pericardium 22. In one embodiment, the cavity 18 is defined by a
substantially concave cavity wall. In other embodiments, the cavity
18 has other shapes and configurations.
[0028] The needle 14 is a hollow tubular structure defining an
inner bore 33 and having a sharp distal tip 36. The needle tip 36
protrudes into the recessed region 18 of the shaft 12 a fixed
distance and, in one embodiment, is angled downwardly, or towards
the pericardium 22. However, the needle 14 extends downwardly no
further than the depth, d, of the cavity 18, such that the needle
tip 36 is wholly located within the cavity 18. This prevents the
needle tip 36 from snagging on tissue as the pericardial access
device 10 is advanced to the heart 20. The needle 14 includes an
access port 34 in fluid communication with the needle bore 33. The
access port 34 is located near the needle tip 36 and is positioned
within the cavity 18 of the shaft 12. The needle bore 33 and access
port 34 are adapted for slidably receiving medical instruments, for
example, guidewires, and/or fluids or gases. In one embodiment, the
needle 14 extends from about 0.5 to about 3 mm into the cavity 18.
In one embodiment, the needle 14 extends downwardly toward the
heart at an angle of from about 15 to about 60 degrees with respect
to a longitudinal axis of the shaft 12.
[0029] As illustrated in FIG. 2, the suction lumen 30 encompasses
generally the entire interior of the shaft 12, and the needle 14 is
positioned within the suction lumen 30, as is shown in FIG. 2. In
other embodiments, the shaft 12 includes a secondary lumen separate
from the suction lumen 30 for receiving the needle 14 (see for
example FIG. 6), or the needle 13 is integrally formed within the
shaft 12.
[0030] FIG. 3 is a flowchart detailing a method 100 of accessing
the pericardial space 24 using the pericardial access system 10 of
FIG. 2 according to one embodiment of the present invention. The
shaft 12 is inserted into the chest by, for example, a sub-xiphoid
insertion route, and maneuvered to the pericardium 22 of the heart
20 so that the recessed region 18 is positioned adjacent the
pericardium 22 (block 102). Suction or negative pressure is applied
to the suction port 32 via the suction lumen 30, drawing the
pericardium 22 into the recessed region 18, as is shown in FIG. 4,
forming what is known as a pericardial bleb. This increases the
volume of the pericardial space 24 at the recessed region 18 (block
104). The negative pressure is sufficient to cause the pericardium
22 to engage the stationary and protruding needle tip 36, such that
the needle tip 36 is caused to penetrate the pericardium 22 (block
106), as shown in FIG. 4. The depth, d, of the cavity 18 is
sufficient that when the pericardium 22 is drawn upwardly, the
needle tip 36 not only penetrates the pericardium 22, but also the
access port 34 extends into the pericardial space 24. A payload,
such as a guidewire 38, is inserted through the access port 34 via
the needle bore 33 and into the pericardial space 24 within the
recessed region 18 (block 108), as shown in FIG. 5.
[0031] Upon completion of the procedure, the negative pressure is
removed, allowing the pericardium 22 to withdraw to a normal
position, disengaging from the needle tip 36 (block 110). Finally,
the shaft 12 is withdrawn from the pericardium 22 (block 112), with
the guidewire 38 remaining in the pericardial space 24. The
guidewire 38 may be employed to facilitate the delivery of other
instruments, for example, cardiac pacing leads. Alternately, rather
than delivering a payload (block 108) the needle 14 may be employed
to drain off excess fluid from the pericardial space 24.
[0032] In this manner, the pericardial space 24 is accessed without
piercing the epicardium 26. As the needle tip 36 is in a fixed
position in relation to the recessed region 18, there is no danger
of over inserting the needle 14 or of the needle 14 inadvertently
snagging on tissues. Furthermore, because it is unnecessary to
advance the needle 14 into position after suctioning to the
pericardium 22, there is no risk of dislodging the suction port 32
from the pericardium 22.
[0033] FIG. 6 is a bottom perspective view of a pericardial access
device 200 according to another embodiment of the present
invention. The pericardial access device 200 includes a shaft 202
and a needle 204 slidably disposed within the shaft 202 (see FIGS.
8-12). The shaft 202 extends from a proximal end (not shown) to a
distal end 206 and includes an inflation lumen 208 and a suction
lumen 210. The inflation lumen 208 extends from a proximal end
adapted for connection to a source of air or fluid pressure (not
shown) to a distal end 212 in fluid communication with an
inflatable member 214. Inflatable member 214 may be toroidal or
ring-shaped, and is disposed on the shaft 202 proximal to an
atraumatic distal tip 216 of the shaft 202. The shaft includes a
slight recess 215 sized to receive the inflatable member 214 when
in a deflated configuration. Inflatable member 214 may have a
variety of other shapes, and recess 215 may have a variety of
configuration to accommodate inflatable member 214. For example,
inflatable member 214 may be elliptical, egg-shaped, elongated, or
asymmetric. Particular shapes may be chosen to facilitate forming a
sealing engagement with a surface of the heart.
[0034] The suction lumen 210 extends from a proximal end adapted
for connection to a source of suction or negative pressure (not
shown) to a distal end 218 in fluid communication with a suction
port 220. The suction port 220 is disposed on the shaft 202
proximal to the distal tip 216 of the shaft 202 and in particular
is positioned within the circumference of the inflatable member
214, such that the inflatable member 214 generally surrounds the
suction port 220. In one embodiment, the shaft 202 may include
multiple suction lumens terminating at various locations within the
circumference of the inflatable member 214. The shaft 202 further
includes a secondary lumen 222 having a distal port 224 disposed
adjacent the suction port 220 within the circumference of the
inflatable member 214. Alternately, the secondary lumen 222 and the
suction lumen 210 are one in the same (Not shown; see generally the
embodiment of FIG. 2). The secondary lumen 222 is adapted for
slidably receiving the needle 204, as is shown in FIGS. 8-12.
[0035] FIG. 7 is a flowchart detailing a method 250 of accessing
the pericardial space 24 using the pericardial access device 200 of
FIG. 6, according to one embodiment of the present invention. The
shaft 202 is inserted into the chest using, for example, a
sub-xiphoid insertion route, and the distal end 206 is brought into
proximity with the pericardium 22 so that the inflatable member 214
is positioned adjacent the pericardium 22 (block 252), as shown in
FIG. 8. As shown in FIG. 9, the inflatable member 214 is inflated,
forming a toroidal or cylindrical-shaped ring adjacent the
pericardium 22 (block 254). The inflated inflatable member 214
defines an open space or cavity 230 adjacent the pericardium 22 and
causes the suction port 220 to be spaced above the pericardium 22.
Negative pressure is then applied to the suction lumen 210, causing
the pericardium 22 to be drawn upwardly into the cavity 230 (block
256), as shown in FIG. 10, forming what is known as a pericardial
bleb. This increases the volume of a region 234 of the pericardial
space 24 adjacent the inflatable member 214.
[0036] At this point, the needle 204 is advanced through the
secondary lumen 220 to penetrate the pericardium 22 and enter the
enlarged pericardial space 234 (block 258), as shown in FIG. 11. A
payload, such as a guidewire 238, may then be delivered through the
needle port 230 into the enlarged region 234 of the pericardial
space 24 (block 260), as shown in FIG. 12. Alternatively, the
needle 204 is removed and the payload is introduced directly
through the secondary lumen 222. Following completion of the
procedure, needle 204 is withdrawn (block 262) and the negative
pressure is eliminated, allowing the pericardium 22 to retract
(block 264). Optionally, the inflation fluid or gas is reduced or
removed, deflating the inflatable member (block 266). The
pericardial access system 200 may then be removed from the heart 20
(block 268), leaving the payload in place.
[0037] When the inflatable member 214 is in a deflated
configuration, for example, during insertion and removal, the
pericardial access device 200 displays a lower profile. When
inflated and after suction is applied, the inflatable member 214
defines a pericardial bleb, as is shown in FIG. 10, suitable for
facilitating a variety of procedures. Furthermore, the inflatable
member 214 may be inflated to an intermediate configuration
defining a cavity of a different volume or configuration than in
the fully inflated configuration. This allows the user to control
the size or configuration of the region 234.
[0038] Although the secondary lumen 222 is shown in FIGS. 8-12 as
having a nearly right angle curve proximal to the port 224, the
secondary lumen 222 may be formed with varying angles adapted to
point the needle 204 toward the pericardium 22. The angle may be
greater or lower to increase or decrease the amount of force needed
to penetrate the pericardium 22, or to facilitate navigation of the
needle 204 therethrough. As shown in FIGS. 8 and 11, the needle 204
extends from a proximal end (not shown) to a sharp distal end 226.
Needle 204 is hollow and terminates in a distal port 230 at or
proximally adjacent to the distal end 226. The needle 204 may be
adapted for receiving a payload such as a medical instrument, for
example, a guidewire, or a fluid or gas.
[0039] FIGS. 13-15 show a pericardial access device 300 in
accordance with another embodiment of the present invention. The
pericardial access device 300 includes a tubular body 302 having an
inner suction lumen 304 and a hollow needle 306 disposed within the
suction lumen 304.
[0040] The needle is held in position by a flange structure 308
made up of a needle flange 310 extending about a proximal portion
312 of the needle 306 and a retention flange 314 extending inwardly
from an inner wall 316 of the shaft 302. An outer diameter OD of
the needle flange 310 is greater than an inner diameter ID of the
retention flange 314. In this manner, the needle 306 is positioned
or inserted within the suction lumen 304 such that a pointed distal
end 318 of the needle 306 is positioned towards an open distal end
or access port 320 of the shaft 302. The needle flange 310 engages
the retention flange 314 and prevents further longitudinal
displacement of the needle 306 with respect to the shaft 302.
However, the needle 306 is free to rotate. A secondary retention
flange 322 is positioned proximal to and spaced apart from the
retention flange 314. The needle flange 310 is positioned
therebetween to prevent inadvertent proximal displacement of the
needle 306. In other embodiments, the needle 306 includes a
secondary needle flange and the needle flange 310 and secondary
needle flange are disposed on opposite sides of a single retention
flange 314.
[0041] As is shown in FIG. 14, the retention flange 314 and
secondary flange 322 are made up of multiple individual flanges 324
spaced apart from one another, defining spaces 326. Spaces 326
provides a passage for vacuum or suction to be applied throughout
the suction lumen 304.
[0042] The needle flange 310 is positioned on the needle 306 such
that the distal end 318 of the needle 306 is recessed by a distance
D from the access port 320 of the shaft 302, forming a cavity or
recessed space 328 between the distal end 320 of the shaft 302 and
the distal end 318 of the needle 306. Thus, in a similar manner as
described with respect to the pericardial access device generally
shown in FIGS. 2-5, the access port 320 of the shaft 302 is engaged
to a surface of the pericardium 22 and suction is applied. The
shaft 302, and thus needle 306, is preferably positioned relative
to the pericardium 22 to form an angle of about 90 degrees with
respect to the pericardium 22. The access port 320 of the shaft 302
is sealed to the pericardium 22, and a portion of the pericardium
22 adjacent the access port 320 is drawn into the cavity 328
forming a pericardial bleb (not shown). The distance D is such that
the portion of the pericardium 22 drawn into the cavity 328 engages
the distal end 318 of the needle 306 and is pierced by the needle
306. The needle 302 can be rotated to facilitate piercing.
Payloads, such as guidewires, can then be fed through the needle
306 into an enlarged space between the pericardium 22 and
epicardium 26 to access the pericardial space 24 therebetween.
[0043] A pericardial access device according to any of the
preceding embodiments may be used for a variety of procedures,
including, for example, epicardial lead placement, cellular
myoplasty, epicardial ablation, drug delivery, blind pericardial
access, endoscopic pericardial access and endoscopic dissection of
tissue reflections or adhesions. It can also be used for entering
other spaces between anatomic tissue layers, including the
peritoneum, vascular sheaths (for treatment of carotid disease or
iliac/femoral artery disease) and the dura. A pericardial access
system according to any of the preceding embodiments requires only
a single surgical access point to locate the pericardium 22, form
an enlarged region of pericardial space, and deliver a medical
instrument into the pericardial space 24 without damaging the
underlying tissues.
[0044] Various modifications and additions can be made to the
exemplary embodiments discussed without departing from the scope of
the present invention. Accordingly, the scope of the present
invention is intended to embrace all such alternatives,
modifications, and variations as fall within the scope of the
claims, together with all equivalents thereof.
* * * * *