Endovascular splinting devices and methods

Abstract

A method for placing a splint assembly transverse a heart chamber includes providing an elongate member having a first end and a second end and a deployable heart-engaging assembly connected to at least the first end. The method includes advancing the elongate member through vasculature structure and into the heart chamber such that the first end of the elongate member extends through a first location of a wall surrounding the heart chamber and the second end extends through a second location of the heart chamber wall substantially opposite the first location. A deployable heart-engaging assembly is deployed such that it engages with a first exterior surface portion of the heart chamber wall adjacent the first location. The elongate member is secured with respect to the heart with a second heart-engaging assembly connected to the second end. The second heart-engaging assembly engages with a second exterior surface portion of the heart chamber wall adjacent the second location. A splint assembly includes an expandable heart-engaging assembly formed partially from portions forming the elongate member of the splint assembly. A delivery tool includes a tubular member configured to be advanced through vasculature structure and has a curved distal end.

What is claimed is:  
     
         1 . A method for direct localized therapeutic treatment of myocardial tissue in heart having a pathological condition comprising the steps of: 
 a. identifying a target region of the myocardium;    b. applying material directly and substantially only to at least a portion of the myocardial tissue of the target region substantially identified in step (a) to physically modify the mechanical properties of said tissue.    
     
     
         2 . The method of  claim 1  wherein the modified mechanical properties include an increase in systolic performance.  
     
     
         3 . The method of  claim 1  wherein the modified mechanical properties include substantially no decrease in global diastolic performance.  
     
     
         4 . The method of  claim 1 , wherein the material applied is passive.  
     
     
         5 . The method of  claim 1 , wherein said target region includes a myocardial infarct.  
     
     
         6 . The method of  claim 1 , wherein said target region at least in part underlies the papillary muscles associated with a cardiac valve.  
     
     
         7 . The method of  claim 6 , wherein said cardiac valve is the mitral valve.  
     
     
         8 . The method of  claim 1 , wherein said material applied to the myocardial tissue is a device.  
     
     
         9 . The method of  claim 1 , wherein said material applied to the myocardial tissue comprises a polymer.  
     
     
         10 . The method of  claim 1 , wherein said material applied to the myocardial tissue comprises a bioactive agent.  
     
     
         11 . The method of  claim 1 , wherein said applying step includes employing a catheter.  
     
     
         12 . The method of  claim 12 , wherein said catheter is employed percutaneously.  
     
     
         13 . The method of  claim 1 , wherein said applying step is preceded by performing a mini-thoracotomy.  
     
     
         14 . The method of  claim 1 , wherein said applying step includes applying material intramyocardially.  
     
     
         15 . A method for direct localized therapeutic treatment of myocardial tissue in heart having a pathological condition comprising the steps of: 
 a. identifying a target region of the myocardium;    b. advancing an element across the septum of the heart to deliver material; and    c. applying said material directly and substantially only to at least a portion of the myocardial tissue of the target region substantially identified in step (a) to physically modify the mechanical properties of said tissue.    
     
     
         16 . The method of  claim 15  wherein the modified mechanical properties include an increase in systolic performance.  
     
     
         17 . The method of  claim 16  wherein the modified mechanical properties include substantially no decrease in global diastolic performance.  
     
     
         18 . The method of  claim 15  wherein the material applied is passive.  
     
     
         19 . The method of  claim 15 , wherein said target region includes a myocardial infarct.  
     
     
         20 . The method of  claim 15  wherein said target region at least in part underlies the papillary muscles associated with a cardiac valve.  
     
     
         21 . The method of  claim 20  wherein said cardiac valve is the mitral valve.  
     
     
         22 . The method of  claim 15  wherein said material applied to the myocardial tissue is a device.  
     
     
         23 . The method of  claim 15  wherein said material applied to the myocardial tissue comprises a polymer.  
     
     
         24 . The method of  claim 15 , wherein said material applied to the myocardial tissue comprises a bioactive agent.  
     
     
         25 . The method of  claim 15 , wherein said applying step includes employing a catheter.  
     
     
         26 . The method of  claim 25 , wherein said catheter is employed percutaneously.  
     
     
         27 . The method of  claim 15  wherein said applying step is preceded by performing a mini-thoracotomy.  
     
     
         28 . The method of  claim 15  wherein said applying step includes applying material intramyocardially.  
     
     
         29 . The method of  claim 15 , further comprising the step of performing an additional therapeutic or diagnostic procedure either before or after said applying step employing access to the heart gained during said advancing step.  
     
     
         30 . The method of  claim 29 , wherein said additional therapeutic or diagnostic procedure is one or more procedures selected from the set consisting of pressure monitoring, angiography, ablation, placement of pacing leads, electrophysiology mapping, and placement of LVAD cannulae.  
     
     
         31 . The method of  claim 15 , wherein said advancing step comprises advancing an element across the atrial septum of the heart.  
     
     
         32 . The method of  claim 15 , wherein said advancing step comprises advancing an element across the ventricular septum of the heart.  
     
     
         33 . The method of  claim 15 , wherein said advancing step comprises advancing an element across both the atrial and ventricular septa of the heart.