Cardiac visualization devices and methods

Abstract

Devices and methods for facilitating transvascular, minimally invasive and other “less invasive” surgical procedures generally include a sheath with an expandable balloon at the distal end, an inflation lumen for expanding the balloon, and a device passage lumen for allowing passage of one or more surgical instruments. The sheath is configured to house at least one visualization device such that an optical element of the device is positioned to view the surgical site. In some embodiments, instruments may be passed through the sheath, with the distal balloon partially or fully circumscribing or encircling the instruments. Any suitable instrument(s) may be passed through sheaths of the invention, such as a surgical clip applier for repairing a heart valve, an ablation member for treating atrial fibrillation, one or more pacemaker leads, a coronary sinus access device or the like.

1 - 87 . (canceled) 
   
   
       88 . A device comprising:
 an elongate member having a lumen extending therethrough; and   an expandable member connected to, and expandable from, the distal end of the elongate member, wherein the expandable member defines a continuous aperture along and through the entire longitudinal length of the expandable member when the expandable member is in the expanded configuration, the aperture having a diameter allowing for passage of at least one device for performing a heart procedure therethrough, wherein the device is selected from the group consisting of an ablation device, an electrocautery device, a suturing device, and a cutting device.   
   
   
       89 . The device of  claim 88 , wherein the expandable member is frustoconical. 
   
   
       90 . The device of  claim 88 , wherein the expandable member is toroidal. 
   
   
       91 . The device of  claim 88 , wherein the expandable member is an inflatable balloon. 
   
   
       92 . The device of  claim 91 , wherein the inflatable balloon comprises one or more inflation lumens. 
   
   
       93 . The device of  claim 88 , wherein a diameter of the lumen is the same as the diameter of the aperture. 
   
   
       94 . The device of  claim 88 , further comprising one or more visualization devices. 
   
   
       95 . The device of  claim 94 , wherein the visualization device is selected from the group consisting of a fiber optic device, an ultrasonic device, a charge coupled device, and a camera. 
   
   
       96 . The device of  claim 88 , wherein the elongate member is slidably disposed within an outer tubular member. 
   
   
       97 . The device of  claim 96 , wherein the length of the expandable member is adjusted by sliding the outer tubular member along the elongate member. 
   
   
       98 . The device of  claim 88 , wherein the elongate member is flexible. 
   
   
       99 . The device of  claim 88 , wherein the elongate member is a catheter. 
   
   
       100 . A method comprising:
 advancing an elongate member having a lumen extending therethrough adjacent to heart tissue;   expanding an expandable member connected to, and expandable from, a distal end of an elongate member, wherein the expandable member defines a continuous aperture along and through the entire longitudinal length thereof; and   advancing at least one device through the continuous aperture where the device is selected from the group consisting of an ablation device, an electrocautery device, a suturing device, and a cutting device.   
   
   
       101 . The method of  claim 99 , further comprising adjusting the size of the expandable member by sliding a sheath along the elongate member. 
   
   
       102 . The method of  claim 99 , further comprising visualizing the location using a visualization device disposed within the expandable member. 
   
   
       103 . The method of  claim 99 , wherein the heart procedure is mitral valve repair. 
   
   
       104 . The method of  claim 99 , wherein the heart procedure is a laparoscopic procedure. 
   
   
       105 . The method of  claim 99 , wherein the elongate member is advanced through the superior vena cava into the right atrium and through the interatrial septum. 
   
   
       106 . The method of  claim 99 , wherein the elongate member is advanced through the inferior vena cava into the right atrium and through the interatrial septum. 
   
   
       107 . A device comprising:
 an elongate member having a lumen extending therethrough; and   an expandable member having a proximal end directly coupled to, and expandable from, the distal end of the elongate member, wherein the expandable member defines a continuous aperture along and through the entire longitudinal length of the expandable member when the expandable member is in the expanded configuration, the aperture having a diameter allowing for passage of at least one device for performing a heart procedure therethrough, wherein the device is selected from the group consisting of an ablation device, an electrocautery device, a suturing device, and a cutting device.   
   
   
       108 . The device of  claim 107 , further comprising a visualization device disposed within the expandable member.