Clinical Case 1

"bentall surgery"

by: Gissel Camila Jerez Muñoz

 PATIENT
INFORMATION
Name: Luis Alejandro Mejia Ordoñez
ID: 13905605
Weight: 88 kg
Height: 1.82 cm
Blood Type: B+
Results: HIV (-), Hepatitis B (-)
Age: 67 years old
FE: 46 %
EPS: Foscal
Diagnosis
dilation of the aortic root

Procedure:
surgery bentall
 The process begins
1. review medical history
2. humanized treatment is
made with the patient
3. He is asked how the surgical
bath was and what antiseptic
was used
 step by step
procedure
• Pass umlaut instruments to the
• Pass to the surgeon an electrocoagulation
surgeon to make the skin incision.
device for hemostasis of the sternal

periosteum, and bone wax for bone marrow.

• Transfer to the surgeon elastic

apprehension instruments and

• Transfer to the surgeon a sternum autostatic
electrocautery for the incision of deep
retractor to keep the sternum in place together
tissues such as TCS and pre-sternal
with the sternum protectors.
fascia of the pectoralis muscle.

• Transfer to the surgeon vascular elastic

• Pass the reciprocating saw to the
apprehension instruments and
surgeon to perform the sternotomy,
electrocoagulation device for opening the
separating the sternal edges with the
pericardium
Farabeuf retractor

 • Transfer to the surgeon instrumental synthesis and

silk suture 0 with a round needle the repair points of
the pericardium

• Pass 2/0 polyester suture and 4/0 polypropylene

suture to the surgeon with a round needle so that the
surgeon can make the purse strings in:
• ascending aorta right atrium
• Arteriotomies and venotomies are performed,
• aortic root.
cannulas are inserted

• Tourniquet and thread guides are passed to repair

tobacco bags, repairing them with kelly clamp • Fixation of the cannulas is performed with silk 1

precut

• The respective tubing (arterial and venous) is

clamped by passing tube caps

• Cardioplegia is performed and clamping

instruments are passed for total occlusion of the
aorta.

• Transfer to the surgeon instrumental
diaeresis (scalpel, blade 11) and vascular
apprehension to incise the aorta, then
Metzembaum-type scissors.
• Pass pericardium suction cannula, to
collect blood
• Pass coronary perfusion cannula, for direct
anterograde cardioplegia in the coronary
ostia
• Passage of elastic vascular instruments and 4-
0 silk suture to repair the walls of the aorta
• Pass vascular grasping forceps and scissors for
dissection and removal of the aortic valve.
• The surgeon is passed 2-0 vascular polyester
suture with felt and a 16 mm needle, the needle
in each of the posts and respective repairs, then
the following sutures are passed, taking special
care not to repeat the color of the strand.
 • It is washed with saline solution and the valve is • Support the surgeon in the passage of sutures in
measured with the gauge approved by the surgeon the valve annulus
and confirmed. • After medical device implantation, 4/0

polypropylene suture is passed for aortic closure
• The nursing assistant is asked to identify the valve ·Withdrawal of cardiovascular cannulae
device to be planted, and it is confirmed aloud. ·check foreign body count

• Pass the valve to the assistant surgeon and he

passes polyester2/0 suture with a 16 mm needle

and synthetic instruments.
 • pericardial suture
• installation of drainage system
• hemostasis and closure of the
sternum surgical Steel
• skin suture
• heals the patient by cleaning and
covering the wound with dressings
or adhesive tape
Complications that the patient
may suffer after surgery
Ventricular pseudoaneurysm in the LV apex after
aortic valve replacement is an unexpected
complication. Its cause is unknown. It is possible that it
is due to an injury caused by surgical cannulas resting
on the area, which increases its rigidity due to
hypothermia. Cardiac imaging in its different
modalities will allow diagnosis, therapeutic decision
and follow-up of these patients.
¡THANKS!
BY
Gissel Camila Jerez Muñoz