FRONT PAGE

CLINICAL CASE PERFUSION PROCESS

LAURA VANESSA ARIAS RODRIGUEZ

HEART INSTITUTE OF BUCARAMANCA

FIRST SURGICAL PRACTICE ROTATION UDES

2024A
 Clinical Case Cardiovascular Surgery
Patient’s Data:
• Name: Gladys Chaparro
• ID: 37657336
• Age: 62
• Sex: Femenine
• Birthdate: 24/04/1961
• Civil status: Married
• Blood type: O+
• Address: Neighborhood El Rocio
• Occupation: Housewife
RECORD
• Pathological: (Diseases)

Ischemic heart disease

• Pharmacological: (medications)

Valsartan

ASA

Atorvastatina

• Surgical: (Previous surgeries)

Pomeroy
 DIAGNOSTIC EXAMS
• Diagnostic Images:
o Transthoracic echocardiogram:

CONCLUSIONS

1- Left ventricle of normal size

and shape, normal wall
thickness, preserved systolic
function, LVEF of 64% and
normal diastolic function.
3 - Mild mitral insufficiency
2 - Right ventricle of normal
size and shape, normal
systolic function.
 DIAGNOSTIC EXAMS
• Diagnostic Images:
o EKG:

RESULTS

1. Sinus rhythm
2. Normal electrical axis
3. No ST-axis alterations
observed
DIAGNOSTIC EXAMS
• Diagnostic Images:
o Arteriography:

RESULTS
LEFT CORONARY ARTERY: Ostium and trunk with
silver
ANTERIOR DESCENDENT: Type II artery with critical
lesion in proximal segment, with its branches
permeable.
CIRCUNFLEJA AND INTERMEDIATE RAMUS: Arteries
with significant lesions.
RIGHT CORONARY: Dominant artery, medium
caliber with severe lesion in middle segment, with
distal vessel permeable.
DIAGNOSTIC EXAMS
• Diagnostic Images:
o Holtter (N/A)
o RX of chest:
Normal thoracic radiograph (PA AND LATERAL)
FINDINGS
Lungs: pulmonary parenchyma with no evidence of alterations
Pleural spaces: no pleural abnormalities were observed.
Heart: the heart is of normal size
Mediastinum: the contours of the mediastinum are normal; the thoracic aorta has no calcifications.
Bone structures: bone structures and soft tissues are of usual appearance.

• Paraclinics:
o Laboratories:
• Dental treatment (Does not require)
 Surgical Foundation (What will be done in Surgery)

MYOCARDIAL REVASCULARIZATION

This procedure consists of bridging using autologous grafts to provide blood flow to ischemic cardiac tissue.
These grafts are anastomosed at one end to the aorta; and at the other end they are anastomosed to the distal portion of the
stenotic coronary artery. They can be free grafts of saphenous vein, gastroepiploic, radial, etc. or pedicled grafts such as the
internal mammary artery supported with extracorporeal circulation.
For the perfusion process it is a short surgery since the time the patient spends on the pump is short, this must be analyzed to
know what type of cardioplegia is going to be used.
 PATIENT PREPARATION AND TABLES

• Type of washing: Total washing with alcohol and isopropyl

alcohol.
• Type of anesthesia: General
• Position: Decubitus supine
• Type of dressed: Dressed leaving thorax exposed and left leg
area uncovered.
 PERFUSION PROCESS
Surgical Planning:
• Body surface: 1,53
• Flow: 3.8
• IMC: 23.5
• Heparin dose: 3.7
• Z value : N/A
• AOE : N/A
Check list: (todo de manera gráfica)

PERFUSION CART CONNECTORS

 PERFUSION PROCESS

SYRINGES

CARDIOPLEGIA
SOLUTION AND
BURETROL

STANDARD PERFUSION
TUBE CLAMPS BASKET
 PERFUSION PROCESS

EXTRACORPOREAL
CIRCULATION MACHINE

GASES (O2 & Co2)

PERFUSIONIST

HEMOTERM
 PERFUSION PROCESS

TIME

1. Moving and positioning of the equipment in the operating room, cleaning of the equipment.
2. The machine is connected to o2, co2 and suction. Check the emergency oxygen pump on the perfusion cart.

3. Blood cardioplegia is prepared for this patient since the on-pump time is short. It is entered into the buretrol
and passed through an infusion pump as it must be delivered according to the patient's weight. And it is
connected to the cardioplegia line.
FORMULA
18 cc Dextrosa
3 Ampollas potasio
12cc magnesio
 TIME
4. It is confirmed if the doctor is going to use extracorporeal circulation in the surgery; and proceed to
unclog the venous reservoir with the membrane oxygenator that is specific to the patient's weight.
The sterile part of the process is performed, uncovering the basket and removing the lines to be used,
with an HB #20 cut them for convenience and join them with the connectors.

5. The reservoir is placed on the support, connecting the lines from the heat exchanger to the
oxygenator and the o2 .
The lines are connected and passed through the rollers and they are calibrated
- Arterial roller line
- Cardioplegia line
- Venous and arterial line
- Root and pericardial aspirator line
 TIME

6. The equipment is purged with ringer's lactate (1500cc) and heparin

(2cc).
7. The safety margin is placed in the venous reservoir, indicating up to what
volume can be lowered.
8. When the instrumentator is ready, the sterile parts of the lines are
passed to her to be placed in the field.

EOPA: 18 Fr
V.U: 32/40 Fr
 PUMP INLET

9. The pump part of the surgery begins, the surgeon goes hand in hand with the
surgeon, after finishing the shanks, when the cannulas enter, the order is given
to connect them to the lines.

10. The circuit is started, and the venous blood comes out through the venous
cannula to the venous line that reaches the reservoir, passing through the filter.

It exits to the arterial roller line and goes to the membrane oxygenator and the
blood is cooled to go into hypothermia. Then the oxygenated blood goes through
2 routes:

1- the first is through the cardioplegia line, where the blood mixes with the
solution and passes through the roller and is propelled towards the cardioplegia
cannula (aortic root).

2- The second is through the arterial line that arrives to the EOPA arterial
cannula directly in the aortic root.
 TIME

VACUUM CLEANERS

PERICARDIUM: Blood comes to the pericardial rollers from the pericardial

aspirator down the line and then goes to the reservoir, down to the
oxygenator and out the arterial line.

RAIZ: This aspirator is always used; it is placed in the cardioplegia line in a

3-way tap and it is activated when the declamping is going to be done to
aspirate the air that is in the flow.
 TIME

PARAMETERS TO MONITOR
ACT (+480)
Arterial gases
Arterial pressure
Oxygenation
Blood glucose
Hemoglobin
Hematocrit (normal values: 26 to 30 if it drops, red blood cells are given)
Temperature (TI: 32° - TF: 36.5°)
Flow (The flow according to the patient has minimum and maximum levels which
are used when:)
The aorta is clamped: minimum
Removing the aortic clamp: minimum
When all the blood is returned to the patient: maximum.
TIME
 TIME

OUT OF C.E

When the pump comes off , we wait for the instrumentator to return the
lines and discard them together with the venous reservoir.
The used syringes and needles are discarded, the machine is cleaned, the
cardioplegia roller pump is calibrated and the devices are transported back
to the surgery room.
GRACIAS