Methods for accessing a left ventricle

Abstract

Two minimally invasive therapeutic procedures, particularly for patients with congestive heart failure, may be performed separately or together. One procedure involves providing a valved passageway through the patient's left ventricular wall at the apex of the patient's heart and advancing instruments through the valved passageway to connect the valve leaflets of the patient's heart valve, e.g. the mitral valve. The second procedure involves advancing a pacing lead and a pacing lead implanting device through a trocar in the patient's chest and implanting the pacing lead on an exposed epicardial region of the patient's heart wall. The pacing lead has a penetrating electrode which is secured within the heart wall. Improved devices for these procedures include a minimally invasive grasping device for heart leaflets, a leaflet connector with artificial cordae tendenae and a pacing lead implant instrument.

What is claimed is: 
     
         1 . A method for accessing a left ventricle of a patient's heart, said method comprising:
 advancing a needle through an apical wall into a first chamber of the heart;   advancing a guidewire through the needle into the first chamber of the heart;   further advancing the guidewire from the first chamber though a heart valve and into a second chamber of the heart; and   removing the needle to leave the guidewire in place though a passageway formed by the needle.   
     
     
         2 . A method as in  claim 1 , further comprising accessing the apical wall by passing the needle through an opening in an intercostal space in the patient's chest. 
     
     
         3 . A method as in  claim 1 , wherein the first chamber is a left ventricle, the valve structure is a mitral valve, and the second heart chamber is a left atrium. 
     
     
         4 . A method as in  claim 1 , further comprising placing a valve structure in the passageway. 
     
     
         5 . A method as in  claim 4 , wherein the valve structure is secured in the passageway by a securing element is disposed circumferentially about a cylindrical wall of the valve structure. 
     
     
         6 . A method as in  claim 5 , wherein the securing element comprises a plurality of hooks or barbs. 
     
     
         7 . A method as in  claim 4 , wherein the valve structure comprises a one-way valve. 
     
     
         8 . A method as in  claim 7 , wherein the one-way valve comprises a duck bill valve. 
     
     
         9 . A method as in  claim 1 , further comprising introducing a tool over the guidewire. 
     
     
         10 . A method as in  claim 9 , further comprising using the tool to repair an incompetent heart valve. 
     
     
         11 . A method as in  claim 10 , wherein the incompetent heart valve comprises a mitral valve. 
     
     
         12 . A method as in  claim 9 , further comprising using the tool to perform a procedure selected from the group consisting of transmyocardial revascularization, aortic stenting for aortic dissections and aneurysm therapy, removal of clots and vegetations from prosthetic valves, excision of heart tumors, implantation of stem cell and vascular growth factors, and closure of ventricular septal defects. 
     
     
         13 . A method for tensioning a mitral valve in a patient's heart, said method comprising:
 forming a passageway through an apical wall into a left ventricle of the heart;   attaching a distal end of an artificial chordae to free ends of the leaflets of the mitral valve;   securing a proximal end of the artificial chordae near or in the passageway, wherein the artificial chordae is sufficiently taut to position the leaflets to better seal the leaflets and minimize leakage through the mitral valve.   
     
     
         14 . A method as in  claim 13 , wherein forming the passageway through the apical wall into a left ventricle of the heart comprises placing a valve structure in the passageway. 
     
     
         15 . A method as in  claim 13 , wherein attaching the distal end of the artificial chordae to free ends of the leaflets of the mitral valve comprises placing a clip secured to the distal end of the artificial chordae over the free ends of the leaflets. 
     
     
         16 . A method as in  claim 15 , wherein the clip is placed to form a bow-tie closure of the leaflets. 
     
     
         17 . A method as in  claim 16 , wherein securing the proximal end of the artificial chordae comprises capturing the proximal end in a valve structure placed in the passageway. 
     
     
         18 . A method as in  claim 13 , wherein the artificial chordae is formed from formed of a non-compliant material. 
     
     
         19 . A method as in  claim 14 , wherein the valve structure is secured in the passageway by a securing element is disposed circumferentially about a cylindrical wall of the valve structure 
     
     
         20 . A method as in  claim 19 , wherein the securing element comprises a plurality of hooks or barbs. 
     
     
         21 . A method as in  claim 20 , wherein the valve structure comprises a one-way valve. 
     
     
         22 . A method as in  claim 21 , wherein the one-way valve comprises a duck bill valve.