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Percutaneous transseptal left atrial cannulation system
| Details |
Inventors: Fonger, James D.; Jonkman, Kenneth R.; Anderson, James H.; Mitchell, Sally E.;
Assignee: Boston University (Boston, MA)
Primary Examiner: Mancene; Gene
Assistant Examiner: LaViola; Frank A.
Attorney, Agent or Firm: Hamilton, Brook, Smith & Reynolds
A transseptal left atrial cannulation system which provides drainage of left atrial blood without the need for thoracotomy. A guide wire and a long needle assembly are inserted into a catheter. A cannula rides over the exterior of this catheter. The guide wire may be advanced past the needle assembly and through a catheter through the distal end of the catheter to assist in directing the system to the right atrium. The cannulation system is inserted in a femoral vein located in the groin. Both the guide wire and needle assembly are long enough to allow a substantial length to extend out of the body at the groin for manipulation even when the distal ends of the guide wire and needle assembly are positioned in the heart. When the catheter distal end is positioned adjacent the septum in the right atrium, the guide wire is withdrawn from the catheter orifice and the needle assembly moves past the guide wire and through the catheter orifice to a position adjacent to the septum. The needle pierces the septum and the catheter moves over the needle assembly to further dilate the septal hole. The cannula attached to the catheter also moves through the septal hole, further dilating it, and resting with the holes in the left atrium. The guide wire, the needle assembly, and the catheter are withdrawn from the cannula. Oxygenated blood from the left atrium drains through the cannula to the extracorporeal pump and back to the body through an arterial cannula. |
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DETAILED DESCRIPTION The cannulation method of Bernstein is complex.
The insertion and removal of the guide wire, the needle, and obturator within the catheter risks potential system movement, dislodgement, inadvertent puncturing of chamber walls, and may compromise system sterility.
Valuable time is wasted during the required insertions and removals.
Also, if the internal obturator circular barb should malfunction, the catheter cannot be removed from within the cannula.
Accordingly, a simpler, quicker, and safer technique for transseptal left atrial cannulation is desirable.
The invention comprises a method and device for draining blood from the left atrium of the heart by utilizing a cannula and catheter in which a guide wire and a needle assembly are positioned axially.
The guide wire and the needle assembly can be extended alternately through the distal catheter orifice.
A cannula is positioned over the catheter (and can slide thereover) and is inserted into a blood vessel with the catheter.
This axial configuration of all the system elements obviates the need for repeated insertion and withdrawal of the guide wire and the needle.
Both the guide wire and needle are initially and throughout the procedure positioned within the catheter close to the catheter orifice and can be alternately advanced.
The cannula is also initially moved through the veins with the catheter.
Once the cannula has been advanced into the left atrium, the guide wire, needle assembly and the catheter can be easily withdrawn in an integral fashion without the risk of barb malfunction leaving the catheter behind.
Thus, left drainage can be accomplished safely, quickly, and without compromising sterility.
The device is used as the venous cannula in a percutaneous transseptal left atrial cannulation system for a left ventricular assist.
In use, the catheter, guide wire, needle assembly, and cannula are coaxially configured and inserted together.
The device is inserted into the femoral vein in the groin, the guide wire is extended through the distal catheter orifice, and under fluoroscopic guidance, the guide wire followed by the catheter, needle, and cannula are positioned in the right atrium of the heart
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Heart Surgery 
