Perc. Transvenous Mitral Commissurotomy: Difference between revisions
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==DRAFT== | ==DRAFT== | ||
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{| class="wikitable" | |||
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!Anesthesia | |||
!Imaging | |||
!Access | |||
!Pre-Procedure | |||
!Billing | |||
|- | |||
|None | |||
|Fluoro, TTE, and ICE | |||
|Femoral Vein x 2 | |||
| | |||
| | |||
|}<br /> | |||
===Device:=== | ===Device:=== | ||
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=== Catheters: === | ===Catheters:=== | ||
* 7F Swan (if recent RHC has not been performed) | *7F Swan (if recent RHC has not been performed) | ||
* 8F Accunav | *8F Accunav | ||
=== Misc Supplies: === | ===Misc Supplies:=== | ||
====Open==== | ====Open==== | ||
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=== Procedure: === | ===Procedure:=== | ||
* 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, Preclose followed by SL1. | **8F standard sheath for Swan insertion if necessary. If no RHC, Preclose followed by SL1. | ||
** 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) | ||
* ICE advanced | *ICE advanced | ||
* Transseptal equipment advanced and septostomy performed | *Transseptal equipment advanced and septostomy performed | ||
* LA pressure measurement | *LA pressure measurement | ||
* Balloon Prepped on back table | *Balloon Prepped on back table | ||
** 80/20 saline to contrast concentration | **80/20 saline to contrast concentration | ||
** Vent port cleared with contrast solution until solution flows from main inflating channel. | **Vent port cleared with contrast solution until solution flows from main inflating channel. | ||
** Balloon sizing verified by filling and measuring with enclosed calipers | **Balloon sizing verified by filling and measuring with enclosed calipers | ||
** Slenderizer inserted to elongate balloon | **Slenderizer inserted to elongate balloon | ||
** MD will shape stylet to match LA anatomy | **MD will shape stylet to match LA anatomy | ||
* Guidewire advanced to LA | *Guidewire advanced to LA | ||
* SL1 removed. ICE catheter removed. | *SL1 removed. ICE catheter removed. | ||
* Black dilator advanced and removed | *Black dilator advanced and removed | ||
* Balloon advanced | *Balloon advanced | ||
* Verification by TTE for acceptable Mitral valve crossing | *Verification by TTE for acceptable Mitral valve crossing | ||
* Balloon inflation performed and gradients measured by echo | *Balloon inflation performed and gradients measured by echo | ||
* Inflation repeated if necessary | *Inflation repeated if necessary | ||
* Guidewire reinserted | *Guidewire reinserted | ||
* Stylet removed, slenderizer advanced. Guidewire reinserted. | *Stylet removed, slenderizer advanced. Guidewire reinserted. | ||
* All equipment removed and perclose knot locked. | *All equipment removed and perclose knot locked. | ||
* Figure 8 stitch around 9F sheath. Sheath removed. | *Figure 8 stitch around 9F sheath. Sheath removed. | ||
<br /> | <br /> | ||
Revision as of 01:18, 19 December 2019
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
- 8frx10cm Pinnacle
- 8.5 SL1 transseptal
Wires:
Open
- Cordis 150J
TransSeptal Equipment:
Open
- Baylis generator from EP
- Large curve C1 Baylis needle
- Baylis cable
- Grounding pad
Catheters:
- 7F Swan (if recent RHC has not been performed)
- 8F Accunav
Misc Supplies:
Open
- Micropuncture
US probe cover
- (2) 3-port manifolds
- Closure
- 0-Prolene
- Perclose
Procedure:
- Dual venous access with micropuncture and ultrasound.
- 8F standard sheath for Swan insertion if necessary. If no RHC, Preclose followed by 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
- 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 reinserted
- Stylet removed, slenderizer advanced. Guidewire reinserted.
- All equipment removed and perclose knot locked.
- Figure 8 stitch around 9F sheath. Sheath removed.
APPROVED: MD initials MM/YY
