CLINICAL CASE

AORTIC VALVE REPLACEMENT

Daniela Quintero Monsalve
01200021025
• Surgical procedure where the aortic valve of the heart is replaced with
an artificial prosthesis, it can be mechanical or biological. This procedure
is performed when the existing valve presents problems such as
narrowing, which would be aortic stenosis or insufficiency.
ANATOMY
PATIENT DATA
Name: Luz Dary Guerra
Age: 73
Weight: 58kg
Height: 1,51
Body surface: 1,61
Flow: 4,02
Heparin: 4,06
EF: 61%
Z score: Z0: 19,2 Z+2: 22,5 Z-2: 15,8
AOE: 1,36
EXAMINATIONS PERFORMED

Echocardiogram showing severe aortic stenosis

Cardiac catheterization: healthy coronary arteries
PATIENT POSITIONING

ANESTESIA: General
INCISIÓN: Esternotomy
CHECK LIST
OPERATING TABLES

Radiopaque gauze
Protected mosquito forceps
Farabeuf retractors
Thick and thin vascular dissections
Metzembaum scissors
May scissors
Scalpel handles
Kelly Forceps
Kelly adson forceps
Rochester Forceps
Tube Clamp
Sharp Cups
OPERATING TABLES
Equipment and clothing package
Wire holder and cutter
Aortic clamps
Dissections with and without clamp
Hooks
Anterograde and retrograde micro
scissors
Sternal and mammary retractors
Sutures
Long may scissors
Needle holder
SURGICAL TEAM LOCATION
 PROCEDURE
-Make a skin incision with a 15 scalpel, hemostasis with electro and separated with Farabeuf for better
visualization
-Perform sternotomy with the reciprocating saw from the sternal notch to the xiphoid process
Hemostasis of the sternum is performed with electroscalpel and bone wax
Protectors are placed with pieces of line and then the external separator
The pericardium is opened.
With 2/0 polyester we make the purses for arterial cannulation in the aorta and venous cannulation in the
right atrium
With polypropylene, the purse for the vent aspirator is made in the right upper pulmonary vein and
tourniquets are placed, which are repaired with Kelly clamp.
The corresponding cannulation is performed in the aorta and the cannulas are fixed with silk.
The tube is clamped and the cannulas are purged.
Perform venous cannulation by expanding the incision with t metzembaum
The extracorporeal circuit is finished connecting
After performing all the cannulations, the total occlusion vascular clamp is prepared to clamp the aorta.
The aorta is incised and cardioplegia is passed through the coronary ostia
The walls of the aorta are repaired with 4/0 silk
 PROCEDURE
The calcified valves are removed with allix forceps and placed in a pathology jar.
Washing with saline solution is performed to remove all the little pieces of calcium that will remain.
Wet valve meters are passed with saline solution
The valve is chosen and mounted on the support to be delivered to the surgeon.
16 mm 2/0 polyester is mounted and repaired on the valve without repeating colors
After implanting the valve, the aorta is sutured with 4/0 prolene and aeration is performed.
Warm saline solution is prepared to level the patient's warming levels and the aorta is unclamped.
It goes off the pump slowly
The pacemaker wire is placed and positioned in the atrium or ventricle as the surgeon sees fit.
The tube is placed in the chest, fixed and the Nelaton 14 probe is inserted for aspiration.
A count of gauze compresses and others is carried out.
The surgical wire 6 is prepared mounted on the wire needle holder and a Rochester on the tip
Muscle and tcs are closed with vicryl and skin with monocryl.
The patient is cured with sealant and dressings.