Tip to Base Lampoon: Difference between revisions

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=== Rough Procedural Plan ===
=== Rough Procedural Plan ===
Obtain access as listed above.
#Obtain access as listed above.
 
#Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
#Balloon pump inserted
 
#Pigtail to arch for injection prior to sentinel. 6fps DSA.
Balloon pump inserted
#Sentinel inserted
 
#SL1- transeptal puncture
Pigtail to arch for injection prior to sentinel. 6fps DSA.
#5F MP used for exchanging wires in LUPV
 
#Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
Sentinel inserted
#SL1 exchanged for Dryseal
 
#Agilis inserted through Dryseal
SL1- transeptal puncture
#6F PA floated through Agilis over guidewire into AO
 
#Guidewire exchanged for Astato
5F MP used for exchanging wires in LUPV
#6F JR4 with gooseneck snare inserted through LFA.  
 
#Astato wire snared and pulled into JR4 Guide
Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
#PA catheter removed and 6F MP1 advanced over snared Astato.
 
#Flying V formed on arterial side of wire
SL1 exchanged for Dryseal
#Finecross/Piggyback advanced over arterial side of astato wire
 
#Flying V positioned over A2
Agilis inserted through Dryseal
#Pacer Inserted
 
#Cut at 50
6F PA floated through Agilis over guidewire into AO
#Leaflet lacerated and verified on TEE
 
#LAMPOON equipment removed
Guidewire exchanged for Astato
#Pigtail advanced through Agilis  
 
#Safari wire inserted into LV
6F JR4 with gooseneck snare inserted through LFA.  
#14mm Armada used for atrial septostomy
 
#Valve inserted and deployed
Astato wire snared and pulled into JR4 Guide
#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
PA catheter removed and 6F MP1 advanced over snared Astato.
#Perclose LFA and RFA
 
#Glue vs woggle depending on heparin reversal
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


[[Category:Procedures]]
[[Category:Procedures]]

Revision as of 23:02, 6 December 2021

Tip to Base Lampoon, also referred to as "Reverse Lampoon". Performed when VIV Mitral will likely cause LVOT obstruction.

VIV Mitral with Tip to Base Lampoon
Anesthesia Imaging Access ACIST/manifold
General Biplane 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
  • Request alcohol from pharmacy

TAVR/TMVI

  1. 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).
  2. 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)
  • 8FLFV (for pacer)
  • ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)

Open:

Wires:

  • .032 260cm J wire
  • .035 260cm J wire
  • (2) .035 150cm J wire
  • 300cm Grandslam
  • Safari
  • Amplatz SS 1cm
  • .014 Astato xs 20 guidewire 300cm

Sheaths:

  • 8F Sheath
  • 7F Sheath
  • 5/6 Slender Sheath
  • 26F Dryseal

Catheters:

  • 6F JR4 Guide
  • 6F MP1 Guide
  • 5F MPA1
  • 6F Straight Pigtail

Misc:

  • 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:

  • SL1
  • Baylis Needle
  • 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

  1. Obtain access as listed above.
  2. Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
  3. Balloon pump inserted
  4. Pigtail to arch for injection prior to sentinel. 6fps DSA.
  5. Sentinel inserted
  6. SL1- transeptal puncture
  7. 5F MP used for exchanging wires in LUPV
  8. Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
  9. SL1 exchanged for Dryseal
  10. Agilis inserted through Dryseal
  11. 6F PA floated through Agilis over guidewire into AO
  12. Guidewire exchanged for Astato
  13. 6F JR4 with gooseneck snare inserted through LFA.
  14. Astato wire snared and pulled into JR4 Guide
  15. PA catheter removed and 6F MP1 advanced over snared Astato.
  16. Flying V formed on arterial side of wire
  17. Finecross/Piggyback advanced over arterial side of astato wire
  18. Flying V positioned over A2
  19. Pacer Inserted
  20. Cut at 50
  21. Leaflet lacerated and verified on TEE
  22. LAMPOON equipment removed
  23. Pigtail advanced through Agilis
  24. Safari wire inserted into LV
  25. 14mm Armada used for atrial septostomy
  26. Valve inserted and deployed
  27. 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.
  28. Balloon Pump removed
  29. Perclose LFA and RFA
  30. Glue vs woggle depending on heparin reversal