Catheter-based tissue remodeling devices and methods

Abstract

Methods and systems for closing an opening or defect in tissue, closing a lumen or tubular structure, cinching or remodeling a cavity or repairing a valve preferably utilizing a purse string or elastic device. The preferred devices and methods are directed toward catheter-based percutaneous, transvascular techniques used to facilitate placement of the devices within lumens, such as blood vessels, or on or within the heart to perform structural defect repair, such as valvular or ventricular remodeling. In some methods, the catheter is positioned within the right ventricle, wherein the myocardial wall or left ventricle may be accessed through the septal wall to position a device configured to permit reshaping of the ventricle. The device may include a line or a plurality of anchors interconnected by a line. In one arrangement, the line is a coiled member.

1 .- 15 . (canceled) 
     
     
         16 . An apparatus configured to alter the shape of a ventricle of a heart, the apparatus comprising:
 a catheter configured to be introduced into a heart chamber through vasculature, the catheter having a sharp distal end which bores through tissue so as to form a passage therethrough, the catheter also having a steering member which steers the sharp distal end through ventricular tissue generally parallel to inner and outer wall of the ventricle, the steering member configured to follow the sharp distal end through the passage, the sharp distal end connected to a line detachable from the distal end, the line sized to extend through the passage such that tension on the line alter the shape of the ventricle.   
     
     
         17 . The apparatus of  claim 16 , wherein the line comprises a suture. 
     
     
         18 . The apparatus of  claim 16 , wherein the line comprises a coiled member. 
     
     
         19 . The apparatus of  claim 16 , wherein the steering member comprises a first catheter having a precurved distal end. 
     
     
         20 . The apparatus of  claim 19 , wherein the steering member further comprises a second catheter including a lumen configured to receive the first catheter such that the precurved distal end may be retracted or advanced from the second catheter to control a specific curvature of the precurved distal end. 
     
     
         21 . An internal basket configured to treat congestive heart failure, the basket comprising:
 multiple rows of lines circumscribing a first heart ventricle without circumscribing a second ventricle, the rows of lines configured to limit an expanded dimension of the first heart ventricle, each row of lines extending through a passage within a tissue wall of the first heart ventricle generally parallel to inner and outer surfaces of the tissue wall.   
     
     
         22 . The basket of  claim 21 , wherein the rows of lines are configured to be tightened to reshape the first heart ventricle. 
     
     
         23 . The basket of  claim 21 , wherein each row of lines is configured to be tightened to a cross-sectional dimension separate from other rows of lines. 
     
     
         24 . The basket of  claim 21 , wherein the rows of lines are configured to be substantially parallel to one another. 
     
     
         25 . The basket of  claim 21 , wherein the rows of lines are configured to converge at a common point and be inclined relative to one another. 
     
     
         26 . The basket of  claim 21 , wherein two or more rows of lines intersect one another. 
     
     
         27 . The basket of  claim 21 , wherein the multiple rows of lines comprise a material that allows the tissue wall to contract. 
     
     
         28 . The basket of  claim 21 , wherein ends of at least one of the rows of lines are secured to one another within the second ventricle. 
     
     
         29 . A method of making an internal basket configured to treat congestive heart failure, the method comprising:
 providing a tunneling device;   creating multiple passages within an external wall of a first ventricle with the tunneling device;   advancing a cinching device through each of the passages such that the cinching device extends within the wall of the first ventricle generally parallel to inner and outer surfaces of the wall;   applying force to the cinching device to alter the shape of the first ventricle; and   securing ends of the cinching device such that the cinching device circumscribes the first ventricle without circumscribing a second ventricle.   
     
     
         30 . The method of  claim 29 , wherein the cinching device comprises a plurality of lines substantially parallel to one another. 
     
     
         31 . The method of  claim 29 , wherein the cinching device comprises a plurality of lines converging at a common point and inclined relative to one another. 
     
     
         32 . The method of  claim 29 , wherein providing the tunneling device comprises providing the tunneling device within a delivery catheter, and wherein creating multiple passages comprises rotating the tunneling device relative to the delivery catheter. 
     
     
         33 . The method of  claim 29 , wherein advancing the cinching device through each of the passages occurs simultaneously with creating multiple passages with the tunneling device. 
     
     
         34 . The method of  claim 29 , further comprising:
 advancing the tunneling device into the second ventricle prior to creating the multiple passages; and   reentering the second ventricle after creating the multiple passages.   
     
     
         35 . The method of  claim 34 , wherein the tunneling device remains within the external wall until reentering the second ventricle.