2024-2025

CLINICALCASE
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: PEDRO
Age:66 years
CARDOZO 06
02 ID: 63542123

FE:54%
07
03 Weight:67kg

04 Height:1.60cmBlood
08 EPS:Nueva EPS

05 Type:O+
 FIRST STEP:
SURGICAL The steps of the opening time
(skin incision,tcs, saphenous vein
extraction as free graft,internal
PROCEDURE mammary artery extraction
aspedicled graft, graft
permeabilization,sternotomy,
incision and pericardium
repair)are performed.
SECOND STEP
The vascular timing steps are
performed(Tobacco Bags, Aortic
Cannulation, Clampingright
atrium, starting pump and
clampingaorta).
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
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...
 THIRD STEP INSTRUMENTATION
SURGICAL An incision is made in the right
coronaryartery to perform the
respectiveanastomosis to the
MB 7 blade 15, fine microcoronary
scissors,vascular dissection forceps,

PROCEDURE saphenous vein as afree graft.

FOURTH STEP
Dennisdissection.
This will be donewith...

Proximal anastomosis of the

free graft fromthe saphenous
vein to the right coronaryartery Prolene 8/0, vascular needle
is performed. holder,dissection, May scissors, Dennis
dissection.

FIFTH STEP
Elevation of the apex of the
heart isperformed to perform Starfished
the secondanastomosis
sequentially to the
circumflexartery continuing
with the saphenous
veingraft.Starfished
 SIXTH STEP INSTRUMENTATION
SURGICAL ncision is made in the circumflex
and in thegraft to perform the
respective anastomosisto the
MB 7 blade 15, fine microcoronary

PROCEDURE saphenous vein as a free

graftsequentially.
scissors,vascular dissection forceps,
Dennis dissection

SEVENTH STEP
Prolene 8/0, vascular needle
holder,dissection, May scissors, Dennis
Sequential anastomosis of the dissection.
free graftfrom the saphenous
vein to the circumflexartery is
performed, and the starfished
isremoved
 EIGHTH STEP INSTRUMENTATION
SURGICAL Separation of the epicardium is
performedand an incision is
made in the anteriordescending
Epicardial retractor, MB 7 blade 15,

PROCEDURE artery to perform the

respectiveanastomosis to the
internal mammaryartery as a
finemicrocoronary scissors, vascular
dissectionforceps, Dennis dissection, 1cc
syringe withnitropusside.
pedicled graft, preparing
themammary graft.

Prolene 7/0, vascular needle

holder,dissection, Mayo scissors,
Dennis dissection.
NINTH STEP
Distal anastomosis of the
pedicled graft fromthe internal
mammary artery to the Clamp of partial occlusion, Punch
anteriordescending artery is
performed.
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.
 ELEVENTH STEP INSTRUMENTATION
SURGICAL Anastomosis is performed
proximal to theaorta of the last
portion of the sequentialfree
Prolene 6/0, vascular needle

PROCEDURE graft.
holder,dissection, May scissors, Dennis
dissection.

TWELFTH STEP Pacing wire 0, Polyester 2/0, Tube to

Thorax,pleuroback, compresses,
The closing time steps are vascular dissection,steel 5, Vycril 0,
performed (Pumpout, unclamp Monocryl 3/0).
(partial occlusion
clamp),unclamp and knot
tourniquet sutures,pacemaker
thread position, chest
tubeposition with pleuroback,
compress count,sternal suture,
tcs and skin suture)I
SURGICAL
PROCEDURE
INSTRUMENTATION

ELEVENTH STEP Wet and dry compresses, silver

The steps of the finishing time
(Cleaning andHealing) are
performed
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