A wall (39) of a catheter (38) (a) includes a braided portion (41) having an outer surface (45), an inner surface (47), and a braided interior (53) between the outer and inner surfaces (45, 47), and (b) is shaped to define first and second longitudinally-running channels (27a, 27b) therethrough. A distal portion of the catheter (38) is shaped to define first and second lateral openings (26a, 26b). An angle between (a) a first line (76) running between the first and second lateral openings (26a, 26b), and (b) a second line (78) that is parallel to a central longitudinal axis of the catheter (38) when the catheter (38) is straight, is between 30 and 150 degrees. A flexible longitudinal member (14) passes from a proximal portion of the catheter (38) to the distal portion via the first channel (27a), out of the first channel (27a) via the first lateral opening (26a), into the second channel (27b) via the second lateral opening (26b), and from the distal portion to the proximal portion via the second channel (27b).

The present invention relates to a method for positioning a tip of a pacemaker lead that has passed through coronary sinus into an interventricular septum. More particularly, it relates to a method for positioning a tip of a pacemaker lead that has passed through a coronary sinus into an interventricular septum in order to more effectively transmit an electrical stimulus in a treatment using a pacemaker for patients with arrhythmia. A method of positioning a tip of a pacemaker lead, which has passed through a coronary sinus, into an interventricular septum, in order to effectively transmit electrical stimulus, includes: inserting into an intervention wire through a superior vena cava and a coronary sinus to pass through the interventricular septum and then guiding the intervention wire to an inferior vena cava; and positioning the tip of the lead into the interventricular septum by inserting the pacemaker lead along the intervention wire.

Apparatus and methods are described, including apparatus for puncturing a fossa ovalis of a heart. The apparatus includes a catheter shaped to define a catheter lumen. A puncturing element is slidably disposed within the catheter lumen, and is deployed from a distal portion of the catheter and to puncture the fossa ovalis. A probing element is deployed from the distal portion of the catheter. Upon being deployed, the probing element probes tissue near the fossa ovalis, the probing element having a first configuration thereof upon probing the tissue near the fossa ovalis. Upon probing tissue of the fossa ovalis, the probing element facilitates positioning of the puncturing element, by automatically adopting a second configuration thereof that is different from the first configuration. Other applications are also described.

The present teachings provide devices and methods for percutaneously removing internal tissue. Specifically, one aspect of the present teachings provides a tissue incising element with a sharp cutting edge and a longitudinal lumen and a tissue stabilizer slidably disposed within the longitudinal lumen of the tissue incising element. The tissue incising element has a deployed configuration during tissue cutting and a small collapsed configuration during the percutaneous delivery and removal. The tissue stabilizer includes a tissue supporting/gripping element configured to support tissue during incising and capture the removed tissue.

Devices and methods are provided for performing a medical procedure using a trans-septal approach. The device includes a dilator including a proximal end, a distal end terminating in a distal tip, and a lumen extending between the dilator proximal and distal ends, and a needle device including a proximal end, a distal end sized for introduction into the dilator lumen and terminating in a sharpened distal tip. The needle is movable relative to the dilator to selectively expose the needle device distal tip distally from the dilator lumen and advance the dilator relative to the needle device. The dilator may have a complex tapered shape on its distal tip, e.g., including first and second tapered regions. The needle device may include an inner needle including the sharpened distal tip and an outer tube including a substantially blunt distal end that slidably receives the inner needle.

Embodiments of the present disclosure are directed to implantable sealing devices, delivery apparatuses, and methods of their use, for closing surgical openings or defects in a sidewall of a vessel in a subject. In several embodiments, the disclosed implantable sealing devices, delivery apparatuses, and methods can be used to close a surgical opening in a sidewall of the heart.

A blood flow regulator for creating a shunt in the heart, comprising; a proximal element having a general disc-shape, defined by a braid of one or more wires extending about a central aperture of the proximal element; a distal element having a general disc-shape, defined by a braid of one or more wires extending about a central aperture of the distal element; and a third element defining a neck section intermediate the proximal and distal elements and forming a cavity having a diameter no greater than a diameter of each of the distal and proximal elements, wherein said distal element comprises at least one loop of a wire extending radially outwardly from a center of the distal element and returning towards said center of said distal element.

An elongated catheter includes a tissue-engaging device configured to be urged to move and contact a first surface of the first biological wall. The tissue-engaging device extends from the distal catheter section. The tissue-engaging device is configured to be urged to puncture through the first biological wall. The tissue-engaging device is also configured to be urged to contact the first biological wall without impinging the second biological wall, after the tissue-engaging device has punctured through the first biological wall.

A transseptal needle or punch wherein the distal end of the transseptal needle is able to articulate laterally out of the longitudinal axis of the steerable transseptal needle. The transseptal needle further comprise a blunted distal end configuration that is minimally traumatic. Under control by the user or a computer, at the proximal end of the transseptal needle can be articulated to generate various curves with high bending force. The transseptal needle is configured for use within a transseptal introducer.

Devices, systems, and methods for treating a heart of a patient may make use of one or more implant structures which limit a size of a chamber of the heart, such as by deploying a tensile member to bring a wall of the heart toward (optionally into contact with) a septum of the heart.