Republic of Yemen

Ministry of Defense ‫وزارة الـدفـاع‬

Presidency of the General Staff ‫رئـاسـة هـيئــة األركـان الـعـامـة‬
Logistics Support Authority ‫هــيئــة اإلسنــاد اللـوجسـتي‬
Military Medical Services ‫دائرة الخدمـات الطــبـية العسكريــة‬
Division ‫مــركـز القـلب العـسكري‬
Military Cardiac Center

OPERATION NOTE

Patient Profile: Date Of Operation: Date Of Admission

.
Name: Hospital No: ID: .
Contact NO: .
Age: Sex: Weight: Bloody Group/ Rh Type: HbsAg ( ) HCV ( ) HIV( )
Diagnosis: .
Operation:
.
Consultant Surgeon: Asst.Surgeon .
Anesthetist: Perfusionist: .
Risk Profile- EUROSCORE: .
HTN ( ) D.M ( ),COPD/Smoking ( ),Gout ( ),Rh. Fever ( ), Dyslipidemia ( )
Renal (Cr>200um),Dialysis( ), CVA( ), PVD ( ), DVT ( ) PAH ( ), A Fib. ( ), Arrhythmia ( ) Redo( ),
MI:old (>3m), LV Aneurysm ( ), IE ( )/Heart failure ( ), Stuck Valve ( ) Acute MI (>)wk), post MI
VSD( ), Lt main ( ), Cath lab -pci ( ), CAG ( )
EF( ) LVEDD ( ),LVESD ( ),Emergency ( ), Urgent ( ) Hemodynamics ( ), Acidosis/ Lactate ( ),
Pre op LABP ( )ICU Intubation ( )
Anesthesia: AHA Intubation Medications Remarks .
PROCEDURE .
 Incision .
 Cardiopulmonary Bypass type/conventional Femora- Femoral LA Femoral .
 Cannula Size: Aortic Venous – Single stage / Two Stage .
 Cardioplegia type& route Retrograde .
 Core Temperature TCA CPB Time X clamp Time .
1- Coronary Artery Bypass/ Op. Findings
 Heart Size& Contractility of LV Scarring/Aneurysm .
 Size of native Coronary Artery .
 Condition of Ascending aorta Plaque Calcification .
 LIMA size & flow RIMA Radial Artery .
 Other conduits Quality .
 Conventional CABG ( ) on pump- beating/ Fib. Heart ( ) OPCAB ( ) No. of Graft ( )
 Site of Graft Plaque Calcification .
 Type of anastomosis & site, End to side Sequential .
 LIMA to .

Combined procedure: M V repair Ring used & size .

 VSD Closure ( ) Patch& Suture .
 LV aneurysm Repair .
 LV Reconstruction ( ) procedure/ Patch& Suture .
.
2- Aortic Aneurysm: AAA/Arch & Thoracic/ Abdominal .
OP.Findings/ Procedure Details/ Conduit used .
 Republic of Yemen
Ministry of Defense ‫وزارة الـدفـاع‬
Presidency of the General Staff ‫رئـاسـة هـيئــة األركـان الـعـامـة‬
Logistics Support Authority ‫هــيئــة اإلسنــاد اللـوجسـتي‬
Military Medical Services ‫دائرة الخدمـات الطــبـية العسكريــة‬
Division ‫مــركـز القـلب العـسكري‬
Military Cardiac Center
.
.
.
.

3- Valve Procedure-op. Findings R.H.D / IE/ NYHA class Parsonnet Score ( )

 Heart Size& Contractility Size of P.A&Pr Chordae Tendinea Leaflet .
.

 Valve Replacement: Bio/mexh. Prosthesis/ Size Ann.Ring Suture .

 Valve Repair_ details .
.
.
 TEE: Intra op. .
.
4- Congenital Heart disease- OP. Findings:
 LV size Contractility RV size PA size/ Pressure
 Coronary Anomaly
 Description of Pathology
.
 Procedure .
.
.
.
 Conduit used: /Outflow Patch / Sutures used .

REMARKS /Discussion

 DC Shock ( ) Pacing Wire Y/N Site Number: .

 Inotropes ( ) 1. 2. 3. 4. 5. .
 Weaning from CPB: .
 IABP ( ) Balloon size Vent. Assist Device Site of the Insertion .
.
.
 Chest tube number, size & site .
 Wound Closure/ Still wire size/ Sutures .
 Condition on transfer to I C U .
 Re- exploration/ Operation Brief Note .
.
 Republic of Yemen
Ministry of Defense
Presidency of the General Staff
Logistics Support Authority
Military Medical Services
Division
Military Cardiac Center
Signature: Consultant
‫وزارة الـدفـاع‬
‫رئـاسـة هـيئــة األركـان الـعـامـة‬
‫هــيئــة اإلسنــاد اللـوجسـتي‬
‫دائرة الخدمـات الطــبـية العسكريــة‬
‫مــركـز القـلب العـسكري‬
Asst.Surgeon .