Telescoping catheter delivery system for left heart endocardial device placement

摘要

A transseptal catheter delivery system includes an elongate first tubular member and an elongate second tubular member receivable within the first tubular member. The first tubular member includes an adjustable portion adjacent a distal end. The second tubular member is adapted to receive an instrument to be placed in the left ventricle, and includes a curved portion adjacent its distal end in a relaxed state. The adjustable portion is deflectable toward the atrial septum to guide a puncturing tool and/or guide insertion of the second tubular member through a septal puncture into the left atrium. Within the left atrium, the curved portion is oriented toward the left ventricle to guide insertion of a guide wire, and subsequently the second tubular member, into the left ventricle. Methods of transvenously accessing a left ventricle are also provided.

主权项

1. A method for transseptal delivery in a heart, comprising:
advancing an elongate first tubular member through a superior vena cava into a right atrium of the heart, the first tubular member defining a first lumen extending between a proximal end and a distal end of the first tubular member, the first tubular member having an adjustable portion adjacent its distal end; deflecting the adjustable portion of the first tubular member within the right atrium toward an atrial septum of the heart; advancing a stiffening member through the first tubular member and through a septal puncture in the atrial septum into a left atrium of the heart; advancing an elongate second tubular member through the first tubular member and through the septal puncture into the left atrium over the stiffening member while maintaining the first tubular member within the right atrium, the second tubular member defining a second lumen extending between a proximal end and a distal end of the second tubular member that receives the stiffening member, the second tubular member having a normally curved portion adjacent its distal end that straightens when advanced through the first tubular member and over the stiffening member; withdrawing the stiffening member from at least a portion of the second tubular member, thereby allowing the curved portion of the second tubular member to regain its normally curved shape, thereby directing an outlet at the distal end of the second tubular member toward a left ventricle of the heart; advancing a guide through the second tubular member into the left ventricle; advancing the second tubular member over the guide into the left ventricle while maintaining the first tubular member within the right atrium; and advancing an instrument through the second tubular member into the left ventricle.