Method and apparatus for performing transesphageal cardiovascular procedures

Abstract

Apparatus for performing a transesophageal cardiovascular procedure includes an elongated tubular main access device having the first lumen with open proximal end and a side opening distal end, and a second lumen with open ends. A balloon having a wall on the outside of the device surrounds the distal end and a fluid conduit extends along the device for inflating the balloon so that when the device is inserted into a patient's esophagus and the balloon is inflated, the portion of the esophagus opposite the distal end is isolated from the remainder of the esophagus. The apparatus may also include a side access unit having an elongated flexible coaxial inner and outer tubes having proximal and distal ends and being movable relatively in the axial direction. First seals are mounted to the distal end of the outer tube, and second seals are mounted to the distal end of the inner tube, an actuator adjacent to the proxable ends of the tubes move the tubes relatively so as to vary the axial spacing the first and second seals. Various methods for using the apparatus are also disclosed.

What is claimed is:  
     
         1 . Apparatus for performing a transesophageal cardiovascular procedure, said apparatus comprising 
 an elongated tubular main access device having a first lumen with an open proximal end and a distal side opening;    inflatable sealing means on the outside of said device above and below said side opening, and    a first fluid conduit extending along said device for inflating said sealing means so that when the device is inserted into a patient's esophagus and the sealing means are inflated, the portion of the esophagus opposite said side opening is isolated from the remainder of the esophagus above and below the side opening.    
     
     
         2 . The apparatus defined in  claim 1  and further including 
 a second fluid conduit extending along said device, said second conduit having a proximal end for connection to a vacuum source and a distal end which opens adjacent to said side opening so that fluid may be sucked from the isolated portion of the esophagus.  
 
     
     
         3 . The apparatus defined in  claim 1   wherein said device has a second lumen with a rigid outer wall and a collapsible inner wall, said second lumen adapted to receive an elongated probe or surgical device, and    further including means for introducing a fluid between said inner and outer walls to collapse the inner wall against the probe or surgical device.    
     
     
         4 . The apparatus defined in  claim 1  and further including 
 perforate fluid channels formed in the outside of said device above and below said side opening, and  
 means extending along the device for conducting fluid to and/or from said channels.  
 
     
     
         5 . The apparatus defined in  claim 1  and further including a side access unit comprising 
 elongated flexible coaxial inner and outer tubes said tubes having proximal and distal ends and being moveable relatively in the axial direction and said inner tube having at least one lumen extending between said ends;  
 second sealing means mounted to the distal end of the outer tube;  
 third sealing means mounted to the distal end of the inner tube, and  
 means adjacent to the proximal ends of said tubes for moving said tubes relatively so as to vary the axial spacing of said second and third said sealing means.  
 
     
     
         6 . The apparatus defined in  claim 5  wherein the second and third sealing means comprise balloons or flanges.  
     
     
         7 . The apparatus defined in  claim 5  wherein the second sealing means comprise 
 a plurality of flexible, axially extending flaps mounted to the distal end of the outer tube, said flaps being movable between a collapsed position wherein the flaps are nested against the outer tube and an extended position wherein the flaps project radially out from the other tube, and  
 means for moving the flaps between said collapsed and extended positions.  
 
     
     
         8 . The apparatus defined in  claim 7  wherein the moving means comprise 
 elongated needles extending from the proximal end of the outer tube into said flaps, the segments of said needles in said flaps being curved so that rotation of said needles about their respective axes moves the flaps between said collapsed and extended positions, and  
 means at said proximal end of the inner tube for rotating said needles about their respective axes.  
 
     
     
         9 . The apparatus defined in  claim 7  and further including cooperating means on the distal ends of said first and second tubes for forming a purse string suture.  
     
     
         10 . The apparatus defined in  claim 5  wherein said third sealing means comprise 
 an umbrella mounted to the outside of the inner tube, said umbrella being moveable between a retracted position wherein the umbrella nests against the inner tube within the outer tube and an extended position wherein the umbrella extends radially out from the inner tube beyond the distal end of the outer tube, and  
 means for moving the umbrella between its retracted and extended positions.  
 
     
     
         11 . Apparatus for performing a transesophageal cardiovascular procedure, said apparatus comprising 
 an elongated flexible tubular shaft having a proximal end, a distal end and a wall extending between said ends;    a first lumen extending along the shaft, said lumen having an open proximal end near the proximal end of the shaft and an open distal end constituted by a side opening in the wall of the shaft near the distal end of the shaft;    first expandable sealing means on the side wall of the shaft and extending above and below said side opening;    expanding means extending along the shaft for expanding said first sealing means so that when the shaft is inserted into a patient's esophagus and the first sealing means are expanded, the portion of the esophagus opposite the side opening is isolated from the remainder of the esophagus above and below the side opening;    a fiber optic endoscope extending along the shaft said endoscope having a proximal end adapted for connection to a light source and a distal end located adjacent to said side opening for viewing the portion of the esophagus opposite the side opening;    an ultrasound transducer in said shaft near the distal end thereof, and    conductors extending along the shaft for connecting the transducer to an ultrasound transceiver.    
     
     
         12 . The apparatus defined in  claim 11  wherein the first sealing means comprise at least one inflatable balloon and the expanding means include a first fluid conduit for conducting an inflation fluid to and from said at least one balloon.  
     
     
         13 . The apparatus defined in  claim 12  and further including at least one vacuum port in the shaft wall adjacent to said side opening, and 
 a second conduit extending along the shaft, said second conduit having a proximal end for connection to a vacuum source and being in fluid communication with said at least one vacuum port so that a vacuum can be drawn in the isolated portion of the esophagus.  
 
     
     
         14 . The apparatus defined in  claim 13  and further including additional vacuum ports in the shaft wall spaced above and below said at least one vacuum port, said second conduit also being in fluid communication with said additional vacuum ports.  
     
     
         15 . The apparatus defined in  claim 11  and further including a light source connected to the proximal end of the endoscope and an ultrasound transceiver connected to said conductors.  
     
     
         16 . The apparatus defined in  claim 11  wherein said first lumen transitions gradually to said side opening.  
     
     
         17 . The apparatus defined in  claim 11  and further including an elongated probe or surgical device received in said first lumen said probe or surgical device having a working end which is deployable from said side opening.