The present teachings provide methods for resizing, reducing, and/or closing an atrial appendage. A delivery catheter is percutaneously advanced to the atrial appendage. At least two tissue anchors are implanted in tissue of the heart. Both tissue anchors are pulled together so that the atrial appendage is resized, reduced, and/or closed. This closure method and system could be used alone in closing the atrial appendage. This closure method and system could also be used in addition to other treatment mechanisms.

A handle apparatus comprising detachable hardware and void regions or attachment devices that accommodate the shape of surgical devices and imaging units such that the device is held securely and mechanically fixed to the imaging unit within the handle assembly.

A delivery device includes an inner shaft, an outer sheath, a nosecone, and a tether component. The outer sheath is slidably disposed over the inner shaft. The nosecone is removably coupled to the inner shaft. The nosecone includes a delivery configuration for delivery to a treatment site, a radially compressed configuration in which a portion of the nosecone is configured to traverse through a heart wall, and a radially expanded configuration in which an outer surface of the nosecone contacts an outer surface of the heart wall. The tether component includes a first end coupled to the nosecone. The nosecone is configured to plug a piercing in the heart wall when in the radially expanded configuration.

Provided herein is a catheter assembly including an imaging device for identifying an anatomical structure. The catheter assembly includes a patient cannula configured to be drawn along a catheter or guide wire; a transseptal puncture catheter at least partially enclosed within the patient cannula; and an imaging catheter. The imaging catheter includes a transducer configured to emit an energy beam capable of reflecting from an anatomical structure and to detect energy reflected from the structure. The catheter assembly also includes a transmitter for conveying a signal representative of the detected energy from the transducer to a signal processor for obtaining information about the structure. An imagining system and a method for identifying a predetermined transseptal puncture location on an atrial septum are also provided herein.

The present invention provides transseptal puncture devices configured to access structures on the left side of the heart from the right side of the heart without requiring open-heart surgery. The devices have adjustable stiffness to enter the vasculature in a flexible, atraumatic fashion, then become rigid once in place to provide a stable platform for penetration of the fossa ovalis. The devices are further configured to controllably and stably extend a needle to puncture the FO. The devices include an indwelling blunt stylus that can extend perpendicularly from the device to increase the accuracy of placement near the fossa ovalis.

A guide wire system configured to guide a medical device (e.g., a medical lead) to a target area within a patient. The guide wire system may be configured to penetrate and pass through a tissue wall in the patient to guide the medical device to the target area. The guide wire system includes a support section configured to expand to substantially maintain a position relative to the tissue wall. The guide wire system includes a pull wire configured to cause the support portion to expand. The expanded support section may provide counter-traction to a distal force on the tissue wall exerted by a medical device during, for example, fixation of the medical device to the target area, or other stages of an implantation. The support section is configured to re-establish an initial configuration for proximal withdrawal from the tissue wall.

A microcatheter with a guidewire therein can be steered to target tissue, then the target tissue can be punctured with the guidewire to create a transseptal puncture. The microcatheter can have a diameter substantially smaller than known sheaths which are typically used to guide a needle to a target puncture site in known transseptal puncture treatments. The guidewire can have an atraumatic, electrically conductive distal end that can be electrically energized to puncture the target tissue. Once the guide wire is across, ancillary devices such as a dilator and sheath can be delivered over the guide wire across the transseptal puncture. The microcatheter can include one or more location sensors. A navigation module can use the electrically conductive distal end as a reference electrode to the location sensor(s) of the microcatheter.

The present disclosure relates to a method and a device for treating heart failure by normalizing elevated blood pressure in the left and right atria of a heart of a mammal. The present disclosure includes methods for creating and maintaining an opening in the atrial septum. Tools for making an opening and enlarging the opening are also disclosed. Use of the techniques and tools described herein prolongs the patency of an intra-atrial pressure relief opening.

A steerable transseptal punch system and method of using the steerable transseptal punch system to access the left atrium.

Apparatus is described that includes a kit. The kit includes a flexible catheter (22) and a support (40). The catheter is transfemorally advanceable to a heart of a subject and the support is dimensioned for percutaneous access to the heart. The support has a proximal end, an elongate portion, and a distal portion (41) having a catheter-engaging element (38). The catheter-engaging element is configured to reversibly engage the catheter in a manner that does not inhibit longitudinal advancement of the catheter. Other embodiments are also described.