CLINICAL CASE

MYOCARDIAL REVASCULARIZATION
WHAT IS A MYOCARDIAL
REVASCULARIZATION?

Myocardial revascularization surgery (CRM),

also called coronary bypass surgery, is a
medical procedure to improve blood flow to
the heart. It may be needed when the
arteries that supply blood to heart tissue,
called coronary arteries, are narrowed or
blocked.
INFORMATION OF THE PATIENTE

01 Name:HENRY JAIMES 06 Age:66 years

02 ID: 91872834 07 FE:54%

03 Weight:67kg 08 EPS:Nueva EPS

04 Height:1.60cmBlood

05 Type:O+
 INFORMATION OF THE PATIENTE
1. Patient's body surface area is evident: 1,75Flow
2. rate evident: 4.3
3. Heparin dose is evidenced: 4.69Z
4. value not applicable
5. Effective orifice area value not applicable.
6. It is evidenced that the perfusion devices are correct.
7. The sterility of the equipment is confirmedIt is evidenced that the pre-surgical
asepsis used was alcohol andisopropyl alcohol.
8. It is evidenced that the washing was total and the plaque is located.
9. Adequate positioning of the patient is evidenced
 SURGICAL PROCEDURE
First step:
The steps of the opening time (skin incision,tcs, saphenous
vein extraction as free graft,internal mammary artery
extraction aspedicled graft, graft
permeabilization,sternotomy, incision and pericardium
repair)are performed.

INSTRUMENTATION...
MB 3 Sheet 15( (Left Leg) Electrosurgicalscalpel, weitlander
retractor, Farabeufretractors, compresses, dissecting
forceps,metzembaun scissors, ligaclip forceps andligaclips
100 and 200, silk4/0, 10 cc syringe,arterial cannula,
heparinized solution, 1 ccsyringe, nitropusside solution, Vycril
2/0,monocryl 3/0, MB 7 Sheet 15 (Thorax)Electrobisturi,
mammary retractor, sternalretractor, vascular dissection
forceps, 0 silk,reciprocating saw
 SURGICAL PROCEDURE
Second step
The vascular timing steps are performed(Tobacco
Bags, Aortic Cannulation, Clampingright atrium,
starting pump and clampingaorta).

INSTRUMENTATION...
2/0 polyester, thread passer, metzembaunscissors,
MB 7 Sheet 11, EOPA 40 cannula, tubeclamp, silk 1,
partial occlusion clamp,metzembaum scissors, vascular
dissection,32/40 single venous cannula,
anterograderoot cardioplegia cannula, curved
Kellys,stracorporeal circulation lines, connectors,rigid
pericardial suction.
This will be donewith...
 SURGICAL PROCEDURE
Third step
An incision is made in the right coronaryartery to
perform the respectiveanastomosis to the saphenous
vein as afree graft.

INSTRUMENTATION..
MB 7 blade 15, fine microcoronary scissors,vascular
dissection forceps, Dennisdissection.
This will be donewith...
 SURGICAL PROCEDURE
Fourth Step
Proximal anastomosis of the free graft fromthe
saphenous vein to the right coronaryartery is performed.
INSTRUMENTATION...
Prolene 8/0, vascular needle holder,dissection, May
scissors, Dennis dissection.
This will be donewith...

Fifth step
Elevation of the apex of the heart isperformed to
perform the secondanastomosis sequentially to the
circumflexartery continuing with the saphenous
veingraft.Starfished
INSTRUMENTATION..
This will be donewith...
 SURGICAL PROCEDURE
Sixth Step
Incision is made in the circumflex and in thegraft to
perform the respective anastomosisto the saphenous
vein as a free graftsequentially.
INSTRUMENTATION..
MB 7 blade 15, fine microcoronary scissors,vascular
dissection forceps, Dennis dissection

Seventh Step
Sequential anastomosis of the free graftfrom the
saphenous vein to the circumflexartery is performed,
and the starfished isremoved
INSTRUMENTATION..
Prolene 8/0, vascular needle holder,dissection, May
scissors, Dennis dissection.
 SURGICAL PROCEDURE
Eighth Step
Separation of the epicardium is performedand an incision is made in
the anteriordescending artery to perform the respectiveanastomosis
to the internal mammaryartery as a pedicled graft, preparing
themammary graft.
INSTRUMENTATION..
Epicardial retractor, MB 7 blade 15, finemicrocoronary scissors,
vascular dissectionforceps, Dennis dissection, 1cc syringe
withnitropusside.

Ninth Step
Distal anastomosis of the pedicled graft fromthe internal mammary
artery to the anteriordescending artery is performed.
INSTRUMENTATION...
Prolene 7/0, vascular needle holder,dissection, Mayo scissors,
Dennis dissection.
 SURGICAL PROCEDURE
Tenth Step
Unclamp (removing Satinsky) and clamp theaorta again and make a
small hole for thethird and final anastomosis of the freesequential
saphenous vein graft.
INSTRUMENTATION..
Clamp of partial occlusion, Punch

Eleventh Step
Anastomosis is performed proximal to theaorta of the last portion of
the sequentialfree graft.
INSTRUMENTATION..
Prolene 6/0, vascular needle holder,dissection, May scissors, Dennis
dissection.
 SURGICAL PROCEDURE
Twelfth Step
The closing time steps are performed (Pumpout, unclamp (partial
occlusion clamp),unclamp and knot tourniquet sutures,pacemaker
thread position, chest tubeposition with pleuroback, compress
count,sternal suture, tcs and skin suture)I
INSTRUMENTATION....
Pacing wire 0, Polyester 2/0, Tube to Thorax,pleuroback,
compresses, vascular dissection,steel 5, Vycril 0, Monocryl 3/0).

Eleventh Step
The steps of the finishing time (Cleaning andHealing) are performed
INSTRUMENTATION
Wet and dry compresses, silver dressing,gauze and transparent
dressing without padand polyester with pad, Dermabond.
ARRANGEMENT OF TABLES
MAY TABLE
ARRANGEMENT OF TABLES
RESERVATION TABLE
BY: PAULA GUTIERREZ
SEVENTH SEMESTER