Clinical case: patient operated on

February 21, 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: Santiago López Acuña
• ID: 90453172
• Age: 73 Years
• Sex: male
• Birthdate: 09/13/1950
• Civil status: Married
• Blood type: A Negative
• Address: Street 30ª # 11 Betulia
• Occupation: Farmer
RECORD
• Pathological: Hemorrhoids, colonic
diverticulosis, bilateral inguinal hernias

• Pharmacological: Acetylsalicylic acid, Valsartan,

amlodipine, carvedilol

https://consultorsalud.com/wp-
• Surgical: Transverse colon pilopus resection content/uploads/2019/07/shutterstock_304668368.jpg
DIAGNOSTIC EXAMS
•Diagnostic Images:
oTransesophageal echocardiogram (TEE):
Severe dilation of the left ventricle with reserved
systolic function, LVEF 58%, severe left atrial
dilation, right ventricle of normal size and
systolic function, aortic valve sclerosis
generating severe insufficiency, without
stenosis, mild mitral insufficiency
oCoronary arteriography: left coronary ostium
and trunk without lesions, patent anterior
descending artery, dominant artery without https://www.google.com/url?sa=i&url=https%3A%2F%2Fcardiologoenguadalajarachavoll

lesions
a.com%

oRX of chest: prominence of the arch of the

aorta with calcifications inside, enlarged cardiac
silhouette
oCarotid Doppler: No major stenosis
DIAGNOSTIC EXAMS
• Paraclinics (LAB):

Normal Platelets: Thyroid profile within

glucose 276,000 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
Aortic valve replacement

The patient undergoes an aortic valve replacement

due to insufficiency secondary to sclerosis in order
to alleviate the pumping overload of the left
ventricle since severe hypertrophy and dilation of
the left ventricle is observed.
 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: 1.79
• Flow: 4.48
• Heparin dose: 4.9
• Z value: Z: 0 = 19.7 Z: -2 = 16.3 Z: +2 = 23.2
• AOE Aortic: 1.52

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 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: Mosaic biological
aortic valve, Vent aspirator, rigid pericardium
aspirator
 Perfusion process
Check list: (todo de manera gráfica)

Perfusion devices: Arterial Cannula: EOPA 20 Fr, single

venous cannula 34-46 Fr, root cardioplegia cannula, Spencer
cannula 90°.
 SURGICAL INSTRUMENTATION PROCESS

Check list: Check list:

Sutures Hemostats
 SURGICAL PROCESS
1.Opening time:

2. Heparin dose time: The patient is administered 4.9 IU/kg

 SURGICAL PROCESS
3. Vascular time: Tobacco bags are made with 2-0 polyester in the aorta artery and the tourniquets are
passed.
Tobacco bags are made in the right atrium for single cannulation
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
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