Perc. Transvenous Mitral Commissurotomy

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Revision as of 01:18, 19 December 2019 by Dronsfj (talk | contribs)

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

  • Cordis 150J

TransSeptal Equipment:

Open

  • Baylis generator from EP
  • Large curve C1 Baylis needle
  • Baylis cable
  • Grounding pad


Catheters:

  • 7F Swan (if recent RHC has not been performed)
  • 8F Accunav

Misc Supplies:

Open

  • Micropuncture

US probe cover

  • (2) 3-port manifolds
  • Closure
    • 0-Prolene
    • Perclose


Procedure:

  • Dual venous access with micropuncture and ultrasound.
    • 8F standard sheath for Swan insertion if necessary. If no RHC, Preclose followed by 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
  • 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 reinserted
  • Stylet removed, slenderizer advanced. Guidewire reinserted.
  • All equipment removed and perclose knot locked.
  • Figure 8 stitch around 9F sheath. Sheath removed.



APPROVED: MD initials MM/YY