Abstract: A steerable percutaneous catheter for guiding at least one functional device to selected surfaces of a body for treatment thereon, particularly adapted for laser-assisted Percutaneous Transmyocardial Revascularization (PTMR). The steerable catheter has a handle portion at its proximal end and a controllably deflectable end portion at its distal end. The distal end of the catheter and the distal end of the functional device maintain alignment automatically during deflection. The invention also includes a surface contact detection system to detect contact with an interior body surface, such as the heart wall.

Abstract: A catheter tracking system for visualization of fluoroscopic images, the system comprising a fluoroscope for generating fluoroscopic image data, a fluoroscopic image visualization monitor, a catheter having an elongated shaft, particularly an intraventricular catheter, distal tip and a radio opaque portion adjacent the distal tip. A circumferential radio opaque band may be used to determine the relative position, orientation and motion of the catheter. An image analysis system capable of analyzing the image of the catheter and the radio opaque band, for receiving fluoroscopic image data from the fluoroscope determining physical parameters related to the left ventricle, and the relative position, orientation and motion of the catheter therein, and for determining the location and other parameters of treatment on intraventricular surfaces.

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: Apparatus for treating a patient's heart by stimulating revascularization of the heart or creating channels in the heart. The apparatus includes a catheter, a laser energy source coupled to the catheter, and a control circuit. The control circuit is configured to cause the laser energy source to deliver an output of laser energy over a first time period shorter than a heart beat cycle.

Abstract: An apparatus for treating a heart by stimulating revascularization of the heart or creating channels in the heart, the apparatus comprising an artificial energy source for causing a first created heartbeat and a revascularization device for creating a first revascularization event in the heart, the revascularization device being controllable to provide a first revascularization event to occur at a selected time in relation to the first created heartbeat.

Abstract: An apparatus for treating a heart by stimulating revascularization of the heart or creating channels in the heart, the apparatus comprising a sensor, an artificial energy source for causing a first created heartbeat, and a revascularization device coupled to the sensor for creating a first revascularization event in the heart, the revascularization device being controllable to cause the first revascularization event to occur at a selected time in relation to the first created heartbeat if the sensor has detected the first created heartbeat.

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 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

Abstract: A method of selecting laser parameters for performing laser-assisted transmyocardial revascularization (TMR) 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

Abstract: A shaped catheter for accessing and treating preselected surfaces of cavities and organs within the human body, the apparatus including a tubular, shaped outer sheath with at least one guide hole and a tubular, flexible inner sleeve with a distal opening disposed adjacent the distal end, the inner sleeve slidably disposed within the outer sheath such that the distal opening of the inner sleeve can be operatively positioned adjacent the at least one of the guide holes and a laser delivery device or other functional device can be extended through the distal opening of the inner sleeve and through the guide hole on the outer sheath into the body cavity or organ. Providing a plurality of guide holes on the outer sheath will allow sequential treatment of the preselected surface within the body cavity or organ. Multiple TMR channels can be created or treatment at a number of sites can be made without moving or otherwise repositioning the outer sheath. The invention is also a method of use of such apparatus.

Abstract: An apparatus for stabilizing a laser delivery device used during a surgical procedure by securing the laser delivery device to a surgeon's hand is defined by a finger mounting portion for securing at least one laser delivery device to at least one of the surgeon's fingers, and laser delivery device guide attached to the finger mounting portion for directing laser energy from the distal end of the laser delivery means. The finger mounting portion has at least one ring portion for removably encircling the surgeon's finger(s). Embodiments of the guide orient the laser delivery device either axially or trans-axially at a predetermined angle. The guide may be tubular with a preselected curvature, or tubular and adjustable so as to orient the laser delivery device into a plurality of positions. A locking mechanism couples the laser delivery device to the guide and rotating the guide may orient the laser delivery means into a plurality of predetermined positions.

Abstract: A catheter device and a method for using same to facilitate removal of obstructive material in a human body channel. The catheter comprises an elongated body with a distal end portion adapted to be inserted within the channel and a proximal end portion. A lumen, extending lengthwise through said catheter body, supports a guidewire having a distal end along which the catheter body can be moved within the channel. A series of parallel, closely spaced fiber members extend through the catheter body from its proximal end and terminate near a distal end face of said catheter. Laser energy supplied at the catheter's proximal end is transmitted along the fiber members and is emitted forwardly therefrom at the catheter's distal end face. In one embodiment the catheter has a tapered nose portion for displacing obstructive material in the body channel before the emission of laser energy.

Abstract: An instrument for removing an obstruction in an internal body channel comprises an elongated catheter body adapted for insertion into a body channel having a first lumen throughout its length. An elongated guide and laser transmission conduit extends through the lumen of said catheter body and is movable therein so that its distal end can be extendable beyond the distal end of the catheter body. The proximal end of the movable conduit is connected to a controlled source of laser energy. A treatment element is provided at the distal end of the catheter body for further reducing the channel obstruction following preliminary penetration thereof by the movable laser transmission conduit. The treatment element may be a fixed laser transmission conduit which terminates at the end of the catheter body or a dilation balloon near its distal end.