Clinical case: patient operated on

February 14, 2024

Isis Daniela Rojas

Gelves
Seventh semester
student of surgical
instrumentation UDES
2024-A
Teacher: Lidy Higuera
 Clinical Case Cardiovascular Surgery
Patient’s Data:
• Name: Ambrosio Leonel Peña León
• ID: 23663012
• Age: 75 Years
• Sex: Male
• Birthdate: 07/24/1948
• Civil status: Married
• Blood type: A+
• Address: Street 62 #31-26 Floresta
• Occupation: No information
RECORD
• Pathological: Severe mitral regurgitation with
myxomatous thickening of the leaflets
• Moderate tricuspid regurgitation

• Pharmacological: Acetylsalicylic acid,

Clopidogrel, Atorvastatin, Bisoprolol

• Surgical: Left inguinal herniorrhaphy https://consultorsalud.com/wp-

content/uploads/2019/07/shutterstock_304668368.jpg
DIAGNOSTIC EXAMS
•Diagnostic Images:
oTransesophageal echocardiogram (TEE): Severe mitral valve regurgitation
secondary to anterior and posterior leaflet prolapse; myxomatous thickening of
its valves; Normal left ventricle, LVEF 62%, right chambers of normal size,
moderate tricuspid regurgitation
oEKG: Sinus rhythm ventricular extrasystoles
oCoronary arteriography: no obstructive lesions
oRX of chest: No parenchymal or pleural lesions
oCarotid Doppler: within normal limits

https://www.bupasalud.com.co/sites/default/files/styles/640_x_400/public/articulos/2020-07/fotos/ecocardiograma-transesofagico.jpg?itok=zAtZQTaX
DIAGNOSTIC EXAMS
• Paraclinics (LAB):

Normal HbA1c: Thyroid profile within

glucose 4.8% normal parameters

Normal Clotting
blood count times in
Does not present
without cell
electrolyte disorders
series normal
disorders parameters

• Dental Treatment: Appropriate Negative HIV and

non- Normal albumin
PCR reactive HB
 Surgical Foundation
Mitral valvuloplasty with neochords in A2 - P2
Vega plasty: annuloplasty with St Jude 34 ring in tricuspid valve

A reconstruction of the chordae tendineae of the

Mitral valve leaflets was performed to improve its
coaptation.
To correct tricuspid insufficiency, a Vega
annuloplasty is performed to correct regurgitation.
 PATIENT PREPARATION

• Type of washing: Partial knee length

• Type of anesthesia: General
• Position: supine
• Type of dressed: IOBAN surgical field is placed in the thorax and inguinal area
PREPARATION MAY TABLE
RESERVATION TABLE PREPARATION
 SURGICAL INSTRUMENTATION PROCESS
Surgical Planning:
• Body surface: 1.65
• Flow: 4.12
• Heparin dose: 4.2
• Z value: Z: 0 = 19.2 Z: -2 = 15.8 Z: +2 = 22.5
• AOE Mitral: 1.98

https://blogs.iadb.org/salud/wp-content/uploads/sites/15/2021/04/Imagenes-Post_GS-POST-copia-5.png
 SURGICAL INSTRUMENTATION PROCESS
Check list:
• Instrumental
 SURGICAL INSTRUMENTATION PROCESS
Check list:
Equipment: Defibrillator, saw, electro console,
Internal defibrillator paddles, sky lamps, tables.
 SURGICAL INSTRUMENTATION PROCESS
Check list:
Check list:
Basic medical devices :Surgical instrumentation cart and
clothing package Specialized medical devices: Mitral Ring #34 St
Jude, Caliper, Mitral ring gauges, Rigid pericardium
aspirator,
 Perfusion process
Check list: (todo de manera gráfica)

Perfusion devices: Arterial Cannula: EOPA 18 Fr,

Cardioplegia cannulas: anterograde and retrograde root,
Selective venous cannulation: 24 and 28 Fr metal tip.
 SURGICAL INSTRUMENTATION PROCESS

Check list: Check list:

Sutures Hemostats
 SURGICAL PROCESS
1.Opening time:

2. Heparin dose time: The patient is administered 4.2 IU/kg

 SURGICAL PROCESS
3. Vascular time: Tobacco bags are made with 2-0 polyester in the aorta artery and the tourniquets are
passed.
The tobacco bags are made in the superior vein and then in the inferior vena cava and the tourniquets
are placed
A bag of tobacco is made for antegrade cardioplegia and the tourniquets are placed
Each purse is cannulated and each tourniquet is adjusted with silk 1 without a needle.

4. Entry in C.E.C: The cardioplegia line is purged. All cannulation lines are connected and the
perfusionist obeys the surgeon's order to enter the patient into the pump.
 SURGICAL PROCESS
5. Aortic campleo: The aorta is clamped with the Debakey aorta clamp proximal to the root of the aorta.

6. Cardioplejia: With the help of the perfusionist, the cardioplegia step is done
 SURGICAL PROCESS
7. Surgical time:
 SURGICAL PROCESS
8. Remove Clamp: The aorta artery is unclamped after checking hemostasis and
possible leaks.

9. C.E.C: Venous cannulas are removed from the venae cavae, tourniquets are removed
and the knots of the purse string are tied.
They pass irrigation to the aortic root
Cardioplegia cannula removed and stitches tied
Arterial cannula is removed

10. Protamine dossis: The surgeon orders a dose of Protamine, which is administered
to the anesthesiologist in the room.
 SURGICAL PROCESS
11. CLOSING TIME:
The vena cava and the aorta artery are sutured with 22 mm SH 4-0
polypropylene.
The repair points of the pericardium are cut and removed.
The sternal retractor is removed and hemostasis is checked.
The retractor is placed again and the tubes are passed to the destination.
The sternal retractor is removed, the sternum is sutured with #6 wire
and the subcutaneous cellular tissue is sutured.
Skin suturing and healing

12. Finish time:

Counting of all surgical instruments and sent to the sterilization center
Registration in the surgical instrumentation sheet
Filling in the drive all medical devices used in surgery
Put all devices back in the warehouse and clean surgical tables.
GRACIAS