CLINICAL CASE

miocardical revascularization

catalina jaimes paredes

 CURRENT ILLNESS:
A 63-YEAR-OLD PATIENT WITH A HISTORY OF
appendectomy, colectomy, ulcerative pancolitis,
adenocarcinoma, acquired hemophilia
HR: B+
CORONARY FAILURE
WEIGHT: 68KG

DIAGNOSIS:
PATIENT MULTI-VESEER CORONARY HEART DISEASE
CARDIAC CATHETERIZATION:
INFORMATION AD: CALCIFIED ARTERY WITH 90-99% PRIOXIMAL
CALCIFIED
CIRCUMFLEX:CALCIFIED IN THE MIDDLE SEGMENT 99%
RIGHT CORONARY: CALCIFIED DOMINANT ARTERY 100%

HIV: NEGATIVE
HB: NEGATIVE
 SURGICAL
OBJECTIVE

It is a medical procedure to improve the irrigation of the heart by

performing a reanastomosis of the so-called coronary arteries
with grafts so that there is better irrigation to the tissue since
these have a narrowing or obstruction.
mainly by calcifications of atheromatous plaques

ANATOMY
 The coronary artery system begins with two mai
arteries that arise from the aortic sinuses at the
root of the aorta.

The right coronary artery:

wraps around the right side of the heart,

traveling in the corona

three GROUPS:
anterior, marginal, and posterior
vascularizATION:
structures located on the right side of the heart.

THE LEFT CORONARY ARTERY:

TRAVELS INTO THE ANTERIOR INTERVENTRICULAR

GROOVE,
TWO TERMINAL BRANCHES:
THE ANTERIOR INTERVENTRICULAR ARTERY AND
THE CIRCUMFLEX ARTERY OF THE HEART.
 MAMMARY ARTERY:
The internal thoracic artery (ITA), also called the
internal mammary artery (IMA), is a descending
collateral branch of the subclavian artery (AS). Its
origin is medial to the phrenic nerve (NF) and
posterior to the brachiocephalic venous trunk.

SAPHENON VEIN:
The great saphenon vein is situated medially in the lower extremity and the saphenan
vein is paravalaterally in the leg, the deep veins have the same names as the arteries,
there are two fibular veins, two anterior tibial and two posterior tibial,
these leave from the poplitea.
CHECK LIST:
Texto
 SEMI RIGID ASPIRATOR

ARTERIAL CANNULA EOPA AND UNIC VENOUS

CANNULA
TABLE ARRANGEMENTS

MAY TABLE
• SCALPEL HADLE #7(2) AND SCALPEL HADLE #3
• MAYO SCISSORS FINE
• METZEMBAUM SCISSORS (NORMAL AND FINE)
• VASCULAR DISSECTION FORCEPS
• ADSON DISSECTION WITH AND WITHOUT CLAW
• RETROGRADE AND ANTERORETROGRADE SCISSORS
• CURVED MOSQUITO FORCEPS WITH PROTECTOR
• CURVED KELLY FORCEPS
• ROCHESTER FORCEPS-
• FIELD CLAMPS
• KOCHER FORCEPS
• FARABEUF SEPARATOR (2)-
• CASTROVIEJO NEEDLE HOLDER
• GAZE
RESERVATION TABLE
• COCA WITH SOLUTION AND ASEPTOJERINGE

• WIRE HOLDER

• CONECTORS

• TORNIQUETS

• ARTERIAL CANNULA EOPA (18) TUBE CONECTOR 3/8

• UNIC VENOUS CANNULA (30-32) TUBE CONECTOR ½

• ASEPTO SYRINGE

• YANKAUER CANNULA

• NELATON PROBE

• CLIPS LT 100 AND 200 LIGACLIP LT 100 AND 200 PLIERS

• WIRE CUTTER

• VENOPUNCTION

• EXTRACORPOREAL BASKET

• JERINGE OF 20 CC

• CLOTHING PACKAGE

• CORONARY EQUIPMENT

• RECIPROCATING SAW
• SUTURES

• MICRO SCALPEL

• COMPRESESS

• CORONARY PUNCH

• VASCULAR DISSECTION

• ELECTIRC SCALPEL

• CAIMAN

• ANTEROGRADE CANNULA FOR CARDIOPLEJIA

• SEMI-RIGID VACUUM CLEANER

• HANDLES, GLOVES-STERNAL (FINOCHETO) AND MAMARY RETRACTOR

• PATHOLOGY JAR

• IOVAN

• AORTIC CLAMP

• 20 CC, 10 CC AND 5 CC SYRINGE

• CASTROVIEJO NEEDLE HOLDER

• EPICARDIAL RETRACTOR

• LISTER'S SCISSOR

• WIRE HOLDER
 SURGICAL PROCEDURE

1. preparation of the patient dressed as a patient, dressed in tables and arrangement.

2. Extraction of the graft from the great saphenous vein of the left leg, guaranteeing its patency, closure by planes

Garter clip forceps Scalpel handle retractor 3 scalpel blade 15 Pre-cut silk 4-0 Poliglactin 910 Monocryl Fine vascular
dissections Kelly Adson Kelly T metzembaum Separators farabeuf Bandage 6*5 T may Electrosurgical Weitlaner
separator 20cc syringe, bulldog clamp, arteriotomy cannula.

3. Sternotomy incision is made to the media, hemostasis, hemostasis of the external bone, and the graft extraction of
the internal mammary artery is performed:

Scalpel handle 7 scalpel blade 15, Electrosurgical scalpel, Farabeuf retractors, Reciprocating saw, Self-static
retractor of internal mammary gland, ligaclip forceps and LT 100 clips (yellow), plasty scissors, 20cc syringe,
arteriotomy cannula with olive, yankawer cannula, bone wax.

4. The pericardium is incised, hemostasis and fixation of the pericardium is performed visualizing the heart and the
placement of the Finochietto separator is performed,

Fine dissections, Silk 0 with a needle, May scissors, Electrobistury

5. CANNULATION:
Tourniquets and purse strings are performed for cannulation of the aorta with
EOPA arterial cannula in the ascending aorta, single venous cannulation in the
right atrium and finally antegrade cardioplegia cannula in the aortic root, finally
the fixation of them:

polyester 2/0needle holder,vascular dissection, aortic clamp .may scissors,

tourniquets, arterial cannula Eopa # 18, single venous cannula 34/36 and
antegrade cardioplegia cannula.

6. the connection of the tubes and the cannulas of the extracorporeal circulation
machine is made.

EXTRACORPOREAL CIRCULATION SYSTEM

when the heart enters the pump, the saphenous graft is placed. in this case
anastomosing it with the circumflex artery and repairing the anterior descending
artery with the mammary artery, de anastomosis is verified and the MCEC is
removed.

saphenous vein and circumflex artery graft, scalpel handle #7 and scalpel blade
15 or microscalpel, fine dissections and Dennis dissection, CO2 Frazier cannula,
semi-rigid aspirator, castroviejo needle holder, anterograde and retrograde Potts
scissors, arteriotomy cannula and syringe 10cc, may scissors, metzembaum
scissors
INPUT OF MEDICAL SUPPLIES

7. incisions are made and placement of tubes in the chest, placement of

pacemaker thread

scalpel handle#7 scalpel blade #15, chest tubes 34 and 32, Y-connector, Kocher
forceps, needle holder, Mayo scissors, pacemaker wire, pleurovac

8. The sternal is sutured, hemostasis is checked and the respective plans tcs and
skin are sutured
#6 steel, wire cutter, rochester forceps, monocryl 3/0, polyglactin 910 0, needle
holder, mayo scissors

9. cleansing and healing

May scissors, dressings without pad, gauze, dermabond, compresses

 BIBLIOGRAPHY:
Kenhub. (s.f.). Corazón - Anatomía y función. Recuperado el 1 de mayo de 2023, de https://www.kenhub.com/es/library/anatomia-es/corazon

Revista Argentina de Anatomía Online. (2012). Volumen 3, Número 3. Recuperado el 1 de mayo de 2023, de https://revista-
anatomia.com.ar/archivos-parciales/2012-3-revista-argentina-de-anatomia-online-e.pdf

Ros ÁL, Al-Mahdi EAR, Ruiz JMM, Gómez JLZ. Ateroesclerosis. Medicine [Internet]. 2021 [citado el24 de marzo de 2023];13(36):2063–70.
Disponible en:hps://medlineplus.gov/spanish/ency/arcle/000171.htm