Expandable trans-septal sheath
Disclosed is an expandable transluminal sheath, for introduction into the body while in a first, low cross-sectional area configuration, and subsequent expansion of at least a part of the distal end of the sheath to a second, enlarged cross-sectional configuration. The sheath is configured for use in the vascular system. The access route is through the inferior vena cava to the right atrium, where a trans-septal puncture, followed by advancement of the catheter is completed. The distal end of the sheath is maintained in the first, low cross-sectional configuration during advancement through the atrial septum into the left atrium. The distal end of the sheath is expanded using a radial dilator. In one application, the sheath is utilized to provide access for a diagnostic or therapeutic procedure such as electrophysiological mapping of the heart, radio-frequency ablation of left atrial tissue, placement of atrial implants, valve repair, or the like.
1. A method of instrumenting a left atrium of a patient comprising the steps of:
routing a guidewire into the right atrium from a peripheral vein;
inserting a sheath with a distal region in a collapsed state and a pre-inserted dilator into the patient over the guidewire; the collapsed state of the distal region having a plurality of folded regions forming two outer fold edges that are oriented adjacent to each other, and forming two inner fold edges that are oriented apart and across from each other;
advancing the sheath to a treatment or diagnostic site within the right atrium of the heart;
performing a trans-septal puncture between the right and left atrium and advancing the distal region in the collapsed state through the puncture into the left atrium;
dilating with a dilation balloon of the pre-inserted dilator the distal region of the sheath to an expanded state so that the distal region of the sheath is expanded to dilate the puncture and increase a diameter of a distal end of a lumen extending through the sheath;
maintaining a position of the distal region of the sheath into the left atrium by inflating a distal balloon of the sheath in the left atrium and inflating a proximal balloon of the sheath in the right atrium, so as to engage the atrial septum,
collapsing the dilator; removing the dilator from the sheath; inserting instrumentation through the lumen of the sheath into the left atrium; said instrumentation being larger in diameter than said distal end of said lumen when said distal region of said sheath is in a collapsed state; performing therapy or diagnosis with the instrumentation; and
removing the sheath from the patient.
2. The method of claim 1 wherein dilating the distal region comprises inflating a balloon on the dilator.
3. The method of claim 1 wherein dilating the distal region comprises attaching a liquid-filled inflation device to a balloon inflation port at the distal end of the dilator and infusing liquid under pressure into the dilator.
4. The method of claim 3 wherein collapsing the dilator comprises withdrawing a plunger on the inflation device to withdraw liquid from the dilator.
5. The method of claim 1 wherein performing therapy or diagnosis with the instrumentation comprises electrophysiology energy delivery.
6. The method of claim 1 wherein inserting instrumentation through the lumen of the sheath comprises inserting two or more catheters through the sheath to perform the therapy.
7. The method of claim 1 wherein performing therapy or diagnosis with the instrumentation comprises delivering an implant into the left atrium.
8. The method of claim 1 wherein dilating the distal region also comprises dilating anchors within the atria.
9. The method of claim 1 wherein the lumen created in the distal region by the dilator is substantially larger than the lumen in a proximal region of the sheath.
10. The method of claim 1 , wherein the distal balloon and the proximal balloon both anchor said sheath relative to said atrial septum.
11. The method of claim 1 , wherein the distal balloon and the proximal balloon are both configured to inflate through a single, first inflation lumen.
12. A method of instrumenting a left atrium of a patient comprising the steps of:
routing a guidewire into the right atrium from a peripheral vein;
inserting a sheath with a distal region in a collapsed state and a pre-inserted dilator into the patient over the guidewire; the collapsed state of the distal region having a plurality of folded regions forming two outer fold edges that are oriented adjacent to each other, and forming two inner fold edges that are oriented apart and across from each other;
advancing the sheath to a treatment or diagnostic site within the right atrium of the heart;
performing a trans-septal puncture between the right and left atrium and advancing the distal region in the collapsed state through the puncture into the left atrium;
dilating with a dilation balloon of the pre-inserted dilator the distal region of the sheath to an expanded state so that the distal region of the sheath is expanded to dilate the puncture and increase a diameter of a distal end of a lumen extending through the sheath;
maintaining a position of the distal region of the sheath into the left atrium by inflating a dumbbell shaped balloon of the sheath, wherein a distal balloon portion of the dumbbell shaped balloon expands in the left atrium, a proximal balloon portion of the dumbbell shaped balloon expands in the right atrium and a middle portion of the dumbbell shaped balloon resides within the trans-septal puncture,
collapsing the dilator; removing the dilator from the sheath; inserting instrumentation through the lumen of the sheath into the left atrium; said instrumentation being larger in diameter than said distal end of said lumen when said distal region of said sheath is in a collapsed state; performing therapy or diagnosis with the instrumentation; and
removing the sheath from the patient.