Valve in MAC with Antegrade Lampoon

General Anesthesia, TEE

MAC- Mitral Annular Calcification

https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf

Access sites:

24F RFV

8F LFV

8F LFA

Open:

Standard Basilica Equipment

Standard Transeptal Equipment

Standard TMVR Equipment (no Safari?)

??Sentinel Equipment**

24F Dryseal

(2) Agilis sm curl

300 cm Runthrough wire

14mm Armada Balloon

Balloon Pump

6F JR4 Guide

6F JL3.5 Guide

7F JR4 Guide

18/30 Ensnare

25mm Gooseneck snare

Preclose x 2

0 Ethibond

0 Prolene

Standby:

12F Flexcath

6F MP Guide

7F Langston

Rough Procedural Plan:

Obtain access as listed above.

Preclose RFV x 2

SL1- transeptal puncture

SL1 exchanged for 24F Dryseal

Agilis x 2 inserted

7F JR4 with ensnare to LFA

6F JR4 through one of the agilis.

Runthrough in 6F JR4 and snared through 7F in LV

6F JR4 removed and reinserted over .032 wire---- or 6FMP??

Lampoon equipment advanced through 6F JR4/MP

6FJL3.5 advanced over Runthrough

25mm snare through JL3.5

Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.

After leaflet traversal and system snared- 7F guide and Runthrough removed.

Balloon pump inserted.

Pacer inserted.

Leaflet lacerated.

Lampoon system deconstructed.

Pigtail advanced with **amplatz super stiff?**

Pigtail out.

Septostomy

Valve inserted and deployed.

Pigtail for wire removal

*ECMO??

*Possible ASD Closure

*Flow monitor on left leg?