US20100234881A1 - Pfo closure devices and related methods of use - Google Patents

Abstract

Devices and methods for sealing a passageway formed by a patent foramen ovale (PFO track) in the heart are provided. One method includes providing an abrading device to the PFO track and abrading the tissue within the PFO track. The abraded tissue forming the PFO track is then held together under pressure, either via lowering right atrial pressure or via applying suction to the septum primum to pull it into apposition against the septum secundum. After a sufficient period of time, the pressure is released and the abraded tissue heals to form a robust seal over the PFO track. Additionally, several devices are provided which can be placed into the PFO track to apply adhesive to the walls of the PFO track. The devices may or may not be left within the PFO track. If the devices are not left within the PFO track, the walls of the PFO track, covered with adhesive, are brought into apposition with one another and adhered together. If the device is left within the PFO track, the device is flattened from an expanded configuration to a flattened configuration, and the walls of the PFO track, adhering to the outer surface of the device, are pulled toward each other as the device flattens. The device may also include interior structure to hold the device in a flattened configuration.

Description

• This application is a divisional application of U.S. application Ser. No. 10/138,565, filed May 6, 2002, the disclosure of which is hereby incorporated by reference herein.
DESCRIPTION OF THE INVENTION
• 1. Field of the Invention
• This invention relates to devices for closing a passageway in a body, for example a patent foramen ovale in a heart, and related methods of using such closure devices for sealing the passageway.
• 2. Background of the Invention
• FIG. 1 shows a short-axis view of the heart at the level of the right atrium (RA) and left atrium (LA), in a plane generally parallel to the atrio-ventricular groove, and at the level of the aortic valve. This view is looking from caudal to cranial.FIG. 1 also shows the septum primum (SP), a flap-like structure, which normally covers the foramen ovale, an opening in the septum secundum (SS) of the heart. In utero, the foramen ovale serves as a physiologic conduit for right-to-left shunting of blood in the fetal heart. After birth, with the establishment of pulmonary circulation, the increased left atrial blood flow and pressure presses the septum primum (SP) against the walls of the septum secundum (SS), covering the foramen ovale and resulting in functional closure of the foramen ovale. This closure is usually followed by anatomical closure of the foramen ovale due to fusion of the septum primum (SP) to the septum secundum (SS).
• Where anatomical closure of the foramen ovale does not occur, a patent foramen ovale (PFO) is created. A patent foramen ovale is a persistent, usually flap-like opening between the atrial septum primum (SP) and septum secundum (SS) of a heart. A patent foramen ovale results when either partial or no fusion of the septum primum (SP) to the septum secundum (SS) occurs. In the case of partial fusion or no fusion, a persistent passageway (PFO track) exists between the septum primum (SP) and septum secundum (SS). This opening or passageway is typically parallel to the plane of the SP, and has a mouth which is generally oval in shape.FIG. 2 shows the opening of the PFO track viewed from an end of the track. Normally the opening is relatively tall, but quite narrow. The opening may be held closed due to the mean pressure in the LA being typically higher than in the RA. In this manner, the SP acts like a one-way valve, preventing fluid communication between the right and left atria through the PFO track. However, at times, the pressure may temporarily be higher in the RA, causing the PFO track to open up and allow some fluid to pass from the RA to the LA, as indicated inFIG. 3. Although the PFO track is often held closed, the endothelialized surfaces of the tissues forming the PFO track prevent the tissue from healing together and permanently closing the PFO track. As can be seen inFIG. 4, (a view from line “C-C” ofFIG. 1), the SP is firmly attached to the SS around most of the perimeter of the Fossa Ovalis, but has an opening along one side. The SP is often connected, as shown, by two or more extensions of tissue along the sides of the PFO track.
• Studies have shown that a relatively large percentage of adults have a patent foramen ovale (PFO). It is believed that embolism via a PFO may be a cause of a significant number of ischemic strokes, particularly in relatively young patients. It has been estimated that in 50% of cryptogenic strokes, a PFO is present. Blood clots which form in the venous circulation (e.g., the legs) can embolize, and may enter the arterial circulation via the PFO, subsequently entering the cerebral circulation, resulting in an embolic stroke. Blood clots may also form in the vicinity of the PFO, and embolize into the arterial circulation and into the cerebral circulation. Patients suffering a cryptogenic stroke or a transient ischemic attack (TIA) in the presence of a PFO often are considered for medical therapy to reduce the risk of a recurrent embolic event.
• Pharmacological therapy often includes oral anticoagulants or antiplatelet agents. These therapies may lead to certain side effects, including hemorrhage. If pharmacologic therapy is unsuitable, open heart surgery may be employed to close a PFO with stitches, for example. Like other open surgical treatments, this surgery is highly invasive, risky, requires general anesthesia, and may result in lengthy recuperation.
• Nonsurgical closure of PFOs is possible with umbrella-like devices developed for percutaneous closure of atrial septal defects (ASD) (a condition where there is not a well developed septum primum (SP)). Many of these conventional devices used for ASDs, however, are technically complex, bulky, and difficult to deploy in a precise location. In addition, such devices may be difficult or impossible to retrieve and/or reposition should initial positioning not be satisfactory. Moreover, these devices are specially designed for ASDs and therefore may not be suitable to close and seal a PFO, particularly because the septum primum (SP) overlaps the septum secundum (SS).
SUMMARY OF THE INVENTION
• In accordance with the invention, methods and devices for closing a passageway in a body, and more specifically closing a patent foramen ovale (PFO), are provided.
• According to one aspect of the invention, a method of sealing a passageway in a heart is provided. The method includes advancing an abrasion device into the passageway to be sealed, abrading at least a portion of the tissue surfaces forming the passageway, withdrawing the abrasion device from the passageway, and forcing abraded portions of the tissue surfaces of the passageway against one another for a period of time.
• According to another aspect of the invention, a device for sealing a passageway in a human body is provided. The device comprises a catheter having a distal portion, and at least one suture lumen, the at least one suture lumen containing a suture having an anchor at an end of the suture.
• According to yet another aspect of the invention, an assembly for sealing a passageway in a human body is provided. The assembly includes a delivery catheter, a suture connected to a barbed anchor, and a support tube configured to surround and support the suture.
• According to a further aspect of the invention, a method of sealing a passageway in a heart is provided. The method comprises advancing a hollow tubular structure into the passageway to be sealed, engaging the walls of the passageway with the hollow tubular structure, and flattening the hollow tubular structure.
• According to another aspect of the invention, a method of sealing a passageway in a heart includes advancing a catheter into the passageway, applying adhesive to the walls of the passageway, withdrawing the catheter from the passageway, and forcing portions of the walls of the passageway against one another for a period of time sufficient to allow the adhesive to at least partially cure.
• According to yet another aspect of the invention, a method of sealing a passageway in a heart is provided. The method comprises advancing a delivery device having an expandable end into the passageway, wherein the delivery device includes at least two suture lumens, each suture lumen having an open end positioned in the passageway when the delivery device is advanced into the passageway, expanding the expandable end, advancing a suture-anchor assembly out of the end of each suture lumen, penetrating the tissue forming the passageway with an anchor of each suture-anchor assembly, and pulling the passageway closed with the anchored sutures.
• According to another aspect of the invention, a method of sealing a passageway between a septum primum and a septum secundum in a heart is provided. The method includes advancing a delivery catheter into the right atrium, advancing an anchor and suture assembly out of the deliver catheter, and passing the anchor and suture assembly through the septum secundum and through the septum primum.
• Additional advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.
• The foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention as claimed.
BRIEF DESCRIPTION OF THE DRAWINGS
• The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the invention and together with the description, serve to explain the principles of the invention.
• FIG. 1 is a short-axis view of the heart at the level of the right atrium (RA) and left atrium (LA), in a plane generally parallel to the atrio-ventricular groove, and at the level of the aortic valve, showing a PFO track.
• FIG. 2 is a cross-sectional view of the PFO track ofFIG. 1 taken along line B-B, the PFO in a “closed” configuration.
• FIG. 3 is a cross-sectional view of the PFO track ofFIG. 2 in an “open” configuration.
• FIG. 4 is a cross-sectional view of the PFO track ofFIG. 1 taken along line C-C.
• FIG. 5 is a perspective view of an abrasion device, according to an aspect of the present invention.
• FIG. 6 is a perspective view of the abrasion device ofFIG. 5 positioned within a PFO track, according to an aspect of the present invention.
• FIG. 7 is a cross-sectional view of the PFO track ofFIG. 6, after the abrasion device has been applied, with right atrial pressure reduced to permit closure of the PFO track, according to an aspect of the present invention.
• FIGS. 8 and 9 are cross-sectional views of a catheter being used to close a PFO track, according to an aspect of the present invention.
• FIG. 10 is a perspective view of an embodiment of a self-flattening closure device in an open configuration according to one aspect of the present invention.
• FIG. 11 is a perspective view of the self-flattening closure device ofFIG. 10 in a closed configuration.
• FIGS. 12-14 are cross-sectional views of the self-flattening closure device ofFIGS. 10 and 11 with a delivery catheter and being deployed within a PFO track, according to an aspect of the present invention.
• FIG. 15 is a top view of an embodiment of a self-flattening closure device according to one aspect of the present invention.
• FIG. 16 is an end view of the self-flattening closure device ofFIG. 15.
• FIG. 17 is a side view of the self-flattening closure device ofFIG. 15.
• FIG. 18 is an end view of the self-flattening closure device ofFIG. 15 in a partially flattened condition.
• FIG. 19 is an end view of the self-flattening closure device ofFIG. 15 in a flattened configuration.
• FIG. 20 is an end view of the self-flattening closure device ofFIG. 15 in an alternative flattened configuration.
• FIG. 21 is an enlarged perspective view of a strut of the self-flattening closure device ofFIG. 15.
• FIG. 22 is a side view of the self-flattening closure device ofFIG. 15 on a delivery catheter and connected to an adhesive lumen, according to an aspect of the present invention.
• FIGS. 23-25 are cross-sectional views of the self-flattening closure device ofFIG. 15, with the delivery catheter ofFIG. 22, being deployed within a PFO track, according to an aspect of the present invention.
• FIG. 26 is a side view of a porous balloon catheter according to one aspect of the present invention.
• FIG. 27 is a cross-sectional view of the porous balloon catheter ofFIG. 26 in an inflated condition.
• FIG. 28 is a cross-sectional view of the porous balloon catheter ofFIG. 26 in a deflated condition.
• FIGS. 29-31 are cross-sectional views of the porous balloon catheter ofFIG. 26 being deployed within a PFO track, according to an aspect of the present invention.
• FIG. 32 is a longitudinal cross-sectional view of a portion of the porous balloon catheter ofFIG. 26 filling and sealing the PFO track after deployment, according to an aspect of the present invention.
• FIG. 33A is a cross-sectional view of an alternative embodiment of a porous balloon in an inflated condition according to another aspect of the invention.
• FIG. 33B is a longitudinal cross-sectional view of the porous balloon ofFIG. 33A connected to a catheter.
• FIG. 34 is a side view of a porous balloon catheter according to one aspect of the present invention.
• FIG. 35 is a first longitudinal cross-sectional view of the balloon ofFIG. 34.
• FIG. 36 is a second longitudinal cross-sectional view of the balloon ofFIG. 34 taken from an opposite side thanFIG. 35.
• FIG. 37 is a cross-sectional view of the porous balloon ofFIG. 34 in a deflated condition.
• FIG. 38 is a cross-sectional top view of the porous balloon ofFIG. 34 in the deflated condition and taken along line A-A ofFIG. 37.
• FIG. 39 is a cross-sectional view of a PFO closure device according to another aspect of the present invention.
• FIGS. 40-42 are cross-sectional views of the PFO closure device ofFIG. 39 in use to close a PFO track, according to an aspect of the present invention.
• FIG. 43 is a cross-sectional view of an alternative PFO closure device disposed within the right atrium, according to an aspect of the present invention.
• FIG. 44 is a cross-sectional view of an anchor and suture used with the PFO device ofFIG. 43, according to an aspect of the present invention.
• FIG. 45 is a cross-sectional view of the anchor and suture ofFIG. 44 after they have been deployed to close the PFO track, according to an aspect of the present invention.
DETAILED DESCRIPTION
• Reference will now be made in detail to embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
• The various figures show embodiments of patent foramen ovale (PFO) closure devices and methods of using the devices to close a PFO. The devices and related methods are described herein in connection with use in sealing a PFO. These devices, however, also are suitable for closing other openings or passageways, including other such openings in the heart, for example atrial septal defects, ventricular septal defects, and patent ductus arterioses, and openings or passageways in other portions of a body such as an arteriovenous fistula. The invention therefore is not limited to use of the inventive closure devices to close PFOs.
• According to one aspect of the present invention, an abrasion device is provided. As embodied herein and shown inFIG. 5, anabrasion device10 is provided for use in a method of closing a PFO track (referenced as PFO in the Figs.). Theabrasion device10 preferably includes aninflatable balloon12 having a plurality ofabrasive elements14 attached to an outer surface of theballoon12. Theabrasive elements14 protrude beyond the outer surface of theballoon12 and may form a surface similar to that of sandpaper. Theabrasive elements14 may be formed by abrasive material, for example microbeads, attached to the outer surface of theballoon12 with an adhesive. Alternatively, the abrasive elements may be formed by any other suitable means. The adhesive should be strong enough to ensure that the abrasive material cannot come loose during contact with structures within the body, and should be flexible enough such that it does not inhibit the ability of the balloon to be inflated and deflated. An example of a preferred adhesive is a flexible adhesive such as polyurethane or epoxy.
• Alternatively, the abrasive elements may be formed by a plurality of small protuberances molded on the outside of the balloon, such that the outer surface of theballoon12 has an abrasive quality once it is inflated. Theabrasion device10 need not utilize aballoon12, but could be fabricated of an expandable material having an abrasive quality or a non-expandable tube-like element with an abrasive quality.
• Theabrasion device10 is attached to a catheter16 (FIG. 6), which contains a lumen (not shown) for inflating and deflating theballoon12. Theabrasion device10 is passed from an access site, preferably in the femoral vein, into the PFO track. Theabrasion device10 may be enclosed within a distal end of the catheter during passage to the PFO track so as to prevent damage to internal structures of the patient. Once positioned near the PFO track, theabrasion device10 may be moved distally relative to the end of the catheter by any suitable means known in the art. Theabrasion device10 is then inflated to place theabrasive elements14 in contact with the tissue defining the PFO track, as shown inFIG. 6. Portions of the SP and SS which define the PFO track are then abraded with theabrasion device10, for example, by rotating theabrasion device10 within the PFO track or a linear back and forth motion ofdevice10 in the PFO track. Abrading the tissue surfaces of the PFO track denudes the endothelium on these tissue surfaces, setting up a healing response in the tissue and tending to cause the PFO track to heal closed over time.
• Since the patients are typically heparinized during endovascular procedures, and heparinization may inhibit the adhesion of the tissues to one another, it may be desirable to counter the effect of the heparin with protamine, bringing the patient back to a more normal coagulation state. However, if the heparin is countered, it is desired to have any remaining devices such as the balloon catheter in the inferior vena cava (IVC) to be coated with an appropriate anti-thrombotic coating such as heparin.
• In addition to an adverse heparin effect, other problems may prevent adherence between the septum primum (SP) and septum secundum (SS). Various methods are provided herein to enhance or ensure adherence between the abraded tissues. For example, during each heart beat, the RA pressure may be temporarily higher than the LA, potentially preventing the denuded tissue surfaces of the PFO track from adhering to one another long enough to promote long term healing of the surfaces in an apposed and closed condition. Therefore, a more active closure of the PFO track coupled with the abrading step is preferred, at least for a period of several minutes, to assure long-term closure of the PFO track.
• One method of causing a more active temporary closure of the PFO track is illustrated inFIG. 7. After the tissue abrasion step is performed, theabrasion device10 is removed. Then the venous return to the RA is temporarily reduced. One way to reduce the venous return is to temporarily occlude the inferior vena cava (IVC). This may be performed by positioning an inflatable balloon in the IVC for a period of several minutes to several hours. The reduction of venous return will reduce the pressure in the RA sufficiently such that the LA pressure will be sufficiently greater than the RA pressure, and the greater pressure in the LA will forcibly push the SP against the SS, closing the PFO track. While held against one another, the denuded tissue surfaces of the SS and SP will quickly pass through the initial stages of the healing response and adhere to one another more aggressively than they would under more normal RA pressures.
• An alternative active temporary closure method is illustrated inFIGS. 8 and 9. In this method, ahollow catheter16, such as a guiding catheter, is introduced and positioned with itsdistal end16ain contact with the septum primum SP, at a location near the PFO track, as shown inFIG. 8. Once in position, a vacuum is created within the lumen of thecatheter16. The vacuum sucks or pulls the tissue of the septum primum SP into the end of thecatheter16, anchoring thecatheter16 to the septum primum SP. The vacuum can be created by any suitable means, such as with the use of a syringe connected in fluid communication with the lumen of the catheter or via aspiration. Once thecatheter16 is anchored to the septum primum SP, the PFO track is temporarily closed by pulling or otherwise manipulating thecatheter16, as shown inFIG. 9, to pull the septum primum SP into apposition with the septum secundum SS.
• After a period of several minutes to several hours has passed as one of the above methods is employed, the PFO track will be reliably closed enough to assure the long term healing of the PFO track in a closed condition. At this point, any indwelling devices can be removed from the patient. One advantage of this PFO closure technique is that no foreign body remains in the patient, eliminating issues of foreign body reaction, thrombosis, or fatigue failure.
• These techniques of abrading the tissue surfaces of the PFO track and temporarily actively closing the abraded PFO track, as described above in conjunction withFIGS. 6-9, may be individually combined with additional closure devices and methods described below.
• According to another aspect of the present invention, a PFO closure device is provided. As embodied herein and shown generically inFIGS. 10 and 11, the PFO closure device comprises a tubular self-flattening closure (SFC)device50. TheSFC device50 is configured to be positioned and left inside the PFO track. TheSFC device50 may be fabricated of a sheet or tube, and may comprise polymeric or preferably metallic materials, for example, a preferred material is an alloy of nickel-titanium. Such an alloy can have either shape-memory characteristics or super-elastic characteristics when formed and heat treated at particular temperatures, as is known in the art. Preferably, theSFC device50 is formed under such conditions to create adevice50 having a parent shape. The device is preferably formed to have a flattened parent configuration, i.e., a configuration which the device will assume when not under other forces, and above its martensite-to-austinite transition temperature. This is accomplished by forming and heat treating thedevice50 in a flattened configuration. Then, when thedevice50 is deformed to a non-flattened configuration during the delivery steps, it will return to a flattened configuration once the deforming forces are removed.
• The device thus has a first configuration during deployment within the PFO track that is tubular, for example circular, as shown inFIG. 10. TheSFC device50 may be positioned on a balloon catheter, which when inflated, the balloon holds theSFC device50 in this configuration. When the balloon is deflated, theSFC device50 returns to a second configuration, the parent shape resembling a flattened tube, as shown inFIG. 11. Within the PFO track, the flattened configuration is oriented such that it tautly maintains a width and a reduced thickness of the PFO track, preventing the PFO track from opening during periods of transient elevated RA pressures. Additionally, the SFC device serves to physically plug any remaining opening of the PFO track as shown inFIGS. 12-14.
• Delivery and deployment ofgeneric SFC device50 is illustrated inFIGS. 12-14.FIG. 12 shows an end view of the PFO track with theSFC device50 in a pre-deployed condition. TheSFC device50 is wrapped around theuninflated balloon72 of aballoon catheter70. Theballoon catheter70 with theSFC device50 is introduced within the venous system, typically at an access site in the femoral vein, and positioned within the PFO track, as shown. Theballoon72 is inflated to allow theSFC device50 to make contact with the PFO track, as indicated inFIG. 13. When theballoon72 is deflated and thecatheter70 is removed from the PFO track, theSFC device50 takes on a flattened configuration, as shown inFIG. 14.
• A preferred embodiment of anSFC device150 is shown inFIGS. 15-20.FIG. 15 is a top view ofSFC device150.FIG. 16 is an end view ofSFC device150, andFIG. 17 is a side view ofSFC device150.SFC device150 is formed from a metallic tube. Like a vascular stent, portions of the wall of the tube are removed by laser cutting, etching or other process to provide a structure having spaced supports.
• As shown inFIG. 15, theSFC device150 includes a plurality of circumferential struts152. Thestruts152 comprise slightly less than half the circumference of the top and bottom sides of theSFC device150. AlongSFC device150 arelongitudinal strips154. Preferably, twostrips154 are formed, spaced 180 degrees from one another, where corners of thedevice150 are formed when the device is in the flattened configuration. As shown inFIG. 17, the upper andlower struts152 may be longitudinally offset from each other. Such a configuration permits theSFC device150 to be shape-set to a flattened configuration such that the upper andlower struts152 don't interfere with each other once the device takes on its flattened configuration. That is, when thedevice150 collapses from a tubular configuration to a flattened configuration, thestruts152 from a top half of the tube fit between thestruts152 of the bottom half of the tube. The offset further allows theSFC device150 to be formed in a parent shape such that thestruts152 are actually pushed through or over-set relative to each other (FIG. 20). When such a parent shape is deformed in theSEC device150 due to other forces, as shown inFIG. 18, thedevice150 is urged toward a flattened configuration (FIG. 19) with thestruts152 of the top half of the device being alternately positioned betweenstruts152 of the bottom half of the device when the other forces are removed. The top and bottom struts152 can then actually move past each other in the absence of any other forces (FIG. 20), i.e., the top struts152 pass through the spaces between the bottom struts152 until the parent configuration is achieved. By forming theSFC device150 with such an over-set parent shape, theSFC device150 more aggressively takes on a flattened configuration when positioned within the PFO track, particularly when further tissue attaching mechanisms are employed, as described below.
• According to another aspect of the invention, theSFC device150 may include an adhesive tissue attaching mechanism. As embodied herein and shown inFIG. 21, at least some of thestruts152 include ahollow lumen156 and may be placed in fluid communication with an adhesive delivery lumen160 (seeFIG. 22). Thelumens156 ofstruts152 are in fluid communication with a lumen (not shown) which extends within one of thelongitudinal struts154 of theSFC device150 and is in fluid communication withadhesive delivery lumen160.Struts152 may also include a plurality of outwardly directedholes158, which provide for delivery of an adhesive from thestruts152 to the tissue surfaces defining the PFO track. A preferred adhesive is one that cures upon exposure to moisture, such as a cyanoacrylate. Other suitable adhesives, such as, for example, fibrin glue, a two-part epoxy, or polyurethane, may be used.
• In use, theSFC device150 is positioned on aballoon172 of aballoon catheter170. A detachable tube defines anadhesive delivery lumen160, and provides for adhesive to be delivered to the lumens ofstruts152,154. Thedelivery lumen160 is connected to a source of adhesive at a proximal end of thecatheter170 by any suitable means known in the art. TheSFC device150 on theballoon catheter170, carryingSFC device150, is passed from an access site, preferably in the femoral vein, into the PFO track (FIG. 23). When theballoon172 is expanded, as inFIG. 24, asuitable adhesive162 is injected throughlumen160, through the lumen inlongitudinal strut154, intolumens156 ofhollow struts152 until it emerges from theholes158 and contacts the walls of the PFO track. The detachabletube forming lumen160 is then removed from theSFC device150 by a suitable detachment mechanism, for example, by a breakaway section that breaks upon torsion. After the adhesive cures, theSFC device150 is firmly attached to the tissue. Once sufficient curing has taken place to ensure that theSFC device150 will remain attached to the walls of the PFO track, theballoon172 is deflated and thecatheter170 is removed, allowing theSFC device150 to flatten (FIG. 25). Since the parent shape is preferably an over-set flattened shape as described above, theSFC device150 will aggressively form a flattened shape, bringing the walls of the PFO track, which are adhered to theSFC device150, in close apposition, and thus closing the PFO track (FIG. 25). Over time, additional scar tissue will form within and around theSFC device150, creating a long-term robust seal of the PFO track. The healing response following implantation of the various embodiments of theSFC device150 may be further enhanced by prior abrading of the PFO track, as described above in connection with the device ofFIG. 5.
• Alternatively, it may be possible to deflate and remove theballoon172 andcatheter170 prior to curing of the adhesive. In such a case, theSFC device150 will flatten prior to the walls of the PFO track adhering to thedevice150. Therefore, it would be desirable to use one of the methods described with respect toFIGS. 7-9 to press the walls of the PFO track into theSFC device150 while the adhesive cures.
• According to another aspect of the present invention, an alternative PFO closure device is provided. As embodied herein and shown inFIGS. 26-32, the PFO closure device may comprise a porous balloon catheter.FIG. 26 shows the distal end of a balloon catheter having a porous balloon, hereinafter referred to as a porous balloon catheter (PBC)180.PBC180 includes aninflatable balloon182 having a plurality ofsmall holes184 that perforate theballoon182.FIG. 27 shows a cross-section of theporous balloon182 in an inflated state andFIG. 28 shows a cross-section of theporous balloon182 in a deflated state. Adetachable tube186 is connected to aproximal end188 of theballoon182.
• Use of thePBC180 in closing a PFO track is illustrated inFIGS. 29-32. ThePBC180 is introduced into the venous circulation through standard techniques, and theballoon182 is positioned within the PFO track, as shown inFIG. 29. Theballoon182 is then inflated with a fluid that exhibits adhesive-like qualities once cured. Initially, theballoon182 inflates, expanding the PFO track and making circumferential contact with the tissue defining the PFO track, as shown inFIG. 30. Further pressurization of theballoon182 then causes some of the liquid adhesive to squeeze out of the pores and form anadhesive film190 between the walls of the PFO and the outer surface of the balloon182 (also shown inFIG. 30). Once the adhesive leaves theballoon182, it cures upon contact with the moist tissue defining the PFO track. As the cure of the adhesive progresses from the walls of the PFO track towards the liquid adhesive inside theballoon182, theballoon182 is deflated, bringing the walls of the PFO track, which are now adhered to theballoon182 via theadhesive film190, along with it. Once theballoon182 is deflated, a thin film of adhesive remaining on the inside of theballoon182 is allowed to cure, and the PFO track is closed (FIG. 31), leavingballoon182 and adhesive190 therein. Thedetachable tube186 is then removed by a suitable detachment mechanism, such as that described above in connection with the removable tube of theSFC device150. The bonded-inballoon182 is left behind in the PFO track (FIG. 32).
• The bonded-inballoon182 will heal in place, resulting in a robust long-term closure of the PFO track. This closure technique results in a minimum amount of foreign body with virtually no contact with blood in either the RA or LA, and as with all devices within the present application, little chance or consequence of mechanical fatigue failure. Also, thePBC180 and method could be combined with a prior abrading step, as previously described in connection with the device ofFIG. 5.
• Preferably, theballoon182 is sized to have a diameter of a size relatively similar to the diameter of the PFO track once expanded, i.e., the perimeter of the balloon is approximately equal to the perimeter of the PFO track, and a length equal to or somewhat shorter than the length of the PFO track. Suitable biocompatible polymers for the porous balloon are preferably polyethylene, expanded polytetrafluoroethylene, PET, Nylon, silicone, polyurethane, or Pebax. Theballoon182 is preferably inflatable by a fluid adhesive. A preferred adhesive is one which cures upon exposure to moisture, such as a cyanoacrylate. The adhesive may be provided toballoon182 by, for example, a lumen intube186 connected to a source of adhesive.
• Alternatively, theballoon182 of thePBC180 need not be left in the PFO track. In such an embodiment, thetube186 need not be detachable. In use, theporous balloon182 is positioned in the PFO track and inflated as shown inFIGS. 29 and 30. However, theballoon182 is deflated and removed prior to curing of the adhesive such that the balloon surface does not adhere to the wall of the PFO track. Thus, after removal ofballoon182, adhesive covers at least some of the walls of the PFO track. In this embodiment, it is preferred that the adhesive not cure instantly, but rather take at least a few minutes, providing sufficient time to remove theballoon182 andcatheter180 without causing adhesion between theballoon182 and the walls of the PFO track. Suitable adhesives for this embodiment are similar to those discussed above, but it is important to select an adhesive with a long enough cure time to minimize curing while theballoon182 is still present in the PFO track.
• In addition, in this embodiment whereballoon182 is not left in the PFO track, the PFO track may be forced closed utilizing any of the steps described above in connection withFIGS. 7-9. Once the adhesive is sufficiently cured, the venous return can be brought back to normal, if the method shown inFIG. 7 is employed, or the catheter with vacuum can be removed if the method employed inFIGS. 8 and 9 is employed, resulting in a robust closure of the PFO track. In this embodiment, only a relatively small amount of a biocompatible adhesive is left behind in the PFO track. And again, for this embodiment, a prior denudation of the walls of the PFO track may further enhance the robustness of the PFO track closure.
• According to another aspect of the present invention, an alternative embodiment of a PFO closure device is provided. As embodied herein and shown inFIGS. 33A and 33B, the PFO closure device comprises aballoon catheter280 having a porous balloon282.Balloon catheter280 includes ashaft286 attached to a proximal end288 of an inflatable balloon282. Theshaft286 may or may not be detachable. The balloon282 comprises two layers, aninner layer283a, which is not porous, and an outer layer283b, which is porous. The dual layer balloon282 is connected to thecatheter shaft286, having afirst lumen286ain fluid communication with the interior of theinner layer283a, and a second lumen286bin fluid communication with aspace285 between the inner andouter layers283a,283b. The second lumen286bis used for delivery of an adhesive, while thefirst lumen286ais used for inflation and deflation of the dual layer balloon282. Since theinner layer283ais non-porous, inflation and deflation of this dual layer balloon282 can be performed completely independently of adhesive delivery.
• In use, balloon282 is used in a manner similar to that described above with respect toFIGS. 26-30. The balloon282 is introduced to the PFO track, then inflated, and adhesive is delivered via the porous outer layer283bto the walls of the PFO track. The balloon282 is then deflated and removed, optionally followed by forced closure of the PFO track, as previously described in connection withFIGS. 7-9. Alternatively, the balloon282 might be detached from the catheter shaft and left implanted in the PFO track as previously described with respect toFIGS. 26-32.
• According to another aspect of the present invention, a PFO closure device is provided. As embodied herein and shown inFIGS. 34-38, a dual layer porous balloon, similar to the balloon shown inFIGS. 33A and 33B, is provided. In this embodiment, theballoon382 is connected to a detachable shaft386. Theinterior surface381 of theballoon382 also includes anadherence mechanism390.Adherence mechanism390 preferably includes strips of a mechanical interlocking structure, such as Velcro. Strips of Velcro are preferably arranged in a helical fashion on theinterior surface381 of theballoon382. The strips are positioned such that rows of “hooks” H alternate with rows of “loops” L. Theadherence mechanism390 serves to maintain theballoon382 in a deflated condition upon removal of inflation medium from theballoon382.
• FIG. 35 shows the alternating strips of hooks (H) and loops (L) on theinner surface381 of one half of theballoon382, andFIG. 36 shows the alternating strips on theinner surface381 of the opposite half of theballoon382. When theballoon382 is deflated, theinner surfaces381 of the two balloon halves come together, forcing the Velcro strips to make contact in at least a plurality of locations where they intersect (FIGS. 37-38).
• In use, the porous balloon catheter is used in a similar manner as that described in connection with the steps shown inFIGS. 26-33B. Theballoon382 is introduced to the PFO track, inflated at a sufficiently high pressure to disengage the Velcro strips of the adherence mechanism, and adhesive is delivered via the porous outer layer383bto the walls of the PFO track. Theballoon382 is then deflated and the rows of Velcro on theinterior381 of theballoon382 come into contact with one another, holding theballoon382 in a flattened configuration. The catheter shaft386 is detached from theballoon382, and the balloon is left implanted in the PFO track as previously described with respect toFIGS. 26-32.
• According to another aspect of the invention, an alternative embodiment of a PFO closure device is provided. As embodied herein and shown inFIGS. 39-42, the PFO closure device includes adelivery device400 carrying suture-anchor assemblies401. Each suture-anchor assembly401 includes abarbed anchor402 connected to asuture tie404. Suitable suture tie materials include those typically used in surgical closure of PFO tracks, such as degradable or non-degradable type commercially available suture material, monofilament or braided type commercially available suture material. Thebarbed anchors402 andsuture ties404 are used to mechanically close the PFO track from within the lumen of the PFO track.
• Thedelivery device400 contains a plurality ofsuture lumens406, one for each suture-anchor assembly401. Eachsuture lumen406 terminates in an opening408. As shown inFIG. 39, eachsuture lumen406 is located on an opposite side of thedelivery device400, such that the suture lumens are spaced approximately 180 degrees apart from one another. An expandable head of the delivery device, for example aballoon410, allows the suture lumen openings408 to be displaced radially outward. This causes the PFO track to be dilated and stretched taut, which facilitates penetration of the anchors into the tissue surrounding the PFO track.
• In use, thedelivery device400 is positioned within the PFO track in a non-deployed condition. The suture-anchor assemblies401 are positioned within thesuture lumens406, with theanchors402 also residing in thesuture lumens406. Once the suture lumen openings408 are in a desired position within the PFO track, theexpandable head410 is deployed (i.e., theballoon410 is inflated). Then the suture-anchor assemblies401 are advanced until theanchors402 emerge from the suture lumen openings408 and penetrate into the tissue forming the PFO track. To assist in supportingsuture anchor assemblies401 during advancement and penetration, it may be useful to surround the suture ties404 with separate tubular support members (not shown), which are advanced with thesuture anchor assemblies401. The tubular support members are removed proximally afteranchors402 are deployed. This step in the procedure is illustrated inFIGS. 39 and 40.
• Once the anchors are firmly engaged in the tissue,balloon410 is deflated and thedelivery device400 is removed, leaving thesutures404 extending outside the access site of the patient. While two sutures are shown, it is contemplated that any number of sutures, two or more, could be placed. Thesutures404 are tied into aknot412 by any suitable method, as shown inFIG. 41, and theknot412 is pushed towards theanchors402 with the help of a knot pushing device (not shown). Once theknot412 is tightened against the walls of the PFO track, the walls are brought into apposition, and the suture tails are cut, resulting in the configuration illustrated inFIG. 42. Cutting of the suture tails can be accomplished by any suitable endovascular cutting mechanism known in the art.
• While these suture andanchor assemblies401 can be used as a sole mechanism for PFO closure, it is preferable to combine this device with a prior abrading of the walls of the PFO track as described previously. When combined as such, the PFO track will heal to a robustly closed condition.
• According to another aspect of the invention, another embodiment of a PFO closure device is provided. As embodied herein and shown inFIGS. 43-45, adelivery catheter500 is positioned within the RA such that thetip500ais adjacent the SS, near the PFO track. A suture andanchor assembly501 comprising asuture504 with a barb-like anchor502 is advanced through the SS, and through the SP, bridging the PFO track roughly perpendicular to the longitudinal aspect of the PFO track (FIG. 43). Suitable suture tie materials include those typically used in surgical closure of PFO tracks, such as degradable or non-degradable type commercially available suture material, monofilament or braided type commercially available suture material. Barb-like anchor502 preferably includestines502awhich are self-expanding once they emerge from the tissue. Once the barb-like anchor502 is passed through the SP, the barb opens up and acts as a strong securement for the suture. Although only one suture andanchor assembly501 is illustrated inFIGS. 43-45, more than one may be used as necessary to ensure sufficient closure of the PFO track.
• To help facilitate advancement of the suture andanchor assembly501 across the SS and SP, it may be necessary to provide additional support to the relativelyflexible suture504.FIG. 44 shows asupport tube506 surrounding the suture.Support tube506 preferably has high column support, but enough lateral flexibility to negotiate any curves within thedelivery catheter500. Suitable materials include metals and relatively rigid polymers. Preferred metals include Ni—Ti alloy and stainless steel. Preferred polymers include polyimide and PEEK. Thesupport tube506 helps advance theanchor502 andsuture504 across the tissue, and is removed after the anchor is deployed across the SP.
• After the barb-like anchor502 is deployed, alock device508, preferably a one-way device, such as, for example, a releasable fixation mechanism (disclosed in U.S. patent application Ser. No. 09/870,813, filed on Jun. 1, 2001, and entitled “Closure Devices, Related Delivery Methods and Tools, and Related Methods of Use,” the entire disclosure of which is incorporated herein by reference), is advanced along thesuture504, pulling the SP and SS together. The remaining suture length is then cut by suitable techniques. While this suture-based concept may be performed as a sole therapy it is preferable to combine this suture closure with a prior abrading of the tissue forming the PFO track to facilitate a robust long-term closure of the PFO.
• Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. The specification and examples are exemplary, with a true scope and spirit of the invention being indicated by the following claims.

Claims (20)

1-87. (canceled)

88. A method of sealing a passageway in a heart, comprising:

advancing a delivery device having an expandable end into the passageway, the delivery device including at least two suture lumens, each suture lumen having an open end positioned in the passageway when the delivery device is advanced into the passageway;

expanding the expandable end;

advancing a suture-anchor assembly out of the open end of each suture lumen;

penetrating the tissue forming the passageway with an anchor of each suture-anchor assembly; and

pulling the passageway closed with the anchored sutures.

89. The method ofclaim 88, wherein the pulling step includes tying the sutures in a knot.

90. The method ofclaim 88, further comprising abrading portions of the tissue surfaces forming the passageway prior to advancing the delivery device.

91. The method ofclaim 88, wherein the expanding step includes inflating a balloon inside of the expandable end.

92-98. (canceled)

99. A method of sealing a passageway in a heart, comprising:

introducing a suture delivery system to the passageway, the suture delivery system including at least two suture lumens, each suture lumen containing a suture-anchor assembly;

advancing the suture-anchor assemblies out of the at least two suture lumens;

penetrating the tissue forming the passageway with an anchor of each suture-anchor assembly; and

pulling the passageway closed with the anchored sutures.

100. The method ofclaim 99, wherein the pulling step includes tying the sutures in a knot.

101. The method ofclaim 99, wherein the passageway to be sealed is a patent foramen ovale, and the penetrating step includes penetrating the septum secundum with one of the anchors and penetrating the septum primum with another of the anchors.

102. A system for sealing a passageway in a human body, the system comprising:

a suture delivery device having at least two suture lumens; and

at least one suture positioned within each of the suture lumens.

103. The system ofclaim 102, further comprising an anchor at an end of each suture.

104. The system ofclaim 103, wherein each anchor includes a barbed end.

105. The system ofclaim 102, wherein one of the at least two suture lumens is positioned on a first side of the suture delivery device and the other of the at least two suture lumens is positioned on an opposite side of the suture delivery device.

106. The system ofclaim 105, wherein the at least two suture lumens are spaced about 180° apart.

107. The system ofclaim 102, wherein each of the two suture lumens has an open end.

108. The system ofclaim 102, wherein the suture delivery device includes an expandable distal portion.

109. The system ofclaim 108, wherein the expandable distal portion of the suture delivery device includes a balloon.

110. The system ofclaim 102, further comprising a lock device.

111. The system ofclaim 110, wherein the lock device is configured to engage the suture and move in only one direction along the suture.

112. The system ofclaim 102, wherein the passageway is a patent foramen ovale.

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