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"
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|-
|-
|General
|General
|Biplane Fluoro and TEE
|Single plane Fluoro and TEE
|Femoral Vein x2
|Femoral Vein x2


Line 25: Line 29:
|-
|-
| colspan="4" |
| colspan="4" |
*Request alcohol from pharmacy  
*Request alcohol from pharmacy! Be ready for ECMO and Alcohol Septal Ablation.
|-
|-
|}
|}
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=== 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  
- have extra one on standby. May want to put one on either side of flying v.
====Sheaths:====
 
*8F Sheath
26F Dryseal
*7F Sheath
 
*5/6 Slender Sheath
14mm Armada Balloon
*26F Dryseal
 
====Catheters:====
25mm Gooseneck snare
*6F JR4 Guide
 
*6F MP1 Guide
SL1
*6F Straight Pigtail
 
====Misc:====
Baylis Needle
*Perclose x 4
 
*Piggyback (??? Maybe finecross, verify preference)
Bovie pen
**have extra one on standby. May want to put one on either side of flying v.
 
*0 Ethibond
Grounding Pad
*0 Prolene x 2
 
*Naked Manifold (simultaneous pressure measurements post procedure)
 
*6F PA Catheter
'''MISC SUPPLIES'''
*(2) Watchdog devices
 
*(2) Stopcocks
(2) Watchdog devices
*4 hemostats
 
*(3) 60ml syringes
(2) Stopcocks
*(2) 12 inch extension tubing
 
*Bowl of D5
4 hemostats
*Agilis SM Curl
 
*Priority Pack
(3) 60ml syringes
*14mm Armada Balloon
 
*25mm Gooseneck snare
(2) 12 inch extension tubing
*Balloon Pump
 
====Pacing:====
Bowl of D5
*8F 35cm Brite Tip Sheath
 
*Josephson Pacing Wire
Agilis SM Curl
*Remington Cable
 
*Blue Pacing Cable
Priority Pack
====Transseptal:====
 
*Versacross System
Balloon Pump
*Bovie pen
 
*Grounding Pad
ACIST setup (if normal creatnine 100% contrast ok.  only used for arch injection)
 
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 145: Line 95:


ASD Closure
ASD Closure
=== Rough Procedural Plan ===
=== Rough Procedural Plan ===
Obtain access as listed above.
#Obtain access as listed above.
 
#Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
#Balloon pump inserted
 
#Pigtail to arch for injection prior to sentinel. 6fps DSA.
Balloon pump inserted
#Sentinel inserted
 
#Versacross transeptal (do not go straight to agilis. put SS wire in for dryseal first)
Pigtail to arch for injection prior to sentinel. 6fps DSA.
#versacross exchanged for Dryseal
 
#Agilis inserted through Dryseal
Sentinel inserted
#6F PA floated through Agilis over guidewire into AO
 
#Guidewire exchanged for Astato
SL1- transeptal puncture
#6F JR4 with gooseneck snare inserted through LFA.  
 
#Astato wire snared and pulled into JR4 Guide
5F MP used for exchanging wires in LUPV
#PA catheter removed and 6F MP1 advanced over snared Astato.
 
#Flying V formed on arterial side of wire
Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
#Finecross/Piggyback advanced over arterial side of astato wire
 
#Flying V positioned over A2
SL1 exchanged for Dryseal
#Pacer Inserted
 
#Cut at 50
Agilis inserted through Dryseal
#Leaflet lacerated and verified on TEE
 
#LAMPOON equipment removed
6F PA floated through Agilis over guidewire into AO
#Pigtail advanced through Agilis  
 
#Safari wire inserted into LV
Guidewire exchanged for Astato
#14mm Armada used for atrial septostomy
 
#Valve inserted and deployed
6F JR4 with gooseneck snare inserted through LFA.  
#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.
Astato wire snared and pulled into JR4 Guide
#Balloon Pump removed
 
#Perclose LFA and RFA
PA catheter removed and 6F MP1 advanced over snared Astato.
#Glue vs woggle depending on heparin reversal
 
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]]
[[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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