Pericardial Space Imaging for Cardiac Support Device Implantation

Abstract

A method for implanting a cardiac support device (CSD) on a patient's heart. An amount of contrast agent sufficient to cause structures on the heart to be visible upon fluoroscopic or other imaging is introduced into the pericardial space surrounding the heart. The heart and contrast agent are imaged to provide a visual indication of the location of the structures of the heart. The CSD is placed on the heart using the visual indications provided by the imaging.

1 . A method for implanting a CSD on a patient's heart, including:
 introducing contrast agent into a pericardial space surrounding the heart;   imaging the heart and contrast agent to provide a visual indication of the location of structures of the heart; and   placing the CSD on the heart, including using the visual indications to position the CSD.   
     
     
         2 . The method of  claim 1  wherein:
 imaging the heart includes providing visual indications of the location of the A-V groove; and 
 placing the CSD on the heart includes using the visual indication of the A-V groove. 
 
     
     
         3 . The method of any of  claim 1  for implanting a CSD having radioopaque markers, wherein:
 imaging the heart further includes imaging the CSD markers to provide a visual indication of the markers; and 
 placing the CSD on the heart includes using the visual indication of the location of the structures on the heart and the visual indication of the markers to position the CSD. 
 
     
     
         4 . The method of  claim 1  and further include flushing the contrast agent from the pericardial space after placing the CSD on the heart. 
     
     
         5 . The method of  claim 1  wherein introducing contrast agent includes:
 inserting a tubular structure through the pericardium into the pericardial space; and 
 delivering contrast agent into the pericardial space through the tubular structure. 
 
     
     
         6 . The method of  claim 1  wherein:
 introducing contrast agent includes introducing a fluoroscopic contrast agent; and 
 imaging the heart and contrast agent includes fluoroscopically imaging the heart and contrast agent. 
 
     
     
         7 . The method of  claim 1  wherein:
 introducing contrast agent includes introducing an ultrasonic contrast agent; and 
 imaging the heart and contrast agent includes ultrasonically imaging the heart and contrast agent. 
 
     
     
         8 . The method of  claim 1  wherein imaging the heart and contrast agent includes imaging the heart and contrast agent with one of fluoroscopic, ultrasound, MRI and CT imaging modalities. 
     
     
         9 . The method of  claim 1  and further including:
 introducing contrast agent into the pericardial space after placing the CSD on the heart; and 
 imaging the heart, contrast agent and CSD to provide a visual indication of the accuracy of the CSD placement. 
 
     
     
         10 . A tool for visualizing locations within a pericardial space during the implantation of a CSD on a patient's heart, including:
 an elongate flexible member having an end; and   one or more radioopaque markers on the member at a predetermined distance from the end.   
     
     
         11 . A method for implanting a CSD on a patient's heart using the tool of  claim 4 , including:
 inserting one or more of the tools into the pericardial space and positioning the end of the member at the intersection of the heart and pericardium;   imaging the heart and marker to provide a visual indication of the location of structures of the heart; and   placing the CSD on the heart, including using the visual indications to position the CSD.   
     
     
         12 . The method of  claim 5  wherein:
 imaging the heart includes providing visual indications of the location of the A-V groove; and 
 placing the CSD on the heart includes using the visual indication of the A-V groove. 
 
     
     
         13 . The method of any of  claim 5  for implanting a CSD having radioopaque markers, wherein:
 imaging the heart further includes imaging the CSD markers to provide a visual indication of the markers; and 
 placing the CSD on the heart includes using the visual indication of the location of the structures on the heart and the visual indication of the markers to position the CSD. 
 
     
     
         14 . The method of any of  claim 5  and further including removing the tools. 
     
     
         15 . The method of any of  claim 5  and further including applying a collar to the pericardium at an opening, and causing the collar to have a relatively high-vacuum seal with the pericardium. 
     
     
         16 . A method for implanting a CSD on a patient's heart, including:
 introducing into a pericardial space surrounding the heart an amount of contrast agent sufficient to cause structures of the heart to be visible upon imaging;   imaging the heart and contrast agent to provide a visual indication of the location of structures of the heart; and   placing the CSD on the heart, including using the visual indications to position the CSD.   
     
     
         17 . The method of  claim 16  wherein introducing contrast agent includes:
 inserting a tubular structure through the pericardium into the pericardial space; and 
 delivering contrast agent into the pericardial space through the tubular structure. 
 
     
     
         18 . The method of  claim 17  wherein:
 introducing contrast agent includes introducing a fluoroscopic contrast agent; and 
 imaging the heart and contrast agent includes fluoroscopically imaging the heart and contrast agent. 
 
     
     
         19 . The method of  claim 17  wherein:
 introducing contrast agent includes introducing an ultrasonic contrast agent; and 
 imaging the heart and contrast agent includes ultrasonically imaging the heart and contrast agent. 
 
     
     
         20 . The method of  claim 17  wherein imaging the heart and contrast agent includes imaging the heart and contrast agent with one of fluoroscopic, ultrasound, MRI and CT imaging modalities.