Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
  • A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
  • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
  • A61F2/91—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes
  • A61F2/915—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
  • A61F2/06—Blood vessels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/958—Inflatable balloons for placing stents or stent-grafts
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
  • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
  • A61F2/91—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes
  • A61F2/915—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
  • A61F2002/91525—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other within the whole structure different bands showing different meander characteristics, e.g. frequency or amplitude
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
  • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
  • A61F2/91—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes
  • A61F2/915—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
  • A61F2002/9155—Adjacent bands being connected to each other
  • A61F2002/91575—Adjacent bands being connected to each other connected peak to trough
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
  • A61F2230/0004—Rounded shapes, e.g. with rounded corners
  • A61F2230/001—Figure-8-shaped, e.g. hourglass-shaped

Definitions

• An artificial shunt serves as a hole or small passage that allows movement of fluid from one part of a patient’s body to another, or, more specifically, from one body lumen to another body lumen.
• body lumens can be associated with virtually any organ in the body but are most commonly associated with lumens in the heart, lungs, cranium and the liver.
• Shunts can be used to treat many different conditions. Such conditions include, but are not limited to, pulmonary hypertension, heart failure, hypertension, kidney failure, volume overload, hypertrophic cardiomyopathy, valve regurgitation, and numerous congenital diseases.
• the present invention is directed to a shunt that expands to an hourglass shape. As the shunt expands, both of its ends radially flare outwards relative to its middle section. Additionally, the length of the shunt foreshortens which causes the flared ends to engage the tissue surrounding a puncture or aperture within a patient’s tissue, not unlike a rivet. In an alternate embodiment, only one of its ends radially flares outwards relative to its middle section, while the opposite end maintains a diameter similar to its middle section.
• the shunt achieves this shape by having a laser-cut body that forms a plurality of cells.
• the cells near the middle of the shunt have a smaller size (e.g., length, width) than the remaining cells.
• the cells near both the proximal and distal ends of the shunt have a larger size (e.g., length, width) than the middle cells, causing them to radially expand to a greater diameter. Further, as the cells radially expand, they increase in width, which causes their length to decrease. The decreased cell length causes the shunt, as a whole, to foreshorten or decrease in length.
• the shunt can be deployed with a balloon catheter.
• the shunt is compressed over the balloon catheter and, when inflated, causes the shunt to expand.
• the balloon catheter has a balloon that inflates to an hourglass shape.
• the balloon s proximal and distal regions expand to a larger diameter relative to the middle portion.
• a distal end of a balloon catheter has a shunt disposed over its balloon.
• the shunt and balloon are positioned about halfway through an opening in a patient’s tissue.
• the balloon is inflated to an hourglass shape, causing the shunt to similarly expand to an hourglass shape while also foreshortening.
• the flared ends of the shunt are thereby caused to engage the tissue surrounding the opening.
• the prior method can further include a later, secondary expansion of the shunt to further increase its diameter. This can be achieved by advancing a second balloon catheter into the shunt and expanding its balloon to a desired shunt passage diameter.
• the shunt includes barbs, hooks or similar anchoring mechanisms on its outer surface.
• the shunt may include a cover located either along its entire length or along only a portion of its length (e.g., a middle portion).
• the balloon delivery catheter may include positioning devices that provide a tactile resistance to indicate the shunt is aligned at a desired position.
• the positioning device may include a plurality of arms extending from the catheter body, an annular ring positioned on the outer surface of the shunt, or portions of the shunt that are heat-set to radially expand.
• FIG. 1 A is an illustration of a shunt in a compressed configuration according to the present invention.
• FIG. 1 B is an illustration of the shunt of Fig. 1 A in a radially expanded position.
• FIG. 2 is a perspective view of the shunt of Fig. 1 A in a radially expanded position.
• Fig. 3 is a side view of the shunt of Fig. 1 A in a compressed configuration.
• Fig. 4A is a top view of the cell pattern of the shunt of Fig. 1 A.
• Fig. 4B is a top view of two cells from the cell pattern in Figure 4A.
• Fig. 5 illustrates a balloon catheter in a deflated configuration according to the present invention.
• Fig. 6 illustrates the balloon catheter of Fig. 5 in an expanded configuration according to the present invention.
• Fig. 7 illustrates the balloon catheter of Fig. 5 with a shunt compressed over it according to the present invention.
• Fig. 8 illustrates the balloon catheter of Fig. 6 with a shunt in its expanded position according to the present invention.
• FIG. 9 illustrates a delivery procedure for a shunt according to the present invention.
• Fig. 10 illustrates a delivery procedure for a shunt according to the present invention.
• FIG. 1 1 illustrates a delivery procedure for a shunt according to the present invention.
• Fig. 12 illustrates a delivery procedure for a shunt according to the present invention.
• Fig. 13 illustrates a perspective view of another embodiment of a shunt according to the present invention.
• Fig. 14 illustrates a side view of another embodiment of a shunt according to the present invention.
• Fig. 15 illustrates a side view of another embodiment of a shunt according to the present invention.
• FIG. 16A illustrates a side view of another embodiment of a shunt according to the present invention.
• Fig. 16B illustrates a side view of the shunt of Fig. 16A.
• Fig. 17 illustrates a side view of another embodiment of a shunt according to the present invention.
• Fig. 18 illustrates a side view of the shunt of Fig. 17.
• Fig. 19 illustrates an alternate embodiment of a balloon catheter according to the present invention.
• Fig. 20 illustrates an alternate embodiment of a balloon catheter according to the present invention.
• Fig. 21 illustrates an alternate embodiment of a balloon catheter according to the present invention.
• the present invention is generally directed to a shunt and a method of deploying a shunt. More specifically, the shunt radially expands to an hourglass or rivet shape while also longitudinally foreshortening.
• the shunt is initially positioned within a tissue opening and then expanded, which causes the distal and proximal ends of the shunt to flare radially outwards and move towards each other. When fully expanded, these radially flared ends engage the tissue surrounding the opening, creating a smooth transition between either side of the tissue.
• This shunt design provides several advantages over prior shunt designs.
• the shunt may“self-position” itself within the tissue opening due to its flared shape and therefore provides increased precision in its positioning than prior designs.
• the flared portions also provide strong attachment to the surrounding tissue as compared with prior shunt designs.
• the shunt may have a small collapsed profile and yet can expand to a consistent inner diameter with high radial force. This allows the use of low-profile balloons to assist in the expansion of the shunt to achieve consistent and reliable implantation results.
• the foreshortening and hourglass shape can be achieved in several different ways and the shunts themselves may have several different features. It should be explicitly understood that the features shown in the different embodiments of this specification can be interchangeably used with features of other embodiments in this specification. In other words, it is intended that the features of the embodiments can be“mixed and matched” with each other.
• FIGs 1 A and 1 B illustrate the change in shape of one embodiment of a tubular shunt 100 of the present invention.
• the shunt 100 is shown in a radially compressed configuration having a relatively long length 101 and a relatively small, uniform diameter 103.
• its length substantially decreases to 101’ and its diameter increases.
• end portions 100A increase to a maximum radial diameter of 103’ and then decrease in diameter towards a middle region 100B, which has a diameter of 103”.
• the shunt 100 when compressed, has a length 101 of about 20 mm and a diameter 103 of about 1 .5 mm, and when expanded the shunt 100 has a diameter 103’ of the end portions 100A of about 8 mm and a diameter 103” of the middle region 100B of about 5 mm.
• the shunt 100 when compressed, has a length 101 of about 30 mm and a diameter 103 of about 2.2 mm, and when expanded the shunt 100 has a diameter 103' of the end portion 100A of about 8 mm and a diameter 103” of the middle region 100B of about 4 mm.
• the shunt 100 when compressed, has a length 101 of about 22 mm and a diameter 103 of about 3.5 mm, and when expanded the shunt 100 has a diameter 103' of the end portion 100A of about 24 mm and a diameter 103” of the middle region 100B of about 20 mm.
• this embodiment of the shunt 100 includes a plurality of tubular radial bands 107 that are each formed from a plurality of uniform, alternating waves that create the shunt passage 100C.
• each radial band 107 comprises a plurality of straight regions 107B joined together to create a pattern of triangular peaks 107A that alternate their longitudinal directions.
• the peaks 107A of each radial band 107 are aligned with each other and connected via a small, straight portion 109, which effectively creates diamond-shaped cells 102 when radially compressed.
• the angle of each peak 107A increases as the shunt 100 is radially expanded and the radial bands 107 become closer together to each other, which causes longitudinal foreshortening (i.e., a decrease in length of the shunt 100).
• FIGS 4A and 4B illustrate the pattern of the shunt 100 as if it were longitudinally cut and flattened.
• a pattern of cells 102 can be created in which some cells 102A, 102B, 102C, 102D are longer in their proximal-to-distal length than other cells (i.e., they have longer straight regions 107B).
• cells 102 in the middle of the shunt 100 have the smallest length and each row of cells 102 progressively increase in length the further away from the middle they are.
• larger length cells 102 can be located only near the ends of the shunt 100.
• middle cell 102A has a first length
• longitudinally adjacent cell 102B has a second, longer length than cell 102A
• longitudinally adjacent cell 102C has a third, longer length than cell 102B
• longitudinally adjacent cell 102D has a fourth, longer length than cell 102C.
• Figure 4B comparatively illustrates cells 102A and 102D next to each other.
• the larger cell 102D will have longer straight portions 107B and a smaller angle of peak 107A relative to cell 102A.
• the larger straight portions 107B allow those cells to expand to a larger diameter and foreshorten more than cell 102A. In this manner, the expanded shape and amount of foreshortening can be determined.
• the size and ratio of the cells 102 and straight portions 107B can vary, depending on the desired expanded shape of the shunt 100. For example, having dramatically larger end cells (e.g., cells 102C and 102D) may cause the expanded configuration of the shunt 100 to have a larger flare diameter size relative to its middle portion.
• the size increases of the straight portion 107B (i.e., struts) of each radial band 107 can be seen in the following listing, which begins with the straight portion 107B in the middle cell 102A and progresses towards the end of the shunt 100. For a shunt with flaring on both ends, the progression of size increase would be the same on either side of the center region of the shunt.
• the shunt 100 may include a variety of different cell numbers.
• Straight portion 107B example sizes: 1 .218 mm, 1 .242 mm, 1 .287 mm, 1 .351 mm, 1 .432 mm, 1 .528 mm, 1 .638 mm, 1 .763 mm, 1 .897 mm, 2.036 mm.
• the shunt 100 can be heat set to an hourglass shape when unconstrained to provide additional expansion force, either with or without the assistance of a balloon catheter.
• each“row” or band in the shunt body reaches maximum expansion at a particular diameter to achieve the final desired shape.
• the shunt 100 can be delivered and expanded via a balloon catheter 1 10, as seen in Figures 5 and 6.
• a balloon 1 14 is disposed on its distal end of a tubular catheter body 1 12.
• the interior of the catheter body 1 12 has an inflation lumen 1 12A that opens to proximal and distal inflation ports 1 12B within the balloon 1 14.
• a guidewire lumen 1 16 is located within the catheter body 1 12, opening on the proximal and distal ends of the body 1 12.
• the balloon 1 14 may inflate to an hourglass shape that has a smaller diameter middle region 1 14C than the proximal region 1 14A and distal region 1 14B of the balloon 1 14.
• the balloon 1 14 can be composed of a compliant material and a non-compliant band (not shown) can be positioned around the middle region 1 14C.
• proximal region 1 14A and distal region 1 14B can be composed of a material with different expansion properties than the middle region 1 14C (e.g., a compliant middle region with noncompliant proximal/distal regions, or a noncompliant middle region with compliant proximal/distal regions).
• Figures 7 and 8 illustrate the shunt 100 positioned over the balloon 1 14.
• the shunt 100 is loaded onto the balloon 1 14 so that the middle region 100B of the shunt 100 is aligned with the middle region 1 14C of the balloon 1 14.
• the proximal region 1 14A and distal region 1 14B cause the end regions 100A of the shunt 100 to expand to a larger diameter than the middle region 100B.
• Figures 9 and 10 illustrate how the shunt 100 may be delivered relative to an area of target tissue 10.
• an initial puncture is made at the desired location (e.g., with a needle).
• the distal end of the delivery catheter 1 10 is advanced through the puncture in the tissue 10 such that there are roughly equal portions of the shunt 100 on either side of the tissue 10.
• Either the shunt 100 or the delivery catheter 1 10 can include radiopaque markers at various known locations to assist a physician with achieving a desired alignment.
• the balloon 1 14 is inflated, causing the shunt 100 to increase in radial diameter to an hourglass shape and to foreshorten.
• the shunt 100 is configured such that the foreshortening causes the flared end regions 100A to engage and press into the tissue 10.
• These flared end regions 100A, as well as the proximal region 1 14A and distal region 1 14B of the balloon help“self-center” the shunt 100 to an appropriate position.
• the end result is an opening in the tissue 10 with a smooth, funnel-like transition on each side of the tissue.
• the shunt 100 i.e., the narrowed middle region 1 10B
• the shunt 100 can be delivered as previously described, but the narrowed middle region 1 10B is expanded to an initial diameter that is smaller than the middle region 1 10B is capable of expanding to. This may be achieved, for example, by limiting the expansion size of the middle region 1 14C of the balloon 1 14.
• the middle region 100B of the shunt 100 can be further expanded in diameter by either a different portion of the balloon (e.g., 1 14A or 1 14B) or by a second balloon catheter that inflates to a desired passage diameter.
• a different portion of the balloon e.g., 1 14A or 1 14B
• a second balloon catheter that inflates to a desired passage diameter
• a second delivery catheter may be used to deliver a tubular spacer having a thickness that reduces the size of the passage through the middle region 100B.
• the tubular spacer may be a second shunt 100, similar to the shunt initially deployed but deployed inside of the first shunt.
• This ability to resize the shunt 100 after delivery allows a physician to customize the amount of shunted fluid for each individual patient. It also allows the shunt 100 to be modified at a later date if the patient’s hemodynamic needs change.
• the balloon catheter may include two or three separate, independently inflatable balloons that can be inflated to different sizes to achieve a similar hourglass shape. This may allow the physician to limit expansion of the middle of the shunt 100 to a desired diameter while ensuring the ends of the shunt 100 radially expand sufficiently to engage the surrounding tissue.
• a mechanical device on a catheter can be used to expand the shunt 100 instead of using a balloon.
• a catheter may include two cone shaped structures that can be longitudinally slid towards each other. The shunt 100 may be positioned between these two structures so that when the cone shaped structures are moved toward each other, they cause the shunt 100 to expand.
• the shunt 100’ may be composed of a shape-memory material and heat set to the expanded hourglass shape when unconstrained.
• a balloon catheter 1 10 may not be necessary.
• Figures 1 1 and 12 illustrate a similar delivery procedure with a delivery catheter 120 configured for deployment of a heat-set shunt 100.
• the catheter 120 includes an elongated catheter body 122 with a retractable sheath 124 disposed over the shunt 100’. Similar to the previously described deployment procedure, a distal end of the catheter 120 is positioned through the opening in the tissue 10 such that roughly equal portions of the shunt 100 are positioned on each side of the tissue 10.
• the sheath 124 When the desired alignment has been achieved (e.g., by referencing radiopaque markers of a known position), the sheath 124 is proximally retracted, causing the shunt 100’ to radially expand to an hourglass shape and foreshorten as shown in Figure. 12.
• the shunt 100 may include a plurality of barbs 1 13, hooks, or similar fastening structures, as seen in Figure 13. These may be positioned on the outside of the flared regions such that they pierce into the tissue of the patient when the shunt 100 is expanded. Alternately, the barbs 1 13 or similar anchoring structure can be located at various locations along the length of the shunt 100, pointing radially outwards.
• the shunt 100 lacks any type of cover and acts to maintain the opening through the tissue by mechanical force.
• Figure 14 illustrates another embodiment of a shunt 130 having a similar laser-cut structure 132 as shunt 100 but also a cover layer 134 that is attached to the laser-cut structure 132 (either on the outside or inside of the structure 132) and forms a similar tubular and hourglass shape.
• part or all of the material 134 may be elastic or stretchable.
• a tubular cover layer 134 can be included only at the middle region of the laser-cut structure 138 of the shunt 136, as seen in Figure 15.
• either of the shunts may have two laser-cut structural layers that are positioned on the inner and outer surfaces of the cover layer so as to “sandwich” the cover layer.
• any of the shunt embodiments in this specification may include a material that extends across and occludes the central lumen of the shunt.
• the material can be a polymer sheet that is attached to an end of the device with a small hole in the center.
• the polymer sheet may be elastic so that the enter hole expands with the balloon from the delivery catheter and then recovers back down to effectively seal the opening once the balloon is removed.
• Figure 22 illustrates a shunt 180 in which only one end is radially flared outwards while the opposite end 180C maintains a diameter similar to that of the middle region 180B. Since the shunt 180 foreshortens in length, it may be beneficial to have barbs or other anchoring mechanisms along the middle region 180B and end 180C to help anchor the shunt 180 during radial expansion.
• neither end of the shunt expands to a flared shape.
• the shunts of this specification can be composed of biocompatible materials such as Nitinol or similar alloys, or bioabsorbable materials such as magnesium, PLA, or PLA-PGA.
• the shunts of this specification may also have features to promote endothelization, such as open surface pores around 60 microns in diameter or a polymer coating known to promote tissue growth.
• Figures 16A and 16B illustrate a shunt 140 comprising a plurality of rings 144 comprising a plurality of alternating peaks. These rings 144 are fixed to a cover 142 and may either be free of connection to each other (other than the cover) or may have connection members 148 that connect to longitudinally adjacent peaks.
• the ends of the shunt 140 each include end rings 146 that are composed of a plurality of alternating peaks that are larger than those of rings 144. As seen in Figure 16B, when radially expanded, the peaks 144 longitudinally compress together and fit within each other.
• the shape depicted therein may be achieved by over-expanding the shunt by a balloon, which would cause the ends to flare open as shown and the central section expansion would be limited by the cover 142.
• alternate embodiments may instead be comprised of a plurality of braided wires, such as the shunt 180 shown in Figures 17 and 18.
• the shunt 180 can be braided on an hourglass-shaped mandrel with a plurality of shape-memory wires. After braiding, the shunt 180 can be heat-set on the mandrel and then removed, allowing it to compress to a tubular shape and radially expand to the hourglass shape (i.e., flared end regions 180A and a smaller diameter middle region 180B).
• the delivery catheters 1 10 and 120 can include radiopaque markers to help a physician align the shunt 100.
• other positioning devices can also be used to aid in positioning.
• Figure 19 illustrates a delivery device 150 that includes elongated arms 152 that are connected to the catheter body at their proximal ends and are configured to radially expand away from the shunt 100 at their distal ends 154.
• the arms 152 are preferably of a length that the blunt distal ends contact the tissue 10 when the shunt 100 is positioned at a desired alignment position (e.g., roughly halfway through the opening). This contact by the arms 152 provides the user with tactile feedback in addition to the visualization of the radiopaque markers.
• the arms 152 are preferably composed of flexible material, such as nitinol, stainless steel, pebax, nylon, polyurethane, or other plastics.
• the arms 152 can be relatively straight or can form a plurality of waves to provide further flexibility and compression.
• Figure 20 illustrates another embodiment of a delivery device 160 that includes an annular ring 162 located over the shunt 100 to assist with a desired alignment of the shunt 100.
• the annular ring 162 preferably has a thickness such that it is larger than the opening of the tissue 10 when the shunt 100 is compressed.
• the ring 162 is longitudinally positioned on a proximal side of the shunt 100 such that when contact is made between the ring 162 and tissue 10, the shunt 100 will have achieved a desired longitudinal alignment through the tissue opening.
• the ring 162 can be composed of cloth, polymer, or bioabsorbable material.
• the shunt 100 itself may include structures 172 on the shunt 100 that are heat-set to radially expand, as seen on device 170 in Figure 21 .
• the structures may be a loop, flap, or similar structure that radially pops up when an overlying sheath is withdrawn from the shunt. Similar to the ring 162, these structures 172 are positioned at a location so as to provide tactile feedback to the physician to indicate a desired alignment of the shunt 100 within the tissue opening.
• the shunt 100 may be used an anchor and/or attachment point for additional structures (e.g., tubes, other shunts, etc.).
• the shunt 100 may be used as an anchoring point for artificial valves, such as a mitral valve or aortic valve.
• the shunt 100 may be used to help restore a circular shape to a structure (e.g., aortic coarctation).
• the shunts and delivery methods described in this specification can be used for a wide variety of shunt procedures.
• One example is a right-to-right shunt between the right pulmonary artery to superior vena cave, between the pulmonary artery to right atrial appendage, between the pulmonary artery or right ventricle to the venous system, or between the azygous vein to the inferior vena cava.
• shunts between chambers of the heart such as atrial septostomy, arteriovenous shunt creation for treating hypertension, arteriovenous shunt for fistula creation for dialysis patients, left atrium to coronary sinus, pulmonary artery to left aortic artery, or aorta to pulmonary artery.

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