Abstract: A tissue visualization system comprises a flexible elongate shaft through which a lumen extends. The system also comprises a pliable visualization device coupled to a distal portion of the flexible elongate shaft. The pliable visualization device includes a chamber configured to receive a fluid. The system also comprises a piercing instrument configured to extend through the lumen and to penetrate a surface of the pliable visualization device.

Abstract: A manipulation assembly comprises: a delivery catheter having a lumen extending therethrough; and a deployment catheter positioned within the lumen of the delivery catheter. The delivery catheter is manipulatable within multiple planes. The deployment catheter is independently manipulatable with respect to the delivery catheter and includes a first lumen and a second lumen. The assembly further comprises an elongate, flexible visualization element positioned within the first lumen of the deployment catheter and extendable distally beyond the delivery catheter. The visualization element is articulatable with respect to the delivery catheter. The assembly further comprises an ablation probe positioned within the second lumen of the deployment catheter and comprises an illumination tool routed through the deployment catheter. The ablation probe is extendable distally beyond the deployment catheter and is positionable off-axis with respect to a longitudinal axis of the delivery catheter.

Abstract: A medical manipulation assembly includes a catheter and distal and proximal steering mechanisms. The catheter includes distal and proximal steerable portions with working channels configured to receive an instrument. The distal steering mechanism is operable to bend the distal steerable portion in a first plane relative to the proximal steerable portion in response to movement of a first portion of the distal steering mechanism about a first axis of rotation and to bend the distal steerable portion in a second plane relative to the proximal steerable portion in response to movement of a second portion of the distal steering mechanism about a second axis of rotation. The proximal steering mechanism is operable to bend the proximal steerable portion by rotational movement of the proximal steering mechanism. Distal pullwires extend between the distal steerable portion and steering mechanism and proximal pullwires extend between the proximal steerable portion and steering mechanism.

Abstract: An apparatus for inhibiting tissue migration during a procedure comprises a deployment catheter defining at least one lumen therethrough and a non-inflatable hood projecting distally from the deployment catheter and defining an open area. The open area is in fluid communication with the at least one lumen. The apparatus also comprises a visualization element disposed within or along the non-inflatable hood for visualizing tissue adjacent to the open area. The apparatus also comprises a tissue grasping end effector positioned within the open area and configured to temporarily engage the tissue adjacent to the open area such that distal migration of the tissue relative to the barrier or membrane is inhibited.

Abstract: A medical manipulation assembly comprises a catheter including distal and proximal steerable portions with working channels. The assembly further comprises a steerable sheath through which the steerable portions extend. A distal steering mechanism, including a first lumen extending along a longitudinal axis of the catheter, bends the distal steerable portion. A proximal steering mechanism, including a second lumen extending along the axis and defined by a wall, bends the proximal steerable portion by rotational movement of the proximal steering mechanism independently of the distal steerable portion. The wall is rotatable about the axis. Distal pullwires extend between the distal steerable portion and the distal steering mechanism. Proximal pullwires extend between the proximal steerable portion and the proximal steering mechanism.

Abstract: A method of cannulating a coronary sinus within a heart chamber includes deploying, from a catheter, an imaging hood to a deployed configuration by extending the imaging hood from a distal end of the catheter and radially expanding the imaging hood to define a constant deployed volume within an open area of the imaging hood. The method further includes positioning a contact edge of the imaging hood and the open area of the imaging hood in the deployed configuration over or upon an ostium of the coronary sinus, displacing an opaque fluid with a transparent fluid from the open area defined by the imaging hood and tissue surrounding the ostium, visualizing the ostium through the transparent fluid by viewing the ostium via an imaging element attached to an inner surface of the imaging hood, and introducing a guidewire through the imaging hood and into the ostium while under visual guidance.

Abstract: A tissue visualization system comprises a flexible elongate shaft through which a lumen extends. The system also comprises a pliable visualization device coupled to a distal portion of the flexible elongate shaft. The pliable visualization device includes a chamber configured to receive a fluid. The system also comprises a piercing instrument configured to extend through the lumen and to penetrate a surface of the pliable visualization device.

Abstract: A method of inhibiting flow of a purging fluid from a device comprises positioning an imaging hood in proximity to a tissue region to be visualized. The imaging hood includes a distal membrane which defines a main aperture. The imaging hood and the distal membrane define an open area. The method also comprises introducing the purging fluid into a proximal portion of the open area. The proximal portion is bounded by a proximal membrane including a plurality of apertures. The method also comprises pressurizing the proximal membrane with the purging fluid to a partially extended state in which the purging fluid flows through the plurality of apertures and through the main aperture. The method also comprises pressurizing the proximal membrane with the purging fluid to a blocking extended state in which the proximal membrane obstructs the main aperture to block the flow of the purging fluid through the main aperture.

Abstract: A method of inhibiting flow of a purging fluid from a device comprises positioning an imaging hood in proximity to a tissue region to be visualized. The imaging hood includes a distal membrane which defines a main aperture. The imaging hood and the distal membrane define an open area. The method also comprises introducing the purging fluid into a proximal portion of the open area. The proximal portion is bounded by a proximal membrane including a plurality of apertures. The method also comprises pressurizing the proximal membrane with the purging fluid to a partially extended state in which the purging fluid flows through the plurality of apertures and through the main aperture. The method also comprises pressurizing the proximal membrane with the purging fluid to a blocking extended state in which the proximal membrane obstructs the main aperture to block the flow of the purging fluid through the main aperture.

Abstract: An apparatus for inhibiting tissue migration during a procedure comprises a deployment catheter defining at least one lumen therethrough and a non-inflatable hood projecting distally from the deployment catheter and defining an open area. The open area is in fluid communication with the at least one lumen. The apparatus also comprises a visualization element disposed within or along the non-inflatable hood for visualizing tissue adjacent to the open area. The apparatus also comprises a tissue grasping end effector positioned within the open area and configured to temporarily engage the tissue adjacent to the open area such that distal migration of the tissue relative to the barrier or membrane is inhibited.

Abstract: A method of inhibiting a flow of a purging fluid from a tissue visualization device comprises positioning an imaging hood attached to a distal end of a flexible elongate shaft in proximity to a tissue region to be visualized The method also comprises introducing the purging fluid into an inflation member suspended within an open area of the imaging hood. The inflation member includes at least one aperture on a proximal portion of the inflation member. The method also comprises inflating the inflation member to a partially inflated state in which the inflation member is circumferentially separated from an inner surface of the hood to form an annular flow path for the purging fluid from the at least one aperture, between the inner surface of the hood and the inflation member, and into fluid communication with an environment external to the hood.

Abstract: In one example, a system includes a deployment catheter defining at least one lumen therethrough. The system further includes a balloon member projecting distally from a distal end of the deployment catheter and defining an area therein, wherein the area is in fluid communication with the at least one lumen. The system further includes a first opening at the distal end of the balloon member, a first instrument lumen extending through the balloon member from the distal end of the deployment catheter to the first opening, and a visualization element disposed within the balloon member for visualizing tissue external to the balloon member.

Abstract: A system comprises a steerable sheath including a passageway therethrough and a steerable segment extendable from the passageway. The steerable segment defines a lumen. The system also includes an imaging element extending from a distal end of the steerable segment.

Abstract: Complex steerable catheter visualization and tissue manipulation systems and their methods of use are disclosed herein. The deployment catheter is articulated using various steering mechanisms. Tissue visualization is accomplished from the visualization hood at the distal end of the deployment catheter, the hood having an ability to expand and other features to facilitate visualization and articulation at the tissue surface.

Abstract: A method of visually locating a vessel within a body lumen comprises displacing an opaque fluid with an inflatable member contained within an open area of a barrier or membrane. The method also comprises positioning the inflatable member against or adjacent to a tissue region at a first location and visually assessing the tissue region at the first location through the inflatable member. The method also comprises repositioning the inflatable member against or adjacent to the tissue region at a second location.

Abstract: Complex steerable catheter visualization and tissue manipulation systems and their methods of use are disclosed herein. The deployment catheter is articulated using various steering mechanisms. Tissue visualization is accomplished from the visualization hood at the distal end of the deployment catheter, the hood having an ability to expand and other features to facilitate visualization and articulation at the tissue surface.