Devices and methods are described for accessing the mediastinum without an intercostal incision and without deflating the lungs. In some embodiments, the devices and methods facilitate mediastinal access via a single percutaneous needle puncture. In some embodiments, a first puncture below the ribs or sternum, and a second puncture that is intercostal are used. Devices and methods to facilitate concurrent access to the pericardial and mediastinal spaces are also described. Multiple minimally invasive procedures are described that advantageously utilize the pericardial and mediastinal space access procedures.
