Abstract: A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the working device such as for drug delivery.

Abstract: The disclosure is directed to a tissue ablation device comprising an elongate probe, with a tissue ablation member located at the deflectable distal end of the probe, which is configured to access a patient's heart. The elongate probe is attached at its proximal end to a handpiece which is ergonomically designed to fit within the hand of the operator. The handpiece houses an advancement mechanism which is mechanically coupled to the tissue ablation member and can be used to axially translate the tissue ablation member in relation to the elongate probe. An activation mechanism is housed within the advancement mechanism and is coupled to the advancement mechanism in such a manner that the operator can simultaneously activate and advance the tissue removal member with one finger or thumb. The handpiece also houses a deflection actuator which applies tension to a tensile member which deflects the distal end of the probe.

Abstract: A steerable drug delivery catheter and method of use, particularly adapted for percutaneous use. The distal end of the drug delivery catheter is deflectable. The catheter has a relative movement compensation mechanism for maintaining positioning between the distal end of the drug delivery catheter and the distal end of the drug delivery device therein.

Abstract: A catheter system with an outer catheter body defining at least one lumen and an inner catheter body defining at least one lumen with proximal and distal portions. An introducer is coupled to the distal portion of the inner catheter body. The introducer has a tissue piercing distal end. A resistive heater element is positioned in the introducer. The outer catheter is introduced into a patient's vasculature. The inner catheter is then introduced through the lumen of the outer catheter to a selected heart site. The tissue piercing distal end of the introducer is then advanced into an interior of the heart at the selected heart site. Energy is delivered to the selected heart site from the resistive heater element to create a blood conducting pathway and/or stimulate angiogenesis. In an alternative embodiment, a heart treatment apparatus includes a handpiece with a proximal and a distal end and an elongated member defining at least one lumen coupled to the handpiece distal end.

Abstract: A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the work device such as for drug delivery.

Abstract: Apparatus and method for creating pathways in tissue and destroying the cored tissue to avoid release of the cored tissue within the body. The apparatus has a coring mechanism and a tissue vaporization mechanism. The apparatus is useful in creating revascularization pathways in the myocardium. The apparatus and methods are adaptable for either surgical or percutaneous procedures.

Abstract: A method for treating myocardium using at least one mechanical or electromagnetic energy functional device for forming a network of branched, interconnecting passages in a boundary between endocardium and myocardium, thereby enhancing blood flow into the treated zone, and a device for selectively treating ischemic myocardium tissue comprising a tube having proximal end and distal end, and at least one hollow lumen and defining an axis, at least two mechanical or electromagnetic energy functional devices disposed within the tube, the at least two mechanical or electromagnetic energy functional devices each having a distal end disposed adjacent the distal end of the central tube, and a deflecting member adjacent the distal portion of the central tube for deflecting the distal end of each of the at least two mechanical or electromagnetic energy functional devices away from the axis, for enabling treatment of selective areas of ischemic or hibernating myocardium tissue.

Abstract: The apparatus for combined mechanical/laser myocardial revascularization of a human heart includes: inserting a mechanical piercing device and an elongated flexible lasing apparatus into the chest cavity of a patient; mechanically auto-piercing, micro-tearing or spreading the epicardium of the heart; and then lasing from beneath the epicardium through the myocardium.

Abstract: A method for improving blood flow in the heart provides a catheter system with an outer catheter defining at least one lumen and an inner catheter defining at least one lumen with proximal and distal portions. An introducer is coupled to the distal portion of the inner catheter. The introducer has a tissue piercing distal end. A resistive heater element is positioned in the introducer. The catheter system is introduced into a patient's vasculature. The inner catheter is then introduced through the a lumen of the outer catheter to a selected heart site. The tissue piercing distal end of the introducer is then advanced into an interior of the heart at the selected heart site. Energy is delivered to the selected heart site from the resistive heater element to create a blood conducting pathway and/or stimulate angiogenesis.

Abstract: Improved methods and devices related to laser-assisted transmyocardial revascularization (TMR), and more particularly, to improved methods and devices for creating branched TMR channels through myocardium in which a single opening is made in an epicardial surface with a plurality of channel branches, having predetermined geometries extending into and through myocardium, depending therefrom. A method of creating branched TMR channels comprises piercing an epicardial surface mechanically or with laser energy, directing laser energy through the opening in a first predetermined angular orientation with respect to the epicardial surface to create a first channel and delivering laser energy in a second predetermined angular orientation to create a second branch. A plurality of branches can thus be created in a single channel structure.

Abstract: A method of selecting laser parameters for performing laser-assisted myocardial revascularization to avoid inducing undesired cardiac arrhythmia without synchronization of delivery of laser energy and the patient's cardiac cycle, the method comprising the steps of minimizing the power level of laser energy used, thereby decreasing the overall trauma to the heart, selecting a pulse frequency as great as possible while avoiding adverse summation effects, selecting a pulse width as wide as possible to prevent excessively high peak powers per pulse and not so wide as to cause undesired thermal damage, selecting an energy flux rate, shaping the front end of each pulse of laser energy to provide efficient, non-explosive TMR channeling, and correcting the selected power level, pulse width, pulse frequency and energy flux rate for mechanical events, including method of access to the heart, position of selected portions of myocardium in the heart, temporal duration of the procedure, natural movement of the heart, spec

Abstract: Improved methods and apparatuses related to laser-assisted intra-coronary transmyocardial revascularization (ITMR), and more particularly, to improved methods and apparatuses for directing an interventional catheter device, via percutaneous or other entry into the vasculature, for example at the femoral artery, over the aortic arch, through the ascending aorta and over the coronary ostia such that the laser delivery means can be positioned inside a coronary artery and laser energy is used to create a plurality of small channels through the coronary artery into the tissue of the myocardium. An proximal hub portion and method of using it are described, the proximal hub portion adapted for attachment to a central, elongated lumen portion, the proximal hub portion optionally having a plurality of branched extending arms, the sheath and associated branched arms having individual blood loss seals and individually capable of receiving a laser delivery means, visualization or marking means, or other tools.

Abstract: A spiral catheter apparatus for access to, and laser or other treatment within, cavities and organs in the human body, the apparatus comprising a flexible, main catheter shaft defining a central axis of the apparatus, the catheter shaft having a proximal end, a distal end and a first hollow lumen region extending therethrough, the catheter shaft further having a spiral portion adjacent the distal end with a selected curvilinear shape, the curvilinear shape defining an inner arcuate sidewall and an outer arcuate sidewall, the catheter shaft flexible enough to assume a temporarily elongated shape such that the apparatus can be extended through at least a portion of the body in the temporarily elongated shape and will assume the selected curvilinear shape when extended into a body cavity or organ, the selected curvilinear shape serving to securely position the apparatus adjacent a selected surface within the body cavity or organ, at least the spiral portion of the catheter shaft having a plurality of guide holes

Abstract: A bow shaped, integrated wire catheter apparatus and method of use for access to, and laser or other treatment within, cavities and organs in the human body, the apparatus having a curvilinear shape but flexible enough to assume a generally elongated shape such that the apparatus can be extended through the vasculature in the generally elongated shape and can assume the curvilinear shape when extended into a body cavity or organ, the curvilinear shape serving to securely position the apparatus adjacent a selected surface within the body cavity or organ for laser or other treatment with a laser delivery device or other functional device thereon, the apparatus having a central axis, the apparatus comprising a main catheter shaft having a proximal end and an apex seeking and stabilizing distal end, the main catheter shaft having material of construction or other mechanism or means for causing a portion of the catheter shaft to have a bowed shape adjacent its distal end, the main catheter shaft having at least on