Percutaneous access systems, including trocars, for accessing desired locations within a subject's body through the subject's skin or other tissues that are configured to minimize incision sizes are disclosed. Such a percutaneous access system includes a cannula and an obturator. The cannula includes a passageway with a tapered section and an expandable section at its distal end. The expandable section may include leaves that are configured to extend radially outward as an elongated instrument that has an outer diameter that exceeds a minimum relaxed inner diameter of the tapered section of the passageway is forced through the tapered section. Methods for using such a percutaneous access system, including medical procedures, are also disclosed.

A catheter or guide wire manipulating device for vascular intervention is provided, comprising a thumb component (3), a forefinger component (4), a driving component (1) and a catheter/guide wire support component (2); the thumb component comprises a roller (7) configured to advance or retreat the catheter/guide wire; the thumb component (3) is configured to drive the catheter/guide wire to rotate clockwise or counterclockwise through a combination motion of the components; the forefinger component (4) is configured to cooperate with the thumb component (3) to implement the rotation and the advancement of the catheter/guide wire by moving manually away from the thumb component, and returning by a pull force of a spring (23) after being released; the driving component (1) is configured to drive the thumb component (3) and the forefinger component (4); the catheter/guide wire support component (2) comprises a Y adapter fixation configured to install a Y adapter and an entry support configured to support and guide the catheter/guide wire into a mechanism.

Tip confirmation systems and related methods are disclosed. A method of determining one or more properties of a catheter in a patient comprises advancing a catheter in vasculature of a patient, the catheter coupled to at least one radiation source and at least one detector, transmitting source electromagnetic radiation from the at least one radiation source out of the catheter proximate a distal tip thereof, measuring an intensity of backscattered electromagnetic radiation from the at least one radiation source with the at least one detector, and providing a signal indicative of a location of the distal tip within the vasculature based, at least in part, on the measured intensity of the backscattered electromagnetic radiation. Related systems and methods are also disclosed.

Apparatus for percutaneous access to a patient's body comprising a first steerable tube (12), shaped to define a first lumen, and a first coupling (152) at a longitudinal site of the first tube; and a second steerable tube (14), shaped to define a second lumen and a second coupling (154), the second coupling being intracorporeally couplable to the first coupling, the apparatus having (A) an unlocked state in which the second tube is rotatable within the first lumen, and (B) a locked state in which the second coupling is coupled to the first coupling, and rotation of the second tube is inhibited. The apparatus is configured such that when the second coupling becomes disposed at the longitudinal site in a given rotational orientation of the second tube, the apparatus moves into the locked state by the second coupling automatically coupling to the first coupling. Other embodiments are also described.

Apparatus and methods for placement of electrodes into selected tissue, such as the septal wall separating the left and right ventricles, with, in some cases, access to the septal wall from the right ventricle. Torque sleeves may be used to provide for rotation as needed.

A percutaneously delivered medical device and its method of use includes a catheter, at least two electromagnetic sensing coils located within the distal tip of the catheter, and at least one within the proximal handle, and a multi-element planar ultrasound transducer array located within the distal tip of the catheter and configured to transmit and receive ultrasonic energy in at least two imaging modes. The device also includes an imaging system coupled to the ultrasound transducer and is used for creating an image of tissue in a first target plane that extends orthogonally from the catheter body. The medical device also includes a backscatter evaluation system for use in receiving and evaluating the acoustic spectral characteristics of tissues within a second target area within the first target plane.

A medical device can be localized by providing at least three non-colinear localization elements (e.g., electrodes) thereon. Once placed in a non-ionizing localization field, three adjacent localization elements, at least one of which will typically be a spot electrode, may be selected, and the non-ionizing localization field may be used to measure their locations. A cylinder is defined to fit the measured locations of the selected localization elements. The cylinder is rotationally oriented using the measured location of a spot electrode. Location and rotational attitude information may be used to construct a three-dimensional representation of the medical device within the localization field. The electrodes may be provided on the medical device or on a sheath into which the medical device is inserted. The invention also provides systems and methods for identifying and calibrating deflection planes where the medical device and/or sheath are deflectable.

A force exerted on a distal end of an elongate medical device can be determined. A graphical representation of the distal end of the elongate medical device and a graphical representation of the force exerted on the distal end of the elongate medical device can be computed. The graphical representation of the force can emanate from the graphical representation of the distal end of the elongate medical device. A first dimension of the graphical representation of the force can be increased in response to a longitudinal force being exerted on the distal end of the elongate medical device. A second dimension of the graphical representation of force can be increased in response to a lateral force being exerted on the distal end of the elongate medical device.

According to one embodiment, a balloon catheter includes a balloon located at a distal end of the balloon catheter. The balloon includes a first transferrable marking and a second transferrable marking on an exterior surface of the balloon. The first transferrable marking includes a partially IR-transmittable marking material. The second transferrable marking includes an IR-transmittable marking material. An OCT probe including the balloon catheter and a method of using the OCT probe are also disclosed.

A method and apparatus are disclosed for a reinforced steerable sheath assembly that is usable with an actuator comprising a shaft section defining a sheath that is operable to be deflected, and one or more pull wires that are coupled to the sheath via a coupling at a point of contact between the pull wires and the sheath. The pull wires being operable to be coupled to the actuator for actuating the pull wires. The reinforced steerable sheath assembly further comprises a means for preventing displacement of the coupling, wherein the means for preventing displacement to minimize failure at the coupling at the point of contact between the pull wires and the sheath upon actuation of the pull wires upon actuation of the actuator to deflect the sheath.