Epicardial Clip

Abstract

An epicardial clip for reshaping the annulus of the mitral valve of a heart includes a curved member having an anterior segment configured to be positioned in the transverse sinus of the heart, a posterior segment configured to be positioned on the posterior side of the heart, such as on or inferior to the atrioventricular groove, and a lateral segment extending between the anterior segment and the posterior segment. The lateral segment includes a curve such that the first end of the member is positioned at or above the plane of the mitral valve and the second end of the member is positioned at or below the plane of the mitral valve.

What is claimed is: 
     
         1 . A method of epicardial treatment of mitral regurgitation associated with the mitral valve of a heart, the anatomy of the heart including an aorta, a pulmonary trunk, a superior vena cava, a transverse sinus, a left atrial appendage, and an oblique sinus, the method comprising:
 providing a clip having an anterior segment. a posterior segment, and a lateral segment extending between the anterior segment and the posterior segment;   positioning the anterior segment in the transverse sinus of the heart: and   positioning the posterior segment on or inferior to the atrioventricular groove of the heart;   wherein the clip reshapes the annulus of the mitral valve.   
     
     
         2 . The method of  claim 1 , wherein the posterior segment applies pressure on the posterior wall of the left ventricle, improving coaptation of the mitral valve. 
     
     
         3 . The method of  claim 1 . wherein the lateral segment extends around a lateral side of the heart below the left atrial appendage of the heart. 
     
     
         4 . The method of  claim 1 , wherein the lateral segment extends around a lateral side of the heart above the left atrial appendage of the heart. 
     
     
         5 . The method of  claim 1 , wherein the mitral valve lies in a plane, and wherein the anterior segment extends above the plane of the mitral valve. 
     
     
         6 . The method of  claim 1 , wherein the mitral valve lies in a plane, and wherein the posterior segment extends below the plane of the mitral valve. 
     
     
         7 . The method of  claim 1 , further comprising a pad extending from the clip, wherein the pad applies pressure on the posterior wall of the left ventricle, improving coaptation of the mitral valve. 
     
     
         8 . A method of epicardial treatment of mitral regurgitation associated with the mitral valve of a heart of a patient, the anatomy of the heart including a right atrium, a right ventricle, a left atrium, a left ventricle, an aorta, a pulmonary trunk, a superior vena cava, a transverse sinus, an oblique sinus, an atrioventricular groove, right pulmonary veins, left pulmonary veins, pericardium, and a left atrial appendage, the method comprising:
 providing a thoracoscopic port in the right chest of the patient;   advancing an endoscopic device through the thoracoscopic port;   incising the right pericardium to gain access to a pericardial cavity;   advancing a visualization cannula into the transverse pericardial sinus via a path anterior to the superior vena cava and posterior to the ascending aorta;   tracking a distal end of a snare catheter from the transverse sinus into the oblique sinus while a proximal end of the snare catheter remains exterior of the chest of the patient through the thoracoscopic port;   repositioning the visualization cannula into the oblique sinus:   retrieving the distal end of the snare catheter;   withdrawing the distal end of the snare catheter out of the thoracoscopic port exterior of the chest of the patient;   providing a clip having a first leg, a second leg and a central portion between the first leg and the second leg;   loading the clip onto the proximal end and the distal end of the snare catheter exterior of the thoracoscopic port:   advancing the clip, disposed in a delivery tube, through the thoracoscopic port;   deploying the clip from the delivery tube, thereby expanding the clip;   advancing a portion of the clip into the transverse sinus and a portion of the clip into the oblique sinus or at or inferior to the atrioventricular groove;   securing the snare catheter to the first leg of the clip and the second leg of the clip; and   excising excess lengths of the snare catheter.   
     
     
         9 . The method of  claim 8 , wherein the thoracoscopic port is located in the third intercostal space. 
     
     
         10 . The method of  claim 8 , wherein the thoracoscopic port is located in the fifth intercostal space. 
     
     
         11 . The method of  claim 8 , wherein the right pericardium is incised 1-2 cm anterior to the right phrenic nerve. 
     
     
         12 . The method of  claim 8 , wherein the snare catheter is crimped to the first leg of the clip and the snare catheter is crimped to the second leg of the clip.