Perc. Transvenous Mitral Commissurotomy: Difference between revisions

From Bay Area Structural Heart Wiki
No edit summary
 
(9 intermediate revisions by 2 users not shown)
Line 1: Line 1:
[[File:Z-Med_Balloon.jpg|thumb|150px|right|Z-Med Inflation Chart|link={{filepath:Z-Med_Balloon.jpg}}]]
[[File:Valvuloplasty_balloon_volumes.jpeg|thumb|150px|right|Other Balloons Inflation Chart|link={{filepath:Valvuloplasty_balloon_volumes.jpeg}}]]
==DRAFT==
==DRAFT==
<br />
{| class="wikitable"
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
!Billing
|-
|None
|Fluoro, TTE, and ICE<BR> possible TEE
|Femoral Vein x 2
|
|
|}<br />
===Device:===
===Device:===


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


=== Sheaths: ===
===Sheaths:===


====Open====
====Open====


*9frx25cm Pinnacle
*9frx25cm Pinnacle (if using ICE)
*8frx10cm Pinnacle
*8frx10cm Pinnacle (if doing RHC)
*8.5 SL1 transseptal
*8.5 SL1 transseptal


Line 20: Line 33:
====Open====
====Open====


*Cordis 150J<br />
*.035 150J (if needed for RHC)
*.032 260cm J


===TransSeptal Equipment:===
===TransSeptal Equipment:===
Line 30: Line 44:
*Grounding pad
*Grounding pad


<br />
 
===Catheters:===
 
*6F Swan (if recent RHC has not been performed)
*8F Accunav (If using ICE))
 
===Misc Supplies:===
===Misc Supplies:===
====Open====
====Open====


*Micropuncture
*Micropuncture
*US probe cover
*US probe cover
*(2) 3-port manifolds
*3-port manifold
*Closure
*Stopcock for woggle
**0-Prolene
 
**Perclose
====Have Prepped:====
*Stopcock
*Cup with full strength contrast
*Bowl with 80/20 saline/contrast mixture
 


<br />
===Procedure:===
===Pericardiocentesis (Standby):===
===Emergency Standby:===


*IABP
*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
*Probable LA-gram (10ml Full strength contrast)
*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 sheath. Sheath removed. Plan for Woggle.


<br />
<br />

Latest revision as of 17:40, 29 October 2021

DRAFT


Anesthesia Imaging Access Pre-Procedure Billing
None Fluoro, TTE, and ICE
possible TEE
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))

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
  • Probable LA-gram (10ml Full strength contrast)
  • 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 sheath. Sheath removed. Plan for Woggle.



APPROVED: MD initials MM/YY