AORTIC VALVE REPLACEMENT

AND MYOCARDIAL
REVASCULARIZATION

CLARA JIMENEZ
INFORMATION OF THE
PATIENTE

THE FOLLOWING CLINICAL CASE

PRESENTS MR. CAMILO BARRAGAN, 82
YEARS OLD, WHO PRESENTS SEVERE
CORONARY DISEASE, FOR WHICH IT
WAS DECIDED TO PERFORM AN AORTIC
VALVE REPLACEMENT PLUS
REVASCULARIZATION DUE TO HAVING
OBSTRUCTED THE CORONARY ARTERY.

BLOOD TYPE: A+
HEIGHT: 150CM
WEIGHT: 53KG
YEARS:82
BIH:(-)

 MEDICAL HISTORY

PATIENT CAMILO BARRAGAN PREVIOUSLY

PRESENTED THE DISEASE KNOWN AS
PTERIGION, WHICH WAS PERFORMED SAID
PROCEDURE.

 ANATOMY

THE IRRIGATION OF THE HEART IS GIVEN MAINLY BY TWO

BRANCHES COMING FROM THE ASCENDING AORTA, CALLED
RIGHT AND LEFT CORONARY ARTERIES; THESE BRANCHES ARE
THE ONES THAT MAKE BLOOD FLOW TO THE MYOCARDIUM
AND EPICARDIUM.
THE RIGHT CORONARY ARTERY IS DERIVED FROM THE
CORONARY SINUS AND DIRECTED THROUGH THE
ATRIOVENTRICULAR SEPTAL DEFECT THAT DIVIDES INTO THE
RIGHT POSTERIOR DESCENDING ARTERY AND THE MARGINAL
ARTERY. AND THE LEFT CORONARY ARTERY ARISES FROM THE
CORONARY SINUS AND EMERGES FROM THIS VERY

·INTERNAL MAMMARY ARTERY (IMA), IS A

DESCENDING COLLATERAL BRANCH OF THE
PRE-SCALENIC PORTION OF THE
SUBCLAVIAN ARTERY (AS). ITS ORIGIN IS
MEDIAL TO THE PHRENIC NERVE (NF) AND
POSTERIOR TO THE BRACHIOCEPHALIC
VENOUS TRUNK.

A GRAFT IS TAKEN FROM THE PATIENT'S

SAPHENOUS VEIN.

 SURGICAL OBJECTIVE

THE OBJETIVE OF THIS SURGERY IS TO

CHANGE THE AORTIC VALVE AND
REVASCULARIZE THE CORONARY
ARTERIES .
CHECK LIST

ARRANGEMENT OF MAYO TABLES AND

RESERVATION
PATIENT POSITION (NAME AND GRAPHIC):

LOCATION OF THE SURGICAL TEAM (MAKE A

GRAPH
 TYPE OF ANESTHESIA: GENERAL

INCISION: MEDIAN STERNOTOMY

 SURGICAL PROCEDURE

·. INCISE WITH SCALPEL 11 PLACE WILANDER SEPARATOR

• TO REMOVE THE SAPHENOUS GRAFT
• TAKE OUT THE GRAFT
• FASCIA IS CLOSED WITH 2/0 VICRYL AND 3/0 MONOCRYL SKIN
• INCISION WITH SCALPEL 15
• IT CONTINUES TO AFFECT WITH ELECTRO
• INCISE THE STERNUM WITH A RECIPROCATING SAW AND GRADUALLY
HEMOSTASIZE THE BONE.

• PLACE BONE WAX ON THE BONE

• PLACE MAMMARY SEPARATOR
• THEN DISSECT THE MAMMARY, PLACE THE CLIPS AND CUT
• THEY ADMINISTER THE HEPARIN
• THE MAMMARY SEPARATOR IS REMOVED AND THE MORSE STERNAL IS
PLACED.
• AN INCISION IS MADE TO BREAK THE PERICARDIAL LAYER WITH THE
ELECTRO AND THE PERICARDIUM IS REPAIRED WITH SILK 0
• 2/0 POLYESTER IS PASSED TO THE SURGEON FOR THE AORTIC
PURSESTRING
• THE PURSE STRING IS MADE FOR RIGHT ATRIAL VENOUS CANNULATION
(SINGLE CANNULATION)
• PERFORMING ARTERIAL CANNULATION AND IT IS ATTACHED TO THE
TUBE OF THE EXTRACORPOREAL CIRCULATION MACHINE THEN SINGLE
CANNULATION IN THE RIGHT ATRIUM AND IT IS ATTACHED TO THE TUBE
• THE VENT IS LOCATED IN THE RIGHT UPPER PULMONARY VEIN.
• THEN ANESTHESIOLOGIST VENTILATES THE PATIENT THEN THE
CUSTODIOL IS PLACED (CARDIOPLEGIA) AND THE PUMP IS ENTERED
• INCISE THE AORTA TO GIVE DIRECT ANTEGRADE CARDIOPLEGIA IN THE
CORONARY OSTIUM AND REMOVE THE VALVE
·• INCISE THE POSTERIOR DESCENDING ARTERY AND PLACE THE SAPHENOUS
GRAFT WITH 7/0 PROLENE
• THEN THEY DO THE TEST TO SEE IF IT PASSES WITH A SOLUTION
• THEN THEY PASS THE METERS # 23 AND 25 BIOLOGICAL TO KNOW THE SIZE OF
THE VALVE AND THEY CHOSE # 25
• 4 CAPOS ARE PLACED SO THAT THE THREADS AT THE TIME OF SUTURING THE
VALVE ARE NOT LOST AND IT IS FIXED WITH 2/0 POLYESTER
• FIELDS ARE REMOVED
• THEN THE AORTA IS CLOSED WITH PROLENE 4/0
• THEN HE BRIDGES THE PROXIMAL GRAFT THAT GOES TO THE AORTA
• REPAIR THE MAMMARY, PLACE A BULLDOG CLAMP AND PROCEED TO PLACE THE
GRAFT
• THE BULLDOG CLAMP IS REMOVED

• THEY PLACE PACE MARKING THREAD

• THEY PLACE THE ALLIGATORS BEFORE LEAVING THE BOMB
• IT COMES OUT OF BOMB
• DECANNULA REMOVE SEPARATOR AND PERFORM HEMOSTASIS
• THE SEPARATOR IS PLACED AGAIN AND HEMOSTASIS IS PERFORMED.
• TUBES ARE PLACED IN THE RIGHT PLEURA AND MEDIASTINUM
• THE SEPARATOR IS REMOVED AND THE STERNUM IS SUTURED IN 6/0 STAINLESS
STEEL.
• FASCIA IS CLOSED WITH VICRYL 0
• LEATHER WITH MONOCRYL 3/0
 BIBLIOGRAPHY

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