Perc. Transvenous Mitral Commissurotomy
From Bay Area Structural Heart Wiki
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