ULTRASONIC IMAGING SYSTEM AND METHOD

Abstract

An ICE imaging system is disclosed, which comprises an Intracardiac echocardiography (ICE) catheter having a longitudinal axis, a proximal end, and a distal end. The ICE catheter corresponds to a micro-electromechanical (MEMS) or other transducer based phased array ultrasound catheter with an out diameter of 6 French or smaller for delivery through an internal jugular, subclavian, axillary, innominate venous system into heart chambers for the purpose of lead placement for a pacemaker or other implantable cardioverter defibrillator (ICD) device. Further, a catheter shaft houses an electronic flex cable which is in communication with at least one signal trace, and is configured to direct a plurality of transducer array elements to transmit and receive ultrasound beams, receive at least one signal from the plurality of transducer array elements, and construct at least one image of at least a portion of the heart based on the at least one signal.

Claims

1. An Intracardiac echocardiography (ICE) imaging system comprising: an ICE catheter having a longitudinal axis, a proximal end, and a distal end, wherein the ICE catheter is 6.0 French or smaller allowing access to heart and vascular structures; an ultrasonic transducer array disposed within the distal end of the ICE catheter, wherein the ultrasonic transducer array comprises a substrate and a plurality of transducer array elements arranged on the substrate; and a catheter shaft connected at one end to a handle assembly and at other end to the ultrasonic transducer array, wherein the catheter shaft houses an electronic flex cable which is in communication with at least one signal trace, and is configured to: direct each of the plurality of transducer array elements, via the at least one signal trace, to transmit and receive, with respect to the heart, ultrasound beams; receive at least one signal from the plurality of transducer array elements based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and construct at least one image of at least a portion of the heart based on the at least one signal.

2. The ICE imaging system of claim 1, wherein the ICE catheter is 6.0 French or smaller allowing joint deployment of the 6.0 French or smaller catheter and the pacemaker defibulator or implantable cardioverter defibrillator (ICD) leads.

3. The ICE imaging system of claim 2, wherein the ICE catheter is 6.0 French or smaller allowing confirmation of pacemaker defibrillator or other ICD lead placement.

4. The ICE imaging system of claim 1, wherein the ultrasonic transducer array corresponds to a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducer (pMUT).

5. The ICE imaging system of claim 1, wherein the ICE catheter comprises a steering control unit positioned within the handle assembly, for articulating a distal tip of the ICE catheter and aligning face of the ultrasonic transducer array towards internal views including an anterior position or a posterior position of the heart.

6. The ICE imaging system of claim 5, wherein the distal tip of the ICE catheter is coated with a material to provide electrical isolation and transmission of ultrasound signals.

7. The ICE imaging system of claim 5, wherein the steering control unit comprises a steering handle and a housing enclosing an actuator and a steering hub, and an internal friction occurs between the actuator and the steering hub, and between the actuator and the housing, which causes the ICE catheter to retain its adjusted configuration without operator attention.

8. The ICE imaging system of claim 1, wherein the ICE catheter corresponds to a mechanical flexible sheath with a marker band, to allow passage into the heart, and form a location on an X-ray image.

9. The ICE imaging system of claim 1, wherein the ICE catheter is coupled to an imaging device using a custom dongle, and the custom dongle is configured to communicate ultrasound transmit pulses and ultrasound receive waveforms between the imaging device and the ICE catheter.

10. The ICE imaging system of claim 9, wherein the custom dongle comprises an interposer having a plurality of pogo pins, board edge connectors or other connection means, attached to a flat circuit board of the handle assembly.

11. The ICE imaging system of claim 1, wherein the catheter shaft encloses a plurality of individual electronic flex cables connected between the handle assembly and the ultrasonic transducer array.

12. The ICE imaging system of claim 1, wherein the ultrasound beams having a bandwidth including a predetermined fundamental mode vibration of each of the plurality of transducer array elements, such that a single array element transmits and receives multiple fundamental mode vibrations simultaneously.

13. The ICE imaging system of claim 1, wherein each of the plurality of transducer array elements having transducer cells of multiple diameters, to achieve a wide bandwidth.

14. An Intracardiac echocardiography (ICE) catheter comprising: a body having a longitudinal axis and a distal end; an ultrasonic transducer array disposed within the distal end of the body, wherein the ICE catheter is 6.0 French or smaller allowing access to heart and vascular structures; wherein the ultrasonic transducer array comprises a plurality of transducer array elements arranged on a substrate, wherein each transducer array element comprises a plurality of transducers, with a first group of two or more transducers in a first transducer array element and a second group of two or more transducers in the first transducer array element, and each transducer array element is connected in parallel, and comprising: at least one piezoelectric layer disposed on the substrate; at least one first electrode connected between the at least one piezoelectric layer and a signal conductor; and at least one second electrode connected between the at least one piezoelectric layer and a ground conductor.

15. The ICE catheter of claim 14, wherein the ultrasonic transducer array corresponds to a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducer (pMUT).

16. The ICE catheter of claim 14, wherein each of the plurality of transducer array elements is a linear phased array.

17. The ICE catheter of claim 14, wherein the plurality of transducer array elements creates an individual focused beam.

18. The ICE catheter of claim 14, further comprising an electrically isolated shaft to cover a shaft up to an imaging window at the distal end of the body.

19. The ICE catheter of claim 18, wherein the electrically isolated shaft uses Pebax material to cover the shaft up to the imaging window at the distal end of the body.

20. The ICE catheter of claim 14, wherein the ICE catheter comprises a steering handle for articulating a distal tip of the ICE catheter and aligning face of the ultrasonic transducer array towards internal views including an anterior position or a posterior position of the heart.

21. The ICE catheter of claim 20, wherein the distal tip of the ICE catheter is coated with a material to provide electrical isolation and transmission of ultrasound signals.

22. The ICE catheter of claim 20, wherein the steering control unit comprises a housing enclosing an actuator and a steering hub, and an internal friction occurs between the actuator and the steering hub, and between the actuator and the housing, which causes the ICE catheter to retain its adjusted configuration without operator attention.

23. An Intracardiac echocardiographic (ICE) imaging system comprising: an ICE catheter having a longitudinal axis, a proximal end, and a distal end: a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducer (pMUT) array disposed within the distal end of the ICE catheter, wherein the MEMS based pMUT array comprises a substrate and a plurality of MEMS based pMUT array elements arranged on the substrate; and an electronic flex cable connected at one end to a handle assembly and at other end to the MEMS based pMUT array, wherein the electronic flex cable is in communication with at least one signal trace, and is configured to: direct each of the plurality of MEMS based pMUT array elements, via the at least one signal trace, to transmit and receive, with respect to heart, ultrasound beams: receive at least one signal from the plurality of MEMS based pMUT array elements based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and construct at least one image of at least a portion of the heart based on the at least one signal.

24. The ICE imaging system of claim 23, wherein the MEMS based pMUT array comprises pMUT cells of multiple diameters to achieve a bandwidth of greater than 55%.

25. A method of deploying an Intracardiac echocardiography (ICE) catheter, wherein the ICE catheter is 6.0 French or smaller allowing access to heart and vascular structures; wherein the ICE catheter has an ultrasonic transducer array with a plurality of transducer array elements, through an internal venous system into heart chambers, the method comprising steps of: directing the plurality of transducer array elements, via at least one signal trace, to transmit and receive, with respect to heart, ultrasound beams; receiving at least one signal from the plurality of transducer array elements based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and constructing at least one image of at least a portion of the heart chamber based on the at least one signal.

26. The method of claim 25, wherein the ultrasonic transducer array corresponds to a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducer (pMUT).

27. The method of claim 25, wherein the venous system is a jugular vein.

28. The method of claim 25, wherein the venous system is a subclavian vein.

29. The method of claim 25, wherein the venous system is an axillary vein.

30. The method of claim 25, wherein the venous system is an innominate vein.

31. A method of deploying an Intracardiac echocardiography (ICE) catheter, having an ultrasonic transducer array with a plurality of transducer array elements, using arterial access into heart chambers, the method comprising steps of: directing the plurality of transducer array elements, via at least one signal trace, to transmit and receive, with respect to heart, ultrasound beams; receiving at least one signal from the plurality of transducer array elements based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and constructing at least one image of at least a portion of the heart chamber based on the at least one signal.

32. The method of claim 31, wherein the ICE catheter is 6 French or smaller.

33. The method of claim 31, wherein the ultrasonic transducer array corresponds to a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducer (pMUT).

34. The method of claim 31, wherein the arterial system is a femoral artery.

35. The method of claim 31, wherein the arterial system is a radial artery.

36. The method of claim 31, wherein the arterial system is a brachial.

37. A method of using a 6 French or smaller Intracardiac echocardiography (ICE) catheter to visualize lead location and facilitate lead/device delivery.

38. The method of claim 37, where the lead location is for a pacemaker.

39. The method of claim 37, further comprising using the 6 French or smaller ICE catheter to visualize an arterial system for device delivery including but not limited to valvular heart procedures, vascular procedures, and left heart procedures.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0015] The accompanying drawings illustrate various embodiments of systems, methods, and embodiments of various aspects of the disclosure. Any person of ordinary skill in the art will appreciate that the illustrated element boundaries (e.g., boxes, groups of boxes, or other shapes) in the figures represent one example of the various boundaries representative of the disclosed invention. It may be that in some examples one element may be designed as multiple elements or that multiple elements may be designed as one element. In other examples, an element shown as an internal component of one element may be implemented as an external component in another and vice versa. Furthermore, elements may not be drawn to scale. Non-limiting and non-exhaustive descriptions of the present disclosure are described with reference to the following drawings. The components in the figures are not necessarily to scale, emphasis instead being placed upon the illustrated principles.

[0016] Various embodiments will hereinafter be described in accordance with the appended drawings, which are provided to illustrate and not to limit the scope of the disclosure in any manner, wherein similar designations denote similar elements, and in which:

[0017] FIGS. 1 and 2 illustrate a prior art imaging system, for acquiring two-dimensional image information:

[0018] FIG. 3 illustrates a schematic diagram of an Intracardiac echocardiography (ICE) imaging system, according to an embodiment of the present disclosure:

[0019] FIG. 4 illustrates a schematic diagram of a front view of an Intracardiac echocardiography (ICE) catheter and a custom dongle, according to an embodiment of the present disclosure:

[0020] FIG. 5 illustrates a perspective view of the custom dongle for connecting the ICE catheter and the imaging device, according to an embodiment of the present disclosure:

[0021] FIG. 6A illustrates a flat circuit board with an electronic flex cable, according to an embodiment of the present disclosure:

[0022] FIG. 6B illustrates a proximal view of an interposer with a board edge connector disposed within the custom dongle, according to an embodiment of the present disclosure:

[0023] FIG. 6C illustrates a side view of the interposer with a plurality of inline connectors and circuit pins disposed over a printed circuit board (PCB), according to an embodiment of the present disclosure:

[0024] FIG. 6D illustrates a distal view of the interposer with the circuit pins to couple the interposer with electronic flex cables in the custom dongle, according to an embodiment of the present disclosure:

[0025] FIG. 6E illustrates the PCB which connects to the interposer, according to an embodiment of the present disclosure:

[0026] FIG. 6F illustrates the PCB located in a catheter handle with a plurality of inline connection pads, according to an embodiment of the present disclosure:

[0027] FIG. 7 illustrates a schematic view of the ICE catheter with a distal tip being diverted to an anterior position and a posterior position using a steering control unit, according to an embodiment of the present disclosure;

[0028] FIG. 8 illustrates a multi-channel electronic communication between the imaging device and an ultrasonic transducer array of the ICE catheter, according to an embodiment of the present disclosure:

[0029] FIG. 9 illustrates a sectional view of a distal end of the ICE catheter with a plurality of transducer array elements, according to an embodiment of the present disclosure;

[0030] FIG. 10 illustrates a schematic diagram of the ICE catheter having a flexible sheath with a marker band, according to an embodiment of the present disclosure;

[0031] FIG. 11 illustrates a schematic diagram of the ICE catheter having an electrically isolated shaft up to an imaging window at a distal end of the ICE catheter, according to an embodiment of the present disclosure:

[0032] FIG. 12 illustrates a schematic diagram showing a proximal side of a catheter handle assembly coupled to a distal side of a dongle handle assembly using pogo pins and a flat circuit board, according to an embodiment of the present disclosure; and

[0033] FIG. 13 illustrates a cross-sectional image of heart with pacemaker leads positioned within the heart, according to an embodiment of the present disclosure; and

[0034] FIG. 14 illustrates another cross-sectional image of the heart with the ICE catheter positioned inside Right Ventricle of the heart.

DETAILED DESCRIPTION

[0035] The components of the embodiments as generally described and illustrated in the figures herein can be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of various embodiments, as represented in the figures, is not intended to limit the scope of the present disclosure but is merely representative of various embodiments. While various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.

[0036] Some embodiments of this disclosure, illustrating all its features, will now be discussed in detail. The words comprising, having, containing, and including, and other forms thereof, are intended to be equivalent in meaning and be open-ended in that an item or items following any one of these words is not meant to be an exhaustive listing of such item or items or meant to be limited to only the listed item or items.

[0037] It must also be noted that as used herein and in the appended claims, the singular forms a. an, and the include plural references unless the context dictates otherwise. Although any systems and methods similar or equivalent to those described herein can be used in the practice or testing of embodiments of the present disclosure, the preferred systems, and methods are now described. The terms proximal and distal are opposite directional terms. For example, the distal end of a device or component is the end of the component that is furthest from the practitioner during ordinary use. The proximal end refers to the opposite end, or the end nearest the practitioner during ordinary use.

[0038] Embodiments of the present disclosure will be described more fully hereinafter with reference to the accompanying drawings in which like numerals represent like elements throughout the several figures, and in which example embodiments are shown. Embodiments of the present disclosure may, however, be embodied in alternative forms and should not be construed as being limited to the embodiments set forth herein. The examples set forth herein are non-limiting examples and are merely examples among other possible examples.

[0039] FIGS. 1 and 2 illustrate a prior art imaging system 100. The imaging system 100 may be used for diagnosis and/or treatment in combination with another imaging modality, such as an x-ray, fluoroscopy, magnetic resonance, computed tomography, or optical system. It can be noted that imaging modalities scan a patient for generating images to assist a physician. Further, the imaging system 100 provides an ultrasound transmit pulse 102 and an ultrasound receive path 104, for connection to an ultrasonic transducer (not shown). The ultrasound transmit pulse 102 may transmit ultrasound signals from the imaging system 100 towards an object such as heart of a patient. Further, the ultrasound receive path 104 may create a waveform based at least on the ultrasound signals. Thereafter, the imaging system 100 may convert the received ultrasound signals or ultrasound information to a two-dimensional (2D) image of the object or a portion of the object.

[0040] FIG. 3 illustrates a schematic diagram of an Intracardiac echocardiography (ICE) imaging system 300, according to an embodiment of the present disclosure. FIG. 3 is described in conjunction with FIGS. 4-12.

[0041] The ICE imaging system 300 may be performed for electrophysiology (EP). The ICE imaging system 300 may be used for diagnosis and/or treatment in combination with another imaging modality, such as an x-ray, fluoroscopy, magnetic resonance, computed tomography, or optical system. Both imaging modalities may scan a patient for generating images to assist a physician. The data from the different modalities may be aligned by locating the markers with a known spatial relationship to the ultrasound scan in the images of the other modality. In other embodiments, the ICE imaging system 300 may use a catheter without the markers and/or without another imaging modality. In one embodiment, the ICE imaging system 300 may utilize a microelectromechanical (MEMS) transducer array defined as piezoelectric micro-machined ultrasound transducer (pMUT) or other types of MEMS transducers, interconnected using matched flexible circuits. In one embodiment, the ICE imaging system 300 may correspond to an ultrasonic imaging system. In one embodiment, the ICE imaging system 300 may correspond to an endovascular MEMS ultrasonic transducer utilizing a high-density flexible circuit for all transmission and electrical interconnects. In one embodiment, the ICE imaging system 300 may be employed to treat patient with cystic fibrosis (CF). It can be noted that the use of the high-density flexible circuits may enable highly repeatable and stable transmission and return signals. Further, the high-density flexible circuit transmission lines may transmit electrical energy from one end to another distal end of the ICE imaging system 300.

[0042] The present invention discloses use of the MEMS based or bulk PZT based phased array transducer enabled ultrasound catheter with an outer diameter of 6 French or smaller for delivery through an internal jugular, subclavian, axillary, or innominate venous system into heart chambers for the purpose of visualization of lead placements for a pacemaker or other implantable cardioverter defibrillator (ICD) devices.

[0043] Referring to FIG. 3, the ICE imaging system 300 may comprise an imaging device 302 coupled to an ICE catheter 304 via a communication channel 306. In one embodiment, the communication channel 306 may be a custom dongle with a cable and bus connections or multiple connections. Hereinafter, the communication channel 306 may be referred to as the custom dongle 306.

[0044] In one embodiment, the ICE catheter 304 may correspond to an ultrasonic catheter. The ICE catheter 304 may be disposed within a chamber of a heart of a patient and the imaging device 302 may receive at least one signal from the ICE catheter 304. The at least one signal may be communicated from the ICE catheter 304 to the imaging device 302 via the custom dongle 306. Further, the imaging device 302 may comprise an image processor 308, a transmit beamformer 310, a receive beamformer 312, and a display 314.

[0045] The image processor 308 may be configured to generate a two-dimensional (2D) image according to data received from the ICE catheter 304. In one embodiment, the image processor 308 may be configured to receive a focussed signal from the receive beamformer 312. The image processor 308 may render the data to construct an image or sequence of images. In one embodiment, the image may be three-dimensional (3D) representation, such as a two-dimensional image rendered from a user or a processor selected viewing direction. In one embodiment, the image processor 308 may be a detector, filter, processor, application-specific integrated circuit, field-programmable gate array, digital signal processor, control processor, scan converter, three-dimensional image processor, graphics processing unit, analog circuit, digital circuit, or combinations thereof. The image processor 308 may receive beamformed data and may generate images, to display on the display 314. It can be noted that the generated images are associated with a two-dimensional (2D) scan. Alternatively, the generated images may be three-dimensional (3D) representations.

[0046] The image processor 308 may be programmed for hardware accelerated two-dimensional re-constructions. The image processor 308 may store processed data of the at least one signal and a sequence of images in a memory. In one embodiment, the memory may be a non-transitory computer-readable storage media. The instructions for implementing the processes, methods and/or techniques discussed herein are provided on the computer-readable storage media or memories, such as a cache, buffer, RAM, removable media, hard drive, or other computer-readable storage media. Non-transitory computer-readable storage media include various types of volatile and non-volatile storage media. The functions, acts, or tasks illustrated in the figures or described herein are executed in response to one or more sets of instructions stored in or on a computer readable storage media. The functions, acts, or tasks are independent of the particular type of instructions set, storage media, processor, or processing strategy and may be performed by software, hardware, integrated circuits, firmware, micro code, and the like, operating alone or in combination.

[0047] The transmit beamformer 310 may be configured for transmission of the electrical signal or electrical impulse in a form of at least one signal towards the ICE catheter 304. The receive beamformer 312 may be configured to receive an electrical signal or electrical impulse from the ICE catheter 304. In one embodiment, the transmit beamformer 310 and the receive beamformer 312 may facilitate transmit beamforming technique to focus energy towards a receiver to improve a signal to noise (SNR) of the at least one signal and then transmit the at least one signal to the image processor 308.

[0048] The display 314 may be configured to screen the image or sequence of images during or after the data is rendered, by the image processor 308. The image may be 3D representation, such as a two-dimensional image rendered from a user or a processor selected viewing direction. Alternatively, the image may be one or more two-dimensional images representing planes in the volume. In one embodiment, the display 314 may be a part of imaging device 302 or may be remote, such as a networked display. In one embodiment, the display 314 may be a cathode ray tube (CRT), liquid crystal display (LCD), a projector, a plasma, or other now known or later developed display device.

[0049] The ICE catheter 304 may be in electronic communication with the imaging device 302 for transmission and receiving of ultrasound signals to and from the vessel wall or structure of interest. In one embodiment, the ICE catheter 304 may be configured to visualize standard echocardiography views of the heart, such as in a standard version, a right atrium may be visualized. The visualizations performed using the ICE catheter 304 is described in conjunction with FIGS. 13 and 14. The ICE catheter 304 may be employed in transseptal catheterization for several percutaneous interventions, including left heart catheter ablation, atrial septal defect closure for effective alternative to surgical intervention. Further, the ICE catheter 304 may comprise a body 316 having a longitudinal axis 318, a proximal end 320, a distal end 322, a handle assembly 324, a steering control unit 326, a distal tip 328, and a dongle cable 330.

[0050] The handle assembly 324 may be positioned between the proximal end 320 and the distal tip 328 of the ICE catheter 304. Further, the steering control unit 326 may be positioned within the handle assembly 324. The steering control unit 326 may be provided for articulating the distal tip 328 of the ICE catheter 304. Further, the steering control unit 326 may align face of an ultrasonic transducer array (not shown) towards different positions with respect to the ICE catheter 304. Further, the steering control unit 326 may comprise a steering handle 332 and a housing 334 enclosing an actuator (not shown) and a steering hub (not shown). It can be noted that an internal friction occurs between the actuator and the steering hub, and between the actuator and the housing 334, which causes the ICE catheter 304 to retain its adjusted configuration without operator attention. The steering handle 332 may be rotated to facilitate positioning of the distal tip 328 of the ICE catheter 304. The movement of the distal tip 328 by the steering control unit 326 is shown in FIG. 7. In one embodiment, the steering handle 332 may be rotated to position the distal tip 328 inside the chamber of the heart of the patient. In one embodiment, the steering control unit 326 may comprise a set of steering lines controlled by a steering actuator to articulate bidirectional a distal segment of the ICE catheter 304. It can be noted that the steering handle 332 may be rotated from 0 degrees to +/?45 degrees. A catheter shaft 336 may be coupled to the handle assembly 324 at one end and to the distal tip 328 of the ICE catheter 304 at the other end. Further, the catheter shaft 336 may enclose an electronic flex cable (not show) and a plurality of steering cables (not shown). In one embodiment, the electronic flex cable may be a stainless-steel cable. The electronic flex cable may be coupled at one end to the handle assembly 324 and at other end to the ultrasonic transducer array. The electronic flex cable and the plurality of steering cables may be described later in conjunction with FIGS. 6A-7. Further, the ICE catheter 304 is described in conjunction with FIG. 4.

[0051] Referring to FIG. 4, the ICE catheter 304 may comprise an ultrasonic transducer array 402, a substrate 404, an interposer 406, and a flat circuit board 408. The ultrasonic transducer array 402 may be disposed within the distal tip 328 of the ICE catheter 304. In one embodiment, the ultrasonic transducer array 402, the substrate 404, the interposer 406, and a flat circuit board 408 may correspond to flexible printed electronic circuits for communicating from the distal end 322 of the ICE catheter to the dongle cable 330 or directly to the ICE imaging system 300. The ultrasonic transducer array 402 may be disposed over the substrate 404 towards the distal end 328 of the ICE catheter 304. It can be noted that the ultrasonic transducer array 402 may correspond to MEMS based pMUT array. The handle assembly 324 may be coupled to the proximal end 320 of the ICE catheter 304, using the interposer 406 and the flat circuit board 408. In one embodiment, the handle assembly 324 may be coupled to the dongle cable 330 using a catheter handle (not shown) and the interposer 406. The catheter handle will be described later in conjunction with FIG. 6B to FIG. 6D. It can be noted that the interposer 406 may be coupled to the custom dongle 306 and the flat circuit board 408 may be coupled to the proximal end 320 of the ICE catheter 304, towards the handle assembly 324.

[0052] As shown in FIGS. 3-4, the catheter shaft 336 may be coupled between the handle assembly 324 and the ultrasonic transducer array 402. The electronic flex cable inside the catheter shaft 336 may receive the at least one signal from the ultrasonic transducer array 402 and the received signal may be communicated back to imaging device 302 via the custom dongle 306. The electronic flex cable may be coupled at one end to the handle assembly 324 and at other end to the ultrasonic transducer array 402. It can be noted that the ultrasonic transducer array 402 may receive electrical signals from the imaging device 302 via the custom dongle 306 and the electronic flex cable. It can also be noted that the ultrasonic transducer array 402 may transmit the at least one signal back to the imaging device 302 to further analyze the at least one signal for image generation. Further, the ICE catheter 304 may be coupled to the ICE imaging device 302 using the dongle cable 330. Further, the interposer 406 and the flat circuit board 408 may be coupled together using circuit pins of male ends and female ends, as shown in FIG. 5 and FIG. 6A.

[0053] Referring to FIG. 5, a perspective view of the custom dongle 306 for communication between the ICE catheter 304 and the imaging device 302 is disclosed, according to an embodiment of the present disclosure. It can be noted that the custom dongle 306 is the communication channel to transmit and receive electrical energy or electrical impulses between the distal tip 328 of the ICE catheter 304 and the imaging device 302. The custom dongle 306 may comprise a dongle handle end 502, the dongle cable 330, and a dongle instrument end 504. The dongle handle end 502 may be coupled to the handle assembly 324 of the ICE catheter 304, using the interposer 406 and the flat circuit board 408. In one embodiment, the dongle handle end 502 may receive the interposer 406, and the handle assembly 324 may hold the flat circuit board 408.

[0054] As shown in FIG. 5, the interposer 406 may comprise a printed board 506 and a plurality of pogo pins 508 disposed over the printed board 506. It can be noted that the plurality of pogo pins 508 may act as male attachment points, to be coupled with the flat circuit board 408. As shown in FIG. 6A, the flat circuit board 408 may be coupled to an electronic flex cable 602. The flat circuit board 408 may comprise a plurality of landing pads 604. The plurality of landing pads 604 may be disposed over the flat circuit board 408. The plurality of landing pads 604 may be configured to receive the plurality of pogo pins 508. It can be noted that the plurality of landing pads 604 of the flat circuit board 408 may be press-fitted into the plurality of pogo pins 508 of the printed board 506. The electronic flex cable 602 coupled at one end to the flat circuit board 408 may be coupled at other ends to the distal end 322 of the ICE catheter 304. Further, the dongle instrument end 504 may be coupled to the imaging device 302. The imaging device 302 may receive the at least one signal and the acoustic echo from the ultrasonic transducer array 402 via the dongle cable 330.

[0055] Further, the ICE catheter 304 may be provided to transmit ultrasound signals inside a subject. In one embodiment, the ICE catheter 304 may be a flexible elongate member with the body 316 having the longitudinal axis 318, the proximal end 320, and the distal end 322. Further, the body 316 may comprise the ultrasonic transducer array 402 disposed within the distal end 322 of the ICE catheter 304.

[0056] Referring to FIGS. 6B-6E, the interposer 406 with board edge connectors 606 disposed within the custom dongle 306 towards the dongle handle end 502, is disclosed. The board edge connectors 606 may correspond to inline printed circuit board (PCB) connectors. In one embodiment, the board edge connectors 606 are standard board edge connectors mounted in a round PCB within the custom dongle 306 towards the dongle handle end 502. The interposer 406 may comprise connector pins 608 towards the proximal view, which allow connection by soldering to the dongle cable 330 inside the custom dongle 306. Further, the board edge connectors 606 may be disposed over the interposer 406 from one side and the connector pins 608 may be disposed over the interposer 406 from other side. In one embodiment, the connector pins 608 may be detachably coupled to the dongle cable 330 using different soldering connections. In another embodiment, the board edge connectors 606 may be detachably coupled to the handle assembly 324 using a PCB 610, as shown in FIGS. 6E-6F.

[0057] The handle assembly 324 may comprise the PCB 610 towards the proximal end 320 of the ICE catheter 304, as shown in FIGS. 6E-6F. Further, the PCB 610 may comprise a plurality of vias 612 disposed at one side of the PCB 610 and a plurality of inline connection pads 614 disposed at other side of the PCB 610. Further, the plurality of inline connection pads 614 may be disposed within the board edge connectors 606 of the interposer 406. It can be noted that the plurality of inline connection pads 614 may be grooved sections of rectangular shape. The board edge connectors 606 may receive the plurality of inline connection pads 614, when the dongle handle end 502 of custom dongle 306 is coupled to the handle assembly 324, towards the proximal end 320 of the ICE catheter 304. In one embodiment, the plurality of inline connection pads 614 of the PCB 610, may mate with the board edge connectors 606 of the interposer 406, at one end. In another embodiment, the plurality of vias 612, may be used to terminate connection of the catheter shaft 336, at other end. It can be noted that the plurality of vias may correspond to a plurality of pads. Further, plurality of vias 612 of the PCB 610 may be configured to receive a plurality of steering cables 616.

[0058] Further, the custom dongle 306 may be coupled to the handle assembly 324 using the interposer 406 and the flat circuit board 408 disposed between the custom dongle 306 and the handle assembly 324. In one embodiment, the custom dongle 306 may be coupled to the handle assembly 324 using the board edge connectors 606. The custom dongle 306 may be configured to communicate ultrasound transmit pulses and ultrasound receive waveforms to the ultrasonic transducer array 402. In one embodiment, the interposer 406 and the flat circuit board 408 may be referred to as a flexible circuit interposers and catheter shaft 336 may be referred to as a flexible circuit transmission line. It can be noted that the at least one signal may be electrical energy transmitted to and/or from the catheter shaft 336 and the interposer 406 from the proximal end 320 to the distal end 322 of the ICE catheter 304. Further, the ultrasonic transducer array 402, disposed within the distal end 322 of the ICE catheter 304, may convert the electrical energy into an-acoustic pressure wave. Further, the acoustic echo may be converted back to electric energy and may be returned through the catheter shaft 336 from the distal end 322 to the proximal end 320 of the ICE catheter 304. The electrical energy or electrical pulse may be transmitted to the imaging device 302 for processing within the image processor 308.

[0059] In one embodiment, the catheter shaft 336, the interposer 406, the flat circuit board 408, and the substrate 326 may be ultra-high density flexible circuits that may be primarily constructed of high ductility copper on a polyimide base substrate. It can be noted that ground return and electromagnetic interference (EMI) shielding may be integrated into the flexible circuit transmission lines. In one embodiment, the catheter shaft 336 attachment to the ultrasonic transducer array 402 may utilize thermo-compression adhesives and/or various metallic solders. It can be noted that the use of flexible circuits such as catheter shaft 336, the interposer 406, the flat circuit board 408, and the substrate 404, minimizes errors that would typically be associated with traditional small gauge coaxial cables utilized in many modern-day imaging catheters.

[0060] Referring to FIG. 7, a schematic view of the ICE catheter 304 with the distal tip 328 being diverted to an anterior position 702 and a posterior position 704 using the steering control unit 326 is disclosed, according to an embodiment of the present disclosure.

[0061] The steering control unit 326 may be positioned within the handle assembly 324 for articulating the distal tip 328 of the ICE catheter 304 and for aligning the face of the ultrasonic transducer array 402 towards internal view including, the anterior position 702 or the posterior position 704 of the heart. It can be noted that the distal tip 328 of the ICE catheter 304 may correspond to a tip of the catheter shaft 336 of the ICE catheter 304. Further, the ultrasonic transducer array 402 may be disposed of within the distal tip 328 of the ICE catheter 304. It can be noted that a cable connecting the distal end 322 of the catheter handle to the distal tip 328 may be the catheter shaft 336. In one embodiment, the ultrasonic transducer array 402 may be positioned towards the internal views including anterior position 702 and the posterior position 704 of the heart. The distal tip 328 of the ICE catheter 304 may be curved towards the distal end 322. In one embodiment, the distal tip 328 of the ICE catheter 304 may be coated with a material to provide electrical isolation and transmission of ultrasound signals. Further, the catheter shaft 336 in communication between the distal tip 328 and the distal end 322 of the ICE catheter 304, may transmit electrical signals or pulses to the distal tip 328 of the ICE catheter 304, and the ultrasonic transducer array 402 may transmit back acoustic echo to the imaging device 302 via the catheter shaft 336 and the custom dongle 306.

[0062] The plurality of steering cables 616 may be diverted to the anterior position and the posterior position using the steering control unit 326, as shown in FIG. 7. The plurality of steering cables 616 may be housed within the catheter shaft 336. In one embodiment, at least two steering cables of the plurality of steering cables 616 may be diverted towards at least two distal tips with ultrasonic transducer arrays, using the steering control unit 326. Further, the catheter shaft 336 having a gradient durometer 706 of Pebax material towards the distal tip 328 of the ICE catheter 304. It can be noted that the gradient durometer 706 of Pebax material may be hard and rigid towards the proximal end 320 and softer towards the distal end 322 of the catheter shaft 336. In one embodiment, the catheter shaft 336 may be softer for at least 6 to 8 inches towards the distal end 322. It can be noted that the distal tip 328 may have the softer Pebax material. Further, the plurality of steering cables 616 may be configured to bend or tilt the distal tip 328, when the steering handle of the steering control unit 326 is rotated clockwise or counter-clockwise. It can be noted that the actuator of the steering control unit 326 may pull a steering cable of the plurality of steering cables 616, when inserted inside the heart. The steering cable of the plurality of steering cables 616 may then bend the distal tip 328 towards the anterior position and the posterior position inside the heart. In one embodiment, at least two steering cables of the plurality of steering cables 616 may be bent using the steering control unit 326.

[0063] In one embodiment, the plurality of steering cables 616 can be made of synthetic materials, such as nylon or similar synthetic fibres, or plastics material, such as urethane, Teflon?, KynarR, KevlarR, polyethylene, multi-stranded nylon, or gel-spun polyethylene fibres. For example, the plurality of steering cables 616 may be a multi-stranded SpectraR brand nylon line sold as SpiderwireR fishing line (10 lbs. test).

[0064] Referring to FIG. 8 a multi-channel electronic communication between the ICE imaging device 302 and the ultrasonic transducer array 402 is disclosed, according to an embodiment of the present disclosure. The ultrasonic transducer array 402 may comprise a plurality of transducer array elements 802 arranged on the substrate 404. Further, each of the plurality of transducer array elements 802 may provide a wide bandwidth of an individual focussed beam. The ultrasonic transducer array 402 may be coupled to the ICE imaging device 302 using the dongle cable 330, as described earlier. The MEMS based ultrasonic transducer array 402 disposed within the distal end 322 of the ICE catheter 304 may transmit the at least one signal via the electronic flex cable 602 inside the catheter shaft 336 to the imaging device 302. The at least one signal may be the acoustic echo transmitted from the ultrasonic transducer array 402. It can be noted that the acoustic echo of acoustic energy may be received from a face of the ultrasonic transducer array 402 and received at the image processor 308.

[0065] Further, the plurality of steering cables 616 may be configured to direct each of the plurality of transducer array elements 802, via the at least one signal trace, to transmit and receive, ultrasound beams. The ultrasound beams may have a bandwidth including a predetermined fundamental mode vibration of each of the plurality of transducer array elements 802, such that a single array element can transmit and receive multiple fundamental mode vibrations simultaneously. It can be noted that the plurality of transducer array elements 802 may transmit and receive the ultrasound beams with respect to the heart or at least a portion of the heart. Further, the electronic flex cable 602 inside the catheter shaft 336 may be configured to receive at least one signal from the plurality of transducer array elements 802 based on transmitting and receiving at least one ultrasound beam of the ultrasound beams. The imaging device 302 may be further configured to construct at least one image of at least the portion of the heart based on the at least one signal. It can be noted that the electronic flex cable may be configured to the transmit beamformer 310 and receive beamformer 312 to display a two-dimensional (2D) image information of the heart or the at least portion of the heart.

[0066] In one embodiment, the plurality of transducer array elements 802 may correspond to a micro-electromechanical (MEMS) based Piezoelectric Micromachined Ultrasonic Transducers (pMUTs). The catheter shaft 336 may be connected to the handle assembly 324 at one end and to the ultrasonic transducer array 402 at other end. The electronic flex cable 602 inside the catheter shaft 336 may be in communication with the at least one signal trace. It can be noted that the electronic flex cable 602 may be further communicate to the transmit beamformer 310 and the receive beamformer 312, via the custom dongle 306 to display a two-dimensional (2D) image information of the heart to be scanned.

[0067] Referring to FIG. 9, a sectional view of the distal end 322 of the ICE catheter 304 having the ultrasonic transducer array 402 with the plurality of transducer array elements 802, is disclosed, according to an embodiment of the present disclosure. The distal end 322 of the ICE catheter 304 may be provided with the ultrasonic transducer array 402 having the plurality of transducer array elements 802. Further, each of the plurality of transducer array elements 802 may have a plurality of individual transducer cells 902 arranged in a manner to provide a wide bandwidth of the individual focussed beam. In one embodiment, the ultrasonic transducer array 402 may be constructed from a pMUT array containing individual elements of different diameters. In one embodiment, to achieve wider bandwidth with pMUT arrays, multiple diameters of pMUT cells may be integrated into one element. It can be noted that by arranging pre-shaped pMUTs with different diameters, a broader bandwidth can be realized through the complex interaction between the individual pMUT elements. In one embodiment, the pMUT cells of multiple diameters may achieve a bandwidth of greater than 55%. For example, in 3 elements, there are 5 different dome diameters, and each array is of a different size, such as 300 ?m.

[0068] Further, the ultrasonic transducer array 402 may correspond to pMUT and the plurality of transducer array elements 802 may correspond to a plurality of pMUT elements. In one embodiment, the plurality of pMUT elements may be directed to transmit and receive, the ultrasound beams having the bandwidth including the predetermined fundamental mode vibration of each of the plurality of pMUT elements, such that a single pMUT element can transmit and receive multiple fundamental mode vibrations simultaneously. Further, the electronic flex cable 602 inside the catheter shaft 336 receives the at least one signal from the plurality of pMUT elements. It can be noted that the at least one signal may correspond to the at least one ultrasound beam. The at least one signal may be transmitted to the ICE imaging device 302 for further processing in the image processor 308. The image processor 308 may construct the at least one image of the heart. It can be noted that the plurality of pMUT elements may be used to create the individual focussed beam.

[0069] In one alternate embodiment, the ultrasonic transducer array 402 may include a cover portion that presents a circular cross-section. It can be noted that a feature of ultrasonic transducer array 402 is typical in ICE imaging catheters. Due to the severe space restrictions imposed by the small diameter of Intracardiac catheters, the ultrasonic transducer array is typically limited to a linear phased array made up of several individual transducer elements, such as 64 transducers or elements. The transducers have a flat surface from which sound is emitted and echoed sound is received. As is well known in the art, the individual transducer elements are pulsed by an ultrasound control system so that the emitted sound waves are constructively combined into a primary beam. By varying the time at which each transducer element is pulsed, the ICE imaging system 300 may render the individual beams into a focused image which can be swept through an arc in order to obtain the 2D image. As a result, the ultrasonic transducer array 402 emits ultrasound along a plane that is perpendicular to the face of the transducer arrays. Thus, the ultrasonic transducer array 402 emits sound along a plane that is perpendicular to the assembly.

[0070] Referring to FIG. 10, the ICE catheter 304 may comprise a flexible sheath 1002 with a marker band 1004 to allow location on an X-ray image 1006, according to an embodiment of the present disclosure. The flexible sheath 1002 may have the marker band 1004 towards the distal end 322 of the ICE catheter 304, to allow a passage into the chamber of the heart of the patient and thereby allow location on the X-ray image 1006. It can be noted that the distal end 322 of the ICE catheter 304 may be coated with a material to provide electrical isolation and transmission of ultrasonic signals generated by the ICE catheter 304. In one embodiment, the flexible sheath 1002 may be inserted inside the chamber of the heart and the marker band 1004 may allow location on the X-ray image 1006. It can be noted that the image processor 308 of the ICE imaging device 302 may provide a real-time 2D image of the heart using the allowed location on the X-ray image 1006. In one embodiment, the flexible sheath 1002 may correspond to the catheter shaft 336 to allow the passage into the heart and thereby achieve location on the X-ray image 1006. In one embodiment, the patient's having CF may be treated with the ICE catheter 304 coated with electrical isolation for transmission of ultrasonic signals generated by the ICE catheter 304.

[0071] Referring to FIG. 11, the ICE catheter 304 may comprise an electrically isolated shaft 1102 towards the distal end 322 of the ICE catheter 304, according to an embodiment of the present disclosure. The electrically isolated shaft 1102 may use a copolymer material up to an imaging window 1104 at the distal end 322 of the ICE catheter 304. In one embodiment, the electrically isolated shaft 1102 may be coated with Pebax material. The imaging window 1104 may allow ultrasound beams to pass back and forth to the ultrasonic transducer array 402. In one embodiment, the steering handle 332 of the steering control unit 326 may be rotated clockwise and/or counterclockwise to a front view or a rear view and thereby, allow the imaging window 1104 to move from a posterior view to an anterior view and/or vice versa. In another embodiment, the steering handle 332 may be steered in a three-dimensional (3D) space. In another embodiment, the steering control unit 326 may be configured to rotate left and/or right the distal tip 328 of the ICE catheter 304 using the steering handle 322. Further, the distal tip 328 of the ICE catheter 304 is coated with an electrically isolated material to provide isolation and transmission of the ultrasound signals.

[0072] Referring to FIG. 12, an electronic communication between the handle assembly 324 and the custom dongle 306 using the plurality of pogo pins 508, the board edge connectors 606 or other connection means is disclosed, according to an embodiment of the present disclosure. The handle assembly 324 may be coupled with the interposer 406 using the board edge connectors 606 and connector pins 608 which may be coupled to the plurality of inline connection pads 614 of the PCB 610. In one embodiment, the interposer 406 may be referred to as a flat interposer. It can be noted that the interposer 406 may act as a bridge for transmission of the at least one signal from the distal end 322 to the proximal end 320 along the longitudinal axis 318 of the ICE catheter 304. Further, the interposer 406 may be connected to a plurality of electronic flex cables 1202 using the plurality of vias 612. In one embodiment, each of the plurality of electronic flex cables 1202 may have individual connections. Further, the plurality of electronic flex cables 1202 may be connected to the ultrasonic transducer array 402.

[0073] In one alternate embodiment, the ICE catheter 304 may comprise a body (not shown) having the longitudinal axis 318 and the distal end 322. Further, the ultrasonic transducer array 402 may be disposed within the distal end of the body. The ultrasonic transducer array 402 may comprise the plurality of transducer array elements 802 arranged on a substrate 326. Further, the ultrasonic transducer array 402 may be connected in series between at least one signal trace and a common ground. Further, each of the plurality of transducer array elements 802 may comprise a plurality of transducers, with a first group of two or more transducers in a first transducer array element and a second group of two or more transducers in the first transducer array element. Further, each of the plurality of transducer array elements 802 may be connected in parallel. Further, each transducer array element may comprise at least one piezoelectric layer disposed on the substrate 326. It can be noted that the at least one piezoelectric layer may comprise the pMUT array element. Further, each transducer array element may comprise at least one first electrode connected between the at least one piezoelectric layer and a signal conductor. Further, at least one-second electrode may be connected between the at least one piezoelectric layer and a ground conductor. In one embodiment, each pMUT array element may have a predetermined geometry configured to accept a predetermined fundamental mode vibration.

[0074] In one embodiment, the ultrasonic transducer array may comprise a plurality of Piezoelectric Micromachined Ultrasonic Transducers (pMUTs) coupled at the distal end of the body. It can be noted that the pMUT array is a linear phased array. In one embodiment, the first group of two or more transducers and the second group of two or more transducers may be connected in parallel. Further, the multiple transducer array elements of the plurality of transducer array elements may be grouped to act as a single array element.

[0075] Further, a method of deploying an Intracardiac echocardiography (ICE) catheter through an internal venous system into heart chambers, can be implemented. The ICE catheter comprises the ultrasonic transducer array 402 with the plurality of transducer array elements 802. The method comprises steps as: directing the plurality of transducer array elements 802, via at least one signal trace, to transmit and receive, with respect to heart, ultrasound beams: receiving at least one signal from the plurality of transducer array elements 802 based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and constructing at least one image of at least a portion of the heart chamber based on the at least one signal. In one embodiment, the ICE catheter is 6 French or smaller. In one embodiment, the venous system may be at least one of a jugular vein, a subclavian vein, an axillary vein, or an innominate vein.

[0076] Further, a method of deploying the ICE catheter, having the ultrasonic transducer array 402 with the plurality of transducer array elements 802, using arterial access into heart chambers, is disclosed. The method comprises steps as: directing the plurality of transducer array elements 802, via at least one signal trace, to transmit and receive, with respect to heart, ultrasound beams; receiving at least one signal from the plurality of transducer array elements 802 based on transmitting and receiving at least one ultrasound beam of the ultrasound beams; and constructing at least one image of at least a portion of the heart chamber based on the at least one signal. In one embodiment, the venous system may be at least one of a femoral artery, a radial artery, or a brachial.

[0077] In another embodiment, a method of using a 6 French or smaller ICE catheter to visualize lead location and facilitate lead/device delivery, is disclosed. The lead location is for a pacemaker or other implantable cardioverter defibrillator (ICD) leads. Further, the method further comprises using the 6 French or smaller ICE catheter to visualize an arterial system for device delivery including but not limited to valvular heart procedures, vascular procedures, and left heart procedures.

[0078] Referring to FIG. 13, a cross-sectional image of a heart 1300 and a left subclavian vein 1302 with pacemaker leads 1304 of a pacemaker 1306 located with a chest wall introduced at the plurality of electronic flex cables 1202 into the left subclavian vein 1302, is disclosed. The pacemaker leads 1304 are moved from the left subclavian vein 1302 toward the different chamber of the heart 1300. The pacemaker leads 1304 are positioned in different chamber of the heart 1300 to stimulate the muscle in the heart 1300. A pacemaker atrial lead 1308, a pacemaker right ventricular lead 1310, a left ventricle 1312, a right atrium 1314, a right ventricle 1316, and a pacemaker left ventricular lead 1318, may be visualized. For instance, the pacemaker atrial lead 1308 is attached to the right atrium 1314 wall. The pacemaker right ventricular lead 1310 is attached to the right ventricle 1316 wall. The pacemaker left ventricular lead 1318 is attached to the left ventricle 1312 wall. Further, a left atrium 1320, a superior vena cava (SVC) 1322, an Interatrial septum (IAS) 1402 and a tricuspid valve 1404, may also be visualized.

[0079] The pacemaker leads 1304 of the pacemaker 1306 may be inserted into the left subclavian vein 1302 via an entry point (not shown). The pacemaker leads 1304 are inserted into the left subclavian vein 1302 under or near collarbone and guided to the heart 1300 using X-ray images. It can be noted that one end of pacemaker leads 1304 is secured at the appropriate position in the heart 1300, while the other end is attached to a pulse generator inside the pacemaker 1306. The pulse generator and other pacemaker parts are contained in a single capsule.

[0080] Referring to FIG. 14, the ICE catheter 304 positioned within the left subclavian vein 1302 of the heart 1300, is disclosed. The distal tip 328 of the ICE catheter 304 may be inserted into the right atrium 1314 via the left subclavian vein 1302 and the SVC 1322. In order to perform an adequate imaging of the IAS 1402 and its neighbouring structures, two standardized views may be used. The movement of the distal tip 328 of the ICE catheter 304 within the right atrium 1314 may be controlled by the steering control unit 326. The steering handle 332 of the steering control unit 326 may be rotated to facilitate positioning of the distal tip 328 of the ICE catheter 304 within the heart 1300 of the patient. In one embodiment, the steering handle 332 may be steered clockwise to position the distal tip 328 of the ICE catheter 304 to a posterior view of the right atrium 1314. In another embodiment, the steering handle 332 may be steered counterclockwise to position the distal tip 328 of the ICE catheter 304 to an anterior view of the right atrium 1314.

[0081] Further, referring to FIG. 14, the ultrasonic transducer array 402 can be advanced into position for imaging the right atrium 1314 after introduction into the patient's vascular structure via the venous structures previously described. Using an ultrasound imaging to monitor the ICE catheter 304 position, a clinician may advance the distal end 322 of the ICE catheter 304 into the right atrium 1314. In order to guide the ICE catheter 304 through turns in the patient's vascular structure, the clinician may rotate the steering handle 332 clockwise or counterclockwise or deflect the catheter tip in either direction to allow the imaging window 1104 to move towards or away from the internal views. Once the distal tip 328 of the ICE catheter 304 is in the right atrium 1314, the clinician may deflect the steering handle 332 so as to introduce a deflection of the catheter to direct the ultrasonic transducer array 402 through the tricuspid valve 1404 and into the right ventricle 1316, as shown in FIG. 14. In this position, a field of view of the ultrasonic transducer array 402 may include portions of the right ventricle 1316 and RV lead tip interface to the ventricular myocardium and additionally the intraventricular septum, left ventricle and pericardial space can be visualized. With the transducer pulled back into the left atrium 1320 and the IAS 1402 can be visualized.

[0082] In one exemplary embodiment, the standard view is obtained by placing the ICE catheter 304 in the right atrium 1314 and the ultrasonic transducer array 402 in a neutral position facing the tricuspid valve 1404. The standard view provides imaging of the right atrium 1314, the tricuspid valve 1404, the right ventricle 1316, and typically an oblique or short-axis view of the aortic valve.

[0083] In one embodiment, most catheters used in intravascular applications, particularly those with ultrasound transducers, are at least about 10 French in diameter. The electronics and wires needed for ultrasound transducer arrays have made it impractical and expensive to reduce the size of such catheters below about 10 French. Nevertheless, there are benefits in reducing the diameter of the catheter, and technology advances may enable the electronics and control structures to be further reduced in size. The bundling arrangement of the coaxial cables, steering and pivot cables and steering and pivot mechanisms described in more detail below, make it possible to effectively reduce the diameter below about 10 French, to 4, 6, or 8 French or even 3 French (approximately 1 mm).

[0084] In one embodiment, the implementation lead placement for Cardiac Implantable Electrical Devices, including but not limited to, pacemakers, defibrillators and cardiac resynchronization therapy devices, and interventional and structural heart procedures, the ICE catheter of 6 French or smaller can be introduced through internal jugular/subclavian/axillary/innominate venous system to visualize lead location and facilitate lead/device delivery.

[0085] While there is shown and described herein certain specific structures embodying various embodiments of the invention, it will be manifest to those skilled in the art that various modifications and rearrangements of the parts may be made without departing from the spirit and scope of the underlying inventive concept and that the same is not limited to the particular forms herein shown and described except insofar as indicated by the scope of the appended claims.