A method and device for perforating an aortic valve to remove excessive calcium deposits on aortic valve leaflets improves the implantation of TAVI replacement valves in patients. By removing excessive calcium deposits, the radial pressure exerted by implanted TAVI replacement valves is reduced, such that there is less blood leakage around the valve and less stress on the cardiac conductive system. A device with a fusiform punch is inserted into the aortic valve. The punch is separable such that the aortic valve leaflets are positioned between at least two elements of the punch. The two elements then compress together with the leaflets between them, causing the aortic valve to be perforated. A circumferential ring of the remaining aortic valve and calcium deposits are left to provide stability for the TAVI replacement valve.

Described herein are shock wave devices and methods for the treatment of calcified heart valves. One variation of a shock wave device may comprise an elongated flexible tube carried by a sheath. The tube may have a fluid input end, which may be located near a proximal end of the sheath. The tube may include a loop portion. The loop portion may be configured to be at least partially accommodated within a cusp of the heart valve. The tube may be fillable with a conductive fluid. In some variations, the shock wave device may include an array of electrode pairs associated with a plurality of wires positioned within the loop portion of a tube. The electrode pairs may be electrically connectable to a voltage source and configured to generate shock waves in the conductive fluid in response to voltage pulses.

Devices, systems, and methods for removing or dividing valve leaflets, wherein the devices have an elongate shaft and a cutting tool disposed on or near a distal end of the shaft. Certain embodiments include a cutting tool comprising an expandable structure with a cutting element associated with the expandable structure. Other embodiments have a cutting tool that can extend out of an opening in the elongate shaft. Further implementations have a cutting tool that is a laser fiber, an ultrasound emitting tool, or a radiofrequency emitting tool. Some specific embodiments have a first expandable structure disposed at or near a distal end of the elongate shaft, and a second expandable structure disposed on the elongate shaft proximally of the first expandable structure, the second expandable structure comprising at least one distal projection, wherein the at least one distal projection comprises a cutting tool. Other implementations have a cutting tool comprising first and second jaw arms and first and second blades coupled to the first and second jaw arms, respectively.

Articulation devices, systems, methods for articulation, and methods for fabricating articulation structures will often include simple balloon arrays, with inflation of the balloons interacting with elongate skeletal support structures so as to locally alter articulation of the skeleton. The skeleton may comprise a simple helical coil or interlocking helical channels, and the array can be used to locally deflect or elongate an axis of the coil under control of a processor. Liquid inflation fluid may be directed so as to pressurize the balloons from an inflation fluid canister, and may vaporize within a plenum or the channels or balloons of the articulation system, with the inflation system preferably including valves controlled by the processor. The articulation structures can be employed in minimally invasive medical catheter systems, and also for industrial robotics, for supporting imaging systems, for entertainment and consumer products, and the like.

The present invention relates to an assembly for replacing a heart valve or coronary angioplasty assembly, including an insertion sheath (13) of an introducer (1) or a delivery catheter (1), which is smaller in size than an introducer, intended for being inserted into an artery of a human body. The invention essentially involves integrating the metal substrate of an electrode of the cardiac stimulator directly into the sheath for insertion into the artery of a patient.

An apparatus for treating or preventing a valvular disease comprises: a ultrasound probe located externally to a heart of patient, able to produce ultrasound waves focused inside the heart and suitable to generate, at a focal spot, a pressure sufficient to result in cavitation, an imaging device for mapping in real time a treatment region of a cardiac valve of the patient, the treatment region comprising at least one leaflet of the cardiac valve, a controller configured for driving the ultrasound probe to emit a sequence of focused ultrasound waves, the controller being further configured for steering the focused ultrasound waves so as to scan the entire treatment region to soften the tissues of the treatment region. A method for treating or preventing valvular disease, carried out using the apparatus is also provided.

A device includes a protection sleeve (10) and a retractable sheath (14) operatively connected to the protection sleeve (10), and a catheter (16) that passes through a main lumen (26) of the sleeve (10). The catheter (16) includes a heart valve treatment device arranged to pass into a lumen of the catheter (16).

A valvuloplasty system comprises a balloon adapted to be placed adjacent leaflets of a valve. The balloon is inflatable with a liquid. The system further includes a shock wave generator within the balloon that produces shock waves that propagate through the liquid for impinging upon the valve. The shock wave generator is moveable within the balloon to vary shock wave impingement on the valve.

Described here are angioplasty balloon devices for generating shock waves to break up calcified plaques along a length of a vessel and methods of making such devices. Generally, the devices may be used in angioplasty and/or valvuloplasty procedures, but may alternatively be used in other applications. In some variations, the device may include an elongate member, a plurality of electrode assemblies, and at least one tubular sleeve interposed between adjacent or neighboring electrode assemblies that form a continuous outer profile between the electrode assemblies. These devices may have a smooth, continuous outer profile without substantial profile transitions and/or may have stiffening sections between electrode assemblies.

Described herein are shock wave devices and methods for the treatment of calcified heart valves. One variation of a shock wave device may comprise an elongated flexible tube carried by a sheath. The tube may have a fluid input end, which may be located near a proximal end of the sheath. The tube may include a loop portion. The loop portion may be configured to be at least partially accommodated within a cusp of the heart valve. The tube may be fillable with a conductive fluid. In some variations, the shock wave device may include an array of electrode pairs associated with a plurality of wires positioned within the loop portion of a tube. The electrode pairs may be electrically connectable to a voltage source and configured to generate shock waves in the conductive fluid in response to voltage pulses.