BORCELLE 2030

CLINICAL CASE
MYOCARDIAL
REVASCULARIZATION
ANGIE BAUTISTA- 01200022008
 CASE DESCRIPTION
Names and surnames: Simón Perez
• Age: 65 years
• WEIGHT: 80 kg
• Gender: Male
• Place of residence: San Alonso
• Marital status Married
• Blood type: O+
• Surgical history: Does not refer
•Allergies: Not reported
•Pathological: diabetes mellitus type 2
 DIAGNOSTIC METHODS
PA OR AP LATERAL CHEST X-ray
DOPPLER ULTRASOUND OF ARTERIAL VESSELS OF LOWER
LIMBS.
DOPPLER ULTRASOUND OF NECK VESSELS.
DUPLEX SCANNING DOPPLER ULTRASOUND OF VENOUS
VESSELS OF LOWER LIMBS.
CORONARY ARTERIOGRAPHY WITH LEFT CATHETERISM.
TRANSTHORACIC ECHOCARDIOGRAM
BLOOD EXAM AND UROANALYSIS
PA OR AP LATERAL CHEST
X-RAY
Cardioaortic and mediastinal silhouette
of normal size and shape.
Central and patent trachea.
No areas of consolidation or pleural
effusions were observed in the lung fields.
There are no alterations in soft and bone
tissues.
 DOPPLER ULTRASOUND OF ARTERIAL VESSELS
OF LOWER LIMBS.
Common femoral arteries and superficial femoral arteries with a slight amount
of calcium atheroma plaques bilaterally that do not generate
hemodynamically significant stenosis, there is adequate patency with triphasic
waves and velocities between 57 and 110 cm/meg at the level of the femoral
arteries. common and between 30 to 44 cm/sec at the level of the superficial
femoral arteries

At knee level
Popliteal arteries and tibioperoneal trunks of preserved caliber and patency,
with triphasic waves and speeds between 58 to 77 cm/sec bilaterally.

At the leg level:

Anterior tibial arteries and posterior tibial arteries with a slight amount of
atheromatous plaques that do not generate hemodynamically significant
stenosis bilaterally, there is adequate patency with biphasic waves and
psychosystolic velocities between 45 to 68 cm/sec. Bilaterally, there is
adequate filling of the plantar arches through these arteries.
 DOPPLER ULTRASOUND
OF NECK VESSELS
1. increased intima-media thickness at the level of the
common carotids, which is a risk factor for cerebrovascular
disease
2. Soft and mixed atheromatous plaque at the level of the left
carotid bulb without signs of ulceration and that does not
generate hemodynamically significant stenosis.
3. Patent internal carotid and vertebral arteries with
ascending flow.
 DUPLEX SCANNING DOPPLER ULTRASOUND
OF VENOUS VESSELS OF LOWER LIMBS.
There is adequate patency of the deep venous system, with adequate
collapsibility and distension without identifying supra- and infrapatellar thrombi.
The right arch measures approximately 3.3mm and the great saphenous vein
measures 1.9mm at the thigh level and 1.6mm at the leg level.
The left arch measures 3.4mm and the great saphenous vein measures 2.5mm at
the thigh level and 1.5mm at the leg level.
CONCLUSIONS
1. Negative study for deep and superficial venous thrombosis bilaterally.
2. The measurements of the arch and the great saphenous veins are dictated at
the level of the thigh and knee bilaterally.
CORONARY ARTERIOGRAPHY
WITH LEFT CATHETERISM
Coronary arteriography with cineangiography
and left catheterization was performed without
complications, documenting:
LEFT CORONARY: Ostium and trunk without lesions.
PREVIOUS DESCENDANT. type II artery with severe
lesion in the proximal to middle segment, its
respective branches patent without lesions in its
lumen.
CIRCUMFLEX AND INTERMEDIATE RAMUS: arteries of
medium size and caliber with lesions in the
middle segment of the circumflex and obtuse
marginal.
RIGHT CORONARY: dominant artery, with critical
lesion in the middle segment, occlusion, distal..
 TRANSTHORACIC
ECHOCARDIOGRAM
1. Lorem ipsum dolor sit amet,1.
Concentric remodeling of the left
ventricle, FEV1 51%.
2. Hypokinesis of the basal segment of
the inferior wall and the basal and
middle segments of the wall
Inferolateral/anterolateral.
3. Right ventricle with normal systolic
structure and function.
4. Mild left atrial dilation.
5. Traces of mitral insufficiency.
6. Mild tricuspid insufficiency. PSAP
estimated at 32 mmHg.
 DIAGNOSIS
MULTIVAVE CORONARY HEART DISEASE
coronary stenoses that produce
a significant reduction in the
vessel lumen and a decrease in
coronary flow, either acutely or
chronically.
SURGICAL PROCEDURE TO BE
PERFORMED
MYOCARDIAL
REVASCULARIZATION
It consists of performing
grafts from the patient
themselves on the coronary
arteries with obstructions to
bringblood to the areas of
the heart where a flow
deficit occurs
ANATOMY
MYOCARDIUM
The myocardium is the thick muscular layer
in the middle, which allows the chambers
ofthe heart to contract and relax to pump
blood to the body. The pericardium is the sac
thatsurrounds the heart. It is made up of thin
layers of tissue and holds the heart in
placeand protects i
ANATOMY

CORONARY ARTERIES
The coronary arteries run along the entire
external surfaceof the heart, forming a kind of
crown, and from it branchbranches that deliver
blood to the entire heart muscle.There are two
coronary arteries: right and left. The leftcoronary
artery divides into two large branches:
anteriordescending and circumflex. We thus
have three largearteries: right coronary, anterior
descending and circumflex
ANATOMY
INTERNAL SAPHENA VEIN
It starts on the dorsum of the foot and
runs along the inner front of the leg and
thigh until it reaches the groin area.
There it empties into the common
femoral vein, forming the arch of the
internal saphenous vein
ANATOMY

INTERNAL MAMMARY ARTERY

It is a descending collateral branch of
the pre-scalene portion of the
subclavian artery. At its origin it is
located medial with respect to the
phrenic nerve and posterior with
respect to the brachiocephalic
venous trunk
IMPORTANT DATA FOR THE
PROCEDURE
TYPES OF CANNULATION
F.E: 61% Arterial cannulation: #20
cannula at the root of the
BODY SURFACE: 1.92 aorta
Venous cannulation:
FLOW: 4.8 Single: right atrium #
HEPARIN: 5.6 34/36
Cardioplegia: antegrade
root
CHECK LIST
TABLE SETTINGS
POSITION OF THE PATIENT AND SURGICAL
EQUIPMENT
 SYMPTOMS
CHEST PAIN
SHORTNESS OF BREATH
FATIGUE
HEART ATTACK
SURGICAL PROCEDURE
SURGICAL PROCEDURE
SURGICAL PROCEDURE
SURGICAL PROCEDURE
COMPLICATIONS
Hemorrhage
Organ dysfunction, including
neuropsychiatric effects
stroke
Arrhythmias
Focal myocardial ischemia
Global myocardial ischemia