MAC Lampoon steps

1. RRA access -> 6fr slender
   • Grandslam to check access to arch
   • Grandslam removed until access is completed
2. LFA access -> 8fr dilator -> Pre-close -> 8fr. Pinnacle
3. LFV access -> 8.5fr. X 23 brite tip
4. RFV access -> 8fr dilator -> Pre-close x2 -> Amplatz Super Stiff -> 26 Dry Seal
5. 6fr pigtail through LFA for arch shot
   • 6 FPS and subtraction
6. Grandslam loaded in Sentinel and inserted
   • Pigtail removed after Sentinel deployed
7. .032x260 loaded in SL1 and advanced through Dryseal
8. Wire removed and Baylis needle advanced
9. Transseptal puncture
10. If septum is soft/thin:
    • SL1 advanced into LA
    • .032x260 x2 inserted into LA via SL1
11. If septum is thick/tough:
    • .032x260 inserted into SL1 with MPA and placed in LUPV
    • .032 exchanged for Amplatz SS 1cm
    • SL1 advanced into LA
    • Amplatz SS exchanged for .032x260 x2 inserted into LA
12. SL1 removed
13. Agilis x2 advanced into LA
14. 6fr. PA loaded with Runthrough inserted into Agilis
15. 6fr JR4 guide loaded with .035x150 inserted into 8fr LFA sheath
16. Wire removed and Gooseneck inserted into JR4
17. Runthrough snared in AO
18. Runthrough externalized
19. PA catheter removed
20. 6fr. JL3.5 advanced over Runthrough
21. Second 6fr JR4 with J-wire advanced through second Agilis
22. Wire removed and Lampoon system advanced
23. Gooseneck snare inserted into JL3.5
24. IF ballooning leaflet for “Keyhole” technique make sure to keep wire straight until after ballooning.
25. Leaflet traversed
    • Bovie settings: 30 cut to test and 70 cut for traversal and laceration
26. Snare