Clinical

case
myocardial
revascularization

JULIANA ANDREA SACHICA

 PATIENT INFORMATION
54 years old patient with a diagnossis
of multivessel coronary disease

WEIGHT: 80 kg
S.C: 1,89
F: 4,72
Heparine: 5,46

SURGICAL OBJECTIVE
Also called coronary bypass
surgery, it 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.

 ANATOMY
The heart is a muscular organ whose function is to circulate
blood through the vessels of the cardiovascular system. It is
located in the middle mediastinum, surrounded by a
fibroserous sac called the pericardium. The heart is shaped
like a quadrangular pyramid, and it is oriented as if this
pyramid had fallen forward on one of its faces, so that its
base is oriented towards the posterior chest wall and its apex
points towards the anterior chest wall. The great vessels that
originate from the heart extend their branches to the head
and neck, thorax and abdomen, and the upper and lower
extremities..

 Mamary Artery
The internal thoracic artery (ITA), also called the internal mammary artery (IMA), is
a descending collateral branch of the subclavian artery (AS). Its origin is medial to
the phrenic nerve (NF) and posterior to the brachiocephalic venous trunk.

the irrigation of the heart is mainly irrigated by two branches of the ascending
aorta, they are called the right and left coronary arteries, these two branches
irrigate the myocardium and the epicardium
right coronary artery: arises from the coronary sinus and directed through the
atrioventricular grouch, is divided into the right posterior descending artery and
marginal artery
left coronary artery
, this branch arises from the coronary sinus and emerges

table setting

 Surgical procedure
preparation of the patient dressed as a patient, dressed in tables and arrangement.
2. Extraction of the graft from the great saphenous vein of the left leg, guaranteeing its patency, closure
by planes Garter clip forceps Scalpel handle retractor
3 scalpel blade 15 Pre-cut silk 4-0 Poliglactin 910 Monocryl Fine vascular dissections Kelly Adson Kelly T
metzembaum Separators farabeuf Bandage 6*5 T may Electrosurgical Weitlaner separator 20cc syringe,
bulldog clamp, arteriotomy cannula.
3. Sternotomy incision is made to the media, hemostasis, hemostasis of the external bone, and the graft
extraction of the internal mammary artery is performed: Scalpel handle 7 scalpel blade 15, Electrosurgical
scalpel, Farabeuf retractors, Reciprocating saw, Self-static retractor of internal mammary gland, ligaclip
forceps and LT 100 clips (yellow), plasty scissors, 20cc syringe, arteriotomy cannula with olive, yankawer
cannula, bone wax.
4. The pericardium is incised, hemostasis and fixation of the pericardium is performed visualizing the
heart and the placement of the Finochietto separator is performed, Fine dissections, Silk 0 with a needle,
May scissors, Electrobistury

 Surgical procedure
5. CANNULATION: Tourniquets and purse strings are performed for cannulation of the aorta with EOPA
arterial cannula in the ascending aorta, single venous cannulation in the right atrium and finally
antegrade cardioplegia cannula in the aortic root, finally the fixation of them: polyester 2/0needle
holder,vascular dissection, aortic clamp .may scissors, tourniquets, arterial cannula Eopa # 18, single
venous cannula 34/36 and antegrade cardioplegia cannula.
6. the connection of the tubes and the cannulas of the extracorporeal circulation machine is made.
EXTRACORPOREAL CIRCULATION SYSTEM when the heart enters the pump, the saphenous graft is placed.
in this case anastomosing it with the circumflex artery and repairing the anterior descending artery with
the mammary artery, de anastomosis is verified and the MCEC is removed. saphenous vein and circumflex
artery graft, scalpel handle #7 and scalpel blade 15 or microscalpel, fine dissections and Dennis dissection,
CO2 Frazier cannula, semi-rigid aspirator, castroviejo needle holder, anterograde and retrograde Potts
scissors, arteriotomy cannula and syringe 10cc, may scissors, metzembaum scissors

 Surgical procedure

INPUT OF MEDICAL SUPPLIES

7. incisions are made and placement of tubes in the chest, placement of pacemaker thread scalpel
handle#7 scalpel blade #15, chest tubes 34 and 32, Y-connector, Kocher forceps, needle holder, Mayo
scissors, pacemaker wire, pleurovac
8. The sternal is sutured, hemostasis is checked and the respective plans tcs and skin are sutured #6 steel,
wire cutter, rochester forceps, monocryl 3/0, polyglactin 910 0, needle holder, mayo scissors
9. cleansing and healing May scissors, dressings without pad, gauze, dermabond, compresses