CLINICAL CASE

BENTALL SURGERY
Daniela Quintero Monsalve
01200021025
BENTALL SURGERY

Surgical procedure where aortic

valve replacement is performed:

- Aortic valve
- Aortic root and ascending aorta.
- Reimplantation of the coronary
ostium.
ANATOMY
PATIENT DATA
Name: Carlos Castro Rojas
Age: 63 years old
Weight: 74 kg
Body surface: 1.84
Flow: 4,6
AOE: 1.56
Z0: 20,3 Z+2:23,9 Z-2: 16,8
Size: 1,70
Glycemia: 112
Total cholesterol: 33
Tsh: 5,05
PATIENT DATA
Male patient is admitted to the clinic service in Valledupar for cervical
abscess after insect bite with isolation in culture of secretion of
staphylococcus aureus, antimicrobial management guided by infectious
disease and echocardiogram is performed where accidentally found
massive functional aortic valve insufficiency secondary to aortic root
aneurysm and aorta asecendente, holodiastolic reverse flow in the aortic
arch, which is referred to the cardiovascular institute of Cesar, there studies
are performed and surgery is indicated aortic valve replacement plus
reconstruction of ascending aorta, is transferred to FOSCAL clinic for
evaluation with medical board.
BACKGROUND
Arterial hypertension
Diabetes myellitus
Atrial fibrillation anticoagulated with rivaroxabam
Ischemic heart disease

Allergy: Ampicillin
PATIENT POSITIONING

ANESTHESIA: General
INCISIÓN: Esternotomy
CHECK LIST
SURGICAL TABLES

Radiopaque gauze
Long metzembaum scissors
Metzembaum scissors
May scissors
Vascular dissections
Kelly Forceps
Cystic Forceps
Kelly adson forceps
Rochester Forceps
Field forceps
Scalpel 15 and 11
Sharp Forceps
Farabeuf Separators
SURGICAL TABLES
Equipment
Arterial and venous cannulas
Line scissors
Long and short needle holders
Wire cutters and holders
Morse spreader
Reciprocating saw
Ioban
Sutures and suture kit
Suction cannulas
Pathology flask
Electrobisturi
Vein separators, micro needle holders
LOCATION OF SURGICAL EQUIPMENT
PROCEDURE
Sternotomy incision, sternal hemostasis or: Scalpel 15. Electroscalpel, Farabeuf spreader, dissection and reciprocating saw,
bone wax.
- Pericardium incision, hemostasis and repair for better visualization: Electroscalpel, vascular dissection, 0 silk with needle,
Morse spreader.
- The aortic aneurysm is visualized.
- Perform cannulation and tobacco bags: 2/0 vascular polyester.
- Placement of aortic cannula eopa in the aorta: 11 blade, metzembaum scissors, eopa cannula, tourniquets
- Placement of venous cannula in the right atrium: scalpel 11, metzembaum scissors, venous cannula, tourniquets.
- Cardioplegia solution is passed through the cannula through the coronary ostium: cardioplegia cannula.
- Occlude the aorta in order to arrest the heart and connect the lines to initiate extracorporeal circulation: straight aortic
clamp.
- Incision of the aortic aneurysm: 15 blade and vascular dissection.
- Clipping of aortic root aneurysm: metzembaum scissors, vascular dissection
- Placement of the valvular tube, it is placed with polyester kit and always wet the surgeon's hands.
- Relocate the coronary ostia and fix them with a felt graft: 5/0 vascular suture, graft cutter.
- Apply Bioglue sealant around the suture performed at the coronary ostia as a reinforcement to the suture.
- Suture of the aorta with the valvular had, 4/0 and 5/0 vascular suture is performed.
- Before the removal of the catheters, the aorta is sutured with a 4/0 and 5/0 vascular suture.
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