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:=== | ||
| Line 10: | Line 25: | ||
====Open==== | ====Open==== | ||
*9frx25cm Pinnacle | *9frx25cm Pinnacle (if using ICE) | ||
*8frx10cm Pinnacle | *8frx10cm Pinnacle (if doing RHC) | ||
*8.5 SL1 transseptal | *8.5 SL1 transseptal | ||
| Line 18: | Line 33: | ||
====Open==== | ====Open==== | ||
* | *.035 150J (if needed for RHC) | ||
*.032 260cm J | |||
===TransSeptal Equipment:=== | ===TransSeptal Equipment:=== | ||
| Line 28: | Line 44: | ||
*Grounding pad | *Grounding pad | ||
=== Catheters: === | ===Catheters:=== | ||
* | *6F Swan (if recent RHC has not been performed) | ||
* 8F Accunav | *8F Accunav (If using ICE)) | ||
=== Misc Supplies: === | ===Misc Supplies:=== | ||
====Open==== | ====Open==== | ||
*Micropuncture | *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: === | ===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 | **8F standard sheath for Swan insertion if necessary. If no RHC directly with 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 | *Probable LA-gram (10ml Full strength contrast) | ||
** 80/20 saline to contrast concentration | *Balloon Prepped on back table | ||
** Vent port cleared with contrast solution until solution flows from main inflating channel. | **80/20 saline to contrast concentration | ||
** Balloon sizing verified by filling and measuring with enclosed calipers | **Vent port cleared with contrast solution until solution flows from main inflating channel. | ||
** Slenderizer inserted to elongate balloon | **Balloon sizing verified by filling and measuring with enclosed calipers | ||
** MD will shape stylet to match LA anatomy | **Slenderizer inserted to elongate balloon | ||
* Guidewire advanced to LA | **MD will shape stylet to match LA anatomy | ||
* SL1 removed. ICE catheter removed. | *Inoue Guidewire advanced to LA | ||
* Black dilator advanced and removed | *SL1 removed. ICE catheter removed. | ||
* Balloon advanced | *Black dilator advanced and removed | ||
* Verification by TTE for acceptable Mitral valve crossing | *Balloon advanced | ||
* Balloon inflation performed and gradients measured by echo | *Verification by TTE for acceptable Mitral valve crossing | ||
* Inflation repeated if necessary | *Balloon inflation performed and gradients measured by echo | ||
* Guidewire | *Inflation repeated if necessary | ||
*Guidewire and slenderizer reinserted | |||
* | *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 17:40, 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
