Abstract: A medical manipulation assembly comprises a sheath steerable in response to rotational movement of a sheath steering mechanism. The assembly also comprises a catheter extendable through the sheath. The catheter is steerable in response to rotational movement of a catheter steering mechanism. The sheath and catheter are independently steerable. The assembly also comprises a set of control wires. At least one of the sheath or the catheter includes a plurality of lumens with at least two of the plurality of lumens each sized for passage of one of the control wires of the set of control wires. The steerable catheter includes a working channel sized to receive a visualization instrument therethrough.

Abstract: A system for visualizing a tissue region of interest includes an imaging element, a sheath, and a dilator. The imaging element is configured to visualize tissue. The sheath includes a channel configured to receive the imaging element. The imaging element is positionable along a central longitudinal axis of the sheath and positionable in an off-axis position relative to the central longitudinal axis. The sheath comprises a flexible section defining at least a portion of the channel. The dilator is configured to advance through the channel to force the imaging element into the off-axis position. The dilator is configured to cause the imaging element to bulge the flexible section as the dilator is advanced through the channel.

Abstract: Off-axis visualization systems are described herein which facilitate the deployment, visualization, and retraction of an imaging element from a catheter. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration as well as an imaging element, such as a CCD or CMOS imager, which may be deployed from a low profile configuration into a position which is off-axis relative to a longitudinal axis of the deployment catheter and/or imaging hood.

Abstract: A system for visualizing a tissue region of interest comprises a deployment catheter defining a lumen and a hood coupled to and extending distally from the deployment catheter. The hood has a low-profile configuration within a delivery sheath and a deployed configuration when extended distally of the delivery sheath. The hood in the deployed configuration defines an open area in fluid communication with the lumen. A distal portion of the deployment catheter extends into the open area. An imaging element is coupled to an imager support member. When in the deployed configuration, the imaging element is configured to extend distally of the distal portion while the imager support member extends within the deployment catheter. The imaging element comprises a tapered surface and the deployment catheter comprises a complementary tapered surface. Retraction of the imaging element causes the imaging element to shift radially outward from a longitudinal axis.

Abstract: A manipulation assembly includes a delivery catheter having a lumen extending therethrough and a deployment catheter positioned within the delivery catheter. The deployment catheter is independently manipulatable with respect to the delivery catheter. The assembly further includes a visualization element extendable distally beyond the deployment catheter and an ablation probe comprising an energy transmitting surface positionable to ablate tissue adjacent to a distal end of the ablation probe. The ablation probe is extendable distally beyond the deployment catheter.

Abstract: A delayed cord-clamping surface is provided that includes a newborn platform having a recessed surface configured to receive a chemical warming mattress, where the chemical warming mattress includes a conformable surface, where the newborn platform includes a detachable platform support that is configured to position the newborn platform proximal to a surgical region of a C-section patient, where the newborn platform is configured to support a newborn baby while an umbilical cord remains connected between the newborn and the C-section patient for draining from a placenta, where the newborn platform is configured to fitably mount with a warming table when the newborn platform is in a detached state from the detachable platform support.

Abstract: A system for visualizing a tissue region of interest comprises a deployment catheter defining a lumen and a hood coupled to and extending distally from the deployment catheter. The hood has a low-profile configuration within a delivery sheath and a deployed configuration when extended distally of the delivery sheath. The hood in the deployed configuration defines an open area in fluid communication with the lumen. A distal portion of the deployment catheter extends into the open area. The system also comprises an imaging element coupled to an imager support member. When the hood is in the deployed configuration, the imaging element is configured to extend distally of the distal portion of the deployment catheter while the imager support member extends within the deployment catheter.

Abstract: A delayed cord-clamping surface is provided that includes a newborn platform having a recessed surface configured to receive a chemical warming mattress, where the chemical warming mattress includes a conformable surface, where the newborn platform includes a detachable platform support that is configured to position the newborn platform proximal to a surgical region of a C-section patient, where the newborn platform is configured to support a newborn baby while an umbilical cord remains connected between the newborn and the C-section patient for draining from a placenta, where the newborn platform is configured to fitably mount with a warming table when the newborn platform is in a detached state from the detachable platform support.

Abstract: An apparatus may be used for ablating a target tissue region disposed along a tissue surface. The apparatus may comprise a means for directing ablating energy into the target tissue region through the tissue surface and a means for imaging the tissue surface along the target tissue region while selectively directing the ablating energy. The imaging means may be coupled to the energy directing means.

Abstract: A method of ablating a tissue region within a blood-filled environment comprises restraining a fluid within a visualization field in a portion of the blood-filled environment and visualizing the tissue region through the fluid within the visualization field. The method also includes transmitting ablating electrical energy from the fluid into the visualized tissue region.

Abstract: A system for visualizing a tissue region of interest comprises a deployment catheter defining at least one lumen therethrough and a hood projecting distally from the deployment catheter. The hood defines an open area that is in fluid communication with the at least one lumen. The system also comprises a delivery catheter sized to extend through the lumen. The delivery catheter includes a distal portion extendable distally from the deployment catheter and into the open area defined by the hood. The distal portion extends distally from the deployment catheter is articulatable within the open area.

Abstract: A method of treatment comprises intravascularly securing an anchor extending from an anchor member at least partially within a vessel lumen such that blood flows unobstructed through or past the anchor. While the anchor is secured, a distance of the anchor member, between the anchor and a barrier or membrane projecting distally from a deployment catheter, is adjusted such that an open area defined by the barrier or membrane is placed against or adjacent to a portion of a patient tissue. Adjusting the distance of the anchor member comprises moving the deployment catheter distally with respect to the anchor member. The method also comprises displacing blood with a transparent fluid from the open area, and while the anchor is secured, articulating the barrier or membrane circumferentially around the anchor. The method also includes treating the tissue while visualizing through the transparent fluid.

Abstract: A system comprises a deployment catheter defining at least one lumen and a hood projecting distally from the deployment catheter and defining an open area. The open area is in direct fluid communication with the at least one lumen. The system also comprises an elongate channel directly coupled to the hood such that the elongate channel terminates distally into the open area. The elongate channel extends proximally from an outer surface of the hood and is bounded proximally at a proximal pocket surface. The system also comprises an imaging element. The imaging element is sized to pass into the elongated channel at a distal end of the elongate channel. Proximal movement within the elongated channel is restricted by the proximal pocket surface. The system also comprises a control member extending within the elongate channel and through the proximal pocket surface for moving the imaging element through the elongate channel.

Abstract: A method of inhibiting tissue migration comprises positioning an open area of a hood against or adjacent to a tissue region. The method also comprises displacing an opaque fluid with a transparent fluid from the open area. The method includes engaging a portion of the tissue region within the open area via an end effector advanced through the open area and which grasps onto the portion. The end effector includes a tapered section, tapered along its entire length, through which a lumen extends. The tapered section includes threads extending from a surface of the tapered section in a direction orthogonal to the longitudinal axis. The tissue region is pierced while displacing the opaque fluid with the transparent fluid through the distal opening of the hood and while maintaining engagement of the portion of the tissue region such that distal movement of the tissue is inhibited.

Abstract: Visualization apparatus and methods for transseptal access are described herein where intravascular access across a septal wall is facilitated via devices which provide for direct visual viewing of tissue area. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to the tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid can be pumped into the imaging hood until the fluid displaces any blood leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. Any number of therapeutic tools or a guidewire can be passed through the catheter and into the imaging hood for crossing the septal wall and passing the guidewire or instruments therethrough.

Abstract: Coronary sinus cannulation apparatus and methods relating to tissue visualization catheters that can locate and/or cannulate a morphological feature within a body lumen, such as the coronary sinus, are described. Such devices can also perform a variety of therapeutic tissue treatments under direct in vivo visualization thereafter. Moreover, such apparatus and methods may also be utilized with guidewires to facilitate delivery into the coronary sinus to eliminate repositioning of the device and/or repeating an entire sequence of operations, consequently improving procedure effectiveness and reducing procedure time.

Abstract: Flow reduction hood systems are described which facilitate the visualization of tissue regions through a clear fluid. Such a system may include an imaging hood having one or more layers covering the distal opening and defines one or more apertures which control the infusion and controlled retention of the clearing fluid into the hood. In this manner, the amount of clearing fluid may be limited and the clarity of the imaging of the underlying tissue through the fluid within the hood may be maintained for relatively longer periods of time by inhibiting, delaying, or preventing the infusion of surrounding blood into the viewing field. The aperture size may be controlled to decrease or increase through selective inflation of the membrane or other mechanisms.

Abstract: Methods and apparatus for efficient purging from an imaging hood are described which facilitate the visualization of tissue regions through a clear fluid. Such a system may include an imaging hood having one or more layers covering the distal opening and defines one or more apertures which control the infusion and controlled retention of the clearing fluid into the hood. In this manner, the amount of clearing fluid may be limited and the clarity of the imaging of the underlying tissue through the fluid within the hood may be maintained for relatively longer periods of time by inhibiting, delaying, or preventing the infusion of surrounding blood into the viewing field. The aperture size may be controlled to decrease or increase through selective inflation of the membrane or other mechanisms.

Abstract: Systems and methods for unobstructed visualization and ablation, particularly of the pulmonary veins, are described herein. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration as well as one or more expandable anchors which are temporarily securable within a respective pulmonary vein while allowing blood flow to pass through the anchor unimpeded. With the one or more non-impeding anchors secured within a respective pulmonary vein, ablation of the tissue surrounding the ostium or several ostia may be effected with the catheter while the tissue is under direct visualization.

Abstract: Off-axis visualization systems are described herein which facilitate the deployment, visualization, and retraction of an imaging element from a catheter. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration as well as an imaging element, such as a CCD or CMOS imager, which may be deployed from a low profile configuration into a position which is off-axis relative to a longitudinal axis of the deployment catheter and/or imaging hood.