PFO CLOSURE

(MIKE MULLEN/AMIT BHAN/AJAY JAIN)

done under General Anaesthetic

T.O.E. (Trans-Oesophageal Echocardiography) guided

1      Barts angiopack

1 8F Femoral Sheath

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%

1 Ultrasound probe cover

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.