CLINICAL CASE

Off-pump myocardial revascularization

 INFORMATION OF THE
PATIENTE
• NAME: miriam nuñez

• ID: 123456789

• WEIGHT: 74 Kg

• BLOOD TYPE: O+

• AGE: 78 years old

• FE: 37%

• RESULTS: VIH (-) HEPATITIS B (-)

• SURGICAL HISTORY: Umbilical hernia, Caesarean section,

cholecystectomy
 DIAGNOSTIC MEANS
ECHOCARDIOGRAM: Normal left ventricle, severe dilation of
the left atrium, mild mitral regurgitation

CARDIAC CATHETERIZATION: left anterior descending artery

100% proximal segment, circumflex 100% proximal

CAROTID DUPLEX: No significant narrowing

ARTERIAL DUPLEX: Distal obstruction of the right

posterior tibia

VENOUS DUPLEX: There is no deep or superficial

vein thrombosis
DIAGNOSIS
Severe coronary artery
disease

PROCEDURE
Myocardial
revascularization
IMPORTANT
VALUES
BODY SURFACE: 1.8
FLOW: 4.6
HEPARIN: 5.1
 THE PROCESS BEGINS
1.Review medical history

2.Humanized treatment ismade with

the patient

3.He is asked how the surgicalbath

was and what antisepticwas used

4. Recommendations are given for the

postoperative period
 CHECK LIST
SURGICAL INSTRUMENTS MEDICAL DEVICES
TABLE SETTING
 SURGICAL PROCEDURE
saphenous veins

1. Incident with mb 3 sheet 15

2. Electro for hemostasis
3. He misses witlander separator
4. Vascular dissection and 200 clips are passed with electro
5. To remove the saphenous vein, a cyst, scissors and silk 1
are passed, this step is repeated
6. After taking it out, it is given 4/0 silk to repair the loose
tributaries and mosquito for eating islands
7. Mosquito and potts scissors are given to enlarge the
hole
8. You are given the arteriotomy cannula and silk 1 to fix it
9. A 10 syringe with heparin is passed to vasodilate the vein
 SURGICAL PROCEDURE
1. The skin is incised with MB 7 blade 15
2. Hemostasis is performed with electro in 40
3. The Farabeuf separator is passed to the assistant
4. Reciprocating saw is passed up
5. Electro is passed at 80 for hemostasis of the sternum
6. Spell mammary retractor is passed with the rake or kocher retractor along with a
compress and two field forceps
7. Electro is passed at 30 to design the vascular bed and gross vascular dissection
8. When the mammary artery is already found, fine vascular dissection is passed to it
9. Clips of 100 are passed to go tying the cups to be able to dissect the mammary
gland
10. Nitropusside is passed in a 1cm syringe to vasodilate the artery
11. A bulldog is passed to roam the bed while it is left in storage
12. The breast retractor is received and the sternum retractor is passed
13. The surgeon is given a vascular and electro dissection in 40 to incise pericardium
14. Repairs are ready for prolene pericardium 0
15. We proceed to pass the cardiac positioner and then the stabilizer to perform the distal
anastomoses
16. A 4/0 prolene mounted by a needle is ready on a small piece of #8 nelaton tube that is
attached to decrease the flow of the artery to be anastomosed (as if it were a silastic band).
Tourniquets for prolene are passed with mosquito forceps
17. MB 7 is passed with blade 15 to incise the pericardial fat, then the ophthalmic scalpel for
the arteriotomy
18. Antegrade Potts scissors are passed to widen the incision
19. The distal saphenous vein anastomosis is performed with 7/0 prolene and Denise is given
to the dissection surgeon
20. After the anastomosis is finished, proceed
to pass a syringe with serum to test the
anastomosis
21. Prolene 4/0 is removed
22. The cardiac stabilizer is removed and the
cardiac positioner repositioned.
23. The distal astomosis is made with the
mammary
24. For proximal anastomosis, a partial clamp is
placed on the ascending aorta
25. Electro is passed and then the intraortic
punch to be able to perform the proximal
anastomosis with prolene 6/0
26. The surgeon checks the astomoses
27. The partial clamp is removed
28. The sternum separator is removed and hemostasis is
verified with electro and the farabeuf is passed to the
assistant.
Two compresses are given and the sternum separator is
returned.
29. The pacemaker wire is placed
30. Incision is made with mb 7 blade 15 and electro
2/0 polyester suture is passed for the ostomy
31. The tubes are passed to the chest and the kocher so
that they cross the skin
32. The sternum separator is removed and the sternum is
sutured
33. It is sutured by planes and healing is done
THANK YOU