Described herein are shock wave devices and methods for the treatment of calcified heart valves. One variation of a shock wave device may comprise an elongated flexible tube carried by a sheath. The tube may have a fluid input end, which may be located near a proximal end of the sheath. The tube may include a loop portion. The loop portion may be configured to be at least partially accommodated within a cusp of the heart valve. The tube may be fillable with a conductive fluid. In some variations, the shock wave device may include an array of electrode pairs associated with a plurality of wires positioned within the loop portion of a tube. The electrode pairs may be electrically connectable to a voltage source and configured to generate shock waves in the conductive fluid in response to voltage pulses.

A catheter system includes a catheter having an elongate shaft, a balloon and a light guide. The balloon expands from a collapsed configuration to a first expanded configuration. The light guide is disposed along the elongate shaft and is in optical communication with a light source and a balloon fluid. A first portion of the light guide extends into a recess defined by the elongate shaft. A protection structure is disposed within the recess and is in contact with the first portion of the light guide. The light source provides pulses of light to the balloon fluid, thereby initiating plasma formation and rapid bubble formation within the balloon, thereby imparting pressure waves upon a treatment site. The protection structure can provide structural protection from the pressure waves to the first portion of the light guide.

A laser fiber for use in performing a medical laser treatment includes an optical fiber and a fiber tip. The optical fiber includes a terminating end surface at a distal end. The fiber tip is positioned at the distal end of the optical fiber and includes a transmissive portion and a spacer portion. Laser energy discharged from the terminating end surface of the optical fiber is transmitted through the transmissive portion. The spacer portion defines a distal terminating end of the fiber tip that is spaced a predetermined distance from the terminating end surface of the optical fiber. The predetermined distance is set for shock wave generation for calculus destruction at the distal terminating end of the fiber tip.

Apparatus for the treatment of a target tissue with a laser beam in which the target tissue is immersed in a liquid medium within a body lumen. The laser device is configured to provide one or more laser pulses which are configured by a controller to have an energy sufficient to form one or more vapor bubbles in the liquid medium at the distal delivery end of the fiber. The one or more pulses are configured by the controller to: first, cause a vapor bubble to be formed distally of the distal end portion of the endoscope and around the distal delivery end of the optical fiber; second, cause a second bubble to be formed distally of the first bubble; and, third, inflate the second bubble as the first bubble has begun to collapse to expand an amount sufficient to displace a substantial portion of the liquid medium from the space between the distal delivery end of the fiber and the target tissue.

Described herein are shock wave devices and methods for the treatment of calcified heart valves. One variation of a shock wave device may comprise an elongated flexible tube carried by a sheath. The tube may have a fluid input end, which may be located near a proximal end of the sheath. The tube may include a loop portion. The loop portion may be configured to be at least partially accommodated within a cusp of the heart valve. The tube may be fillable with a conductive fluid. In some variations, the shock wave device may include an array of electrode pairs associated with a plurality of wires positioned within the loop portion of a tube. The electrode pairs may be electrically connectable to a voltage source and configured to generate shock waves in the conductive fluid in response to voltage pulses.

A catheter system for treating a treatment site within or adjacent to a vessel wall within a body of a patient includes an energy source, a balloon, and an energy guide. The energy source generates energy. The balloon includes a balloon wall that defines a balloon interior. The balloon is configured to retain a balloon fluid within the balloon interior. The balloon is selectively inflatable with the balloon fluid to expand to an inflated state, wherein when the balloon is in the inflated state the balloon wall is configured to be positioned substantially adjacent to the treatment site. The balloon further includes a balloon central axis that extends through a geometric center of the balloon when the balloon is in the inflated state. The energy guide selectively receives energy from the energy source and guides the energy from the energy source into the balloon interior. The energy guide including a guide distal end that is positioned on the balloon central axis when the balloon is in the inflated state.

A catheter system for treating a treatment site within or adjacent to a vessel wall or a heart valve, includes a light source, a balloon, a light guide and an optical analyzer assembly. The light source generates first light energy. The balloon is positionable substantially adjacent to the treatment site. The balloon has a balloon wall that defines a balloon interior that receives a balloon fluid. The light guide receives the first light energy and guides the first light energy in a first direction from a guide proximal end toward a guide distal end positioned within the balloon interior. The optical analyzer assembly optically analyzes a second light energy from the light guide that moves in a second direction that is opposite the first direction. The optical analyzer assembly includes a safety shutdown system to inhibit the first light energy from being received by the guide proximal end of the light guide.

A system and method for detecting relative location of a surgical laser fiber tip relative to a surgical laser target during a surgical laser procedure utilizes a spectrophotometer to detect radiation indicative of the relative location. For example, the detected radiation may indicate contact between the fiber tip and a stone being subjected to laser lithotripsy, so as to prompt the surgeon to withdraw the fiber tip from the stone and/or take other action to limit contact-induced erosion of the fiber tip, and to avoid saturation of the endoscope camera resulting from the flash that occurs following contact. In addition, the absence of any detected radiation by the spectrophotometer may be used to indicate that the stone is no longer present, or that the fiber tip is no longer aimed at the stone, prompting the operator to reposition the fiber and/or temporarily cease firing of the laser. The main surgical laser may be a pulsed Holmium laser, which is delivered to the target through the optical fiber together with a pulsed 532 nm aiming beam.

A laser light irradiation system that irradiates a stone in a body with laser light to cause the stone to be dust, the laser light irradiation system including a laser fiber that emits the laser light, and a processor configured to control a frequency of the laser light emitted from the laser fiber, wherein the processor is configured to switch between first laser light of a first frequency and second laser light of a second frequency such that the second laser light is emitted at least before or after an emission timing of the first laser light, the first laser light generating a water flow that pulls the stone toward the laser fiber, the second laser light generating a water flow that stirs the stone.

Systems and methods for treating tissue by concentrating a laser emission to at least one depth at a fluence sufficient to create an ablation volume in at least a portion of the target tissue and controlling pulse width within the picosecond regime to provide a desired mechanical pressure in the form of shock waves and/or pressure waves.