CLINICAL CASE

MYOCARDICAL
REVASCULARIZATION
Maria Paula Mendez 0120021063
 ANATOMY
Coronary arteries are blood vessels that supply blood rich in
oxygen and other nutrients to the heart muscle. The
coronary arteries are attached to and wrap around the
surface of the heart.

The left coronary artery branches into smaller arteries. The

most prominent are:
The left anterior descending artery, which supplies
blood to the front part of the heart.
The left circumflex artery, which surrounds the heart
muscle and supplies blood to the back of the heart.
The right coronary artery supplies the back of the heart.
The right marginal branch usually extends from the right
coronary artery and supplies blood to the lower right part
of the heart.
 ANATOMY
The saphenous vein, also known as the great saphenous vein or
great saphenous vein, is one of the most important superficial veins
in the venous system of the legs. Here is a basic description of its
anatomy:
Origin: The great saphenous vein originates on the dorsum of
the foot, specifically in the dorsal region of the foot and the
dorsum of the first toe.
Course: Then, ascend the inner or medial part of the leg.
Confluence: As you go up the leg, you encounter smaller veins
that drain blood from other superficial and deep veins in the leg,
contributing to their growth.
Course: Continues up the inner thigh and joins the femoral vein
in the inguinal (groin) region. This junction point is known as the
saphenous-femoral junction.
Function: The great saphenous vein is one of the main veins
responsible for carrying blood back to the heart from the leg.
 PATIENT
81-year-old patient with high blood
pressure, kidney patient on dialysis.
ALLERGIC HISTORY: denies
TOXICOLOGICAL HISTORY: denies
SURGICAL HISTORY: prostatectomy,
peritoneal catheter
 IMPORTANT EXAMS
DUPLEX OF VESSELS IN UPPER LIMBS: Recanalized thrombi are
identified almost entirely at the level of the arch of the right
great saphenous vein.
DOPPLER NECK VESSELS: Left and right common carotid with
presence of mixed atheromatous plaques, carotid bulb:
presence of atheromatous plaques.
CORONARY ARTERIOGRAPHY WITH LEFT CATHETERIZATION: Left
coronary artery 70-90% obstructed. Anterior descending
artery 70-90% obstructed. Marginal branch 70-90%
obstructed.
CHECK LIST
RESERVATION TABLE
MAY TABLE
PATIENT POSITION
SURGICAL TEAM POSITION
 SURGICAL PROCESS
To make an incision, pass the #7 handle and #15 scalpel blade to the
surgeon.
Pass to the instrumental surgeon for apprehension and electrocoagulation for
deep tissue incision.
For the sternotomy, pass the surgeon reciprocating saw equipment with
downward saws.
For manual separation of the sternum, go to the Farabeuf-type separator
surgeon.
For hemostasis of the sternum, pass the surgeon an electrocoagulation
device for hemostasis of the sternal periosteum and for hemostasis of the
bone marrow, pass bone wax, electro at 60.
 SURGICAL PROCESS
Pass the sternal protectors and self-static retractor to the surgeon for fixed
separation of the sternum.
Pass to the surgeon vascular-type elastic apprehension instruments, and
en40 electrocoagulation device for opening the pericardium.
Go to the surgeon with instruments of vascular-type elastic apprehension
and needle holder with 0 silk suture to perform the repair of the pericardium.
The mammary artery and saphenous vein are extracted.
Verify that the sternal retractor is appropriate for off-pump revascularization.
Pass compress and gauze-type healing items to the surgeon to improve
exposure.
 SURGICAL PROCESS
Provide the surgeon with special support and stabilization devices to position
the heart and expose the arteries to be revascularized. (Support of the
surgeon and assistant)
Connect suction to the systems in order to achieve the pressure necessary
for the operation of the coronary positioner and stabilizer.
Pass to the instrumental surgeon with umlaut (scalpel with 15 blade), and
vascular apprehension, to dissect the epicardial fat and locate the coronary
artery to be revascularized.
Pass the elastic band (silastic stitch with round needle) to precondition the
coronary artery and repair it with protected hemostatic forceps.
 SURGICAL PROCESS
Pass the umlaut instrument surgeon, micro vascular elastic apprehension to perform
the coronary arteriotomy (scalpel handle blade 15) and to extend the incision pass
antegrade and/or retrograde Potts type micro vascular scissors depending on the cut.
Pass the coronary shunts (1.0,1.5,2.0,2.5) to the surgeon using a fine elastic grasping
forceps in order to maintain coronary flow.
Prepare the 7/0 and /or 8/0 polypropylene synthesis and suturing instruments for the
surgeon to perform the distal anastomoses.
Do not forget that for better exposure of the surgical field at the anastomosis site,
use continuous CO2 aeration with aspiration line and cannula and/or jelco-type
intravenous catheter or warm saline solution at all times.
If it is necessary to reinforce the suture, prepare microvascular synthesis instruments,
microvascular dissection forceps and suture.
Removal of elastic bands, hemostasis check.