Steerable Endoluminal Punch with Introducer and Guidewire

A method of crossing the septum of a patient's heart, to gain access to the left atrium through the right atrium, in which a steerable endoluminal punch is advanced over a guidewire, said method comprising the steps of:

• inserting the guidewire into vasculature of the patient to locate the distal tip of the guidewire in the superior vena cava;
• advancing the steerable endoluminal punch over the guidewire to locate the distal end of the steerable endoluminal punch in the right atrium, such that the distal tip of the guidewire is disposed within the distal tip of the steerable endoluminal punch, and both reside in the superior vena cava proximate the right atrium;
• operating the steerable endoluminal punch to steer the distal end of the punch to place the distal end of the punch against the interatrial septum;
• pressing the punch and guidewire distal tips against the interatrial septum to tent the interatrial septum;
• advancing the distal tip of the punch and guidewire distally until a sharp distal tip of the punch perforates the interatrial septum;
• delivering a large bore introducer sheath and a dilator over the steerable endoluminal punch, to locate a distal end of the large bore introducer sheath in the left atrium;
• without exchanging the large bore introducer sheath for a different introducer sheath, with the guidewire remaining in place, removing the steerable endoluminal punch and delivering a device delivery catheter, diagnostic catheter, or therapeutic catheter through the large bore introducer sheath and into the left atrium.