Method and device for accessing a pericardial space

Abstract

A method for accessing a pericardial space of a heart of a mammalian patient is disclosed comprising: guiding a catheter through a coronary sinus of the heart and to a cardiac vein; advancing said catheter to a distal segment of the cardiac vein; intentionally puncturing the vein with the catheter to access the pericardial space, and performing a therapy or a diagnostic procedure using the catheter an the puncture in the vein and using the pericardial space.

1 . A method for accessing a pericardial space of a heart of a mammalian patient comprising: 
 advancing a catheter through a coronary sinus of the heart, a cardiac vein and to a distal branch of the cardiac vein;    intentionally puncturing the distal branch of the cardiac vein and a serous layer of a pericardium with the catheter to access the pericardial space between the serous and a fibrous layer of the pericardium, and    performing a therapy or a diagnostic procedure in the pericardial space using the catheter extending through the puncture into the pericardial space.    
   
   
       2 . A method as in  claim 1  further comprising separating fibrous and serous layers of the pericardium no later than when puncturing the distal branch.  
   
   
       3 . A method as in  claim 2  further comprising inserting a tip of the catheter between the fibrous and serous layers of pericardium.  
   
   
       4 . A method as in  claim 1  further comprising establishing fluid communication with the pericardial space through a lumen in the catheter, and infusing or withdrawing a fluid in or from the pericardial space and from or to the lumen.  
   
   
       5 . A method as in  claim 4  further comprising sealing the punctured distal branch.  
   
   
       6 . A method as in  claim 5  wherein sealing the branch occurs before the infusion or withdrawal of fluid.  
   
   
       7 . A method as in  claim 1  wherein the therapy or diagnostic procedure includes delivery of drugs to the pericardial space.  
   
   
       8 . A method as in  claim 1  wherein the therapy or diagnostic procedure includes delivery of a genetic agent to the pericardial space.  
   
   
       9 . A method as in  claim 1  wherein the therapy or diagnostic procedure includes placement of electrodes into the pericardial space.  
   
   
       10 . A method as in  claim 1  wherein the therapy or diagnostic procedure includes infusion of fluid into the pericardial space.  
   
   
       11 . A method for accessing a pericardial space of a heart of a mammalian patient comprising: 
 advancing a catheter through a coronary sinus of the heart, a cardiac vein and to a distal branch of the cardiac vein;    distending the distal branch of the cardiac vein;    intentionally puncturing the distal branch of the cardiac vein with the catheter to access the pericardial space of the pericardium, and    performing a therapy or a diagnostic procedure in the pericardial space using the catheter extending through the puncture into the pericardial space.    
   
   
       12 . A method as in  claim 11  wherein distending the distal branch separates fibrous and serous layers of the pericardium to facilitate access to the pericardial space.  
   
   
       13 . A method as in  claim 11  wherein an expansion device attached to the catheter expands to distend the distal branch.  
   
   
       14 . A method as in  claim 13  wherein the expansion device is a balloon.  
   
   
       15 . A method as in  claim 11  wherein the distal branch is distended before puncturing the distal branch.  
   
   
       16 . A method for inserting an access device into a pericardial space of a heart of a mammalian patient comprising: 
 advancing a catheter through a coronary sinus of the heart, a cardiac vein and to a distal branch of the cardiac vein;    distending the distal branch of the cardiac vein;    extending the access device from a distal end of the catheter to intentionally puncture the distal branch of the cardiac vein with the access device to access the pericardial space of the pericardium, and    inserting the access device into the pericardial space;    removing the catheter from the patient and leaving at least a distal tip of the access device in at least one of the pericardial space and distal branch of the cardiac vein.    
   
   
       17 . A method as in  claim 16  wherein the access device includes at least one of a wire, a fluid infusion catheter and an electrode lead.  
   
   
       18 . A method as in  claim 16  wherein distending includes infusing a fluid into the pericardial space to expand the pericardial space.  
   
   
       19 . A method as in  claim 16  wherein further comprising extending the access device from a lumen in the catheter to puncture the distal branch of the cardiac vein.  
   
   
       20 . A method as in  claim 19  wherein the catheter extends from the lumen through a side opening in the catheter.