CLINICAL

CASE #4

NAME OF PATIENT: EDILMA A

DOCUMENT: 2801***
DATE OF BIRTH: 15-09-1953
AGE: 69 AÑOS
WEIGHT: 81 KG
SIZE:1,56 CM
HEMOCLASSIFICATION: O+
FE: 50%

DIAGNOSIS:
CORONARY HEART DISEASE
INDICATIONS:
It is indicated when: By means of a coronary arteriography study
and according to the clinical context of the present case,
Critical occlusive lesions in the main coronary arteries as a result of
detonation and cion of atheromatous pathways that prevent the
irrigation (arrival of blood) of the coronary flow to the different
segments of the thickness of the cardiac muscle (myocardium) with
which it increases the risk of exacerbating a new
acute myocardial ischemia or infarction with adverse patient
outcomes including death
 PROCEDURE DESCRIPTION
First step:The steps of the opening time (skin incision, tcs, saphenous
vein extraction as free graft, internal mammary artery extraction as
pedicled graft, graft permeabilization, sternotomy, incision and
pericardium repair) are performed.

This will be done with: MB 3 Sheet 15( (Left Leg) Electrosurgical scalpel,
weitlander retractor, Farabeuf retractors, compresses, dissecting
forceps, metzembaun scissors, ligaclip forceps and ligaclips 100 and 200,
silk4/0, 10 cc syringe, arterial cannula, heparinized solution, 1 cc syringe,
nitropusside solution, Vycril 2/0, monocryl 3/0, MB 7 Sheet 15 (Thorax)
Electrobisturi, mammary retractor, sternal retractor, vascular dissection
forceps, 0 silk, reciprocating saw.
 PROCEDURE DESCRIPTION
Second step: The vascular timing steps are performed (Tobacco Bags,
Aortic Cannulation, Clamping right atrium, starting pump and clamping
aorta)

This will be done with: 2/0 polyester, thread passer, metzembaun

scissors, MB 7 Sheet 11, EOPA 40 cannula, tube clamp, silk 1, partial
occlusion clamp, metzembaum scissors, vascular dissection, 32/40 single
venous cannula, anterograde root cardioplegia cannula, curved Kellys,
stracorporeal circulation lines, connectors, rigid pericardial suction.
 PROCEDURE DESCRIPTION
Third step: An incision is made in the right coronary artery to perform
the respective anastomosis to the saphenous vein as a free graft.

This will be done with: MB 7 blade 15, fine microcoronary scissors,

vascular dissection forceps, Dennis dissection.
 PROCEDURE DESCRIPTION
Fourth Step: Proximal anastomosis of the free graft from the saphenous
vein to the right coronary artery is performed.
This will be done with: Prolene 8/0, vascular needle holder, dissection,
May scissors, Dennis dissection
 PROCEDURE DESCRIPTION
Fifth step: Elevationor the apex of the heard is performed to perform the
second anastomosis sequentially to the circumflex artery continuing with
the saphenous vein.
T h i s w i l l b e d o n e w i t h: S t a r fis h e d
 PROCEDURE DESCRIPTION
Sixth Step: Incision is made in the circumflex and in the graft to perform
the respective anastomosis to the saphenous vein as a free graft
sequentially.

This will be done with: MB 7 blade 15, fine microcoronary scissors,

vascular dissection forceps, Dennis dissection
 PROCEDURE DESCRIPTION
Seventh Step: Sequential anastomosis of the free graft from the
saphenous vein to the circumflex artery is performed, and the starfished
is removed
. This will be done with: Prolene 8/0, vascular needle holder, dissection,
May scissors, Dennis dissection.
 PROCEDURE DESCRIPTION
Eighth Step: Separation of the epicardium is performed and an incision
is made in the anterior descending artery to perform the respective
anastomosis to the internal mammary artery as a pedicled graft,
preparing the mammary graft.

This will be done with: Epicardial retractor, MB 7 blade 15, fine

microcoronary scissors, vascular dissection forceps, Dennis dissection,
1cc syringe with nitropusside.
 PROCEDURE DESCRIPTION
Ninth Step: Distal anastomosis of the pedicled graft from the internal
mammary artery to the anterior descending artery is performed.

This will be done with: Prolene 7/0, vascular needle holder, dissection,
Mayo scissors, Dennis dissection.
 PROCEDURE DESCRIPTION
Tenth Step: Unclamp (removing Satinsky) and clamp the aorta again and
make a small hole for the third and final anastomosis of the free
sequential saphenous vein graft.

This will be done with: Clamp of partial occlusion, Punch

 PROCEDURE DESCRIPTION
Eleventh Step: Anastomosis is performed proximal to the aorta of the
last portion of the sequential free graft.

This will be done with: Prolene 6/0, vascular needle holder, dissection,
May scissors, Dennis dissection.
 PROCEDURE DESCRIPTION
Twelfth Step: The closing time steps are performed (Pump out, unclamp
(partial occlusion clamp), unclamp and knot tourniquet sutures,
pacemaker thread position, chest tube position with pleuroback,
compress count, sternal suture, tcs and skin suture).

This will be done with: Pacing wire 0, Polyester 2/0, Tube to Thorax,
pleuroback, compresses, vascular dissection, steel 5, Vycril 0, Monocryl
3/0).
 PROCEDURE DESCRIPTION
Eleventh Step: The steps of the finishing time (Cleaning and Healing) are
performed.

This will be done with: Wet and dry compresses, silver dressing, gauze
and transparent dressing without pad and polyester with pad,
Dermabond.
Clinical Case finished