A catheter system includes an inflatable balloon, an optical fiber and a laser. The optical fiber has a distal end positioned within the inflatable balloon. The optical fiber receives an energy pulse to emit light energy in a direction away from the optical fiber to generate a plasma pulse within the inflatable balloon. The laser includes a seed source that emits a seed pulse, and an amplifier that increases energy of the seed pulse. The energy pulse can have a somewhat square or triangular waveform with a duration T, a minimum power P.sub.0, a peak power P.sub.P, and a time from P.sub.0 to P.sub.P equal to T.sub.P, wherein T.sub.P is not greater than 40% of T. T can be within the range of greater than 50 ns and less than 3 μs. T.sub.P can be within the range of greater than 2.5 ns and less than 1 μs. P.sub.P can be within the range of greater than 50 kW and less than 1000 kW. A ratio in kW to ns of P.sub.P to T.sub.P can be greater than 1:5. The seed pulse can at least partially increase in amplitude over time.

In some embodiments, a method includes delivering to a native valve annulus (e.g., a native mitral valve annulus) of a heart a prosthetic heart valve having a body expandable from a collapsed, delivery configuration to an expanded, deployed configuration. The method can further include, after the delivering, causing the prosthetic heart valve to move from the delivery configuration to the deployed configuration. With the prosthetic heart valve in its deployed configuration, an anchor can be delivered and secured to at least one of a fibrous trigone of the heart or an anterior native leaflet of the native valve. With the prosthetic heart valve disposed in the native valve annulus and in its deployed configuration, an anchoring tether can extending from the anchor can be secured to a wall of the heart to urge the anterior native leaflet towards the body of the prosthetic heart valve.

A deflectable sheath or dilator or catheter used for cardiac procedures; it has a shaft with one or more lumens; an optical fiber for use in channeling light used for visualization of calcification, heart tissue architecture or the progress of the cardiac procedure; the sheath or dilator or catheter includes an additional optical fiber for use as part of an ultrafast laser for calcium removal on or in heart valve tissue or for performing surgical intervention of the heart, or where the optical fiber is configurable for propagating a photon beam as part of an ultrafast laser for removing calcium on or in heart valve tissue or for performing surgical intervention of the heart.

A retrieval catheter and methods of use are described for removing a heart valve therapy such as a leaflet clip or artificial leaflet cord. The retrieval catheter can include a cutting element and a basket, piercing element, clamping mechanism, or similar grasping device. The method includes delivering a catheter to the region of the heart valve therapy and then manipulating the catheter and associated instruments to cut tissue as necessary and then remove the heart valve therapy and withdraw the catheter.

A plurality of catheter-based ablation apparatus embodiments are provided that address several areas of atrial target tissue and which feature firm and consistent ablation element to tissue contact enabling the creation of effective continuous lesions.

In some embodiments, a method includes delivering to a native valve annulus (e.g., a native mitral valve annulus) of a heart a prosthetic heart valve having a body expandable from a collapsed, delivery configuration to an expanded, deployed configuration. The method can further include, after the delivering, causing the prosthetic heart valve to move from the delivery configuration to the deployed configuration. With the prosthetic heart valve in its deployed configuration, an anchor can be delivered and secured to at least one of a fibrous trigone of the heart or an anterior native leaflet of the native valve. With the prosthetic heart valve disposed in the native valve annulus and in its deployed configuration, an anchoring tether can extending from the anchor can be secured to a wall of the heart to urge the anterior native leaflet towards the body of the prosthetic heart valve.

The disclosure relates to methods, systems and devices for severing and optionally removing at least a portion of heart valve leaflets. Leaflets can be partially removed or entirely removed or otherwise, the leaflets can be severed or splayed in such a way as to avoid coronary blockage, LVOT obstruction, or access challenges in procedures where a prosthetic valve is to be implanted within a previously implanted prosthetic valve. The disclosure also relates to numerous devices for and methods of disabling one or more valve ligating devices to provide an unobstructed valve opening so that a prosthetic heart valve can be implanted within the opening. The ligation device(s) is disabled either by removing the ligation device(s) or severing one leaflet so that ligated leaflets can be separated. In some embodiments, the ligation device(s) are severed to disable the ligation device(s).

A steerable medical apparatus includes a shaft, a steering mechanism, and an actuation mechanism. The shaft has a proximal portion, a distal portion, a first pull wire, and a second pull wire. The distal ends of the first and second pull wires are coupled to the distal portion of the shaft. The steering mechanism has a first wheel and a second wheel coupled by a differential mechanism. The proximal ends of the first and second pull wires are respectively coupled to the first and second wheels. The actuation mechanism is coupled to the steering mechanism. Actuating the actuation mechanism in a first operational mode causes the distal portion of the shaft to curve in a first plane. Actuating the actuation mechanism in a second operational mode causes the distal portion of the shaft to curve away from the first plane.

A catheter system (100) for placement within a treatment site (106) at a vessel wall (208A) or a heart valve includes an energy source (124), a balloon (104), an energy guide (122A), and a tissue identification system (142). The energy source (124) generates energy. The balloon (104) is positionable substantially adjacent to the treatment site (106). The balloon (104) has a balloon wall (130) that defines a balloon interior (146). The balloon (104) is configured to retain a balloon fluid (132) within the balloon interior (146). The energy guide (122A) is configured to receive energy from the energy source (124) and guide the energy into the balloon interior (146) so that plasma is formed in the balloon fluid (132) within the balloon interior (146). The tissue identification system (142) is configured to spectroscopically analyze tissue within the treatment site (106). A method for treating a treatment site (106) within or adjacent to a vessel wall (208A) or a heart valve can utilize any of the catheter systems (100) described herein.

A balloon device for treating a calcified structure of a body tissue, including an elongated body extending between a proximal end and a distal end and having at least one lumen extending along at least a portion thereof and defining a fluid path, and at least one inflatable balloon secured to the elongated body and fluidly connected to the at least one lumen, with the at least one lumen being fluidly connectable to a fluid source for selectively inflating and deflating the at least one inflatable balloon, and with the at least one inflatable balloon, when being inflated, is positioned in close proximity to the calcified structure and vibrating, mechanical vibrations of the at least one inflatable balloon causes destructuration of the calcified structure.