Clinical case: patient operated on

March 15, 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: Milena Parada
• ID: 43112009
• Age: 62 Years
• Sex: Female
• Birthdate: 07/24/1948
• Civil status: Married
• Blood type: O+
• Address: Street 104B #16ª -54 El Rocío
• Occupation: Housewife
RECORD
• Pathological: Arterial hypertension, Severe
coronary heart disease

• Pharmacological: Valsartan, atorvastatin,

acetylsalicylic acid

• Surgical: Pomeroy
DIAGNOSTIC EXAMS
•Diagnostic Images:
oCoronary arteriography: Left coronary
artery ostium and trunk with plaque
Right coronary artery with severe lesion in the
middle segment
oTransthoracic echocardiogram: left and
right ventricle of normal size and shape, with
preserved systolic function, LVEF of 64%
Mild mitral regurgitation
o Venous duplex of lower limbs: no deep
vein thrombosis
o Arterial duplex of upper limbs: without
morphological or hemodynamic alterations
DIAGNOSTIC EXAMS
•Diagnostic Images:
oEKG: Sinus rhythm, normal electrical axis, no ST segment alterations are
observed
oRX of chest: No parenchymal or pleural lesions, normal size heart
oDuplex of the neck vessels: internal carotids with small lipid and fibrocalcic
plaques that do not generate hemodynamically significant stenosis
DIAGNOSTIC EXAMS
• Paraclinics (LAB):

Chlorine: 99.7 Potassium: 4.1

Calcium: 1.2 mmol/L mmol/L
mmol/L Partial urine: non- Sodium: 138.4
pathological mmol/L

HbA1c: 5.9% TSH: 3.21

HB AND HIV: NOT
Hemoglobin: 13.4 PT: 10.4 seg
REACTIVE
gr/dl PTT: 24.6 seg

• Dental Treatment:
Appropriate

Albumin: 4.92
PCR: 0.9 BUN: 23.6
Platelets: 263,000
Blood glucose: 97.7 Creatinine: 0.6
mm3
 Surgical Foundation
MYOCARDIAL REVASCULARIZATION

correct the supply of oxygen to the

cardiac muscle through a coronary
bypass due to a narrowing or
obstruction of the coronary arteries
In the surgery, a graft from the
saphenous vein of the left lower limb
and the mammary artery was used.
 PATIENT PREPARATION
• Type of washing: Total
• Type of anesthesia: General
• Position: supine
• Type of dressed: IOBAN surgical field is placed in the thorax
May Table
Reservation table
 SURGICAL INSTRUMENTATION PROCESS

Surgical Planning:
• Body surface: 1.53
• Flow: 3.8
• Heparin dose: 3.7
• Z value: Z: 0 = 18.6 Z: -2 = 15.3 Z: +2 = 21.8

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, Reciprocating 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: Aortic punch,
semi-rigid pericardium aspirator, retrograde
cardioplegia cannula, ligaclip forceps 100 and
200, self-retaining retractor.
 Perfusion process
Check list:

Perfusion devices: EOPA arterial cannula 20 Fr,

single venous cannula 32/40 Fr, antegrade root
cardioplegia cannula, C.E.C lines
 SURGICAL INSTRUMENTATION PROCESS
Check list: Check list:
Sutures Hemostats
 SURGICAL PROCESS
1.Opening time:

2. Heparin dose time: The patient is administered 3.7 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 left atrium for single cannulation 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
Blood cardioplegia: Crystalloid solution: Dextrose, potassium and magnesium
oxygenated blood
 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: The single venous cannula is removed from the right atrium, 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:
Adjustment of the sutures of the right atrium is made 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 #5
wire and the subcutaneous cellular tissue is sutured.
Skin suturing with Vicryl 0 CT-1 and Monocryl 3-0and 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