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STUDENT NAME: CODE: PRACTICE

LEVEL: III /IV
ANDREA VALENTINA VILLAMIZAR BLANCO 01200021056

TEACHER'S NAME: Lidy Higuera PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE:

CARDIOVASCULAR DR GIRALDO 23/08/2023

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

CESAR ANTONIO FONSECA LEURO 6758073 65 YEARS

SURGICAL PROCEDURE TO PERFORM:

AORTIC VALVE REPLACEMENT

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

replace the damaged aortic valve with a new one, it can be biological or mechanical
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1.2. Anatomy and physiology: (Make graph and description).

The aortic root is a complex structure linking the left ventricular outflow tract and the ascending aorta, made up of the
following structures, which work together to achieve normal valve function:

aortoventricular junction

intervalval triangles

The zone of insertion of the leaflets and the commissures

Aortic Leaflets

the sinuses of valsalva

sinotubular junction

The proximal limit of the aortic root is determined by the basal insertion of the leaflets into the left ventricle and extends
distally to the sinotubular junction, where it is continued by the ascending or tubular aorta. The aortic annulus is crown-
shaped and is the site where the leaflets are inserted, thus forming 3 commissures at the highest junction site between
them and 3 sinuses of Valsava.

The aortic leaflets are three triangular fibrous structures that coapt together in the shape of a cup. They have greater
consistency in their free edge and are more lax in their body. At the midpoint of their free edge of coaptation they have a
fibrous thickening known as the Nodule of Arancio.

The sinuses of Valsalva are small saccular dilatations of the aortic root. They are limited by the aortic wall, which is less
thick at this height, and its respective leaflet. Under normal conditions, the coronary arteries arise respectively from the
right and left coronary sinus, leaving a third non-coronary sinus.
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The aortic annulus is not a single structure, but rather consists of 3 components: the sinotubular junction, the ventriculo-
aortic junction, and the crown-shaped annulus that serves as an attachment for the leaflets. These three components
work together to make up the functional aortic annulus.

The coordinated dynamic action allows the unidirectional transmission of blood from the left ventricle to the aorta through
a channel that allows maintaining a laminar flow, with minimal resistance, optimizing coronary flow and with the least
possible damage to the blood elements.

The aortic root could be defined as the portion of the left ventricular outflow tract that contains the aortic leaflets limited
above by the sinotubular junction and below by the basal ring at the level of aortic leaflet implantation. The aortic root
acts as a single hemodynamic complex that undergoes changes (expansion/contraction) during the cardiac cycle.

There is a normal relationship between the length of the free edge of the leaflet and the length of its base of implantation.
This ratio should be 1/1.5; that is, any increase in the length of the free edge of the leaflet modifies this relationship; this
is the mechanism of aortic valve prolapse.
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1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

DEVICES SOLUTIONS
INSTRUMENTAL SUTURES AND
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NEEDLES

VICRYL 0• SEDA 4/0•

SEDA 0• SEDA
PRECUT 1/0•
ETHIBOND 2/0• BONE
WAX• MONOCRYL 3/0•
PROLENE 4/0•
PACEMAKERLEAD 2/0•
PLEDGET• TI-CRON 2/0
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2. ORGANIZATION STAGE:

a. Arrangement of May tables and reservation (make scheme).

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2.2. Patient position (Name and graphic):

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2.3. Location of the Surgical Team (make a graph):

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3. EXECUTION STAGE

a) Anesthesia (write the type of anesthesia):

General
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b) Incision (write the type of approach and the name of the incision):

Sternotomy

c) Surgical Process (Describe the main steps of the surgical medical technique with the instruments to be used).

Aortic valve change It is incised with a blade 15 scalpel handle 7 A wide incision is made with electrocautery The
sternum is opened with a reciprocating saw Bone wax (2): hemostatic to protect the external bone and bone
marrow Protectors are put on and the External separator Silk 0 sh 75 cm (2): to repair the pericardium Ethibon 2/0
2sh 90cm (3): to make the venous and arterial tobacco pouches Colored tourniquets and cannulae Prolene 4/0 (3) :
vent snuff bag Separate the pulmonary vein with the rigid pericardium aspirator Then make the pursestring with
prolene 4/0 Incise with blade #11 and introduce the arterial cannulation Hold the tourniquet to the cannulation
and fix it with pre-cut silk 1/ 0 Connect the arterial cannula to the arterial line Incise the right atrium and place the
venous cannula and fix a tourniquet to the cannula with precut silk 1/0 Connect the venous cannula to the venous
line 3-way connectors were placed on both arterial and venous cannulae /8 3/8 The vent is placed The pulmonary
vein is incised and the vent aspirator is introduced and connected to a suction line The aorta is clamped with the
satinsky clamp and the aorta is incised They connect the 90 cannula • to the cardioplegia line and introduce the
cannula in the two ostium, retrograde cardioplegia begins Silk 4/0 RB1 (3): repair the aorta Calcified tissue is
removed from the aorta Pass the carbomedics - st jude valve sizers Place st jude 21 mechanical aortic valve Fields
are placed The valve is passed And the valve fixation points are placed Ti-cron 2/0 Y-31 with 8 needles: for aortic
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valve replacement Prolene 4/0 (3): with Pledget to close the aorta They remove the aortic clamp The pacemaker
thread is passed The cavity is washed with warm saline solution The alligators are installed to carry the current
from the defibrillator to the heart The supraumbilical incision is made to leave a drain The vent aspirator is
removed, the colored tourniquets, the cannulas are removed and the tobacco bags are closed If the aorta is
bleeding or ruptured, it is clamped, 17mm 4/0 prolene with double plush is used for closure, one is passed with
plush and the other without ethibond to repair the aorta The pericardial repairs are removed, the sternal retractor
is removed and the periosteum of the sternum is cauterized Two compresses are placed around it and the retractor
is reinserted A rochester is passed through the incision and with the end it is grasped and inserted the tube and fix
it with ethibond The separator is removed and the sternum is closed with aciflex 6 The nelaton probe and the
suction rubber are introduced into the tube to aspirate After closing the sternum, it is washed with saline solution
Infiltrates with bupivacaine Vicryl 0 CT -1 (2): fascia is closed Monocryl 3/0: skin is closed Pledget: helps to reinforce
the suture Clean the wound with a moist compress and dry the wound with a dry compress and heal with a
dressing leukomed
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES

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STUDENT SIGNATURE: TEACHING SIGNATURE: __________________________