Perc. Transvenous Mitral Commissurotomy

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 (if using ICE)
• 8frx10cm Pinnacle (if doing RHC)
• 8.5 SL1 transseptal

Wires:

Open

• .035 150J (if needed for RHC)
• .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 (If using ICE))
• 5F MPA

Misc Supplies:

Open

• Micropuncture
• US probe cover
• 3-port manifold
• Stopcock for woggle

Have Prepped:

• Cup with full strength contrast
• Bowl with 80/20 saline/contrast mixture

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.

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APPROVED: MD initials MM/YY