Tip to Base Lampoon: Difference between revisions

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Tip to Base Lampoon, also referred to as "Reverse Lampoon".  Performed when VIV Mitral will likely cause LVOT obstruction.
'''Tip to Base Lampoon, also referred to as "Reverse Lampoon".'''  
 
'''Performed when VIV Mitral will likely cause LVOT obstruction.'''
 
{{Protip|Need alcohol in the room in event of LVOT obstruction.}}
 
{| class="wikitable"
{| class="wikitable"
! colspan="4" |VIV Mitral with Tip to Base Lampoon
! colspan="4" |VIV Mitral with Tip to Base Lampoon
Line 6: Line 11:
!Imaging
!Imaging
!Access
!Access
!ACIST/manifold  
!ACIST/manifold
|-
|-
|General
|General
|Biplane Fluoro and TEE
|Single plane Fluoro and TEE
|Femoral Vein x2
|Femoral Vein x2


Femoral Artery x2
Femoral Artery x2
R Radial Artery
|ACIST with 100% contrast ok if normal creat
|ACIST with 100% contrast ok if normal creat
One manifold with contrast
One manifold with contrast
Line 22: Line 29:
|-
|-
| colspan="4" |
| colspan="4" |
*Request alcohol from pharmacy for urgent alcohol septal ablation
*Request alcohol from pharmacy! Be ready for ECMO and Alcohol Septal Ablation.
|-
|-
|}
|}
Line 30: Line 37:


=== Access Sites: ===
=== Access Sites: ===
7F RFA  
*7F RFA  
 
*26F RFV (primary access)
26F RFV (primary access)
*7.5F LFA (for balloon pump)
 
*8F LFV (for pacer)
7.5F LFA (for balloon pump)
 
8FLFV (for pacer)
 
===Open:===
===Open:===
'''FROM STRUCTURAL HEART CART'''
====Wires:====
 
*.035 260cm J wire
.014 Astato xs 20 guidewire 300cm  
*(2) .035 150cm J wire
 
*300cm Grandslam
Piggyback (??? Maybe finecross, verify preference)
*Safari
 
*.014 Astato xs 20 guidewire 300cm  
26F Dryseal
====Sheaths:====
 
*8F Sheath
14mm Armada Balloon
*7F Sheath
 
*5/6 Slender Sheath
25mm Gooseneck snare
*26F Dryseal
 
====Catheters:====
SL1
*6F JR4 Guide
 
*6F MP1 Guide
Baylis Needle
*6F Straight Pigtail
 
====Misc:====
Bovie pen
*Perclose x 4
 
*Piggyback (??? Maybe finecross, verify preference)
Grounding Pad
**have extra one on standby. May want to put one on either side of flying v.
 
*0 Ethibond
 
*0 Prolene x 2
'''MISC SUPPLIES'''
*Naked Manifold (simultaneous pressure measurements post procedure)
 
*6F PA Catheter
(2) Watchdog devices
*(2) Watchdog devices
 
*(2) Stopcocks
(2) Stopcocks
*4 hemostats
 
*(3) 60ml syringes
4 hemostats
*(2) 12 inch extension tubing
 
*Bowl of D5
(3) 60ml syringes
*Agilis SM Curl
 
*Priority Pack
(2) 12 inch extension tubing
*14mm Armada Balloon
 
*25mm Gooseneck snare
Bowl of D5
*Balloon Pump
 
====Pacing:====
Agilis SM Curl
*8F 35cm Brite Tip Sheath
 
*Josephson Pacing Wire
Priority Pack
*Remington Cable
 
*Blue Pacing Cable
Balloon Pump
====Transseptal:====
 
*Versacross System
ACIST setup (if normal creatnine 100% contrast ok.  only used for arch injection)
*Bovie pen
 
*Grounding Pad
Naked Manifold (simultaneous pressure measurements post procedure)
 
 
'''FROM STORE ROOM'''
 
8F 35cm Brite Tip Sheath
 
Josephson Pacing Wire
 
Remington Cable
 
Blue Pacing Cable


===Standby:===
Sentinel- opened after grandslam wire across great vessels
Sentinel- opened after grandslam wire across great vessels
'''FROM ROOM SUPPLIES'''
6F PA Catheter
.032 260cm J wire
.035 260cm J wire
(2) .035 150cm J wire
300cm Grandslam
Safari
Amplatz SS 1cm
8F Sheath
7F Sheath
6F JR4 Guide
6F MP1 Guide
5F MPA1
6F Straight Pigtail
5/6 Slender Sheath
Perclose x 4
0 Ethibond
0 Prolene x 2


=== Be Ready For: ===
=== Be Ready For: ===
Line 140: Line 95:


ASD Closure
ASD Closure
=== Rough Procedural Plan ===
#Obtain access as listed above.
#Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
#Balloon pump inserted
#Pigtail to arch for injection prior to sentinel. 6fps DSA.
#Sentinel inserted
#Versacross transeptal (do not go straight to agilis. put SS wire in for dryseal first)
#versacross exchanged for Dryseal
#Agilis inserted through Dryseal
#6F PA floated through Agilis over guidewire into AO
#Guidewire exchanged for Astato
#6F JR4 with gooseneck snare inserted through LFA.
#Astato wire snared and pulled into JR4 Guide
#PA catheter removed and 6F MP1 advanced over snared Astato.
#Flying V formed on arterial side of wire
#Finecross/Piggyback advanced over arterial side of astato wire
#Flying V positioned over A2
#Pacer Inserted
#Cut at 50
#Leaflet lacerated and verified on TEE
#LAMPOON equipment removed
#Pigtail advanced through Agilis
#Safari wire inserted into LV
#14mm Armada used for atrial septostomy
#Valve inserted and deployed
#If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath.
#125cm pigtail inserted to LV. 2nd manifold needed.
#Balloon Pump removed
#Perclose LFA and RFA
#Glue vs woggle depending on heparin reversal
[[Category:Procedures]]

Revision as of 20:02, 19 January 2024

Tip to Base Lampoon, also referred to as "Reverse Lampoon".

Performed when VIV Mitral will likely cause LVOT obstruction.

Note Protip: Need alcohol in the room in event of LVOT obstruction.

VIV Mitral with Tip to Base Lampoon
Anesthesia Imaging Access ACIST/manifold
General Single plane Fluoro and TEE Femoral Vein x2

Femoral Artery x2

R Radial Artery

ACIST with 100% contrast ok if normal creat

One manifold with contrast

One naked manifold

Pre-Procedure Watchouts
  • Request alcohol from pharmacy! Be ready for ECMO and Alcohol Septal Ablation.

TAVR/TMVI

  1. Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
  2. Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).

Access Sites:

  • 7F RFA
  • 26F RFV (primary access)
  • 7.5F LFA (for balloon pump)
  • 8F LFV (for pacer)

Open:

Wires:

  • .035 260cm J wire
  • (2) .035 150cm J wire
  • 300cm Grandslam
  • Safari
  • .014 Astato xs 20 guidewire 300cm

Sheaths:

  • 8F Sheath
  • 7F Sheath
  • 5/6 Slender Sheath
  • 26F Dryseal

Catheters:

  • 6F JR4 Guide
  • 6F MP1 Guide
  • 6F Straight Pigtail

Misc:

  • Perclose x 4
  • Piggyback (??? Maybe finecross, verify preference)
    • have extra one on standby. May want to put one on either side of flying v.
  • 0 Ethibond
  • 0 Prolene x 2
  • Naked Manifold (simultaneous pressure measurements post procedure)
  • 6F PA Catheter
  • (2) Watchdog devices
  • (2) Stopcocks
  • 4 hemostats
  • (3) 60ml syringes
  • (2) 12 inch extension tubing
  • Bowl of D5
  • Agilis SM Curl
  • Priority Pack
  • 14mm Armada Balloon
  • 25mm Gooseneck snare
  • Balloon Pump

Pacing:

  • 8F 35cm Brite Tip Sheath
  • Josephson Pacing Wire
  • Remington Cable
  • Blue Pacing Cable

Transseptal:

  • Versacross System
  • Bovie pen
  • Grounding Pad

Standby:

Sentinel- opened after grandslam wire across great vessels

Be Ready For:

ECMO

Alcohol Septal Ablation

ASD Closure

Rough Procedural Plan

  1. Obtain access as listed above.
  2. Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
  3. Balloon pump inserted
  4. Pigtail to arch for injection prior to sentinel. 6fps DSA.
  5. Sentinel inserted
  6. Versacross transeptal (do not go straight to agilis. put SS wire in for dryseal first)
  7. versacross exchanged for Dryseal
  8. Agilis inserted through Dryseal
  9. 6F PA floated through Agilis over guidewire into AO
  10. Guidewire exchanged for Astato
  11. 6F JR4 with gooseneck snare inserted through LFA.
  12. Astato wire snared and pulled into JR4 Guide
  13. PA catheter removed and 6F MP1 advanced over snared Astato.
  14. Flying V formed on arterial side of wire
  15. Finecross/Piggyback advanced over arterial side of astato wire
  16. Flying V positioned over A2
  17. Pacer Inserted
  18. Cut at 50
  19. Leaflet lacerated and verified on TEE
  20. LAMPOON equipment removed
  21. Pigtail advanced through Agilis
  22. Safari wire inserted into LV
  23. 14mm Armada used for atrial septostomy
  24. Valve inserted and deployed
  25. If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath.
  26. 125cm pigtail inserted to LV. 2nd manifold needed.
  27. Balloon Pump removed
  28. Perclose LFA and RFA
  29. Glue vs woggle depending on heparin reversal
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