CLINICAL CASE

MYOCARDIAL
REVASCULARIZATION
ANDREA VILLAMIZAR
YUZ HERNANDEZ
SEVENTH SEMESTER

INSTITUTO DEL
CORAZON
PRIMARY PATIENTINFORMATION
The present clinical case is of the
male patient who presents a severe
coronary disease, generating
functional mild mitral valve
regurgitation

PATIENT DATA:
Height: 170cm
Weight: 67kg
Age: 70 years
Blood type: A+
HiV: (-)
Hepatitis B: (-)
Surgical history: phakectomy
 MEDICAL HISTORY

01
CORONARY ANGIOGRAPHY
WITH LEFT CATHETERIZATION

Severe obstructive
coronary disease of
three main vessels is

02
documented.
MEDICAL HISTORY
DIAGNOSTIC METHODS
Mild Tricupedal Regurgitation
ANATOMY
 ANATOMY
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 branchesirrigate the myocardium
and the epicardiumright coronary artery, arises from the coronary sinus and directed
through the atrioventricular grouch, is divided into the right posterior descending artery
andmarginal artery
CHECK LIST
ARRANGEMENT OF
MAY TABLES AND
RESERVATION

MAY
TABLE
 ARRANGEMENT OF
MAY TABLES AND
RESERVATION

RESERVATION
TABLE
PACIENT POSITION
LOCATION OF THE SURGICAL
TEAM
SURGICAL PROCESS
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 planesGarter clip forceps
Scalpel handle retractor 3 scalpel blade 15 Pre-
cut silk 4-0 Poliglactin 910 Monocryl
Finevascular dissections Kelly Adson Kelly T
metzembaum Separators farabeuf Bandage
6*5 T mayElectrosurgical Weitlaner separator
20cc syringe, bulldog clamp, arteriotomy
cannula.3.
 SURGICAL PROCESS
Sternotomy incision is made to the media, hemostasis,
hemostasis of the external bone, and the graft extraction
ofthe internal mammary artery is performed: Scalpel
handle 7 scalpel blade 15, Electrosurgical scalpel,
Farabeufretractors, Reciprocating saw, Self-static retractor
of internal mammary gland, ligaclip forceps and LT 100clips
(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 theplacement of
theFinochietto separatoris performed,Fine dissections, Silk
0 with a needle, May scissors,Electrobistury
 SURGICAL PROCESS
CANNULATION:Tourniquets and purse strings are performed for cannulation of the
aorta with EOPA arterial cannula in theascending aorta, single venous cannulation in
the right atrium and finally antegrade cardioplegia cannula in theaortic 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
SYSTEMwhen the heart enters the pump, the saphenous graft is placed. in this case
anastomosing it with the circumflexartery and repairing the anterior descending
artery with the mammary artery, de anastomosis is verified and theMCEC is
removed.saphenous vein and circumflex artery graft, scalpel handle #7 and scalpel
blade 15 or microscalpel, finedissections and Dennis dissection, CO2 Frazier cannula,
semi-rigid aspirator, castroviejo needle holder,anterograde and retrograde Potts
scissors, arteriotomy cannula and syringe 10cc, may scissors,
metzembaumscissorsINPUT OF MEDICAL SUPPLIES 7.
SURGICAL PROCESS
Incisions are made and placement of tubes in
the chest, placement of pacemaker
threadscalpel handle#7 scalpel blade #15,
chest tubes 34 and 32, Y-connector, Kocher
forceps, needle holder, Mayoscissors,
pacemaker wire, pleurovac8. 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
scissors9. cleansing and healingMay scissors,
dressings without pad, gauze, dermabond,
compresses
THANKS!