Abstract: A myocardial revascularization system that includes a laser energy source (e.g., a semiconductor laser), an outer guide member providing access to a patient's heart, and an optical fiber. The optical fiber is coupled to receive laser energy pulses from the source, is slidably located within the guide member, and is extendible from the distal end of the guide member. A drive motor is connected to the fiber to automatically move the distal end of the optical fiber with respect to the distal end of the guide member. A controller controls the drive motor to automatically move the fiber in synchronism with firing of the laser energy, and automatically calibrates the position of the distal end of the fiber with respect to the distal end of the catheter. The fiber has, at its tip, an enlargened portion with a front surface coated with a heat absorbing material that is nonmetallic and is partially transparent to the pulses. The outer guide member is 7 French or smaller and has a deflectable distal end.

Abstract: An energy delivery system for performing myocardial revascularization on a heart of a patient including an energy pulse source that produces energy pulses sufficient to create channels in a wall of a heart, and an energy pulse delivery system connected to receive the energy pulses and deliver the energy pulses to desired locations for channels in the wall of the heart. Also disclosed are a sensor that senses a cyclical event related to the contraction and expansion of the beating heart; a controller responsive to the sensor for automatically firing the energy pulse system to provide energy to strike the beating heart only within a safe time period during a heart beat cycle; RF electrical or laser energy pulses; a temperature sensor to avoid damage caused by overheating adjacent heart tissue; a thermal conductivity cooling system; and programmably adjusting duty cycle, duration and amplitude of energy pulses.

Abstract: An energy delivery system for performing myocardial revascularization on a heart of a patient including an energy pulse source that produces energy pulses sufficient to create channels in a wall of a heart, and an energy pulse delivery system connected to receive the energy pulses and deliver the energy pulses to desired locations for channels in the wall of the heart. Also disclosed are a sensor that senses a cyclical event related to the contraction and expansion of the beating heart; a controller responsive to the sensor for automatically firing the energy pulse system to provide energy to strike the beating heart only within a safe time period during a heart beat cycle; RF electrical or laser energy pulses; a temperature sensor to avoid damage caused by overheating adjacent heart tissue; a thermal conductivity cooling system; and programmably adjusting duty cycle, duration and amplitude of energy pulses.

Abstract: A percutaneous mapping system includes a mapping wire, for percutaneous insertion into an internal body cavity, having a plurality of spaced imaging markers; and an insertion device for deploying the mapping wire in a spiral configuration inside the cavity with the markers distributed about the inner wall of the cavity.

Abstract: A handpiece for use in transmyocardial revascularization heart-synchronized pulsed laser system includes a barrel having a passage for transmitting a laser beam; a surface at the distal end of the barrel for contacting the wall of the heart; an aperture located at the distal end of the barrel and the enlarged surface for transmitting the laser beam; and means for focusing the laser beam proximate to the aperture to vaporize the tissue of the heart wall and create a hole to the interior heart chamber.

Abstract: A handpiece for a medical laser system comprising a barrel for having a passage for transmitting a laser beam and a contacting wall on one end of said barrel including an aperture in communication with the passage, a solid face extending radially outward from the aperture to the periphery of said contacting wall, and a knurled surface on the face for preventing movement of the contacting wall with respect to the heart wall during surgery.

Abstract: An apparatus for percutaneous laser revascularization of a patient's beating heart includes a laser system that produces a pulsed laser beam with a wavelength in a range of approximately 1.7 .mu.m to approximately 2.15 .mu.m, each pulse of the laser beam having a pulse duration in a range of approximately 1 ms and greater and having a pulse energy in a range of approximately 5 J to approximately 25 J. The pulse can include a train of micropulses. A fiber optic element that is coupled to the laser system is arranged with a catheter to pass through a vasculature of the patient and to deliver pulses of the laser beam to an interior wall of the patient's heart. The laser system can include a flash lamp-pumped laser in which a large capacitor bank discharges only a fraction of its stored energy through a flash lamp to fire the laser, wherein the capacitor discharge is turned off by a switchable device, such as a high current transistor, after the integrated energy of a laser pulse reaches a selected value.

Abstract: A system and method of marking percutaneous transmyocardial revascularization channels in a human heart includes inserting a catheter system into the left ventricle of a heart, applying tissue ablative energy through the catheter to create a channel into the heart wall, and introducing an imaging medium to the heart wall proximate the channel for marking the position of that channel for imaging.

Abstract: A sensor system for detecting concealed blood vessels including a handpiece having a passage for transmitting a laser beam and a detector housing at the distal end of the handpiece, the housing including a common electrode, a plurality of segmented electrodes spaced from the common electrode and between the common electrode and the segmented electrodes a plurality of four sensitive elements having an electrical characteristic which varies with the force applied; and an indicator device responsive to variations in the electrical characteristic for representing the presence of a concealed vessel.

Abstract: A gauging system for monitoring channel depth in percutaneous endocardial revascularization surgery includes a catheter for percutaneous insertion into a heart chamber, including a source of tissue ablative energy for ablating a part of the wall of the heart chamber where a channel is to be created; a sensor device proximate the distal end of the catheter for sensing a boundary of the heart wall proximate the channel; and a detection circuit, responsive to the sensor device, for determining the position of the terminus of the channel in the heart chamber; alternatively, a mechanical stop extending radially beyond the distal tip may be used for physically limiting penetration of the catheter tip into the drilled channels.

Abstract: A surgical laser handpiece comprising: an outer barrel having an inner chamber; an inner zoom barrel movable in said chamber relative to said outer barrel; at least a first lens device in said zoom barrel for propagating and focusing a laser beam; and a drive member externally accessible on said outer barrel for moving said zoom barrel with one hand relative to said outer barrel for varying the focus of the laser beam.

Abstract: A video assisted thoracoscopic transmyocardial revascularization (TMR) surgical method includes making at least two spaced incision ports between the ribs of a patient proximate the patient's heart; inserting through one of the ports a thoracoscopic TMR handpiece assembly for creating a channel through the heart wall; inserting through the other incision port a thoracoscope connected to a video display system; viewing the heart of the patient through the video display system and positioning the handpiece assembly relative to the heart; and actuating the handpiece assembly to create a channel through the wall of the patient's heart.

Abstract: A catheter navigation apparatus includes a catheter system for percutaneous insertion into an internal organ cavity. The catheter system includes a treatment catheter and a navigation catheter; the navigation catheter includes a deployable framework at its distal end; the treatment catheter includes at least one conduit extending from its proximal to its distal end; the conduit having its distal end engaged with the framework; the navigation catheter includes a flexible link interconnecting the framework with a control mechanism at the proximal end of the navigation catheter for driving the link to deploy and retract the framework to guide the distal tip of the treatment catheter to target one or more selected positions on the inner wall of the organ cavity.

Abstract: An ultrasonic detection system for transmyocardial revascularization (TMR) is disclosed using a detector in the TMR handpiece for detecting concealed coronary blood vessels as well as verifying completion of transmural TMR channels by displaying the detector's output on a video monitor or analyzing the detector output electronically to identify those conditions.

Abstract: A thoracoscopic transmyocardial revascularization handpiece assembly for a medical laser system which includes a barrel which fits between the patient's ribs, a handpiece which fits between the ribs, a contacting surface on one end of the handpiece with a width which fits between the patient's ribs, and a contacting surface which has a length larger than the width resulting in a contact surface with a surface area which is greater than the cross-sectional area of the handpiece and which yet still fits between the patient's ribs.

Abstract: A thoracoscopic cannula system includes a cannula having an enlarged limiter flange and an elongated hollow tube for insertion between the ribs of a thoracic patient; the tube includes first and second opposed concave recesses for snap-fitting and interlocking with the adjacent ribs to securely anchor it; and an introducer including an elongated member slidably received in the hollow tube with a stop flange at one end to limit movement of the introducer through the tube and a beveled, blunted surface at the other end for gently penetrating and leading the cannula through an incision between the ribs of the patient.

Abstract: A non-reusable lens cell for a surgical laser handpiece having a contact surface with an aperture for exiting a laser beam includes a housing having a first connector at a first end for engaging a laser source and a second connector at a second end for engaging a handpiece; and a hydroscopic lens device for focusing the laser beam through the handpiece proximate the aperture and being degradable in the presence of moisture during attempts at sterilization to deteriorate the lens device, disrupt the focus and thwart reuse of the lens cell.

Abstract: An angled beam-delivery handpiece includes a barrel for delivering a monochromatic light beam; a contact surface at the distal end of the barrel; a window in the side of the barrel proximate the contact surface; an aperture in the contact surface; and a refractive element in the barrel above the window for diverting the beam carried by the barrel to exit the aperture at an angle to the laser beam in the barrel.

Abstract: An improved medical laser treatment system and method generates a beam of laser energy at a predetermined wavelength; transmits the beam of laser energy along a path to a medical treatment site; delivers to the medical treatment site an insufflating gas which is absorbent at the predetermined wavelength; and introduces into the path of the beam of laser energy a non-absorbent purge gas which is transparent to the predetermined wavelength of the laser, at a flow rate for opposing the influx of insufflating gas to reduce the resonant absorption of the laser beam energy.

Abstract: A unitary ECG monitor lead and needle electrode system includes a connector for connection to an ECG monitor junction; an electrode lead interconnected with the connector at one end of the electrode lead, the lead including a signal conductor; and a needle electrode unit interconnected with the other end of the electrode lead and including a needle electrode, a body portion for receiving the other end of the lead and for receiving an electrode needle, for forming the needle electrode unit as a single integral unit.