Perc. Transvenous Mitral Commissurotomy
From Bay Area Structural Heart Wiki
DRAFT
| Anesthesia | Imaging | Access | Pre-Procedure | Billing |
|---|---|---|---|---|
| None | Fluoro, TTE, and ICE possible TEE |
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 (if using ICE)
- 8frx10cm Pinnacle (if doing RHC)
- 8.5 SL1 transseptal
Wires:
Open
- .035 150J (if needed for RHC)
- .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 (If using ICE))
Misc Supplies:
Open
- Micropuncture
- US probe cover
- 3-port manifold
- Stopcock for woggle
Have Prepped:
- Cup with full strength contrast
- Bowl with 80/20 saline/contrast mixture
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
- Probable LA-gram (10ml Full strength contrast)
- 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
- Possible gradient measured with SL1 and 6fr PA catheter.
- Figure 8 stitch around sheath. Sheath removed. Plan for Woggle.
APPROVED: MD initials MM/YY
