Steerable Endoluminal Punch

An apparatus adapted for punching a hole in a body lumen or hollow organ of a mammal comprising:

• an outer tube having a proximal end and a distal end;
• an inner tube having a proximal end and a distal end;
• a plurality of radially oriented slots in the wall of the outer tube;
• a longitudinal slot in the inner tube that divides the inner tube generally into two sides along its longitudinal axis, said longitudinal slot having a proximal end that traverses laterally to the side of the inner tube and a distal end that terminates proximal to the distal end of the inner tube.
• a connection point between the inner tube and the outer tube such that the side of the inner tube that is not separated from the proximal inner tube is affixed to the outer tube on the side of the outer tube comprising the radially oriented slots.
• a hub affixed to the proximal end of the inner axially elongate tube, wherein the hub comprises an internal lumen capable of receiving a jack-screw body element and preventing said jack-screw body element from rotating about the longitudinal axis of the hub, wherein the inner tube is constrained to not move relative to the hub;
• a jack-screw body element affixed to the proximal end of the axially elongate outer tube, wherein the jack-screw body element comprises a traveler thread on at least a portion of its outer surface, and further wherein the outer tube can move axially relative to the inner tube in response to movement of the jack-screw body element;
• a knob affixed to the hub, capable of being rotated by a user, wherein the knob comprises a knob thread on an inner lumen such that the knob thread and the traveler thread engage;
• and
• a fixation element configured to prevent longitudinal motion of the knob relative to the hub, when the knob is rotated.

An apparatus adapted for punching a hole in a body lumen or hollow organ wall comprising:

• A pair of coaxially nested axially elongate tubes each comprising a distal end, a proximal end and a central lumen, wherein the distal ends of the coaxial tubes are affixed to each other and the proximal ends are separately affixed to elements within a control hub that can be moved longitudinally relative to each other with mechanical advantage;
• a means for punching tissue disposed at or near the distal end of the inner axially elongate tube;
• a means for protecting the sharp distal end of the axially elongate tube while said axially elongate tube is being advanced to the treatment site;
• a means for deflecting a pre-determined region near the distal end of the axially elongate tube from a straight to a substantially curved configuration;
• and
• a means to actuate the punch from the proximal end of the axially elongate tube.

A transseptal punch system comprising:

• an outer tube characterized by a proximal end, a distal end, and a lumen extending from the proximal end to the distal end of the outer tube;
• an inner tube characterized by a proximal end, a distal end, a sharp distal tip, and a lumen extending from the proximal end to the distal end of the inner tube, said inner tube disposed within the lumen of the outer tube;
• and
• a stylet characterized by a proximal end, a distal end, and a self-expandable basket disposed on the distal end of the stylet, said self-expandable basket having a small diameter configuration which fits within lumen of the inner tube and a large diameter configuration which it takes on when not constrained, said stylet slidably disposed within the lumen of the inner tube, and operable from the proximal end of the stylet to withdraw the self-expandable basket into the lumen of the inner tube and eject the self-expandable basket from the lumen of the inner tube.