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" | ||
| Line 10: | Line 14: | ||
|- | |- | ||
|General | |General | ||
| | |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. | ||
|- | |- | ||
|} | |} | ||
| Line 36: | Line 40: | ||
*26F RFV (primary access) | *26F RFV (primary access) | ||
*7.5F LFA (for balloon pump) | *7.5F LFA (for balloon pump) | ||
* | *8F LFV (for pacer) | ||
===Open:=== | ===Open:=== | ||
====Wires:==== | ====Wires:==== | ||
*.035 260cm J wire | *.035 260cm J wire | ||
*(2) .035 150cm J wire | *(2) .035 150cm J wire | ||
*300cm Grandslam | *300cm Grandslam | ||
*Safari | *Safari | ||
*.014 Astato xs 20 guidewire 300cm | *.014 Astato xs 20 guidewire 300cm | ||
====Sheaths:==== | ====Sheaths:==== | ||
| Line 56: | Line 56: | ||
*6F JR4 Guide | *6F JR4 Guide | ||
*6F MP1 Guide | *6F MP1 Guide | ||
*6F Straight Pigtail | *6F Straight Pigtail | ||
====Misc:==== | ====Misc: ALSO TO BE OPENED==== | ||
*Perclose x 4 | *Perclose x 4 | ||
*Piggyback (??? Maybe finecross, verify preference) | *Piggyback (??? Maybe finecross, verify preference) | ||
| Line 83: | Line 82: | ||
*Blue Pacing Cable | *Blue Pacing Cable | ||
====Transseptal:==== | ====Transseptal:==== | ||
* | *Versacross System | ||
*Bovie pen | *Bovie pen | ||
*Grounding Pad | *Grounding Pad | ||
| Line 97: | Line 95: | ||
ASD Closure | ASD Closure | ||
=== Rough Procedural Plan === | === Rough Procedural Plan === | ||
#Obtain access as listed above. | #Obtain access as listed above. | ||
| Line 105: | Line 101: | ||
#Pigtail to arch for injection prior to sentinel. 6fps DSA. | #Pigtail to arch for injection prior to sentinel. 6fps DSA. | ||
#Sentinel inserted | #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 | #Agilis inserted through Dryseal | ||
#6F PA floated through Agilis over guidewire into AO | #6F PA floated through Agilis over guidewire into AO | ||
| Line 126: | Line 120: | ||
#14mm Armada used for atrial septostomy | #14mm Armada used for atrial septostomy | ||
#Valve inserted and deployed | #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 | #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 | #Balloon Pump removed | ||
#Perclose LFA and RFA | #Perclose LFA and RFA | ||
Latest revision as of 16:45, 1 November 2024
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.
| 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 | |||
| |||
TAVR/TMVI
- 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).
- 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: ALSO TO BE OPENED
- 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
- 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
