Source: http://www.google.fr/patents/US8050746?hl=fr
Timestamp: 2013-05-21 00:50:34
Document Index: 583531374

Matched Legal Cases: ['Application No. 06734083', 'Application No. 06734083', 'Application No. 06734083', 'Application No. 06734083', 'Application No. 07758716', 'Application No. 07799466', 'Application No. 07812146', 'Application No. 07841754', 'Application No. 08746822', 'Application No. 08746822', 'Application No. 2007', 'Application No. 2007', 'Application No. 2009']

Brevet US8050746 - Tissue visualization device and method variations - Google�BrevetsRecherche Images Maps Play YouTube Actualit�s Gmail Drive Plus » Recherche avanc�e dans les brevets | Historique Web | Connexion Recherche avanc�e dans les brevets BrevetsTissue visualization device and method variations are described herein where an imaging hood is temporarily sealed against a region of tissue to be treated while under direct visualization. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration....http://www.google.fr/patents/US8050746?utm_source=gb-gplus-shareBrevet US8050746 - Tissue visualization device and method variations Num�ro de publicationUS8050746 B2Type de publicationOctroi Num�ro de demande11/775,771 Date de publication1 nov. 2011 Date de d�p�t10 juil. 2007 Date de priorit�2 f�vr. 2005Autre r�f�rence de publicationUS20080015445US20120004577 InventeursVahid SaadatRuey-Feng PehEdmund TamAmir A. AbolfathiChris A. Rothe Cessionnaire d'origineVoyage Medical, Inc.Triplepoint Capital Llc Classification aux �tats-Unis600/476600/109600/106600/478600/479600/129600/101 Classification internationaleA61B6/00 Classification coop�rativeA61B5/02007A61B5/6882A61B1/00085A61B1/04A61B1/00089A61B1/005A61B1/018A61B1/00082A61B5/0031A61B1/0008A61B2018/0212A61B8/12A61B1/015 Classification europ�enneA61B1/015A61B1/018A61B1/04A61B1/005A61B1/00E4H1A61B1/00E4HA61B1/00E4H2A61B1/00E4H4A61B5/02DA61B5/68D3DR�f�rencesCitations de brevets (104)Citations hors brevets (76) R�f�renc� par (3)Liens externesUSPTO Cession USPTO EspacenetTissue visualization device and method variationsUS 8050746 B2 R�sum� Tissue visualization device and method variations are described herein where an imaging hood is temporarily sealed against a region of tissue to be treated while under direct visualization. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration. The imaging hood is placed against or adjacent to the tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid is pumped into the hood until the fluid displaces any blood leaving a clear region of tissue to be imaged via an imaging element. Temporary sealing against the tissue can be achieved in a number of ways such as circumferential balloons inflatable within the hood or other sealing techniques. A field of view of the imaging element can be expanded by inflating the balloon beyond the imaging hood.
1. A tissue imaging system, comprising:
a barrier or membrane which forms a fluid barrier projecting distally from the deployment catheter and adapted to self-expand from a low-profile delivery configuration into an expanded deployed configuration defining an open area therein, wherein the open area is in fluid communication with the at least one lumen and with an environment external to the barrier or membrane through an opening defined by the barrier or membrane;
a visualization element disposed within or adjacent to the barrier or membrane for visualizing tissue adjacent to the open area; and
at least one balloon integrally formed along an interior surface of the barrier or membrane, wherein the balloon is configured to lie flat against the interior surface when deflated and is further configured to extend through the opening and distally beyond the barrier or membrane and occupy the open area when inflated.
4. The system of claim 3 wherein the deployment catheter is steered via pulling at least one wire.
6. The system of claim 1 wherein the barrier or membrane is comprised of a compliant material.
7. The system of claim 1 wherein the barrier or membrane defines a contact edge for placement against a tissue surface.
8. The system of claim 1 wherein the barrier or membrane is adapted to be expanded into its deployed configuration by inflation of a fluid or gas.
9. The system of claim 1 wherein the barrier or membrane comprises one or more support struts along the barrier or membrane.
10. The system of claim 9 wherein the one or more support struts are adapted to be rigidized from a flexible state when inflated by a fluid or gas.
11. The system of claim 1 wherein the barrier or membrane is conically shaped when in the expanded configuration.
12. The system of claim 1 wherein the visualization element comprises at least one optical fiber, CCD imager, or CMOS imager.
13. The system of claim 1 wherein the visualization element is disposed within a distal end of the deployment catheter.
14. The system of claim 1 wherein the visualization element is articulatable off-axis relative to a longitudinal axis of the deployment catheter.
15. The system of claim 1 further comprising a fluid reservoir fluidly coupled to the barrier or membrane.
16. The system of claim 15 wherein the fluid comprises saline, plasma, water, or perfluorinated liquid.
17. The system of claim 1 wherein the balloon comprises a circumferentially-shaped balloon within the open area.
18. The system of claim 1 wherein the balloon defines a channel therethrough when inflated within the open area.
19. The system of claim 1 wherein the balloon expands beyond the barrier or membrane when inflated such that the barrier or membrane is raised away from a tissue surface contacted by the balloon.
20. The system of claim 19 wherein the visualization element is positioned proximally of the balloon such that a field of view of the visualization element is expanded through the inflated balloon over the contacted tissue surface.
21. The system of claim 1 further comprising a plurality of additional balloons disposed along an interior surface of the barrier or membrane such that each balloon occupies a quadrant of the open area and a central channel is defined by each balloon through the open area.
22. The system of claim 21 wherein the visualization element comprises an imaging catheter positioned within the central channel.
23. The system of claim 21 wherein each balloon is differentially inflatable in a complementary manner such that selective inflation and deflation of adjacent balloons articulate a position of the imaging catheter within the central channel.
24. A method for intravascularly imaging a tissue region within a body lumen, comprising:
positioning a barrier or membrane projecting distally from a deployment catheter in proximity to a region of tissue to be imaged wherein the barrier or membrane self-expands from a low-profile delivery configuration into an expanded deployed configuration, wherein the barrier or membrane defines an open area therein which is in fluid communication with a lumen defined through the catheter and also with an environment external to the barrier or membrane through an opening defined by the barrier or membrane;
inflating a balloon integrally formed along an interior surface of the barrier or membrane such that the balloon lies flat against the interior surface when deflated and extends through the opening and distally beyond the barrier or membrane and occupies the open area when inflated;
positioning a portion of the balloon projecting distally of the barrier or membrane against or adjacent to the tissue region to be imaged; and
visualizing the tissue region through the inflated balloon.
identifying the tissue region to be treated through the inflated balloon;
deflating the balloon such that the open area is unobstructed by the balloon;
displacing an opaque bodily fluid with a translucent fluid from the open area; and
visualizing the tissue region within the open area through the translucent fluid.
26. The method of claim 25 wherein displacing an opaque bodily fluid with a translucent fluid comprises infusing the translucent fluid into the open area through a fluid delivery lumen defined through the deployment catheter.
27. The method of claim 26 wherein infusing the translucent fluid comprises pumping saline, plasma, water, or perfluorinated liquid into the open area such that blood is displaced from therefrom.
28. The method of claim 24 wherein positioning comprises steering the deployment catheter to the tissue region.
29. The method of claim 24 wherein inflating comprises inflating at least three additional balloons such that each balloon occupies a quadrant within the open area and each balloon defines a central channel through the open area.
30. The method of claim 29 wherein visualizing comprises selectively inflating and deflating each of the balloons in a complementary manner such that selective inflation and deflation of adjacent balloons articulate a position of an imaging catheter within the central channel. Description
CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to the following U.S. Prov. Pat. App. Ser. Nos. 60/806,923; 60/806,924; and 60/806,926 each filed Jul. 10, 2006; this is also a continuation-in-part of U.S. patent application Ser. No. 11/259,498 filed Oct. 25, 2005, which claims priority to U.S. Prov. Pat. App. Ser. No. 60/649,246 filed Feb. 2, 2005. Each application is incorporated herein by reference in its entirety.
FIELD OF THE INVENTION The present invention relates generally to medical devices used for accessing, visualizing, and/or treating regions of tissue within a body. More particularly, the present invention relates to methods and apparatus for obtaining sufficient sealing between a visualization catheter and a tissue surface within a patient heart for directly visualizing the tissue.
In operation, after the imaging hood has been deployed, fluid may be pumped at a positive pressure through the fluid delivery lumen until the fluid fills the open area completely aid displaces any blood from within the open area. The fluid may comprise any biocompatible fluid, e.g., saline, water, plasma, Fluorinert�, etc., which is sufficiently transparent to allow for relatively undistorted visualization through the fluid. The fluid may be pumped continuously or intermittently to allow for image capture by an optional processor which may be in communication with the assembly.
As shown and described above, in placing the hood against a region of tissue to be imagined and/or treated, various configurations of the hood may be utilized to ensure sufficient temporary contact or seal creation between the hood and the underlying tissue for injecting the displacing fluid into the hood. Accordingly, additional variations for facilitating the sufficient formation of the temporary seal are further described. One example may include a hood having an inflatable circumferential balloon which may protrude distally from the hood to provide a wider viewing angle of the underlying contacted tissue.
When deflated, the balloon may lie flat against the inner surface of the hood such that the open area is unobstructed. During inflation, the balloon may be infused with a clear fluid, such as saline, or a gas, such as carbon dioxide or air, such that as the balloon expands circumferentially, a central lumen is formed by the balloon within the open area of the hood. The field of view from the imaging element through the distally expanded balloon may be increased for imaging the tissue beyond the contact lip.
In another variation, an imaging catheter may be articulated by three or more variably inflatable balloons contained within the hood. The three or more variably inflatable balloons may define a working channel through the hood within which the imaging catheter may be positioned for articulation by the balloons. To articulate the position of the imaging element, each of the balloons may be differentially inflated where some balloons are inflated further and other balloons are correspondingly deflated in a complementary manner to move or push the imaging catheter in a desired direction.
Yet another variation includes a prolapsed balloon variation. As an inflatable balloon is expanded, an inner shaft may be pulled proximally to retract the inner shaft relative to the deployment catheter such that the distal portion of the balloon is partially everted to create a working theater within which the imaging catheter and/or various instruments may be introduced for treating the underlying tissue.
Other variations may include obliquely-shaped balloons as well as hoods defining a plurality of extensions or flaps around the contact lip which flare radially or overlie one another to facilitate sealing of the hood. Additional variations include articulatable hoods and hoods which may themselves be inflated with an inflation fluid.
FIGS. 47A to 47C which show a hood having an inflatable circumferential balloon which may protrude distally from the hood to provide a wider viewing angle of the underlying contacted tissue.
FIG. 48 shows a side view of an example of how the field of view from the imaging element through the distally expanded balloon may be increased for imaging the tissue beyond contact lip.
FIG. 49 illustrates a fully inflated balloon pressed against the tissue surface where the contact lip is raised away from the tissue surface by the balloon to provide the expanded field of view through the balloon.
FIGS. 50A and 50B show perspective and side views, respectively, of an imaging catheter having an imaging element which may be articulated by three or more variably inflatable balloons contained within the hood.
FIGS. 50C and 50D illustrate perspective and side views, respectively, of the imaging catheter which has been articulated into an angled configuration relative to the hood by the differential inflation of the balloons.
FIG. 51 schematically illustrates an example of an electrical control system for controlling the differential inflation of the balloons in a complementary manner.
FIG. 52 schematically illustrates another variation where mechanical linkages may be used to control the differential inflation of the balloons within the hood.
FIGS. 53A to 53C illustrate side views of another variation with a prolapsed balloon prior to, during, and after inflation with an inner shaft retracted to create a working theater.
FIG. 53D shows a side view of the device of FIG. 53C engaging tissue.
FIGS. 54A and 54B show side views of another variation with an asymmetrical balloon urged to move laterally towards where the balloon wall is thinner.
FIGS. 55A to 55C show perspective and side views of a hood having a circumferential balloon positioned around the circumference of the contact lip of the hood and pressed against a portion of tissue.
FIG. 56 shows another variation of the tissue visualization catheter having multiple channels through which a number of shafts, e.g., first shaft, second shaft, and third shaft may be positioned.
FIGS. 57A and 57B show perspective and side views, respectively, of another variation of the hood which may be articulatable to bend into a flattened profile to facilitate navigation through narrow gaps and/or for placement against tissue surfaces.
FIGS. 58A and 58B show perspective and side views, respectively, of the hood articulated into its flattened and lower profile configuration.
FIGS. 59A and 59B show perspective and partial cross-sectional views, respectively, of an inflatable hood assembly contained within the lumen of the catheter.
FIGS. 60A and 60B show perspective and partial cross-sectional views, respectively, of inflation fluid being injected to deploy the hood.
FIGS. 61A and 61B show perspective and partial cross-sectional views, respectively, of the inflatable hood fully deployed.
FIGS. 62A and 62B show perspective and cross-sectional end views, respectively, of an inflatable hood expanded and extended past the catheter to illustrate the longitudinal formation of ligaments along the length of the hood.
FIGS. 63A and 63B show perspective and cross-sectional end views, respectively, of a distended inflatable hood with the absence of ligaments.
FIGS. 64A to 64C illustrate a reconfigurable mesh structure having a layer of elastic coating or covering deployed for contact against a tissue surface.
FIGS. 65A to 65C illustrate a self-expanding mesh structure having a layer of elastic coating or covering deployed for contact against a tissue surface.
FIG. 66 shows a perspective view of a catheter having the hood positioned upon a neck joint having a gusseted coupling which may be passively articulated to bend the hood.
FIG. 67 shows a perspective view of another variation with a hood stabilized by a suction hood.
FIGS. 68A and 68B show side views of yet another variation where the hood includes a plurality of overlapping extension flaps over the circumference of the hood.
FIGS. 69A and 69B show perspective views of the hood of FIGS. 68A and 68B temporarily sealed against a tissue surface.
FIGS. 70A and 70B show perspective and side views, respectively, of another variation utilizing a plurality of flaps which are angled relative to a longitudinal axis of hood.
FIG. 70C shows a perspective view of the device of FIGS. 70A and 70B placed against a tissue surface.
FIG. 71 shows a partial cross-sectional side view of another variation utilizing at least one gas injection port for infusing CO2 gas within the hood interior to replace the displaced blood.
DETAILED DESCRIPTION OF THE INVENTION A tissue-imaging and manipulation apparatus described below is able to provide real-time images in vivo of tissue regions within a body lumen such as a heart, which is filled with blood flowing dynamically therethrough and is also able to provide intravascular tools and instruments for performing various procedures upon the imaged tissue regions. Such an apparatus may be utilized for many procedures, e.g., facilitating transeptal access to the left atrium, cannulating the coronary sinus, diagnosis of valve regurgitation/stenosis, valvuloplasty, atrial appendage closure, arrhythmogenic focus ablation, among other procedures.
If one or more optical fibers are utilized for imaging, the optical fibers 58 may be passed through deployment catheter 16, as shown in the cross-section of FIG. 4B, and routed through the support member 50. The use of optical fibers 58 may provide for increased diameter sizes of the one or several lumens 56 through deployment catheter 16 for the passage of diagnostic and/or therapeutic tools therethrough. Alternatively, electronic chips, such as a charge coupled device (CCD) or a CMOS imager, which are typically known, may be utilized in place of the optical fibers 58, in which ease the electronic imager may be positioned in the distal portion of the deployment catheter 16 with electric wires being routed proximally through the deployment catheter 16. Alternatively, the electronic imagers may be wirelessly coupled to a receiver for the wireless transmission of images. Additional optical fibers or light emitting diodes (LEDs) can be used to provide lighting for the image or operative theater, as described below in further detail. Support member 50 may be pivoted via connection 54 such that the member 50 can be positioned in a low-profile configuration within channel or groove 60 defined in a distal portion of catheter 16, as shown in the cross-section of FIG. 4C. During intravascular delivery of deployment catheter 16 through the patient body, support member 50 can be positioned within channel or groove 60 with imaging hood 12 also in its low-profile configuration. During visualization, imaging hood 12 may be expanded into its deployed configuration and support member 50 may be deployed into its off-axis configuration for imaging the tissue adjacent to hood 12, as in FIG. 4A. Other configurations for support member 50 for off-axis visualization may be utilized, as desired.
To facilitate stabilization of the deployment catheter 16 during a procedure, one or more inflatable balloons or anchors 76 may be positioned along the length of catheter 16, as shown in FIG. 6A. For example, when utilizing a transeptal approach across the atrial septum AS into the left atrium LA, the inflatable balloons 76 may be inflated from a low-profile into their expanded configuration to temporarily anchor or stabilize the catheter 16 position relative to the heart B. FIG. 6B shows a first balloon 78 inflated while FIG. 6C also shows a second balloon 80 inflated proximal to the first balloon 78. In such a configuration, the septal wall AS may be wedged or sandwiched between the balloons 78, 80 to temporarily stabilize the catheter 16 and imaging hood 12. A single balloon 78 or both balloons 78, 80 may be used. Other alternatives may utilize expandable mesh members, malecots, or any other temporary expandable structure. After a procedure has been accomplished, the balloon assembly 76 may be deflated or re-configured into a low-profile for removal of the deployment catheter 16.
Although a helical anchor 84 is shown, this is intended to be illustrative and other types of temporary anchors may be utilized, e.g., booked or barbed anchors, graspers, etc. Moreover, the tool delivery catheter 82 may be omitted entirely and the anchoring device may be delivered directly through a lumen defined through the deployment catheter 16.
An illustrative example is shown in FIG. 5A of a tissue imaging assembly connected to a fluid delivery system 90 and to an optional processor 98 and image recorder and/or viewer 100. The fluid delivery system 90 may generally comprise a pump 92 and an optional valve 94 for controlling the flow rate of the fluid into the system, A fluid reservoir 96, fluidly connected to pump 92, may hold the fluid to be pumped through imaging hood 12. An optional central processing unit or processor 98 may be in electrical communication with fluid delivery system 90 for controlling flow parameters such as the flow rate and/or velocity of the pumped fluid. The processor 98 may also be in electrical communication with an image recorder and/or viewer 100 for directly viewing the images of tissue received from within imaging hood 12. Imager recorder and/or viewer 100 may also be used not only to record the image but also the location of the viewed tissue region, if so desired.
FIGS. 16A and 16B show yet another variation in which imaging hood 12 may comprise one or more hood support members 232 integrated with the hood membrane. These longitudinally attached support members 232 may be pivotably attached at their proximal ends to deployment catheter 16. One or more pullwires 234 may be routed through the length of deployment catheter 16 and extend through one or more openings 238 defined in deployment catheter 16 proximally to imaging hood 12 into attachment with a corresponding support member 232 at a pullwire attachment point 236. The support members 232 may be fabricated from a plastic or metal, such as stainless steel. Alternatively, the support members 232 may be made from a superelastic or shape memory alloy, such as Nitinol, which may self-expand into its deployed configuration without the use or need of pullwires. A heat-activated Nitinol may also be used which expands upon the application of thermal energy or electrical energy. In another alternative support members 232 may also be constructed as inflatable lumens utilizing, e.g., PET balloons. From its low-profile delivery configuration shown in FIG. 16A the one or more pullwires 234 may be tensioned from their proximal ends outside the patient body to pull a corresponding support member 232 into a deployed configuration, as shown in FIG. 16B, to expand imaging hood 12. To reconfigure imaging hood 12 back into its low profile, deployment catheter 16 may be pulled proximally into a constraining catheter or the pullwires 234 may be simply pushed distally to collapse imaging hood 12.
FIGS. 17A and 17B show yet another variation of imaging hood 240 having at least two or more longitudinally positioned support members 242 supporting the imaging hood membrane. The support members 242 each have cross-support members 244 which extend diagonally between and are pivotably attached to the support members 242. Each of the cross-support members 244 may be pivotably attached to one another where they intersect between the support members 242, A jack or screw member 246 may be coupled to each cross-support member 244 at this intersection point and a torquing member, such as a torqueable wire 248, may be coupled to each jack or screw member 246 and extend proximally through deployment catheter 16 to outside the patient body. From outside the patient body, the torqueable wires 248 may be torqued to turn the jack or screw member 246 which in turn urges the cross-support members 244 to angle relative to one another and thereby urge the support members 242 away from one another. Thus, the imaging hood 240 may be transitioned from its low-profile, shown in FIG. 17A, to its expanded profile, shown in FIG. 17B, and back into its low-profile by torquing wires 248.
FIGS. 18A and 18B show yet another variation on the imaging hood and its deployment. As shown, a distal portion of deployment catheter 16 may have several pivoting members 250, e.g., two to four sections, which form a tubular shape in its low profile configuration, as shown in FIG. 15A. When pivoted radially about deployment catheter 16, pivoting members 250 may open into a deployed configuration having distensible or expanding membranes 252 extending over the gaps in-between the pivoting members 250, as shown in FIG. 18B. The distensible membrane 252 may be attached to the pivoting members 250 through various methods, e.g., adhesives, such that when the pivoting members 250 are fully extended into a conical shape, the pivoting members 250 and membrane 252 form a conical shape for use as an imaging hood. The distensible membrane 252 may be made out of a porous material such as a mesh or PTFE or out of a translucent or transparent polymer such as polyurethane, PVC, Nylon, etc.
In yet another alternative, FIG. 22A shows another variation in which an imaging hood 282 is attached to deployment catheter 280. The contact lip or edge 284 may comprise one or more electrical contacts 286 positioned circumferentially around contact edge 284. The electrical contacts 286 may be configured to contact the tissue and indicate affirmatively whether tissue contact was achieved, e.g., by measuring the differential impedance between blood and tissue. Alternatively, a processor, e.g., processor 98, in electrical communication with contacts 286 may be configured to determine what type of tissue is in contact with electrical contacts 286. In yet another alternative the processor 98 may be configured to measure any electrical activity that may be occurring in the underlying tissue, e.g., accessory pathways, for the purposes of electrically mapping the cardiac tissue and subsequently treating, as described below, any arrhythmias which may be detected.
Another variation for ensuring contact between imaging hood 282 and the underlying tissue may be seen in FIG. 22B. A is variation may have an inflatable contact edge 288 around the circumference of imaging hood 282. The inflatable contact edge 288 may be inflated with a fluid or gas through inflation lumen 289 when the imaging hood 282 is to be placed against a tissue surface having an uneven or varied anatomy. The inflated circumferential surface 288 may provide for continuous contact over the hood edge by conforming against the tissue surface and facilitating imaging fluid retention within hood 282.
In utilizing LEDs for illumination, whether positioned along imaging hood 12 or along a separate instrument, the LEDs may comprise a single LED color, e.g., white light. Alternatively, LEDs of other colors, e.g., red blue, yellow, etc., may be utilized exclusively or in combination with white LEDs to provide for varied illumination of the tissue or fluids being imaged. Alternatively, sources of infrared or ultraviolet light may be employed to enable imaging beneath the tissue surface or cause fluorescence of tissue for use in system guidance, diagnosis, or therapy.
As shown and described above, in placing the hood against a region of tissue to be imagined and/or treated, various configurations of the hood may be utilized to ensure sufficient temporary contact or seal creation between the hood and the underlying tissue for injecting the displacing fluid into the hood. Accordingly, additional variations for facilitating the sufficient formation of the temporary seal are further described. An example is illustrated in the side views of FIGS. 47A to 47C, which show hood 12 having an inflatable circumferential balloon which may protrude distally from the hood 12 to provide a wider viewing angle of the underlying contacted tissue.
FIG. 47A shows hood 12, having a number of longitudinally aligned structural supports 510 extending along the hood 12. Imaging element 512, e.g., a CCD or CMOS imager or optical fiber, positioned along an inner surface 516 of hood 12 may be used to provide direct visualization of the open area 26 within hood 12. Circumferential balloon 514 may be positioned along the inner surface 516 of hood 12 in its deflated state during intravascular delivery and when hood 12 is collapsed in its low profile. When deflated, balloon 514 may be lie flat against inner surface 516 such that open area 26 is unobstructed. During inflation, balloon 514 may be infused with a clear fluid, such as saline, or a gas, such as carbon dioxide or air, such that as balloon 514 expands circumferentially, a central lumen 518 is formed by the balloon 514 within open area 26 of hood 12, as shown in FIG. 47B. Moreover, as the balloon 514 expands, it may extend distally past the atraumatic contact lip or edge 22 of hood 12, as shown in FIG. 47B. Once balloon 514 is fully expanded, the lumen 518 may be closed entirely and balloon 514 may occupy the entire volume of hood 12. The portion of balloon 514 which is inflated and extended beyond lip 22 may create an expanded range of view through which the imager 512 may visualize through.
FIG. 48 shows an example of how the field of view 522 from imaging element 512, which may be articulated as illustrated by the direction of rotation 520, through the distally expanded balloon 514 may be increased for imaging the tissue beyond contact lip 22. FIG. 49 illustrates the fully inflated balloon 514 pressed against the tissue surface T where the contact lip 22 is raised away from the tissue surface by balloon 514 to provide the expanded field of view through the balloon. In use, balloon 514 may be expanded within hood 12 to provide an initial visual assessment of the location of hood 12 along the tissue surface as imager 512 may view the contacted underlying tissue through the balloon 514. Once a suitable location has been found, balloon 514 may be deflated such that it collapses back into its low profile shape against the inner surface 516 of hood 12, which may then be infused with the clear fluid for displacing any blood trapped within hood 12 for directly visualizing and treating the tissue unobstructed by balloon 514.
In another variation, FIGS. 50A and 50B show perspective and side views, respectively, of an imaging catheter 530 having imaging element 532 which may be articulated by three or more variably inflatable balloons contained within hood 12. The three or more variably inflatable balloons may define a working channel through the hood 12 within which imaging catheter 530 may be positioned for articulation by the balloons. Although three balloons may be used, the example shown illustrates the use of four balloons, i.e., first quadrant balloon 534, second quadrant balloon 536, third quadrant balloon 538, and fourth quadrant balloon 540 where each balloon may occupy a quadrant within the volume of hood 12 when inflated.
To articulate the position of imaging element 532 and imaging catheter 530, each of the balloons may be differentially inflated where some balloons are inflated further and other balloons are correspondingly deflated in a complementary manner to move or push the imaging catheter 530 in a desired direction. For example, FIGS. 50C and 50D illustrate perspective and side views, respectively, of imaging catheter 530 which has been articulated in a direction 542 into an angled configuration relative to hood 12 by the differential inflation of the balloons. To move imaging catheter 530 to direct imager 532 to a particular portion of the underlying tissue, first and second balloons 534, 536 may be partially deflated while third and fourth balloons 538, 540 may be further inflated such that the occupied volume within hood 12 remains relatively constant.
FIG. 51 schematically illustrates an example of an electrical control system for controlling the differential inflation of the balloons in a complementary manner. In this example, each balloon 534, 536, 538, 540 may be fluidly coupled through the deployment catheter to a respective syringe or pump. Thus, first syringe or pump 550 having a fluid reservoir 552 is fluidly coupled through deployment catheter to first quadrant balloon 534; second syringe or pump 554 having a fluid reservoir 556 is fluidly coupled through deployment catheter to second quadrant balloon 536; third syringe or pump 558 having a fluid reservoir 560 is fluidly coupled through deployment catheter to third quadrant balloon 538; and fourth syringe or pump 562 having a fluid reservoir 564 is fluidly coupled through deployment catheter to fourth quadrant balloon 540. The number of syringes or pumps used depends, of course, upon the number of corresponding balloons utilized.
Each syringe or pump may be mechanically coupled to a respective gear drive which may be actuated to infuse or withdraw a volume of fluid from the respective fluid reservoir into or from the balloon to control its inflation. Thus, first gear drive 566 is mechanically coupled to first syringe or pump 550; second gear drive 568 is mechanically coupled to second syringe or pump 554; third gear drive 570 is mechanically coupled to third syringe or pump 558; and fourth gear drive 572 is mechanically coupled to fourth syringe or pump 562. Each of the gear drives 566, 568, 570, 572 may be electrically coupled via respective lines 574, 576, 578, 580 to processor 582 which may also be coupled to a respective pressure gauge 584, 586, 588, 590 contained within each balloon 534, 536, 538, 540 via respective lines 592, 594, 596, 598.
In use, controller 600 may be articulated or manipulated by the user to send signals of the desired imaging catheter movement to processor 582. Inflation of each balloon 534, 536, 538, 540 is controlled by the connected syringe or pump 550, 554, 558, 562. The amount of injected fluid is powered by gear drives 566, 568, 570, 572 which are controlled by a processor 582. In every balloon, a respective pressure sensor 584, 586, 588, 590 is attached to monitor the amount of inflation in each balloon and the difference in pressure between each of the balloons is recorded and calculated by processor 582. Hence, if the user desires the imaging catheter 530 to articulate a certain angle, he or she upon operating the controller 600 may control processor 582 to power the syringes to inflate or deflate until the desired pressure difference between each of the balloons is detected by the pressure sensors. A pressure meter 602 which is also in communication with processor 582 may give the user an overall pressure measurement of one or more of the balloons.
FIG. 52 schematically illustrates another variation where mechanical linkages may be used to control the differential inflation of the balloons within hood 12. Each balloon 534, 536, 538, 540 may be coupled to a respective syringe or pump 550, 554, 558, 562, as above. But where gear drives and pressure sensors were used above to control the variable inflation, each syringe or pump may be coupled to a respective mechanical linkage 616, 618, 620, 622 which are each affixed to a controller 610 at attachments 614. The user may manipulate controller 610 which may pivot about point 612 such that when controller 610 is moved by the user, the different positions of controller 610 may inflate and deflate each balloon by the movement of linkages with respect to each respective syringe or pump. These variations effect the differential inflation between the balloons and consequently articulate the working channel through hood 12.
Yet another variation for controlling the placement of the hood upon the tissue surface to be imaged and/or treated is shown in the side views of FIGS. 53A to 53C, which illustrate a prolapsed balloon variation. FIG. 53A shows inner shaft 638 extending from deployment catheter 16 with inflatable balloon 630 in its deflated low-profile state attached at proximal location 634 to catheter 16 and to distal location 636 to inner shaft 638. A working lumen 632 may be defined through inner shaft 638. As balloon 630 is inflated, as shown in FIG. 53B, inner shaft 638 may be being to be pulled proximally to retract inner shaft 638 relative to deployment catheter 16. With balloon 630 fully inflated, inner shaft 638 may be fully retracted, as indicated by the direction of retraction 640 (or deployment catheter 16 may be moved distally relative to inner shaft 638), such that the distal portion of balloon 630 is partially everted to create a working theater 642 within which imaging catheter 530 and/or various instruments may be introduced for treating the underlying tissue, as shown in FIG. 53C. The working theater 642 may be infused with the saline fluid 644 to displace any blood therein to provide the clear region for visualization, as shown in FIG. 53D. Moreover, as the surrounding theater is comprised of the compliant material of balloon 630, apposition of the balloon 630 against any uneven anatomy of the tissue T to be treated may facilitate the creation of a temporary seal to contain the saline fluid 644.
In additional variations, an asymmetrical or obliquely-shaped transparent balloon 650 may be inflated having a first side 652 with a first wall thickness and a second side 654 with a second wall thickness which is thicker than the first wall thickness, as shown in FIG. 54A. The second side 654 may be fabricated from the same material as first side 652 yet reinforced with additional layers of material. Alternatively, second side 654 may be reinforced with support members integrated along the balloon. When balloon 650 is immersed within blood within the patient heart, the underlying tissue T may be visualized by pressing balloon 650 against a first point of contact 658 against the tissue T. If the underlying tissue is to be treated, a treatment instrument, such as a piercing needle 656, may be advanced into the balloon interior and pierced through the balloon membrane and into the underlying tissue. However, if an adjacent region of tissue is to be treated, catheter 16 may be urged axially (indicated by direction 660) such that when balloon 650 is pressed against tissue T at contact region 658, piercing instrument 656 and catheter 16 is moved laterally to adjacent region of tissue 664 by balloon 650 pivoting along contact region 658, indicated by the direction of balloon travel 662 in FIG. 54B. This motion is due to the pressure exerted on the tissue surface by balloon 650 and an equal and opposite reaction force causing more deformation on the thinner walls of side 652 that are not reinforced relative to second side 654. This lateral movement 662 provides fine localization of the penetrating needle 650 inside the balloon by merely applying the axial load. The balloon 650 can be rotated to change the direction of the lateral movement 662.
Another variation for facilitating sealing of hood 12 against a tissue surface, particularly a tissue surface having anatomical variations, is shown in the perspective views of FIGS. 55A and 55B. Hood 12 is shown having a deflated circumferential balloon 670 positioned around the circumference of contact lip 22, similar to the variation shown above in FIG. 22B. FIG. 55B illustrates the balloon 670 having been inflated such that the open area 26 of hood 12 is preserved. Balloon 670 may extend distally of hood 12 such that when placed against an uneven tissue surface T, as shown in the side view of FIG. 55C, the compliant material of balloon 670 may conform to the uneven surfaces of tissue and provide adequate sealing for hood 12 against the tissue surface as well as providing a cushioning effect when axial loads are placed by hood 12 against the underlying tissue T. Moreover, balloon 670 may be transparent such that visualization of the underlying circumferentially contacted tissue may be possible via imaging element 512. Additionally, the balloon 670 provides a relatively larger contact surface with the tissue T which provides a more even distribution of pressure between hood 12 and the tissue.
FIG. 56 shows another variation of the tissue visualization catheter having multiple channels through which a number of shafts, e.g., first shaft 680, second shaft 682, and third shaft 684 may be positioned. Each shaft may have respective inflatable balloons 686, 688, 690 inflatable thereon with a respective inner shaft 692, 694, 696 extending through each balloon with a different instrument, e.g., engaging element, penetrating element tissue grasper, or any other tool, instrument or guidewire. Each clear balloon 686, 688, 690 may enable visualization through the balloon when the catheter 16 is submersed within opaque bodily fluid, such as blood, and when maneuvered within the chambers of the heart.
FIGS. 57A and 57B show perspective and side views, respectively, of another variation of the hood which may be articulatable to bend into a flattened profile to facilitate navigation through narrow gaps and/or for placement against tissue surfaces when the catheter 16 and hood are angled relative to the tissue surface. The articulatable hood 700 may have at least a first wire 702 and an optional second wire 702 each passing through catheter 16 and extending along hood 700 and attached to the contact lip of hood 700. Wires 702, 704 may be placed opposite to one another along hood 700. When first wire 702 is tensioned along proximal direction 706 (alternatively, second wire 704 may be pushed as well along distal direction 708), hood 700 may undergo a shape distortion into a flattened and lower profile configuration, as shown in the perspective and side views of FIGS. 58A and 58B. As the bendable hood 700 also provides different angles of visualization when an imaging element, such as a CCD camera, is attached onto or within hood 700, the imaging element may be able to visualize at different angles when placed against the tissue surface.
Another is illustrated in FIGS. 59A and 59B which shows perspective and partial cross-sectional views, respectively, of an inflatable hood assembly 710 contained within lumen 714 of catheter 16. Inflatable hood 710 may be fabricated from a double layer of pliable or conformable biocompatible material including but not limited to, e.g., latex, polyurethane, or other polymeric or plastic materials, etc. Spacing between the two layers can be occupied with saline, air or other inflation fluid 716. When inflatable hood 710 is ready to be deployed, inflation fluid 716 may be injected to deploy hood 710, as shown in the perspective and side views of FIGS. 60A and 60B. Upon deployment hood 710 may be unconstrained to expand or open as shown in FIGS. 61A and 61B. The compliant material of inflatable hood 710 and the atraumatic contact edge or lip 718 may facilitate the temporary sealing of hood 710 against uneven tissue surfaces, as described above.
When inflated, a number of strengthening members or ligaments 712 may be formed along the length of inflatable hood 710 to provide structural support. These ligaments 712 may comprise reinforced bundles of polymeric (or other materials such as lengths of flexible metals like nickel-titanium alloys) material attached along the hood 712 or they may be formed by the layers of the balloon membrane adhered to one another. Ligaments 712 may allow for the inflation fluid 716 to be concentrated into specified pockets within hood 710 to provide greater structural stability and strength along the walls of hood 710.
FIGS. 62A and 62B show perspective and cross-sectional end views, respectively, of an inflatable hood 710 expanded and extended past catheter 16 to illustrate the longitudinal formation of ligaments 712 along the length of hood 710. Although four ligaments 712 are illustrated, fewer or greater than four ligaments may be disposed over the circumference of hood 710. FIGS. 63A and 63B show perspective and cross-sectional end views, respectively, of inflatable hood 710 with the absence of ligaments 712. As indicated, inflation fluid injected into hood 710 may extend and bulge regions 720 of hood 710 without the presence of ligaments resulting in dimensional inconsistencies and reduced axial strength of the walls of inflatable hood 710.
Another variation is illustrated in the side views of FIGS. 64A to 64C which shows a reconfigurable mesh structure 730 which may have a layer of elastic coating or covering 732, e.g., latex, polyurethane etc. Once mesh 730 is advanced from catheter 16, as shown in FIG. 64A, it may be placed into contact with tissue surface T. With the application of an axial load, the distal portion of mesh 730 may expand while the elastic coating or covering 732 may stretch and conform to the underlying tissue, as shown in FIG. 64B. Mesh structure 730 when fully deployed in its final configuration, as shown in FIG. 64C, may expand laterally into a conical shape that conforms to and seals against the tissue and that defines an open area between catheter 16 and the underlying tissue surface. Upon release, mesh 730 may return to its original low-profile shape.
FIGS. 65A to 65C shows another variation where the encapsulated mesh structure may comprises a self-expanding mesh 740 fabricated from a shape memory material, such as nickel-titanium alloy. Self-expanding mesh 740 may also comprise an elastic coating or coveting 742, as above. After delivering the device intravascularly in its low-profile configuration, shown in FIG. 65A, the mesh may be urged distally to be free from the constraints of catheter 16 where it may then begin to self-expand into its deployed conical configuration, as shown in FIGS. 65B and 65C.
In yet another variation, FIG. 66 shows a perspective view of catheter 16 having hood 12 positioned upon a neck joint 750 having a gusseted coupling which may be passively articulated to bend such that hood 12 may be bent over a wide range of angles, indicated by the direction of articulation 752, relative to catheter 16 to enable better contact and sealing between the hood 12 and tissue surface T. The gusseted neck joint 750 may also prevent sealing problems related to the relative motion of the tissue wall due to regular muscular contractions, such as the beating of the heart. Moreover, neck joint 750 may provide the flexibility for hood 12 to be constantly engaged relative to the tissue surface perpendicularly.
FIG. 67 shows yet another variation in the perspective view of hood 12 having suction catheter 760 advanceable from catheter 16 distally of hood 12. A suction hood 762 may be disposed upon the distal end of suction catheter 760 which may be used to contact the tissue surface T. Suction with the tissue surface is created when an axial load is applied to the suction hood 762. When stable engagement by the suction hood 762 is achieved, hood 12 can be advanced into contact with the tissue surface T as guided by suction hood 762. The suction hood 762 may also provide additional stability and better sealing between the tissue surface T and hood 12.
FIGS. 68A and 68B show side views of yet another variation where hood 12 includes a plurality of overlapping extension flaps 770 over the circumference of hood 12. When pressed against a tissue surface by axial load 772, as shown in FIG. 68B, each adjacent flap 770 may overlie one another and flare radially to ensure enhanced sealing between hood 12 and tissue surface T engaged. As shown in the perspective views of FIGS. 69A and 69B, as hood 12 is expanded and pressed against the tissue surface, the overlapping flaps 770 may flare radially against the tissue surface to provide enhanced sealing, particularly against regions of uneven anatomy 774.
FIGS. 70A and 70B show perspective and side views, respectively, of another variation utilizing a plurality of flaps 780 which are angled relative to a longitudinal axis of hood 12. When pressed against the tissue surface, as shown in the perspective view of FIG. 70C, each adjacent angled flap 780 may be overlie one another to create a temporary seal against the tissue surface.
FIG. 71 shows another variation where hood 12, upon contact with tissue surface, suctions away any blood 30 within the hood 12 through suction lumen 796 within the catheter 16. A gas 794, such as CO2 gas, may be injected through lumens 792 defined through or along hood 12 and into hood 12 through one or more gas injection ports 790 situated at the end of the hood 12 to replace the displaced blood 30. The blood replaced by the CO2 gas within hood 12 may allow for direct real-time visualization of the tissue surface via an imaging element positioned along the hood interior or in the distal end of catheter 16, as above. By controlling the amount of CO2 gas to be injected into hood 12, a pressure seal between the tissue surface and the hood can be obtained as well.
Citations de brevets Brevet cit� Date de d�p�t Date de publication D�posant TitreUS62302211 avr. 1899 Titre non disponibleUS23054626 juin 194115 d�c. 1942Richard WolfCystoscopic instrumentUS387438812 f�vr. 19731 avr. 1975Alton Ochsner Medical FoundationShunt defect closure systemUS41755458 ao�t 197727 nov. 1979Zafmedico Corp.Method and apparatus for fiber-optic cardiovascular endoscopyUS43265295 d�c. 197927 avr. 1982The United States Of America As Represented By The United States Department Of EnergyCorneal-shaping electrodeUS44458926 mai 19821 mai 1984Laserscope, Inc.Dual balloon catheter deviceUS447040711 mars 198211 sept. 1984Laserscope, Inc.Endoscopic deviceUS456933522 mars 198411 f�vr. 1986Sumitomo Electric Industries, Ltd.FiberscopeUS457614622 mars 198418 mars 1986Sumitomo Electric Industries, Ltd.FiberscopeUS461533330 janv. 19857 oct. 1986Olympus Optical Co., Ltd.Rigid endoscope of oblique window typeUS461924723 mars 198428 oct. 1986Sumitomo Electric Industries, Ltd.CatheterUS46762585 juin 198630 juin 1987Kureha Kagaku Kogyo Kabushiki KaishaDevice for hyperthermiaUS468109312 d�c. 198321 juil. 1987Sumitomo Electric Industries, Ltd.EndoscopeUS470969814 mai 19861 d�c. 1987Thomas J. FogartyHeatable dilation catheterUS471019217 oct. 19861 d�c. 1987Liotta; Domingo S.Diaphragm and method for occlusion of the descending thoracic aortaUS472741820 juin 198623 f�vr. 1988Olympus Optical Co., Ltd.Image processing apparatusUS478413328 janv. 198715 nov. 1988Mackin; Robert A.Working well balloon angioscope and methodUS48483239 f�vr. 198818 juil. 1989Daniel Den Hoed StichtingApparatus for, and method of, examining and/or illuminating a body cavityUS491114814 mars 198927 mars 1990Intramed Laboratories, Inc.Deflectable-end endoscope with detachable flexible shaft assemblyUS49145213 f�vr. 19893 avr. 1990Adair; Edwin L.Sterilizable video camera coverUS494329027 avr. 198924 juil. 1990Concept Inc.Electrolyte purging electrode tipUS495028527 nov. 198921 ao�t 1990Wilk; Peter J.Suture deviceUS495748426 juil. 198818 sept. 1990Automedix Sciences, Inc.Lymph access catheters and methods of administrationUS496041130 juin 19882 oct. 1990Medtronic Versaflex, Inc.Low profile sterrable soft-tip catheterUS49617382 d�c. 19879 oct. 1990Mackin; Robert A.Angioplasty catheter with illumination and visualization within angioplasty balloonUS497671015 nov. 198811 d�c. 1990Mackin; Robert A.Working well balloon methodUS49915784 avr. 198912 f�vr. 1991Siemens-Pacesetter, Inc.Method and system for implanting self-anchoring epicardial defibrillation electrodesUS49940692 nov. 198819 f�vr. 1991Target TherapeuticsVaso-occlusion coil and methodUS49989164 janv. 199012 mars 1991Hammerslag; Gary R.Steerable medical deviceUS499897223 mars 198912 mars 1991Thomas J. FogartyReal time angioscopy imaging systemUS50571069 juil. 199015 oct. 1991Kasevich Associates, Inc.Microwave balloon angioplastyUS509095913 sept. 199025 f�vr. 1992Advanced Cardiovascular Systems, Inc.Imaging balloon dilatation catheterUS512342810 oct. 199123 juin 1992Marger, Johnson, Mccollom Et Al.Laparoscopically implanting bladder control apparatusUS517125930 mars 199115 d�c. 1992Inoue; KanjiDevice for nonoperatively occluding a defectUS52812383 mars 199325 janv. 1994Chin; Albert K.Endoscopic ligation instrumentUS52828275 mars 19921 f�vr. 1994Kensey Nash CorporationHemostatic puncture closure system and method of useUS530623423 mars 199326 avr. 1994State Street Bank & Trust Corporate Trust Dept.Method for closing an atrial appendageUS531394325 sept. 199224 mai 1994Ep Technologies, Inc.Catheters and methods for performing cardiac diagnosis and treatmentUS53304966 mai 199119 juil. 1994Alferness; Clifton A.Vascular catheter assembly for tissue penetration and for cardiac stimulation and methods thereofUS533415930 mars 19922 ao�t 1994Symbiosis CorporationThoracentesis needle assembly utilizing check valveUS533419313 nov. 19922 ao�t 1994American Cardiac Ablation Co., Inc.Fluid cooled ablation catheterUS533625222 juin 19929 ao�t 1994Cohen; Donald M.System and method for implanting cardiac electrical leadsUS53398005 f�vr. 199323 ao�t 1994Devmed Group Inc.Lens cleaning means for invasive viewing medical instruments with anti-contamination meansUS53485541 d�c. 199220 sept. 1994Cardiac Pathways CorporationCatheter for RF ablation with cooled electrodeUS535379226 juil. 199311 oct. 1994Avl Medical Instruments AgSensing deviceUS537064713 mai 19936 d�c. 1994Surgical Innovations, Inc.Tissue and organ extractorUS53738402 oct. 199220 d�c. 1994Cardiothoracic Systems, Inc.Endoscope and method for vein removalUS537561230 mars 199327 d�c. 1994B. Braun CelsaPossibly absorbable blood filterUS538514830 juil. 199331 janv. 1995The Regents Of The University Of CaliforniaCardiac imaging and ablation catheterUS54033261 f�vr. 19934 avr. 1995The Regents Of The University Of CaliforniaMethod for performing a gastric wrap of the esophagus for use in the treatment of esophageal refluxUS540537627 ao�t 199311 avr. 1995Medtronic, Inc.Method and apparatus for ablationUS54213383 juin 19946 juin 1995Boston Scientific CorporationAcoustic imaging catheter and the likeUS543164927 ao�t 199311 juil. 1995Medtronic, Inc.Method and apparatus for R-F ablationUS545378528 juil. 199326 sept. 1995Jos. Schneider Optische Werke Kreuznach Gmbh & Co. KgMeasurement camera with fixed geometry and rigid length supportUS546252121 d�c. 199331 oct. 1995Angeion CorporationFluid cooled and perfused tip for a catheterUS547151528 janv. 199428 nov. 1995California Institute Of TechnologyActive pixel sensor with intra-pixel charge transferUS54982303 oct. 199412 mars 1996Adair; Edwin L.Sterile connector and video camera cover for sterile endoscopeUS550573024 juin 19949 avr. 1996Stuart D. EdwardsThin layer ablation apparatusUS551585328 mars 199514 mai 1996Sonometrics CorporationThree-dimensional digital ultrasound tracking systemUS55273389 d�c. 199318 juin 1996Board Of Regents, The University Of Texas SystemIntravascular deviceUS554960328 nov. 199427 ao�t 1996Feiring; Andrew J.Method and apparatus for inducing the permeation of medication into internal tissueUS555861915 sept. 199424 sept. 1996Olympus Optical Co., Ltd.Endoscope system with automatic control according to movement of an operatorUS55710886 juin 19955 nov. 1996Boston Scientific CorporationAblation cathetersUS557575612 ao�t 199419 nov. 1996Olympus Optical Co., Ltd.Endoscope apparatusUS557581015 sept. 199519 nov. 1996Ep Technologies, Inc.Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the likeUS558487211 mars 199417 d�c. 1996Scimed Life Systems, Inc.Electrophysiology energy treatment devices and methods of useUS55911197 d�c. 19947 janv. 1997Adair; Edwin L.Sterile surgical coupler and drapeUS55934059 janv. 199514 janv. 1997Osypka; PeterFiber optic endoscopeUS55934226 janv. 199514 janv. 1997Kensey Nash CorporationOcclusion assembly for sealing openings in blood vessels and a method for sealing openings in blood vesselsUS559342410 ao�t 199414 janv. 1997Segmed, Inc.Apparatus and method for reducing and stabilizing the circumference of a vascular structureUS567215326 sept. 199430 sept. 1997Vidamed, Inc.Medical probe device and methodUS567669314 juin 199414 oct. 1997Scimed Life Systems, Inc.Electrophysiology deviceUS568130828 nov. 199428 oct. 1997Stuart D. EdwardsAblation apparatus for cardiac chambersUS569544825 ao�t 19959 d�c. 1997Olympus Optical Co., Ltd.Endoscopic sheathUS56972817 juin 199516 d�c. 1997Arthrocare CorporationSystem and method for electrosurgical cutting and ablationUS569788222 nov. 199516 d�c. 1997Arthrocare CorporationSystem and method for electrosurgical cutting and ablationUS57092247 juin 199520 janv. 1998Radiotherapeutics CorporationMethod and device for permanent vessel occlusionUS571390720 juil. 19953 f�vr. 1998Endotex Interventional Systems, Inc.Apparatus and method for dilating a lumen and for inserting an intraluminal graftUS571394628 oct. 19963 f�vr. 1998Biosense, Inc.Apparatus and method for intrabody mappingUS571632110 oct. 199510 f�vr. 1998Conceptus, Inc.Method for maintaining separation between a falloposcope and a tubal wallUS572240328 oct. 19963 mars 1998Ep Technologies, Inc.Systems and methods using a porous electrode for ablating and visualizing interior tissue regionsUS572552329 mars 199610 mars 1998Eclipse Surgical Technologies, Inc.Lateral-and posterior-aspect method and apparatus for laser-assisted transmyocardial revascularization and other surgical applicationsUS574674713 mai 19945 mai 1998Mckeating; John A.Polypectomy instrumentUS57498467 juin 199512 mai 1998Vidamed, Inc.Medical probe device with optical viewing capabilityUS57498903 d�c. 199612 mai 1998Incept, LlcMethod and system for stent placement in ostial lesionsUS575431317 juil. 199619 mai 1998Welch Allyn, Inc.Imager assemblyUS576613712 sept. 199616 juin 1998Axiom Co., Ltd.Frequency deviation detecting circuit and measuring apparatus using the frequency deviation detecting circuitUS576984621 avr. 199523 juin 1998Stuart D. EdwardsAblation apparatus for cardiac chambersUS57920454 mars 199611 ao�t 1998Adair; Edwin L.Sterile surgical coupler and drapeUS579790312 avr. 199625 ao�t 1998Ep Technologies, Inc.Tissue heating and ablation systems and methods using porous electrode structures with electrically conductive surfacesUS582726830 oct. 199627 oct. 1998Hearten Medical, Inc.Device for the treatment of patent ductus arteriosus and method of using the deviceUS58294477 mai 19963 nov. 1998Heartport, Inc.Method and apparatus for thoracoscopic intracardiac proceduresUS584311827 f�vr. 19971 d�c. 1998Target Therapeutics, Inc.Fibered micro vaso-occlusive devicesUS584896928 oct. 199615 d�c. 1998Ep Technologies, Inc.Systems and methods for visualizing interior tissue regions using expandable imaging structuresUS586097411 f�vr. 199719 janv. 1999Boston Scientific CorporationHeart ablation catheter with expandable electrode and method of coupling energy to an electrode on a catheter shaftUS586099122 ao�t 199719 janv. 1999Perclose, Inc.Method for the percutaneous suturing of a vascular puncture siteUS586579123 juin 19972 f�vr. 1999E.P. Technologies Inc.Atrial appendage stasis reduction procedure and devicesUS587381523 juin 199723 f�vr. 1999Conceptus, Inc.Access catheter and method for maintaining separation between a falloposcope and a tubal wallUS587936620 d�c. 19969 mars 1999W.L. Gore & Associates, Inc.Self-expanding defect closure device and method of making and usingUS604721823 avr. 19994 avr. 2000Ep Technologies, Inc.Systems and methods for visualizing interior tissue regionsUS642853621 d�c. 20006 ao�t 2002Ep Technologies, Inc.Expandable-collapsible electrode structures made of electrically conductive materialUS667983621 juin 200220 janv. 2004Scimed Life Systems, Inc.Universal programmable guide catheterUS2005011952327 ao�t 20042 juin 2005Guided Delivery Systems, Inc.Cardiac visualization devices and methodsUSRE3400212 sept. 199021 juil. 1992 Sterilizable video camera coverCitations hors brevetsR�f�rence1Avitall, A Catheter System to Ablate Atrial Fibrillation in a Sterile Pericarditis Dog Model, PACE, vol. 17, p. 774, 1994.2Avitall, Right-Sided Driven Atrial Fibrillation in a Sterile Pericarditis Dog Model, PACE, vol. 17, p. 774, 1994.3Avitall, Vagally Mediated Atrial Fibrillation in a Dog Model can be Ablated by Placing Linear Radiofrequency Lesions at the Junction of the Right Atrial Appendage and the Superior Vena Cava, PACE, vol. 18, p. 857, 1995.4Baker, Nonpharmacologic Approaches to the Treatment of Atrial Fibrillation and Atrial Flutter, J. Cardiovasc. Electrophysiol., vol. 6, pp. 972-978, 1995.5Bhakta, Principles of Electroanatomic Mapping, Indian Pacing & Electrophysiol J., vol. 8, No. 1, pp. 32-50, 2008.6Bidoggia, Transseptal Left Heart Catheterization: Usefulness of the Intracavitary Electrocardiogram in the Localization of the Fossa Ovalis, Cathet Cardiovasc Diagn., vol. 24, No. 3, pp. 221-225, 1991.7Bredikis, Surgery of Tachyarrhythmia: Intracardiac Closed Heart Cryoablation, PACE, vol. 13, pp. 1980-1984, 1990.8Cox, Cardiac Surgery for Arrhythmias, J. Cardiovasc. Electrophysiol., vol. 15, pp. 250-262, 2004.9Cox, Five-Year Experience With the Maze Procedure for Atrial Fibrillation, Ann. Thorac. Surg., vol. 56, pp. 814-824, 1993.10Cox, Modification of the Maze Procedure for Atrial Flutter and Atrial Fibrillation, J. Thorac. Cardiovasc. Surg., vol. 110, pp. 473-484, 1995.11Cox, The Status of Surgery for Cardiac Arrhythmias, Circulation, vol. 71, pp. 413-417, 1985.12Cox, The Surgical Treatment of Atrial Fibrillation, J. Thorac Cardiovasc. Surg., vol. 101, pp. 584-592, 1991.13Elvan, Radiofrequency Catheter Ablation (RFCA) of the Atria Effectively Abolishes Pacing Induced Chronic Atrial Fibrillation, PACE, vol. 18, p. 856, 1995.14Elvan, Radiofrequency Catheter Ablation of the Atria Reduces Inducibility and Duration of Atrial Fibrillation in Dogs, Circulation, vol. 91, pp. 2235-2244, 1995.15Elvan, Replication of the "Maze" Procedure by Radiofrequency Catheter Ablation Reduces the Ability to Induce Atrial Fibrillation, PACE, vol. 17, p. 774, 1994.16European Patent Application No. 06734083.6 filed Jan. 30, 2006 in the name of Saadat et al., Examination Communication mailed May 18, 2010.17European Patent Application No. 06734083.6 filed Jan. 30, 2006 in the name of Saadat et al., extended European Search Report mailed Jul. 1, 2009.18European Patent Application No. 06734083.6 filed Jan. 30, 2006 in the name of Saadat et al., office action mailed Oct. 23, 2009.19European Patent Application No. 06734083.6 filed Jan. 30, 2006 in the name of Voyage Medical, Inc., Office Action mailed Nov. 12, 2010.20European Patent Application No. 07758716.0 filed Mar. 16, 2007 in the name of Voyage Medical, Inc., Supplemental European Search Report mailed Feb. 28, 2011.21European Patent Application No. 07799466.3 filed Jul. 10, 2007 in the name of Voyage Medical, Inc., European Search Report mailed Nov. 18, 2010.22European Patent Application No. 07812146.4 filed Jun. 14, 2007 in the name of Voyage Medical, Inc., European Search Report mailed Nov. 18, 2010.23European Patent Application No. 07841754.0 filed Aug. 31, 2007 in the name of Saadat et al., Supplemental European Search Report mailed Jun. 30, 2010.24European Patent Application No. 08746822.9 filed Apr. 24, 2008 in the name of Rothe et al., European Search Report mailed Mar. 29, 2010.25European Patent Application No. 08746822.9 filed Apr. 24, 2008 in the name of Rothe et al., Office Action mailed Jul. 13, 2010.26Fieguth, Inhibition of Atrial Fibrillation by Pulmonary Vein Isolation and Auricular Resection-Experimental Study in a Sheep Model, European J. Cardiothorac. Surg., vol. 11, pp. 714-721, 1997.27Fieguth, Inhibition of Atrial Fibrillation by Pulmonary Vein Isolation and Auricular Resection�Experimental Study in a Sheep Model, European J. Cardiothorac. Surg., vol. 11, pp. 714-721, 1997.28Hoey, Intramural Ablation Using Radiofrequency Energy Via Screw-Tip Catheter and Saline Electrode, PACE, vol. 18, p. 487, 1995.29Huang, Increase in the Lesion Size and Decrease in the Impedance Rise with a Saline Infusion Electrode Catheter for Radiofrequency, Circulation, vol. 80, No. 4, pp. II-324, 1989.30Japanese Patent Application No. 2007-554156 filed Jan. 30, 2006 in the name of Voyage Medical, Inc., Notice of Allowance mailed Jun. 13, 2011.31Japanese Patent Application No. 2007-554156 filed Jan. 30, 2006 in the name of Voyage Medical, Inc., Office Action mailed Feb. 15, 2011.32Japanese Patent Application No. 2009-500630 filed Mar. 16, 2007 in the name of Voyage Medical, Inc., Office Action mailed Apr. 27, 2011.33Moser, Angioscopic Visualization of Pulmonary Emboli, CHEST, vol. 77, No. 2, pp. 198-201, 1980.34Nakamura, Percutaneous Intracardiac Surgery With Cardioscopic Guidance, SPIE, vol. 1652, pp. 214-216, 1992.35Pappone, Circumferential Radiofrequency Ablation of Pulmonary Vein Ostia, Circulation, vol. 102, pp. 2619-2628, 2000.36Sethi, Transseptal Catheterization for the Electrophysiologist: Modification with a "View", J. Interv. Card. Electrophysiol., vol. 5, pp. 97-99, 2001, Kluwer Academic Publishers, Netherlands.37Thiagalingam, Cooled Needle Catheter Ablation Creates Deeper and Wider Lesions than Irrigated Tip Catheter Ablation, J. Cardiovasc. Electrophysiol., vol. 16, pp. 1-8, 2005.38U.S. Appl. No. 11/259,498, filed Oct. 25, 2005 in the name of Saadat et al., Non-final Office Action mailed Feb. 25, 2010.39U.S. Appl. No. 11/259,498, filed Oct. 25, 2005 in the name of Saadat, Notice of Allowance mailed Nov. 15, 2010.40U.S. Appl. No. 11/560,732, filed Mar. 16, 2007 in the name of Saadat, Notice of Allowance mailed Feb. 24, 2011.41U.S. Appl. No. 11/560,732, filed Nov. 16, 2006 in the name of Saadat, Notice of Allowance mailed Feb. 3, 2011.42U.S. Appl. No. 11/560,742, filed Nov. 16, 2006 in the name of Saadat, Non-final Office Action mailed Jun. 10, 2010.43U.S. Appl. No. 11/560,742, filed Nov. 16, 2006 in the name of Saadat, Notice of Allowance mailed Nov. 15, 2010.44U.S. Appl. No. 11/687,597, filed Mar. 16, 2007 in the name of Saadat et al., Non-final Office Action mailed Jul. 21, 2010.45U.S. Appl. No. 11/687,597, filed Mar. 16, 2007 in the name of Saadat, Notice of Allowance mailed Feb. 24, 2011.46U.S. Appl. No. 11/763,399, filed Jun. 14, 2007 in the name of Saadat et al., non-final Office Action mailed Apr. 11, 2011.47U.S. Appl. No. 11/775,819, filed Jul. 10, 2007 in the name of Saadat et al., non-final Office Action mailed May 20, 2011.48U.S. Appl. No. 11/775,837, filed Jul. 10, 2007 in the name of Saadat et al., non-final Office Action mailed May 23, 2011.49U.S. Appl. No. 11/828,267, filed Jul. 25, 2007 in the name of Saadat et al., final Office Action mailed Sep. 16, 2010.50U.S. Appl. No. 11/828,267, filed Jul. 25, 2007 in the name of Saadat et al., Non-final Office Action mailed Jan. 14, 2010.51U.S. Appl. No. 11/828,267, filed Jul. 25, 2007 in the name of Saadat et al., non-final Office Action mailed May 11, 2011.52U.S. Appl. No. 11/828,281, filed Jul. 25, 2007 in the name of Peh et al., non-final Office Action mailed Apr. 27, 2011.53U.S. Appl. No. 11/848,202, filed Aug. 30, 2007 in the name of Saadat et al., non-final Office Action mailed Mar. 11, 2011.54U.S. Appl. No. 11/848,207, filed Aug. 30, 2007 in the name of Saadat et al., non-final Office Action mailed Feb. 25, 2011.55U.S. Appl. No. 11/848,429, filed Aug. 31, 2007 in the name of Peh et al., non-final Office Action mailed Nov. 24, 2010.56U.S. Appl. No. 11/848,532, filed Aug. 31, 2007 in the name of Saadat et al., non-final Office Action mailed Apr. 26, 2011.57U.S. Appl. No. 11/877,386, filed Oct. 23, 2007 in the name of Saadat et al., non-final Office Action mailed May 20, 2011.58U.S. Appl. No. 11/959,158, filed Dec. 18, 2007 in the name of Saadat et al., non-final Office Action mailed Apr. 25, 2011.59U.S. Appl. No. 11/961,950, filed Dec. 20, 2007 in the name of Saadat et al., non-final Office Action mailed May 9, 2011.60U.S. Appl. No. 11/961,995, filed Dec. 20, 2007 in the name of Saadat et al., non-final Office Action mailed May 9, 2011.61U.S. Appl. No. 11/962,029, filed Dec. 20, 2007 in the name of Saadat et al., non-final Office Action mailed May 9, 2011.62U.S. Appl. No. 12/026,455, filed Feb. 5, 2008 in the name of Saadat et al., non-final Office Action mailed Dec. 27, 2010.63U.S. Appl. No. 12/117,655, filed May 8, 2008 in the name of Peh et al., final Office Action mailed Jun. 2, 2011.64U.S. Appl. No. 12/117,655, filed May 8, 2008 in the name of Peh et al., Final Office Action mailed Mar. 1, 2010.65U.S. Appl. No. 12/117,655, filed May 8, 2008 in the name of Peh et al., non-final Office Action mailed Dec. 16, 2010.66U.S. Appl. No. 12/117,655, filed May 8, 2008 in the name of Saadat et al., Non-final Office Action mailed Jun. 8, 2009.67U.S. Appl. No. 12/323,281, filed Nov. 25, 2008 in the name of Saadat et al., non-final Office Action mailed Jun. 7, 2011.68U.S. Appl. No. 12/367,019, filed Feb. 6, 2009 in the name of Miller et al., non-final Office Action mailed Apr. 22, 2011.69U.S. Appl. No. 12/464,800, filed May 12, 2009 in the name of Peh et al., non-final Office Action mailed Nov. 24, 2010.70U.S. Appl. No. 12/499,011, filed Jul. 7, 2009 in the name of Rothe et al., non-final Office Action mailed Apr. 12, 2011.71U.S. Appl. No. 12/947,198, filed Nov. 16, 2010 in the name of Saadat, non-final Office Action mailed Feb. 18, 2011.72U.S. Appl. No. 12/947,246, filed Nov. 16, 2006 in the name of Saadat, Notice of Allowance mailed Feb. 18, 2011.73U.S. Appl. No. 61/286,283, filed Dec. 14, 2009 in the name of Rothe et al.74U.S. Appl. No. 61/297,462, filed Jan. 22, 2010 in the name of Rothe et al.75Uchida, Developmental History of Cardioscopes, Coronary Angioscopy, pp. 187-197, 2001, Future Publishing Co., Armonk, NY.76Willkampf, Radiofrequency Ablation with a Cooled Porous Electrode Catheter, JACC, vol. 11, No. 2, p. 17A, 1988. R�f�renc� par Brevet citant Date de d�p�t Date de publication D�posant TitreUS834882712 juin 20078 janv. 2013Ethicon Endo-Surgery, Inc.Specimen removal pouchUS2008031249612 juin 200718 d�c. 2008Ethicon Endo-Surgery, Inc.Specimen removal pouchUS2012015004621 oct. 201114 juin 2012Voyage Medical, Inc.Tissue contrast imaging systemsFaire pivoterImage d'origineAccueil Google - Plan du site - T�l�chargements par lot sur l'USPTO - R�gles de confidentialit� - Conditions d'utilisation - � propos de Google�Brevets - Envoyer des commentairesDonn�es fournies par IFI CLAIMS Patent Services©2012 Google