CLINICAL CASE

Aortic Valve Replacement

+ Myocardial
Revascularization

Angie Bautista
 CASE DESCRIPTION
Names and surnames: Daniel Quintero
• Age: 74 years
• WEIGHT: 64 kg
• Gender: Male
• Place of residence: Aguachica
• Marital status Married
• Blood type: A+
• Surgical history: STEND CD
•Allergies: Not reported
•Pathological: diabetes mellitus type 2, arterial
hypertension, hypothyroidism, radiotherapy
DIAGNOSTIC
METHODS

1. PA OR AP LATERAL CHEST DOPPLER ULTRASOUND OF

X-ray
ARTERIAL VESSELS OF
2.
DOPPLER ULTRASOUND LOWERLIMBS.
3.
OF NECK VESSELS DUPLEX SCANNING DOPPLER
4. ULTRASOUND OF VENOUSVESSELS OF
CORONARY ARTERIOGRAPHY WITH
5. LEFT CATHETERISM
LOWER LIMBS

6. TRANSTHORACIC
7. BLOOD EXAM AND UROANALYSIS ECHOCARDIOGRAM
1. PA OR AP LATERAL CHEST
X-ray

Cardiac silhouette within normal limits.

There is a prominence of the aortic button
with calcifications inside. In the lungs
there are no opacities, consolidations or
pleural effusions, with no lesions in the
soft and bone tissues.
 DOPPLER ULTRASOUND OF
2. ARTERIAL VESSELS OF
LOWERLIMBS.

Calcified atheromatous
plaques and calcification of
the walls of the vessels
without absence of flow inside
 DOPPLER ULTRASOUND OF
3. NECK VESSELS

Calcified atheromatous plaques at the level of both

carotid bulbs do not generate an increase in
psychosystolic velocities that suggest hemodynamically
significant stenosis.

Thickening of the media at the level of the common

carotids bilaterally as a cardiovascular risk factor.
 DUPLEX SCANNING DOPPLER
4. ULTRASOUND OF VENOUSVESSELS
OF LOWER LIMBS

Negative study for superficial

or deep venous thrombosis of
both lower limbs
 CORONARY ARTERIOGRAPHY
5. WITH LEFT CATHETERISM

Trunk without lesions

Anterior descending with severe lesions in
proximal and middle segments.
Right Coronary: no lesions. Severe Aortic
Stenosis.
 TRANSTHORACIC
6. ECHOCARDIOGRAM
Concentric remodeling of the left ventricle.
Diastolic function is indeterminate.
Right ventricle with normal systolic structure and
function.
Extensive calcification of the aortic valve with moderate
stenosis.
Mild tricuspid regurgitation without adequate spectrum
for PSAP estimation.
 DIAGNOSIS
SEVERE AORTIC STENOSIS: Narrowing
prevents the valve from opening completely,
which reduces blood flow and makes it harder
for the heart to function.
SEVERE ANTERIOR DESCENDING
INJURY:Obstruction in the artery that prevents
the correct passage of blood flow to the heart
 SURGICAL
PROCEDURE TO
BEPERFORMED
Aortic valve replacement
plus myocardial
revascularization
 ANATOMY

MYOCARDIUM
The myocardium is the thick muscular layer
in the middle, which
allows the chambers of the heart to contract
and relax to pump
blood to the body. The pericardium is the sac
that surrounds the
heart. It is made up of thin layers of tissue
and holds the heart in
place and protects it.
 ANATOMY

CORONARY ARTERIES
The 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.
 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.
 ANATOMY

AORTIC VALVE
It is an enormously complex structure
despite its apparent simplicity. When
studying the anatomy of the aortic valve we
see that it is formed by three semilunar-
shaped fragments of tissue, the leaflets,
which are attached to the wall of the aorta
and that separate it from the left ventricle.
 IMPORTANT DATA FOR
THEPROCEDURE

TYPES OF CANNULATION
F.E: 61% Arterial cannulation: #20cannula
BODY at the root of the aorta
Venous cannulation:Single: right
SURFACE: 1.70 atrium #34/40
FLOW: 4.25 Cardioplegia: antegrade by
coronary ostium
HEPARIN: 4.5
CHECK LIST
table settings
POSITION OF THE PATIENT
AND SURGICALEQUIPMENT