Perc. Transvenous Mitral Commissurotomy: Difference between revisions
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====Open==== | ====Open==== | ||
* | *.035 150J | ||
*.032 260cm J<br /> | |||
===TransSeptal Equipment:=== | ===TransSeptal Equipment:=== | ||
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===Catheters:=== | ===Catheters:=== | ||
* | *6F Swan (if recent RHC has not been performed) | ||
*8F Accunav | *8F Accunav | ||
*5F MPA | |||
===Misc Supplies:=== | ===Misc Supplies:=== | ||
| Line 56: | Line 58: | ||
*Micropuncture | *Micropuncture | ||
US probe cover | * US probe cover | ||
*(2) 3-port manifolds | *(2) 3-port manifolds | ||
*0- Prolene | |||
| Line 67: | Line 67: | ||
*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) | ||
| Line 79: | Line 79: | ||
**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 | *Inoue Guidewire advanced to LA | ||
*SL1 removed. ICE catheter removed. | *SL1 removed. ICE catheter removed. | ||
*Black dilator advanced and removed | *Black dilator advanced and removed | ||
| Line 86: | Line 86: | ||
*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 | *Guidewire and slenderizer reinserted | ||
*Figure 8 stitch around 9F sheath. Sheath removed. | *Figure 8 stitch around 9F sheath. Sheath removed. | ||
Revision as of 23:44, 6 August 2020
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
- .035 150J
- .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
- 5F MPA
Misc Supplies:
Open
- Micropuncture
- US probe cover
- (2) 3-port manifolds
- 0- Prolene
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
- 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
- Figure 8 stitch around 9F sheath. Sheath removed.
APPROVED: MD initials MM/YY
