Percutaneous intravascular access to cardiac tissue

Abstract

Devices, systems, and methods for accessing the internal and external tissues of the heart are disclosed. At least some of the embodiments disclosed herein provide access to the external surface of the heart through the pericardial space for localized delivery of substances to the heart tissue. In addition, various disclosed embodiments provide access to the internal surface of the heart for aspiration and delivery of substances to a targeted region without disturbing or interfering with nearby structures or surfaces.

1 . A system for use with a vacuum source for accessing the tissue of a heart, comprising:
 an engagement catheter comprising a proximal end, a distal end, and first and second lumens extending between the proximal end and the distal end;   a delivery catheter comprising a proximal end, a distal end, and a hollow tube extending between the proximal end and the distal end, the delivery catheter configured such that the hollow tube is capable of insertion into the second lumen of the engagement catheter;   a needle located at the distal end of the delivery catheter; and   a vacuum port located at the proximal end of the engagement catheter, the vacuum port being operatively connected to the first lumen of the engagement catheter and capable of operative connection to the vacuum source;   wherein the first lumen of the engagement catheter includes a suction port located at or near the distal end of the engagement catheter, the suction port configured to removably attach to a targeted tissue on the interior of a wall of the heart, such that the suction port is capable of forming a reversible seal with the targeted tissue when the vacuum source is operatively attached to the vacuum port, and   wherein the system is capable of enlarging a pericardial space between the targeted tissue and a pericardial sac that surrounds the heart by retracting the targeted tissue away from the pericardial sac.   
     
     
         2 . The system of  claim 1 , wherein the targeted tissue comprises a portion of an atrial wall. 
     
     
         3 . The system of  claim 1 , wherein the targeted tissue comprises a portion of an atrial appendage. 
     
     
         4 . The system of  claim 1 , wherein:
 the needle is positioned to be capable of piercing the targeted tissue when the hollow tube is inserted into the second lumen and the suction port is attached to the targeted tissue, such that, when the targeted tissue is pierced, access to the pericardial space is achieved.   
     
     
         5 . The system of  claim 4 , further comprising:
 a guide wire for insertion into the pericardial space.   
     
     
         6 . The system of  claim 5 , wherein:
 the needle comprises a hollow needle in communication with the hollow tube, and   the guide wire is capable of insertion through the hollow tube and the hollow needle into the pericardial space.   
     
     
         7 . The system of  claim 1 , wherein the engagement catheter further comprises an injection channel in fluid communication with the second lumen of the engagement catheter, the injection channel being configured to administer a fluid to the targeted tissue. 
     
     
         8 . The system of  claim 7 , wherein the fluid comprises an adhesive. 
     
     
         9 . The system of  claim 7 , wherein the injection channel is ring-shaped. 
     
     
         10 . The system of  claim 1 , wherein the engagement catheter further comprises an injection channel formed along the length of the engagement catheter, the injection channel having at its distal end at least one opening for administering a fluid to the targeted tissue, the injection channel being capable of operable attachment to an external fluid source at the proximal end of the injection channel, such that fluid from the external fluid source can flow through the injection channel to the targeted tissue when the external fluid source is operatively attached to the injection channel. 
     
     
         11 . The system of  claim 1 , wherein the needle comprises a needle wire for piercing the targeted tissue. 
     
     
         12 . The system of  claim 1 , wherein the needle comprises a pressure tip needle. 
     
     
         13 . An engagement catheter for use with a vacuum source in accessing heart tissue, comprising:
 an elongated tube comprising a proximal end, a distal end, an outer wall positioned circumferentially along the length of the tube, and an inner wall positioned circumferentially along the length of the tube, wherein the outer wall and the inner wall form at least one suction channel along the length of the tube between the outer wall and the inner wall;   a vacuum port in communication with the proximal end of the tube, the vacuum port being operatively connected to the at least one suction channel and capable of operative connection to the vacuum source; and   a suction port in communication with the at least one suction channel at the distal end of the tube, the suction port configured to removably attach to targeted tissue on the interior of a wall of the heart such that the suction port is capable of forming a reversible seal with the wall of the heart when the vacuum source is operatively attached to the vacuum port,   wherein the engagement catheter is capable of enlarging a pericardial space between the heart and a pericardial sac when the suction port is attached to the interior wall of the heart.   
     
     
         14 . The engagement catheter of  claim 13 , further comprising:
 at least one internal lumen support positioned within the at least one suction channel and attached to the outer wall and the inner wall, the at least one internal lumen support extending from the distal end of the tube along at least a substantial portion of the length of the tube.   
     
     
         15 . The engagement catheter of  claim 14 , wherein:
 the at least one internal lumen support comprises two internal lumen supports and the at least one suction channel comprises two suction channels.   
     
     
         16 . The engagement catheter of  claim 13 , further comprising:
 an injection channel formed along the length of the tube, the injection channel having at its distal end at least one opening for administering a fluid to the targeted tissue, the injection channel being capable of operable attachment to an external fluid source at the proximal end of the injection channel, such that fluid from the external fluid source can flow through the injection channel to the targeted tissue when the external fluid source is operatively attached to the injection channel.   
     
     
         17 . A delivery catheter for use in accessing a pericardial space surrounding the external surface of a heart, comprising
 an elongated hollow tube comprising a proximal end, a distal end, and a lumen;   a needle extending from the distal end of the tube; and   a security notch formed circumferentially around the needle, the security notch being configured to prevent over-perforation of the needle when piercing a wall of the heart into the pericardial space.   
     
     
         18 . The delivery catheter of  claim 17 , further comprising:
 an elongated guide wire sized to be placed inside the lumen of the tube.   
     
     
         19 . The delivery catheter of  claim 18 , wherein:
 the needle comprises a hollow needle in communication with the lumen of the hollow tube, and   the distal end of the guide wire is capable of insertion through the hollow tube and the hollow needle to access the pericardial space.   
     
     
         20 . The delivery catheter of  claim 17 , wherein the tube further comprises at least one opening at the distal end of the tube for administering a fluid to the external surface of the heart located in the pericardial space, such that the at least one opening is in fluid communication with the lumen of the tube. 
     
     
         21 . A method of accessing the tissue of a heart, the method comprising the steps of: providing a system, comprising:
 an engagement catheter comprising a proximal end, a distal end, and first and second lumens extending between the proximal end and the distal end;   a delivery catheter comprising a proximal end, a distal end, and a hollow tube extending between the proximal end and the distal end, the delivery catheter configured to be inserted into the second lumen of the engagement catheter;   a needle located at the distal end of the delivery catheter; and   a vacuum port located at the proximal end of the engagement catheter, the vacuum port being operatively connected to the first lumen of the engagement catheter and capable of operative connection to the vacuum source;   wherein the first lumen of the engagement catheter includes a suction port located at or near the distal end of the engagement catheter, the suction port configured to removably attach to a targeted tissue on the interior of a wall of the heart, such that the suction port is capable of forming a reversible seal with the targeted tissue when the vacuum source is operatively attached to the vacuum port, and   wherein the system is capable of enlarging a pericardial space between the targeted tissue and a pericardial sac that surrounds the heart by retracting the targeted tissue away from the pericardial sac;   inserting the engagement catheter into the body such that the distal end of the engagement catheter is positioned inside the heart and the suction port is in contact with the targeted tissue on the interior of a wall of the heart;   operatively connecting a vacuum source to the vacuum port such that the suction port is reversibly attached to the targeted tissue on the interior of a wall of the heart;   inserting the delivery catheter into the second lumen of the engagement catheter;   piercing the targeted tissue on the interior of a wall of the heart with the needle; and   administering a substance into the pericardial space.   
     
     
         22 . The method of  claim 21 , further comprising:
 withdrawing the needle from the targeted tissue; and   administering a substance to the targeted tissue after withdrawal of the needle.   
     
     
         23 . The method of  claim 22 , wherein:
 the substance comprises an adhesive for sealing a puncture wound in the targeted tissue.   
     
     
         24 . The method of  claim 21 , wherein:
 the targeted tissue comprises a portion of an atrial wall.   
     
     
         25 . The method of  claim 21 , wherein:
 wherein the targeted tissue comprises a portion of an atrial appendage.   
     
     
         26 . The method of  claim 22 , further comprising:
 accessing the pericardial space by inserting a guide wire through the wall of the heart into the pericardial space.   
     
     
         27 . A method of accessing the tissue of a heart, the method comprising:
 extending into a blood vessel an elongated tube having a proximal end, a distal end, and at least one lumen, such that the distal end of the tube is in contact with a targeted tissue on the interior of a wall of the heart;   aspirating the targeted tissue such that the wall of the heart is retracted away from a pericardial sac surrounding the heart to enlarge a pericardial space between the pericardial sac and the wall of the heart;   delivering a fluid onto the targeted tissue; and   removing the elongated tube from the body.   
     
     
         28 . The method of  claim 27 , further comprising:
 inserting through one of the at least one lumen of the elongated tube a delivery catheter having a proximal end, a distal end, and a needle located at the distal end, such that the needle is located within the heart;   inserting the needle into the targeted tissue; and   injecting a fluid into the pericardial space such that the fluid contacts the exterior of the heart within the pericardial space.   
     
     
         29 . The method of  claim 28 , wherein:
 the needle comprises a security notch circumferentially around the needle.   
     
     
         30 . The method of  claim 28 , further comprising:
 inserting at least the distal end of an elongated guide wire through the needle into the pericardial space;   withdrawing the needle from the targeted tissue; and   inserting the delivery catheter into the pericardial space.   
     
     
         31 . The method of  claim 27 , wherein the elongated tube further comprises at least one internal lumen support positioned within the at least one lumen, the at least one internal lumen support extending from the distal end of the elongated tube along at least a substantial portion of the length of the elongated tube. 
     
     
         32 . The method of  claim 31 , wherein the at least one internal lumen support comprises two internal lumen supports.