What is claimed is:
1. A cardiopulmonary bypass catheter system for arresting a patient’s heart and maintaining arterial circulation comprising:
a return cannula having an elongated cannula body, a distal end adapted for positioning in a blood vessel, a proximal end, a return lumen in the cannula body adapted for flowing blood therethrough, a return outlet at the distal end in communication with the return lumen, a return inlet at the proximal end in communication with the return lumen, a catheter port at the proximal end in communication with the return lumen and adapted to removably receive a catheter therein, and a hemostasis valve in the catheter port adapted to seal around a catheter positioned in the catheter port; and
an occlusion catheter slidably and removably positioned through the catheter port and the return lumen, the occlusion catheter having an infusion lumen with an infusion inlet and an infusion outlet, the infusion inlet being adapted for connection to a source of cardioplegic fluid, and an expandable occlusion member proximal to the infusion outlet having a collapsed configuration adapted for introduction through the return lumen and an expanded configuration adapted for occlusion of the ascending aorta between the coronary ostia and the brachiocephalic artery;
wherein the return lumen is adapted to deliver blood when the occlusion catheter is positioned therein at a flow rate sufficient to maintain arterial circulation with the heart arrested.
2. The cardiopulmonary bypass catheter system of claim 1 further comprising a venting port in communication with the infusion lumen, the venting port being adapted for connection to a pump for withdrawing fluids from the ascending aorta through the infusion lumen.
3. The cardiopulmonary bypass catheter system of claim 1 wherein the return lumen is adapted to deliver blood at a flow rate of at least about 4 lmin and a pressure of less than about 250 mm Hg.
4. The cardiopulmonary bypass catheter system of claim 1 wherein the return lumen has an inner diameter of about 5-9 mm.
5. The cardiopulmonary bypass catheter system of claim 4 wherein the occlusion catheter has an outer diameter of about 2-5 mm.
6. The cardiopulmonary bypass catheter system of claim 1 further comprising a source of cardioplegic fluid coupled to the infusion port.
7. The cardiopulmonary bypass catheter system of claim 1 further comprising a source of oxygenated blood coupled to the infusion port.
8. The cardiopulmonary bypass catheter system of claim 1 further comprising a pump coupled to the return inlet adapted for pumping oxygenated blood through the return lumen.
9. The cardiopulmonary bypass catheter system of claim 8 wherein the pump is adapted to pump oxygenated blood through the return lumen at a rate of at least about 4 lmin. at a pressure of less than about 250 mm Hg with the occlusion catheter positioned in the return lumen.
10. The cardiopulmonary bypass catheter system of claim 1 wherein the infusion lumen is configured to deliver cardioplegic fluid at a rate of at least 250 mlmin at a pressure of less than about 300 mm Hg.
11. The cardiopulmonary bypass catheter system of claim 10 wherein the infusion lumen has a cross-sectional area of at least about 4.5 mm2.
12. The cardiopulmonary bypass catheter system of claim 1 further comprising a venous cannula positionable in a vein and an oxygenator fluidly coupled to the venous cannula, the oxygenator being fluidly coupled to the return inlet.
13. The cardiopulmonary bypass catheter system of claim 1 wherein the return cannula is positionable in a femoral artery and the occlusion catheter has a length of at least about 80 cm such that the occlusion member is positionable in the ascending aorta.
14. The cardiopulmonary bypass catheter system of claim 1 wherein the occlusion catheter has a pre-shaped distal portion configured to conform to at least a portion of the aortic arch.
15. The cardiopulmonary bypass catheter system of claim 1 wherein the occlusion catheter has a pressure lumen with a pressure outlet distal to the occlusion member and a pressure port proximal to the occlusion member adapted for connection to a pressure monitoring device.
16. A cardiopulmonary bypass catheter system for arresting a patient’s heart and maintaining arterial circulation comprising:
a return cannula having an elongated cannula body, a distal end adapted for positioning in a blood vessel, a proximal end, a return lumen in the cannula body adapted for flowing blood therethrough, a return outlet at the distal end in communication with the return lumen, a return inlet at the proximal end in communication with the return lumen, a catheter port at the proximal end in communication with the return lumen and adapted to removably receive a catheter therein, and a hemostasis valve in the catheter port adapted to seal around a catheter positioned in the catheter port;
an occlusion catheter slidably and removably positioned through the catheter port and the return lumen, the occlusion catheter having an infusion lumen with an infusion inlet and an infusion outlet, a venting port in communication with the infusion lumen, and an expandable occlusion member proximal to the infusion outlet having a collapsed configuration adapted for introduction through the return lumen and an expanded configuration adapted for occlusion of the ascending aorta between the coronary ostia and the brachiocephalic artery;
a return pump coupled to the return inlet and adapted for pumping oxygenated blood through the return lumen with the occlusion catheter positioned therein at a flow rate sufficient to maintain arterial circulation with the heart arrested;
a source of cardioplegic fluid coupled to the infusion port; and
a venting pump coupled to the venting port for withdrawing fluids from the ascending aorta through the infusion lumen.
The claims below are in addition to those above.
All refrences to claim(s) which appear below refer to the numbering after this setence.
1. A method of routing voice communications, comprising:
establishing a first path between a remote originating node and a gateway using a first channel of a circuit-switched network, wherein the gateway is communicatively coupled to the circuit-switched network and a packet-switched network;
establishing a second path between an answering node and the gateway using a second channel of the circuit-switched network if the answering node is remote relative to the gateway, wherein the first and second paths collectively form a bi-directional communication path;
converting first circuit-switched voice data received from the circuit-switched network on the first channel into packet-switched voice data;
converting the packet-switched voice data into second circuit-switched voice data for any packet designating the remote answering node as a destination node; and
routing the second circuit-switched voice data to the remote destination node across the circuit-switched network on the second channel.
2. The method of claim 1 further comprising:
establishing the second path between the answering node and the gateway using the packet-switched network, if the answering node is local relative to the packet-switched network.
3. The method of claim 1 further comprising:
communicating voice data between the first and second nodes through the gateway.
4. The method of claim 1 wherein at least one of the originating and answering nodes is circuit-switched subscriber equipment comprising a selected one of a telephone, modem, and facsimile apparatus.
5. A method of routing voice communications between first and second nodes of a communication system, comprising:
converting first circuit-switched voice data received from a remote first node on a first channel of a circuit-switched network to packet-switched voice data;
determining whether the second node is local to a gateway;
in response to determining the second node is local to the gateway, routing the packet-switched voice data to the second node on a packet-switched network;
determining whether the second node is a remote node that is not local to the gateway;
in response to determining the second node is the remote node not local to the gateway, converting the packet-switched voice data into second circuit-switched voice data; and
routing the second circuit-switched voice data to the remote second node across the circuit-switched network.
6. Apparatus for communicating between two nodes of a communication system, comprising:
a gateway using a first channel of a circuit-switched network to communicate between the gateway and a remote first node, and the gateway is communicatively coupled to the circuit-switched network and a packet-switched network,
the gateway using a second channel of the circuit-switched network to communicate with a remote second node that is remote relative to the gateway,
wherein the gateway converts first circuit-switched voice data received from the remote first node on the first channel of the circuit-switched network to packet-switched voice data,
wherein the gateway converts the packet-switched voice data to second circuit-switched voice data for any packet designating the remote second node, wherein the gateway communicates the second circuit-switched voice data to the remote second node using the second channel of the circuit-switched network.
7. The apparatus of claim 6, wherein the packet-switched voice data is routed to a local second node using the packet-switched network for any packet designating the local second node.
8. The apparatus of claim 6 wherein at least one of the first and second nodes is communicatively coupled to the gateway through both the circuit-switched network and the packet-switched network.
9. The apparatus of claim 6 wherein the first channel carries analog data on an analog subscriber line.
10. The apparatus of claim 6 wherein the first channel carries digital data on a digital subscriber line.
11. The apparatus of claim 10 wherein the digital subscriber line is time division multiplexed.
12. The apparatus of claim 6 wherein the first channel defines a connection between the gateway and subscriber equipment of the first node, wherein the subscriber equipment is a selected one of a modem, telephone, and facsimile apparatus.
13. Apparatus for communicating between first and second nodes of a circuit-switched network coupled to a packet-switched network, comprising:
gateway conversion means for bi-directional conversion of voice data between the circuit-switched network and the packet-switched network, wherein the gateway conversion means is communicatively coupled to the first node using a first channel of the circuit-switched network, wherein the gateway conversion means is communicatively coupled to the second node using a second channel of the circuit-switched network, wherein the gateway conversion means converts first circuit-switched voice data originating from one of the first and second nodes into packetized voice data; and
routing means for routing packetized data, wherein the routing means routes packetized voice data on the packet-switched network, designating one of the first and second nodes as a destination node to the gateway conversion means, if the destination node is determined to be local to the gateway conversion means,
wherein the gateway conversion means converts the received packetized voice data to second circuit-switched voice data if the destination node is determined to be remote from the gateway conversion means, wherein the gateway conversion means communicates the second circuit-switched voice data to one of the first and second nodes using a corresponding one of the first and second channels in accordance with the identity of the designated node.
14. The apparatus of claim 13 wherein at least one of the first and second nodes is communicatively coupled to the gateway through both the circuit-switched network and the packet-switched network.
15. The apparatus of claim 13 wherein the first channel carries analog data on an analog subscriber line.
16. The apparatus of claim 13 wherein the first channel carries digital data on a digital subscriber line.
17. The apparatus of claim 16 wherein the digital subscriber line is time division multiplexed.
18. The apparatus of claim 13 wherein the first channel defines a connection between the gateway conversion means and subscriber equipment of the first node, wherein the subscriber equipment is a selected one of a modem, telephone, and facsimile apparatus.