Valve in MAC with Antegrade Lampoon
General Anesthesia, TEE
MAC- Mitral Annular Calcification
https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf
Access sites:
24F RFV
8F LFV
8F LFA
Open:
Standard Basilica Equipment
Standard Transeptal Equipment
Standard TMVR Equipment
??Sentinel Equipment**
Safari
24F Dryseal
(2) Agilis sm curl
300 cm Runthrough wire
14mm Armada Balloon
Balloon Pump
6F JR4 Guide/ 6F MP
6F JL3.5 Guide
7F JR4 Guide
18/30 Ensnare
25mm Gooseneck snare
Preclose x 2
0 Ethibond
0 Prolene
Standby:
12F Flexcath
6F MP Guide
7F Langston
Rough Procedural Plan:
Obtain access as listed above.
Preclose RFV x 2
SL1- transeptal puncture
SL1 exchanged for 24F Dryseal
Agilis x 2 inserted
7F JR4 with ensnare to LFA
6F JR4 through one of the agilis.
Runthrough in 6F JR4 and snared through 7F in LV
6F JR4 removed and reinserted over .032 wire---- or 6FMP??
Lampoon equipment advanced through 6F JR4/MP
6FJL3.5 advanced over Runthrough
25mm snare through JL3.5
Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
After leaflet traversal and system snared- 7F guide and Runthrough removed.
Balloon pump inserted.
Pacer inserted.
Leaflet lacerated.
Lampoon system deconstructed.
Pigtail advanced with Safari
Pigtail out.
Septostomy
Valve inserted and deployed.
Pigtail for wire removal
*ECMO??
*Possible ASD Closure
*Flow monitor on left leg?
