Abstract: A method of perforating a tissue of a heart of a patient when an inferior approach to the heart is contraindicated. The method utilizes an electrosurgical apparatus having an energy delivery device which can function as an ECG measuring device at a distal end thereof and a delivery system comprising a dilator. Said method comprises the steps of (a) advancing the dilator through a superior vena cava into the heart of the patient, from a superior approach, until a distal end of the dilator is adjacent the tissue; (b) checking an ECG signal to confirm a position of the energy delivery device; (c) using the electrosurgical apparatus, which is positioned through the dilator, to create a perforation in the tissue by delivering electrical energy to the tissue; (d) advancing the distal end of the electrosurgical apparatus through the perforation; and (e) advancing the dilator over the electrosurgical apparatus.

Abstract: A method of perforating a tissue of a heart of a patient when an inferior approach to the heart is contraindicated. The method utilizes an electrosurgical apparatus and a delivery system comprising at least two dilators wherein a first dilator is configured for facilitating positioning of the electrosurgical apparatus adjacent the tissue and wherein a second dilator is configured for advancement through a perforation in the tissue. An outer diameter of the second dilator is substantially equal to or less than an outer diameter of the first dilator.

Abstract: This disclosure describes embodiments of a kit and its constituent components which together form an apparatus in which fluid communication between a medical device's lumen and the surrounding environment is provided by a conduit cooperatively defined by the medical device and a tubular member into which the device is inserted. The medical device and tubular member are configured to fit together such that an outer surface of the distal region of the medical device cooperates with an inner surface of the tubular member to define the conduit between the side-port of the medical device and a distal end of the tubular member. The conduit is operable to be used for injecting fluid, withdrawing fluid, and measuring pressure, for example. Methods of assembling and using the apparatus are described as well.

Abstract: A method of perforating a tissue of a heart of a patient when an inferior approach to the heart is contraindicated. The method utilizes an electrosurgical apparatus and a delivery system comprising at least two dilators wherein a first dilator is configured for facilitating positioning of the electrosurgical apparatus adjacent the tissue and wherein a second dilator is configured for advancement through a perforation in the tissue. An outer diameter of the second dilator is substantially equal to or less than an outer diameter of the first dilator.

Abstract: Apparatuses and methods for the perforation of heart tissue of a patient when an inferior approach to the heart is contraindicated are disclosed. The method includes using a superior approach to introduce the apparatus, positioning the apparatus at a tissue location and delivering a controlled amount of non-mechanical energy to the tissue to create a perforation. For example, a method of surgical perforation via the delivery of electrical, radiant or thermal energy may include: introducing an apparatus comprising an energy delivery device into a patient's heart via the patient's superior vena cava; positioning the energy delivery device at a first location adjacent material to be perforated; and perforating the material by delivering energy via the energy delivery device; wherein the energy is selected from the group consisting of electrical energy, radiant energy and thermal energy.

Abstract: Described herein is a method for creating a channel through a foreign material located in a body of a patient. The foreign material defines a material first surface and a substantially opposed material second surface and the channel extends through the foreign material between the material first and second surfaces. The method uses an apparatus including an electrode, and includes the steps of: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel. In some embodiments, the patient's body includes a heart defining a septum, the septum defines an aperture extending there-through and the foreign material extends across the aperture to cover the aperture.

Abstract: Described herein is a method for creating a channel through a foreign material located in a septum of a heart at the site of a septal defect. The foreign material defines a material first surface and a substantially opposed material second surface, and the channel extends through the foreign material at least partially between the material first and second surfaces. The method uses an apparatus including an electrode and includes the steps of: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel.

Abstract: This disclosure describes embodiments of a kit and its constituent components which together form an apparatus in which fluid communication between a medical device's lumen and the surrounding environment is provided by a conduit cooperatively defined by the medical device and a tubular member into which the device is inserted. The medical device and tubular member are configured to fit together such that an outer surface of the distal region of the medical device cooperates with an inner surface of the tubular member to define the conduit between the side-port of the medical device and a distal end of the tubular member. The conduit is operable to be used for injecting fluid, withdrawing fluid, and measuring pressure, for example. Methods of assembling and using the apparatus are described as well.

Abstract: Described herein is a method for creating a channel through a foreign material located in a septum of a heart at the site of a septal defect. The foreign material defines a material first surface and a substantially opposed material second surface, and the channel extends through the foreign material at least partially between the material first and second surfaces. The method uses an apparatus including an electrode and includes the steps of: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel.

Abstract: Described herein is a method for creating a channel through a foreign material located in a body of a patient. The foreign material defines a material first surface and a substantially opposed material second surface and the channel extends through the foreign material between the material first and second surfaces. The method uses an apparatus including an electrode, and includes the steps of: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel. In some embodiments, the patient's body includes a heart defining a septum, the septum defines an aperture extending there-through and the foreign material extends across the aperture to cover the aperture.

Abstract: A method for creating a channel through a foreign material located in a body of a patient, the foreign material defining a material first surface and a substantially opposed material second surface, the channel extending through the foreign material between the material first and second surfaces, the method using an apparatus including an electrode, the method comprising: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel, wherein the foreign material is included in a stent graft.

Abstract: A method for creating a channel through a foreign material located in a body of a patient, the foreign material defining a material first surface and a substantially opposed material second surface, the channel extending through the foreign material between the material first and second surfaces, the method using an apparatus including an electrode, the method comprising: positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel, wherein the foreign material is included in a stent graft.

Abstract: A method for creating a channel through a foreign material located in a body of a patient, the foreign material defining a material first surface and a substantially opposed material second surface, the channel extending through the foreign material between the material first and second surfaces, the method using an apparatus including a substantially elongated member defining a proximal end region and a substantially longitudinally opposed distal end region, the apparatus including an electrode located about the distal end region, the method comprising: introducing the distal end region into the body of the patient; positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel.

Abstract: Apparatuses and methods for the perforation of heart tissue of a patient when an inferior approach to the heart is contraindicated are disclosed. The method includes using a superior approach to introduce the apparatus, positioning the apparatus at a tissue location and delivering a controlled amount of non-mechanical energy to the tissue to create a perforation. For example, a method of surgical perforation via the delivery of electrical, radiant or thermal energy may include: introducing an apparatus comprising an energy delivery device into a patient's heart via the patient's superior vena cava; positioning the energy delivery device at a first location adjacent material to be perforated; and perforating the material by delivering energy via the energy delivery device; wherein the energy is selected from the group consisting of electrical energy, radiant energy and thermal energy.

Abstract: A method of surgical perforation via the delivery of electrical, radiant or thermal energy comprising the steps of: introducing an apparatus comprising an energy delivery device into a patient's heart via the patient's superior vena cava; positioning the energy delivery device at a first location adjacent material to be perforated; and perforating the material by delivering energy via the energy delivery device; wherein the energy is selected from the group consisting of electrical energy, radiant energy and thermal energy.

Abstract: A method for creating a channel through a foreign material located in a body of a patient, the foreign material defining a material first surface and a substantially opposed material second surface, the channel extending through the foreign material between the material first and second surfaces, the method using an apparatus including a substantially elongated member defining a proximal end region and a substantially longitudinally opposed distal end region, the apparatus including an electrode located about the distal end region, the method comprising: introducing the distal end region into the body of the patient; positioning the electrode substantially adjacent to the material first surface; energizing the electrode with a radiofrequency current; and using the electrode energized with the radiofrequency current to deliver energy into the foreign material to create the channel.

Abstract: A device with a functional tip containing at least one active electrode capable of creating a controlled perforation in body tissue through the application of energy (e.g. Radio Frequency (RF)) is described. The position of the tip of the device can be determined in response to ECG measured at the tip and determined by a monitor coupled to the device. The device is useful to remove or perforate unwanted tissue in a controlled manner in any location in the body, particularly in the atrial septum for controlled transseptal puncture. In this application, the device is introduced into the right atrium, and the functional tip is then positioned against the atrial septum. ECG is used to locate the region of the fossa ovalis on the atrial septum. Energy is applied to create the perforation and ECG is monitored to determine if the perforation was created in a desired location.

Abstract: A device with a functional tip containing at least one active electrode capable of creating a controlled perforation in body tissue through the application of Radio Frequency (RF) energy is described. The position of the tip of the device can be determined in response to pressure sensed at the tip and determined by a monitor. The device is useful to remove or perforate unwanted tissue in a controlled manner in any location in the body, particularly in the atrial septum for controlled transseptal puncture. In this application, the device is introduced into the right atrium, and the functional tip is then positioned against the atrial septum. Energy is applied to create the perforation and pressure is monitored to determine if the perforation was created in a desired location. Other possible applications include the removal of plaque or thrombotic occlusions from diseased vessels.

Abstract: A method of surgical perforation via the delivery of electrical, radiant or thermal energy comprising the steps of: introducing an apparatus comprising an energy delivery device into a patient's heart via the patient's superior vena cava; positioning the energy delivery device at a first location adjacent material to be perforated; and perforating the material by delivering energy via the energy delivery device; wherein the energy is selected from the group consisting of electrical energy, radiant energy and thermal energy.

Abstract: A device for creating a surgical perforation with a functional distal tip for creating a controlled perforation. The functional tip may comprise at least one active electrode for creating the perforation through the application of Radio Frequency (RF) energy. The device is curved in order to decrease the likelihood of injury to structures of a patient such as inadvertent cardiac perforation when used in transseptal perforation procedures. The device is introduced into the right atrium, and the functional tip is then positioned against the atrial septum. Energy is applied to create the perforation. The tip is advanced toward the left atrium to create the perforation and as it advances into the left atrium, the device takes on its curved shape to direct the tip away from cardiac structures. The position of the tip of the device can be determined in response to pressure sensed at the tip and determined by a monitor.