PFO CLOSURE (ICE guided)

(MIKE MULLEN/AMIT BHAN/AJAY JAIN)

Local Anaesthetic

I.C.E. (Intra-Cardiac Echocardiography) guided

1      Barts angiopack

1 8F Femoral Sheath

1 10F Femoral sheath (for ICE catheter)

1 6F MPA1 diagnostic catheter

1 Amplatz Super Stiff J-tip wire 0.035” x 260cm

1 PFO plug (ask for size)

1 Delivery system (appropriate for PFO size choice)

2 30mL luerlock syringe (for prepping the device)

1 3-way tap with extension (BD Connecta)

1 500mL Saline bag

1 Spike

1 Backstop

1 Ethilon 1-0 Suture for closure (Z-suture)

1 10mL Heparin (10,000iu)

1 10ml Bupivacaine 0.5%

1 10ml Lidocaine 1%

2 Ultrasound probe cover (1 for UTS probe, 1 for ICE catheter)

*Prepare a manifold for contrast injection to confirm device placement

For sizing balloon:

25 or 30mm PTS-X balloon

Contrast mixture: 30ml contrast/70ml saline

3 way tap

60ml luerlock syringe

30ml luerlock syringe

Procedural Steps:

Right femoral venous access

Insert 8F femoral sheath + 10Fr venous access (if using an ICE catheter)

Introduce 6F MPA catheter and cross the PFO

Park the MPA catheter in the pulmonary vein, and replace the guidewire with Amplatz guidewire

Remove the catheter

Insert the sizing balloon (PTS-X), and measure the PFO using QA (quantitative angiography) and TOE

Remove the balloon, introduce and deploy the PFO plug

Remove everything, then close the access.

Things to note:

-Remind the medical team to prescribe antibiotics while they consent patients.

-To aid the turn around time between cases, call the ward to administer the antibiotics an hour before bringing the next patient (basically call to give antibiotics for the next patient while your current patient enters the cathlab).

-For Saturday list, please check (middle of the week) you have enough sizing balloons (PTS-X), delivery sheaths and closure devices for the weekend’s cases.

-Antibiotics: Fluocloxacillin + Gentamycin combination