Transvascular TMR device and method

Abstract

A catheter assembly for performing transmyocardial revascularization through the coronary arteries or veins, and a method of using this assembly for creating TMR channels through the myocardium coronary artery shunts through the myocardium and a device and method for injecting therapeutic agents into TMR channels interoperatively, together with a number of therapeutic agents.

We claim:  
     
         1 . A device for making channels in the myocardial tissue of a patient's heart from a coronary blood vessel, said device comprising: 
 a laser channeling catheter ( 81 ) having a distal segment adapted for insertion into a coronary blood vessel, said laser channeling catheter having a longitudinal axis;    said laser channeling catheter comprising a catheter body ( 82 ), an optical fiber ( 83 ) for carrying laser light housed within the catheter body, said optical fiber having an optical outlet ( 84 ) within the distal segment of the catheter, and a laser power source operably connected to the optical fiber: 
 said device characterized in that: 
 said optical outlet ( 84 ) is aligned to emit laser light in the distal direction substantially parallel to the longitudinal axis of the catheter;  
 a mirror ( 86 ) is disposed within the catheter body, distal to the optical outlet and aligned to reflect laser light from the optical outlet radially outward toward an optical window ( 87 ) on the side of the distal segment of the laser channeling catheter; and  
 said laser power source is operable to deliver laser energy through the optical fiber to the coronary blood vessel and heart sufficient to lase narrow channels through the myocardial tissue.  
 
   
     
     
         2 . The device of  claim 1  further characterized by: 
 a first balloon ( 90 ) is disposed on the distal segment of the laser channeling catheter, said balloon being located radially opposite the optical window; and  
 a first lumen ( 91 ) is provided within the laser channeling catheter, said first lumen being in fluid communication with the balloon.  
 
     
     
         3 . The device of  claim 2  further characterized by: 
 a second balloon ( 92 ) disposed on the distal segment of the laser channeling catheter, said second balloon located proximal to the optical window ( 87 ), said second balloon ( 92 ) being inflatable to occlude the coronary blood vessel in which the laser channeling catheter is located; and  
 a second lumen ( 93 ) within the laser channeling catheter, said second lumen being in fluid communication with the second balloon.  
 
     
     
         4 . The device of  claim 3  further characterized by: 
 a third lumen ( 93 ) within the laser channeling catheter, said third lumen being in fluid communication with the exterior of the distal segment of the catheter at the location distal to the second balloon.  
 
     
     
         5 . The device of  claim 1  characterized by: 
 a lens assembly ( 85 ) disposed between the optical outlet and the mirror ( 86 ), said lens assembly comprising a concave lens ( 98 ) positioned distal to the optical outlet and a convex lens ( 99 ) located distal to the concave lens.  
 
     
     
         6 . The device of  claim 1  characterized by: 
 a lens assembly ( 85 ) disposed between the optical outlet and the mirror ( 86 ), said lens assembly comprising a spherical lens positioned distal to the optical outlet.  
 
     
     
         7 . The device of  claim 1  further characterized by: 
 a guidewire lumen ( 94 ) adapted to accommodate a guidewire ( 88 ), said guidewire lumen passing through the distal segment of the laser channeling catheter at a position radially opposite from the optical window.  
 
     
     
         8 . The device of  claim 7  further characterized by: 
 an ultrasound lumen ( 95 ) adapted to accommodate an intravascular ultrasound probe ( 96 ), said ultrasound lumen passing through the distal segment of the laser channeling catheter at a position radially opposite from the optical window.  
 
     
     
         9 . The device of  claim 8  further characterized by: 
 the guidewire lumen ( 94 ) and the ultrasound lumen ( 95 ) are joined in a common lumen in the distal segment of the laser channeling catheter at a position radially opposite from the optical window ( 87 ).  
 
     
     
         10 . The device of  claim 1  characterized in that the optical fiber ( 83 ) has a diameter in the range of 50-200 microns and a numerical aperture in the range of 0.12 to 0.26.  
     
     
         11 . The device of  claim 1  characterized in that the laser power source is operable to deliver laser energy of approximately 30-60 mJ/mm 2  to the myocardial tissue.