Perc. Transvenous Mitral Commissurotomy: Difference between revisions

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*.035 150J
*.035 150J
*.032 260cm J<br />
*.032 260cm J


===TransSeptal Equipment:===
===TransSeptal Equipment:===
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*Grounding pad
*Grounding pad


<br />


===Catheters:===
===Catheters:===
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*Micropuncture
*Micropuncture
 
*US probe cover
* US probe cover
 
*(2) 3-port manifolds
*(2) 3-port manifolds
*0- Prolene




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*Inflation repeated if necessary
*Inflation repeated if necessary
*Guidewire and slenderizer reinserted
*Guidewire and slenderizer reinserted
*Possible gradient measured with SL1 and 6fr PA catheter.
*Figure 8 stitch around 9F sheath. Sheath removed.
*Figure 8 stitch around 9F sheath. Sheath removed.



Revision as of 17:09, 1 April 2021

DRAFT


Anesthesia Imaging Access Pre-Procedure Billing
None Fluoro, TTE, and ICE Femoral Vein x 2


Device:

  • Toray INOUE-Balloon Kit

Size determined using the equation (height in cm/10 +10), but verify with MD because body habitus is also a factor.

Sheaths:

Open

  • 9frx25cm Pinnacle
  • 8frx10cm Pinnacle
  • 8.5 SL1 transseptal

Wires:

Open

  • .035 150J
  • .032 260cm J

TransSeptal Equipment:

Open

  • Baylis generator from EP
  • Large curve C1 Baylis needle
  • Baylis cable
  • Grounding pad


Catheters:

  • 6F Swan (if recent RHC has not been performed)
  • 8F Accunav
  • 5F MPA

Misc Supplies:

Open

  • Micropuncture
  • US probe cover
  • (2) 3-port manifolds


Procedure:

  • Dual venous access with micropuncture and ultrasound.
    • 8F standard sheath for Swan insertion if necessary. If no RHC directly with SL1
    • 9F 25cm sheath for ICE catheter
  • Swan advanced for RHC pressures (if needed)
  • ICE advanced
  • Transseptal equipment advanced and septostomy performed
  • LA pressure measurement
  • Balloon Prepped on back table
    • 80/20 saline to contrast concentration
    • Vent port cleared with contrast solution until solution flows from main inflating channel.
    • Balloon sizing verified by filling and measuring with enclosed calipers
    • Slenderizer inserted to elongate balloon
    • MD will shape stylet to match LA anatomy
  • Inoue Guidewire advanced to LA
  • SL1 removed. ICE catheter removed.
  • Black dilator advanced and removed
  • Balloon advanced
  • Verification by TTE for acceptable Mitral valve crossing
  • Balloon inflation performed and gradients measured by echo
  • Inflation repeated if necessary
  • Guidewire and slenderizer reinserted
  • Possible gradient measured with SL1 and 6fr PA catheter.
  • Figure 8 stitch around 9F sheath. Sheath removed.



APPROVED: MD initials MM/YY