CLINICAL CASE OF

MYOCARDIAL
REVASCULARIZATION
Lorena Aguilera Camacho
UDES
 ANATOMY

• The coronary arteries supply

blood to the heart muscle. As
with all other body tissues, the
heart muscle needs oxygen-rich
blood to function and oxygen-
free blood must be expelled.
• Coronary arteries run along the
outside of the heart and have
small branches penetrate the
heart muscle to carry blood.
 PATIENT

• 71-year-old patient is surgically operated

for myocardial revascularization for
severe lesions in circuncleja artery and
right coronary artery. It is considered
suitable by the anesthesiology service, it
explains the risks of the patient and
possible complications arising from
anesthesia.
 PATIENT DATA
• Name: Pepe Perez
• Age: 71
• Weight: 66
• Height: 1.73
• HB: 14
• HTO: 44
• PLAQ: 188.000
• LEUCOS: 5170
• PCR: 1,48
• Hepatitis: Negative
• Uroanalysis: 5.0
• Albumin: 4.5
• Sars Cov 2: Negative
 DIAGNOSTIC METHODS
• CORONARY ARTERIOGRAPHY WITH LEFT CATHETERIZATION:

• ANTERIOR DESCENDING ARTERY: MEDIUM SEGMENT OCCLUSION WITH

HETEROCORONARY FILLING
• CIRCUMFLEX ARTERY: WITH SEVERE LESION IN CIRCUMFLEX TRUNK
• RIGHT CORONARY ARTERY: WITH SEVERE LESION IN THE PROXIMAL TO DISTAL
SEGMENT
• TREATMENT:
• Myocardial revascularization is performed to
restore blood supply to blocked coronary
arteries

• INDICATIONS:

• Stenosis: thickening of the valve tissue that

causes narrowing of the hole.
• Insufficiency: inability of the valve to close
completely causing reflux or blood leakage.
 RISKS

• Bradycardia
• Hypotension
• Tachycardia
• Coagulopathy
• Acidosis
• Hypoglycemia
• Pneumothorax
• Pneumonia
• Nosocomial Infections
CHECK
LIST
SURGICAL TABLES
 PATIENT SURGICAL
POSITION TEAM
• SUPINE POSITION
 SURGICAL PROCEDURE
THE EXTRACTION OF THE SAPHENAL VEIN GRAFT IS PERFORMED IN THE LEG.
STERNAL OPENING TIME:
• MB# 7 and HB# 15 to make an incision
• Perform dissection and electrocautery to make a deep tissue incision.
• Use wire cutters and needle holders to extract the surgical steel for reoperation.
• Employ oscillating saw equipment for sternotomy.
• Pass sep. Farabeuf, for manual separation of the sternum.
• Apply bone wax and electrocautery to achieve hemostasis of the sternal periosteum and bone marrow.
• Implement sternal protectors and the sep. Self-static breast for sep. sternum fixation.
DISSECTION OF THE MAMMARY ARTERY:
• Perform microvascular dissection and electrocautery to dissect the mammary artery.
• Use Ligaclip forceps and select the appropriate clip cartridge based on the vessel's caliber for
ligation and hemostasis.
• Apply gauze in a nitroglycerin solution to induce arterial vasodilation of the mammary artery.
VASCULAR TIME:

• Provide the vascular dissection and electrocautery device to the surgeon for the purpose of opening the pericardium.
• Needle holder with 0 silk suture to repair the pericardium.
• Vascular dissection, T. Mayo, 2/0 polyester, and 4/0 polypropylene to create tobacco pouches in the ascending aorta,
right atrium, and root of the aorta.
• Prepare the appropriate cannula for patient infusion as needed.
• MB# 7 HB# 11 to perform arteriotomy for cannulation.
• Have pre-cut silk 1 available to secure the placed cannulas.
• MB# 7 HB# 11 to make an incision in the right atrium.
• Long Metzembaum scissors to widen the incision and perform the corresponding cannulation.
• Keep pre-cut silk 1 ready for securing the placed cannulas.
• MB# 7 HB# 11 in making an incision in the right upper pulmonary vein.
• Total occlusion vascular clamp for the surgeon to perform aortic clamping.
CORRECTION TIME:
• Perform microvascular dissection to carry out the coronary arteriotomy and its extension.
• Prepare the 7/0 gauge polypropylene suture for performing distal anastomoses of the vein graft
to the coronary artery.
• Set up CO2 aeration with an aspiration line and cannula to enhance exposure.
• Gather instruments for diaeresis, elastic vascular grasping, and bulldog clamp to cut the free
saphenous graft and prepare
the vessel for proximal anastomosis.
• Use MB#7 HB#11 and a punch for preparing the aorta at the anastomosis site during proximal
anastomoses.
• Prepare the 6/0 gauge polypropylene suture for performing proximal anastomoses of the graft
to the aorta.
CLOSING TIME:

• Administer warm saline solution to accelerate the patient's warming process.

• Prepare for aortic unclamping and removal of the patient from extracorporeal circulation by utilizing T. Mayo, vascular
dissection, cardiovascular cannulas, clamp, and sutures.
• Provide the pacemaker wire to the surgeon to position them in the atrium and ventricle as needed.
• Supply the surgeon with MB#3 HB#15, vascular dissection, suture, long T. Metzenbaum, and chest tubes for positioning
in the pleurae and mediastinum respectively.
• Achieve hemostasis of the surgical area by using electrocautery, suture material, gauze, compresses, and hemostasis
elements.
• Verify counts to ensure all instruments and materials are accounted for.
• Prepare number 6 surgical wire, Rochester, needle holder, and wire cutters for the surgeon to face the sternum.
• Utilize 2/0 polypropylene to face the muscles and T.C.S., while poliglecaprone is used to face the skin.
• Clean and cover the wound with dressings and/or adhesive tapes to facilitate patient healing.