Perc. Transvenous Mitral Commissurotomy: Difference between revisions
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|None | |None | ||
|Fluoro, TTE, and ICE | |Fluoro, TTE, and ICE<BR> possible TEE | ||
|Femoral Vein x 2 | |Femoral Vein x 2 | ||
| | | | ||
| Line 23: | Line 23: | ||
===Sheaths:=== | ===Sheaths:=== | ||
====Open==== | ====Open ==== | ||
* | *8frx10cm Pinnacle (if doing RHC) | ||
* | *9frx25cm Pinnacle (if using ICE) | ||
===Wires:=== | ===Wires:=== | ||
| Line 33: | Line 32: | ||
====Open==== | ====Open==== | ||
*.035 150J | *.035 150J (if needed for RHC) | ||
* | * | ||
===TransSeptal Equipment:=== | ===TransSeptal Equipment:=== | ||
====Open==== | ====Open==== | ||
* | *Versacross | ||
*Grounding pad | *Grounding pad | ||
| Line 48: | Line 45: | ||
*6F Swan (if recent RHC has not been performed) | *6F Swan (if recent RHC has not been performed) | ||
*8F Accunav | *8F Accunav (If using ICE)) | ||
===Misc Supplies:=== | ===Misc Supplies:=== | ||
| Line 57: | Line 53: | ||
*Micropuncture | *Micropuncture | ||
*US probe cover | *US probe cover | ||
* | *3-port manifold | ||
*Stopcock for woggle | |||
====Have Prepped:==== | |||
*Cup with full strength contrast | |||
*Bowl with 80/20 saline/contrast mixture | |||
| Line 63: | Line 64: | ||
*Dual venous access with micropuncture and ultrasound. | *Dual venous access with micropuncture and ultrasound. | ||
**8F standard sheath for Swan insertion if necessary. If no RHC directly | **8F standard sheath for Swan insertion if necessary. If no RHC directly versacross | ||
**9F 25cm sheath for ICE catheter | **9F 25cm sheath for ICE catheter | ||
*Swan advanced for RHC pressures (if needed) | *Swan advanced for RHC pressures (if needed) | ||
| Line 69: | Line 70: | ||
*Transseptal equipment advanced and septostomy performed | *Transseptal equipment advanced and septostomy performed | ||
*LA pressure measurement | *LA pressure measurement | ||
*Probable LA-gram (10ml Full strength contrast) | |||
*Balloon Prepped on back table | *Balloon Prepped on back table | ||
**80/20 saline to contrast concentration | **80/20 saline to contrast concentration | ||
| Line 76: | Line 78: | ||
**MD will shape stylet to match LA anatomy | **MD will shape stylet to match LA anatomy | ||
*Inoue Guidewire advanced to LA | *Inoue Guidewire advanced to LA | ||
* | *ICE catheter removed. | ||
*Black dilator advanced and removed | *Black dilator advanced and removed | ||
*Balloon advanced | *Balloon advanced | ||
| Line 84: | Line 86: | ||
*Guidewire and slenderizer reinserted | *Guidewire and slenderizer reinserted | ||
*Possible gradient measured with SL1 and 6fr PA catheter. | *Possible gradient measured with SL1 and 6fr PA catheter. | ||
*Figure 8 stitch around | *Figure 8 stitch around sheath. Sheath removed. Plan for Woggle. | ||
<br /> | <br /> | ||
Latest revision as of 17:00, 20 October 2025
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
- 8frx10cm Pinnacle (if doing RHC)
- 9frx25cm Pinnacle (if using ICE)
Wires:
Open
- .035 150J (if needed for RHC)
TransSeptal Equipment:
Open
- Versacross
- 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 versacross
- 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
- 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
