Devices and methods for coronary sinus pressure relief

Abstract

A method and devices for relieving pressure in the left atrium of a patient's heart is disclosed. The method includes using an ablative catheter in a minimally invasive procedure to prepare an opening from the coronary sinus into a left atrium of the patient's heart. Once the opening is prepared, the opening may be enlarged by a technique such as expanding a balloon within the opening. A stent is then placed within the coronary sinus of the patient, with a transverse portion expanding within the opening, allowing blood to flow from the left atrium to the coronary sinus and then to the right atrium. Pressure within the left atrium is thus relieved.

1 . A stent for use in a patient, comprising:
 a plurality of struts; and   a plurality of intersections joining the struts to form a stent having a longer cylindrical portion and a shorter cylindrical portion adjacent the longer cylindrical portion and extending beyond the longer cylindrical portion in a direction perpendicular to an axis of the longer cylindrical portion,   wherein the longer cylindrical portion is adapted to fit into and bear against a coronary sinus and wherein the shorter portion is adapted to form an opening from the coronary sinus to a left atrium of the patient.   
     
     
         2 . The stent according to  claim 1 , wherein the struts are made from a metal selected from the group consisting of shape memory alloys, nitinol, stainless steel and MP35. 
     
     
         3 . The stent according to  claim 1 , wherein the stent further comprises at least two features with properties selected from the group consisting of radiographic properties and echogenic properties. 
     
     
         4 . The stent according to  claim 1 , further comprising at least one flap attached to the shorter portion, the flap attached and oriented to allow blood to flow only one way, from the left atrium into the coronary sinus. 
     
     
         5 . The stent according to  claim 1 , further comprising at least one flap made from mammalian pericardium attached to the shorter portion, the flap attached and oriented to allow blood to flow only one way, from the left atrium into the coronary sinus. 
     
     
         6 . The stent according to  claim 1 , further comprising a flange on the shorter portion for engaging an atrial wall of the patient. 
     
     
         7 . The stent according to  claim 1 , further comprising a segmented flange on the shorter portion for engaging an atrial wall of the patient. 
     
     
         8 . A stent for use in a patient, comprising:
 a longer, radially-expanding portion adapted for placement in a coronary sinus of the patient; and   a shorter portion adjacent and joined to the longer, radially-expanding portion, the shorter portion extending beyond the longer, radially-expanding portion in a direction perpendicular to an axis of the longer radially-expanding portion, the shorter portion adapted for placement within a left atrium of the patient,   wherein the longer, radially-expanding portion is adapted to bear against a wall of the coronary sinus and wherein the shorter portion is adapted to form an opening between the left atrium and the coronary sinus of the patient.   
     
     
         9 . The stent of  claim 8 , wherein the longer or shorter portion comprises radiopaque or echogenic features. 
     
     
         10 . The stent of  claim 8 , wherein the shorter portion is formed from a plurality of struts and intersections joining the struts, and further comprising at least one flap attached to the shorter portion, the flap attached and oriented to allow blood to flow only one way, from the left atrium into the coronary sinus. 
     
     
         11 . The stent of  claim 10 , wherein the at least one flap is attached and oriented so that blood flows from the left atrium into the coronary sinus when a pressure difference across the at least one flap reaches at least 1-10 mm Hg. 
     
     
         12 . The stent of  claim 8 , wherein the shorter portion is more flexible than the longer portion. 
     
     
         13 . A method for relieving intracardial pressure, the method comprising:
 providing an opening between a left atrium of a heart and a coronary sinus; and   allowing blood to flow from the left atrium into the coronary sinus, thus relieving pressure.   
     
     
         14 . The method of  claim 13 , further comprising providing a stent and implanting the stent in the opening between the left atrium and the coronary sinus. 
     
     
         15 . A method for relieving intracardial pressure, the method comprising:
 furnishing a stent suitable for implantation into a coronary sinus of a patient, the stent suitable for extending from the coronary sinus to within a left atrium of the patient and for maintaining communication between the left atrium and the coronary sinus;   preparing an opening into the left atrium using at least one instrument in the coronary sinus;   maneuvering the stent into the coronary sinus to a position near the opening; and   deploying a portion of the stent into the opening, wherein the stent maintains communication between the left atrium and the coronary sinus to relieve pressure within the left atrium.   
     
     
         16 . The method according to  claim 15 , wherein the step of preparing the opening further comprises:
 guiding a first catheter into the coronary sinus of the patient, the first catheter including a side port and also including a cutting or ablating instrument for creating the opening into the left atrium.   
     
     
         17 . The method according to  claim 15 , further comprising expanding the opening using a balloon catheter. 
     
     
         18 . The method according to  claim 15 , wherein the step of maneuvering the stent comprises:
 guiding the stent into the coronary sinus with a catheter; and   placing the stent into the opening by withdrawing an outer sheath from around the stent.   
     
     
         19 . A method for relieving intracardial pressure, the method comprising:
 furnishing a stent suitable for implantation into coronary sinus of a patient, the stent suitable for extending from the coronary sinus to within a left atrium of the patient and for maintaining communication between the left atrium and the coronary sinus;   preparing an opening in a wall between the left atrium and the coronary sinus;   maneuvering the stent to a position near the opening; and   deploying the stent into the opening, wherein the stent maintains communication between the left atrium and the coronary sinus.   
     
     
         20 . The method of  claim 19 , wherein the opening in the wall is prepared using an ablative catheter in the coronary sinus to create the opening and a balloon catheter in the coronary sinus to expand the opening to a desired dimension. 
     
     
         21 . The method of  claim 19 , further comprising engaging a wall of the atrium with a flange of the stent. 
     
     
         22 . The method of  claim 19 , further comprising engaging an inner surface of the coronary sinus using a close fit between the stent and the coronary sinus.