Transseptal guide wire puncture system
A trans-atrial septal catheter system for delivery of a steerable sheath into the left atrium contains three components. The first component is a three-segmented needle-guide wire composed of a distal needle designed to flex sharply in relation to the conjoined looped guide wire segment after fossa ovalis puncture and needle advancement. The distal guide wire loops are advanced into the left atrium maintaining the angled needle in a central location relevant to the loops for preserving an atraumatic position while stabilizing the loops in the left atrium. The elongated proximal extra stiff guide wire segment is conjoined to the looped segment which crosses the fossa ovalis and extends proximally to become externalized to the femoral vein. This segment is extra stiff and significantly elongated to permit catheter and device exchanges. The guide wire serves as a support rail over which the dilator and sheath can be advanced into the left atrium. This transseptal system is uniquely forward looking and permits cautious and iterative delivery of the dilator into the fossa ovalis for “tenting” by way of a proximal sheath activator that interacts with the dilator. The proximal externalized GW is then advanced to permit puncture of the fossa ovalis. After puncturing a precise location of the fossa ovalis, the needle and coiled guide wire loops are further advanced into the left atrium. With the proximal activator, the dilator is advanced across the fossa ovalis into the left atrium using single-handed maneuvering for separate dilator advancement and steering of the sheath by way of turning or actuating the sheath handle.
1. A transseptal guide wire, comprising a proximal end, a distal end and a middle segment,
a. wherein the proximal end is in continuity with the middle segment via a proximal guide wire segment;
b. wherein the proximal guide wire segment is stiff and further comprises a distal segment and a proximal segment connected by a secondary bend in achieving a more perpendicular angle at the tissue for coaxial support;
c. wherein the distal end comprises a linear transseptal needle configured to flex at a hinge point from a linear puncturing arrangement to an acute angle with respect to a distal end of the middle segment after puncturing tissue; and
d. wherein the middle segment is formed of a shape memory material and preformed to include at least two non-circular coils that form an outer protective shield in which the transseptal needle is positioned centrally within the at least two non-circular coils once the middle segment returns to a preformed configuration.
2. The transseptal guide wire of claim 1 , wherein the secondary bend has an angle of 2° to 20°.
3. The transseptal guide wire of claim 1 , wherein the proximal guide wire segment has a diameter of 0.021 inches to 0.035 inches.
4. The transseptal guide wire of claim 1 , wherein the length of the transseptal needle is between about 0.75 cm and 2.0 cm.
5. The transseptal guide wire of claim 1 , wherein the transseptal needle has a lubricous coating and a sharply tapered tip.
6. The transseptal guide wire of claim 1 , wherein the transseptal needle has shape memory at the point of attachment to the guide wire, and wherein the shape memory is sufficient to have the transseptal needle retain the acute angle with respect to the distal end of the middle segment to maintain central atraumatic stability.
7. The transseptal guide wire of claim 1 , wherein the acute angle is between 45° and 90° with respect to the distal end of the middle segment.
8. The transseptal guide wire of claim 1 , wherein at least one non-circular coil is between about 2.5 cm and 4.0 cm in length.
9. The transseptal guide wire of claim 1 , wherein the at least two non-circular coils including an inner coil and an outer coil with the inner coil central to the outer coil, wherein the inner coil has a length between about 1.5 cm and 3.0 cm, and the outer coil has a length between about 3.0 cm and 4.0 cm.
10. The transseptal guide wire of claim 1 , wherein the shape memory material is nitinol.
11. The transseptal guide wire of claim 1 , wherein the at least two non-circular coils are parallel with a distance between the coils about 0.75 cm to 2.0 cm.
12. The transseptal guide wire of claim 1 , wherein the at least two non-circular coils are about equal in size.
13. The transseptal guide wire of claim 1 , wherein the proximal end has a length between about 240 cm to 300 cm.
14. A transseptal guide wire puncture system, comprising:
a. the transseptal guide wire of claim 1 ; and
b. a transseptal dilator for placement of the transseptal needle on the fossa ovalis of a subject.
15. The transseptal guide wire puncture system of claim 14 , wherein the transseptal dilator has a lumen having a diameter between about 0.021 inches and 0.035 inches.
16. The transseptal guide wire puncture system of claim 14 , further comprising a sheath.
17. The transseptal guide wire puncture system of claim 16 , wherein the dilator and the sheath each comprises a radiopaque marker for alignment.
18. The transseptal guidewire of claim 1 , wherein the at least two non-circular coils are offset; wherein the transseptal needle is positioned between the offset non-circular coils in a third dimension once the middle segment returns to the preformed configuration.