CLINICAL CASE

CHANGE OF
AORTIC VALVE
Laura Daniela Mendoza Rios
01200021041

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CLINICAL CASE
María Pinzón, 59 years old female, history
of rheumatic fever, mitral valve
replacement 21 years ago, anti-cugulated
with warfarin, aortic valve dysfunction is
commented and programmed for
mechanical aortic valve replacement,
physical examination within normal
parameters, however, bilateral reticular
opacity on thoracic X-ray is noteworthy.
 EXAMINATIONS
Spirometry:
Decreased vital capacity,
suggesting probable restrictive
. ventilatory disturbance with
significant post-bronchodilator
changes.
TAC TORAX:
Within normal limits

DIAGNOSIS
-Aortic valve stenosis
-Pannus

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 PARACLINICS
HEMOGLOBIN: 5.4

CREATINE: 0.98

IMPORTANT VALUES GLYCEMIA: 86

Body Surface: 1,87 LEUKOCYTES: 5550

Flow: 4,6 PLAQ: 234000
Heparina: 5,32
Effective orifice area: 2,2 PCR: 2.53
FEVI: 60%
TSH: 5.95

CORONARY ARTERIOGRAPHY: CORONARY

ARTERIES WITHOUT LESIONS
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 ANALYSYS AND PLAN
However, with a finding of bilateral interstitial opacity in thorax x-ray, he comes
with a thorax ct within normal limits, spirome tria with slight restrictive uro
pathological analysis, however it is considered asymptomatic bacteiruria, serology
for covid 19 that suggests old infection, the rest of paraclinics already reported is
considered patient asa 3. Current functional class nyha II/IN, scheduled for a high
risk procedure. High anesthetic risk due to current condition, age and
comorbidities. Priority procedure due to structural compromise. Currently
asymptomatic cardiovascular, respiratory asymptomatic, denies symptoms
suggestive of covid-19, no signs of systemic inflammatory response is considered
suitable by the anesthesiology service. Risks and possible complicities derived
from the anesthetic act were explained to the patient, who reported to understand,
comprehend and accept. General recommendations are given.

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 ANATOMY
The aortic valve is an enormously
complex structure despite its
apparent simplicity. When
studying the anatomy of the aortic
valve, we see that it is formed by
three crescent-shaped tissue
fragments, the leaflets, which are
attached to the wall of the aorta
and separate the aorta from the
left ventricle.

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FISIOLOGY
AORTIC VALVE DYSFUNCTION

is caused by the defective closure

of the aortic valve that generates a
leakage (regurgitation) of blood
from the aorta into the left
ventricle with each heartbeat

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 AORTIC VALVE ETIOLOGY
As the aortic valve narrows, the left
ventricle of the heart has to work
harder to pump blood through the
valve. To do this extra work, the
muscles in the walls of the
ventricle become thicker. This can
lead to chest pain.

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 CHECK LIST
INSTRUMENTS MEDICAL DEVICES

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TABLESETTING

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 SURGICAL PROCEDURE
Surgical process
Preparation time steps are performed
Opening time steps (skin incision, tcs, sternotomy,
pericardial incision and repair) are performed.
The steps of the vascular technique are performed (tobacco
bags, cannulating in the aortic root, cannulating in a single
venous way in the right atrium, starting the pump, clamping
the aorta and incising it to apply cardioplegia)
Correction time steps are performed and aortic repair is
performed
Removal of the damaged aortic valve is performed.
Measurement of the new valve is performed and it is
determined that the size is #25, deciding to place a biological
or mechanical valve
The biological valve is positioned where the natural aortic
valve was located and knotted to fix it.
Suture test performed
Suture of the aorta is performed
Proceed with aeration and closure time steps (tube to thorax
position with pluroback, pacing wire position, gauze and
compress count, sternal suture, tcs and skin suture)
Completion time steps (Cleaning and healing) are performed
Instruments
MB 7 blade 15, electrosurgical scalpel, farbeuf spreaders, compresses,
oscillating saw, bone wax, 2/0 silk, vascular dissection forceps
Prolene 4/0, thread passer, silk 0, single venous cannula, curved Kellys,
extracorporeal circulation tubes, connectors, tube clamp, Derrach clamp,
debakey clamp, Metzembaum scissors, vascular clamp, spencer
cardioplegia cannula, cardioplegia solution.
Vascular clamp, 4/0 silk, curved Kelly clamp
Vascular clamp, Metzembaum's scissors, pathology bottle
Valve gauges
Biological and mechanical valve #25, valve positioner, polyester 2/0 with
pledget, kelly curved forceps, may scissors, mb 3 sheet 11, saline
solution
Nerve hook
Polypropylene 4/0, vascular dissection, needle holder, Mayan scissors
Tube to thorax 32, pleuroback, polyester 2/0, Pacing wire 0,
Compresses, gauze, vascular dissection, steel 5, vicryl 0, monocryl 3/0
Wet and dry compresses, gauze, and transparent dressings without pad 11
and polyester
THANKS YOU

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