A steering tool includes an internal tube disposed inside an external tube. The internal and external tubes are arranged for longitudinal axial movement relative to one another. A distal portion of the internal tube is fixedly joined to a distal portion of the external tube. Either or both of the tubes are formed with patterns of cuts made along adjacent longitudinal stations along a length of the cut tube. The cutting pattern at a first longitudinal station is shifted with respect to a cutting pattern at a second longitudinal station and a cutting pattern at the second longitudinal station is shifted with respect to a cutting pattern at a third longitudinal station but at a different shift defined between the first and second longitudinal stations, so that a shift from one longitudinal station of cuts to the next adjacent longitudinal station of cuts is not repeated.

An operator advances a delivery catheter through a guiding catheter, after positioning an inflatable sleeve of the guiding catheter in proximity to a target implant site on an epicardial surface. By inflating the positioned sleeve, the operator displaces the epicardial surface to create a gap that accommodates a reach of the delivery catheter. With the delivery catheter extending distally from the guiding catheter, the operator can activate the reach of the delivery catheter within the gap, and then advance the lead out through a distal-most opening of the delivery catheter. The reach may orient a fixation member of the advanced lead relative to the epicardial surface so the operator can secure the lead to the surface. The sleeve of the guiding catheter is preferably non-compliant and has a maximum diameter of at least twice the reach of the delivery catheter, when inflated.

The present disclosure provides unique products and methods for accessing the vasculature of a patient. The catheter arrangements disclosed herein include a distal segment having a first substantially straight portion, a laterally extending portion, a tip-opposing portion, a tip-deflecting portion and a distal tip. The first substantially straight portion has a longitudinal axis that extends between the tip-opposing portion and the distal tip. The tip-deflecting portion extends transverse to and passes or crosses through the longitudinal axis and deflectably supports the distal tip such that the distal tip can deflect towards the tip-opposing portion upon an external force.

An apparatus includes an elongate body and a sensor. The elongate body has a proximal end and a distal end. The distal end is sized and configured to fit through a naturally occurring orifice of a human body. The sensor is positioned at the distal end of the elongate body. The sensor includes an electrically conductive coil. The coil extends along a longitudinal axis. The coil has a distal terminal winding and a proximal terminal winding. The distal terminal winding extends along a plane that is obliquely oriented relative to the longitudinal axis. The proximal terminal winding extends along a plane that is obliquely oriented relative to the longitudinal axis.

Various embodiments of a steerable sheath or catheter are disclosed. The sheath or catheter may comprise a preformed curve or angle proximate the distal end of the sheath or catheter and may comprise either an outer straighter or an inner straightener to deform, or control, the degree of curvature. Other embodiments comprise at least two lumens axially along the sheath or catheter wall that are anchored proximate the distal end of the sheath or catheter and extend proximally to the operator, allowing either pushing or pulling control of the region of the sheath or catheter located distal to the anchoring points of the push or pull wires. The push/pull wires may be used to deform, or at least partially straighten, a precurved section of the sheath or catheter or may be use deform, or at least partially curve a straight section of the sheath.

A guidewire for guidance of a catheter or of a catheter introducer sheath into a human patient. The guidewire has, when in untensioned condition, a curved deflection section at its distal end and a shaft with one or more curved steering sections proximal of a straight section proximally neighboring the deflection section. This facilitates steering a guidewire to a predetermined location inside the patient.

A steering tool includes an internal tube disposed inside an external tube. The internal and external tubes are arranged for longitudinal axial movement relative to one another. A distal portion of the internal tube is fixedly joined to a distal portion of the external tube. Either or both of the tubes are formed with patterns of cuts made along adjacent longitudinal stations along a length of the cut tube. The cutting pattern at a first longitudinal station is shifted with respect to a cutting pattern at a second longitudinal station and a cutting pattern at the second longitudinal station is shifted with respect to a cutting pattern at a third longitudinal station but at a different shift defined between the first and second longitudinal stations, so that a shift from one longitudinal station of cuts to the next adjacent longitudinal station of cuts is not repeated.

A method of changing a catheter into a distal steering tool catheter includes adding to an existing catheter a tube assembly that passes through the catheter, the tube assembly including an internal tube and an external tube whose distal ends are coupled to each other and which are arranged for longitudinal axial movement relative to one another, and providing a tube manipulator coupled to the tube assembly, which is operative to cause relative axial movement of the internal and external tubes and bending of a distal portion of at least one of the internal and external tubes.

A delivery device for a collapsible prosthetic heart valve includes an inner shaft, an outer shaft, and a distal sheath. The distal sheath may be disposed distal to the outer shaft and about a portion of the inner shaft to form a compartment with the inner shaft. The compartment may be sized to receive the prosthetic heart valve. The inner shaft and the distal sheath may be movable relative to one another. A spine may extend along the outer shaft, the spine biasing the outer shaft so that the outer shaft tends to bend in a pre-determined direction.

Described herein are bend-limited catheters (e.g., apparatuses, including devices and systems) and methods of using them.