Perc. Transvenous Mitral Commissurotomy: Difference between revisions
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==DRAFT== | ==DRAFT== | ||
<br /> | |||
{| class="wikitable" | |||
|- | |||
!Anesthesia | |||
!Imaging | |||
!Access | |||
!Pre-Procedure | |||
!Billing | |||
|- | |||
|None | |||
|Fluoro, TTE, and ICE<BR> possible TEE | |||
|Femoral Vein x 2 | |||
| | |||
| | |||
|}<br /> | |||
===Device:=== | ===Device:=== | ||
*Toray INOUE-Balloon Kit | *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. | Size determined using the equation (height in cm/10 +10), but verify with MD because body habitus is also a factor. | ||
===Sheaths:=== | ===Sheaths:=== | ||
====Open==== | ====Open==== | ||
* | *9frx25cm Pinnacle (if using ICE) | ||
* | *8frx10cm Pinnacle (if doing RHC) | ||
*8.5 SL1 transseptal | *8.5 SL1 transseptal | ||
=== Wires: === | ===Wires:=== | ||
====Open==== | ====Open==== | ||
* | *.035 150J (if needed for RHC) | ||
*.032 260cm J | |||
===TransSeptal Equipment:=== | ===TransSeptal Equipment:=== | ||
| Line 30: | Line 44: | ||
*Grounding pad | *Grounding pad | ||
===Catheters:=== | |||
*6F Swan (if recent RHC has not been performed) | |||
*8F Accunav (If using ICE)) | |||
===Misc Supplies:=== | ===Misc Supplies:=== | ||
====Open==== | ====Open==== | ||
*Micropuncture | *Micropuncture | ||
*US probe cover | *US probe cover | ||
* | *3-port manifold | ||
*Stopcock for woggle | |||
*Stopcock | |||
====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 with 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 | |||
*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 | |||
*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 and slenderizer reinserted | |||
*Possible gradient measured with SL1 and 6fr PA catheter. | |||
*Figure 8 stitch around sheath. Sheath removed. Plan for Woggle. | |||
<br /> | <br /> | ||
Latest revision as of 17:40, 29 October 2021
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
- 9frx25cm Pinnacle (if using ICE)
- 8frx10cm Pinnacle (if doing RHC)
- 8.5 SL1 transseptal
Wires:
Open
- .035 150J (if needed for RHC)
- .032 260cm J
TransSeptal Equipment:
Open
- Baylis generator from EP
- Large curve C1 Baylis needle
- Baylis cable
- 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 with 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
- 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
- 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 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
