METHODS FOR CARRYING OUT A CARDIAC PROCEDURE

1 . A method for carrying out a cardiac procedure, comprising:

a. via an inferior artery, advancing a perforating tip of a perforation device towards an aorta;

b. positioning the perforating tip adjacent a wall of the aorta, proximate a left pulmonary artery; and

c. advancing the perforating tip to perforate through the wall of the aorta and then through a wall of the left pulmonary artery, to create a pathway between the aorta and the left pulmonary artery.

2 . The method of claim 1 , wherein the perforation device is a radiofrequency perforation device, the perforating tip comprises a radiofrequency perforation electrode, and step c. comprises delivering radiofrequency energy from the radiofrequency perforation electrode while advancing the perforating tip.

3 . The method of claim 1 , further comprising:

d. via the inferior artery, advancing a dilator over the perforation device to the aorta;

e. after step c., advancing a dilating tip of the dilator over the perforation device and through the pathway to dilate the pathway.

4 . The method of claim 3 , wherein the dilator is a steerable dilator.

5 . The method of claim 3 , further comprising:

f. via the inferior artery, advancing a sheath over the dilator and the perforation device to the aorta;

g. after step e., retracting the dilator through the sheath.

6 . The method of claim 5 , further comprising:

h. after step f., exchanging the perforation device for a guidewire.

7 . The method of claim 5 , further comprising:

h. after step g., delivering a therapeutic device to the pathway via the sheath.

8 . The method of claim 7 , wherein step h. comprises positioning a shunt in the pathway.

9 . The method of claim 7 , wherein step h. comprises positioning a stent in the pathway.

10 . The method of claim 5 , further comprising:

h. via the inferior artery, exchanging the sheath for a secondary sheath; and

i. delivering a therapeutic device to the pathway via the secondary sheath.

11 . The method of claim 5 , wherein the sheath is a steerable sheath.

12 . The method of claim 1 , wherein the inferior artery is a femoral artery.

13 . The method of claim 1 , further comprising:

d. advancing a snare towards the left pulmonary artery via a venous access site; and

e. after step c., snaring the perforation device with the snare.

14 . The method of claim 13 , wherein step d. comprises advancing the snare towards the left pulmonary artery via a femoral vein, a hepatic vein, or a superior vein.

15 . The method of claim 13 , further comprising:

f. after step e., retracting the snare to advance the perforating tip out of the body towards the venous access site.

16 . The method of claim 15 , further comprising delivering a therapeutic device over the perforation device towards the pathway, via the venous access site.

17 . The method of claim 1 , wherein at least one of fluoroscopy, angiography, electro-anatomical mapping, intracardiac echocardiography, and transesophageal echocardiography is carried out concurrently with at least one of steps a. to c.

18 . The method of claim 1 , further comprising confirming the creation of the pathway with at least one of fluoroscopy, electro-anatomical mapping, pressure measurement, contrast injection, and echocardiography.

19 . The method of claim 1 , further comprising advancing a balloon catheter over the perforation device to dilate the pathway.

20 . The method of claim 1 , further comprising using an anchor system to bring the aorta and the left pulmonary artery together.