SURGICAL INSTRUMENTATION PROGRAM

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STUDENT NAME: ISIS DANIELA ROJAS GELVES CODE: 01210021006 PRACTICE LEVEL: III SEVENTH SEMESTER

TEACHER'S NAME: LIDY HIGUERA PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE: FEBRUARY, 14, 2024

CARDIOVASCULAR Dr. Giraldo

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE: 75 YEARS OLD

JORGE ELIECER MANJARRES GUERRERO 63277189
SURGICAL PROCEDURE TO PERFORM: MITRAL VALVULOPLASTY + TRICUSPID VALVULOPLASTY

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. SURGICAL OBJECTIVE : SURGICALLY CORRECT THE ANATOMICAL DEFECT OF THE MITRAL AND TRICUSPID VALVES TO IMPROVE
BLOOD FLOW THROUGH THESE STRUCTURES.

1.2. ANATOMY AND PHYSIOLOGY: The mitral valve is responsible for separating the left atrium from the left ventricle, in order to regulate the
passage of blood between these chambers dynamically, adapting to the movements and forces of the cardiac cycle.
The mitral valve is a complex group of interrelated structures and its function is the result of an interaction between the leaflets, the mitral annulus, the
subvalvular apparatus (tendinous cords and papillary muscles) and the left ventricle.
Biological valves Mechanical valves
Organic animal tissues (cow or pig) are used They are made of inorganic materials such as pyrolytic carbon
Advantages: resistant materials, durability
Disadvantage: tends to form thrombi around the metal valve.
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http://crvalvular.com.ar/wp-content/uploads/2022/05/Cuerdasss.png
Valves and compressions of the mitral valve:
The mitral valve has two leaflets, one anterior and the other posterior, with a similar surface and thickness of about 1 mm, separated by their respective commissures.
Diagnostic tests to evaluate cardiac valve function:
Echocardiogram: diagnostic test that allows to see images through ultrasound waves and thus to evaluate the strength of the heart, size, function, shape, thickness of
its walls and function of its valves. You can also see information about the pulmonary circulation and its pressures, the initial portion of the aorta and see if there is a
pericardial effusion.
These leaflets are anchored at their bases to the mitral annulus and at their free edges by the chordae tendineae.
Mitral Insufficiency: causes anatomical and/or functional alteration of the mitral valve apparatus leading to reflux of blood from the left ventricle to the left atrium
during systole.
Organic mitral insufficiency: it is a primary condition of the mitral valve and can be myxomatous or rheumatic.
Valvuloplasty: surgical procedure to repair a narrowed heart valve.
Tricuspid valve stenosis: causes arrhythmias and heart failure.

1.3 CHECKLIST
INSTRUMENTS
Extracorporeal Basket
Coronary accessory basket
Dr. Giraldo sternal retractor
Reciprocating saw with battery
SURGICAL INSTRUMENTATION PROGRAM
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MEDICAL DEVICES/EQUIPMENT SUTURES AND NEEDLES DRUGS AND SOLUTIONS
Disposable cardiovascular linen package Wire suture #6 Warm saline solution
Gauze container VICRYL Plus 0 CT-1 36.4 mm for
Container for sharps subcutaneous cellular tissue
Handles Bone Wax
Accessory Skin Drapes PROLENE 4-0 2 RB-1 17 mm for making
Sterile gloves tobacco pouch with cardioplegia probe
Electrosurgical pencil PROLENE 4-0 2 SH-1 22 mm for suturing
Gauze (10) the atrium
Compresses (20) PROLENE 4-0 2 SH 26 mm for suturing
Suction rubber the interatrial septum
Surgical drape IOBAN MONOCRYL 3-0 PS-2 26 mm for skin
Tegaderm dressing suturing
Yankawer cannula SILK 1 precut for fixation of the cannulae
Sample bottle SILK 4-0 RB-1 17 mm for repairing the
20cc syringe epicardium
Pericardial aspiration cannula TEMPOWIRE 2-0 SH Pacemaker Suture or
Arterial cannula + guide 18 Fr EOPA Thread
Venous cannulae with metal tip 24 Fr Suture Ti-Cron polyester 2-0 Y-5 26 mm
and 28 Fr 10 needles for tricuspid ring suturing
Valve ring gauges #32 and #34 Hypodermic needle
Chest tube #34 Gore-Tex PTFE CV-5 26mm
Nelaton probe 14 Fr (clamp repair) Bupivacaine 0.5% raised to 100%
Asepto syrinx
Fibrillar Surgicel
And connectors for cannulas
Scalpel blades #11 and #15
Cannular cardioplegia
Tricuspid ring #34
Sternal protection tubes
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2. Organizational stage

2.1. ARRANGEMENT OF SURGICAL TABLES

MAY TABLE LEFT

1. Scalpel handle #7 with blade #11

2. Scalpel handle #7 with blade #15
3. May scissors
4. Fine metzembaum scissors
5. Farabeuf separators
6. Vascular dissection forceps
7. Tourniquets with guide
8. Long may scissors
9. Protected curved mosquito forceps
10. Gauze
11. Container for sharps
12. Field forceps
13. Sternal protection tubes
14. Tube clamp
15. Curved Rochester clamp
16. Kocher clamp
17. Curved Kelly clamp
18. Curved mosquito tweezers
19. Straight Kelly tweezers
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RESERVE TABLE 1. Extracorporeal Basket

2.Compresses
3. Manubrium
4.Gauze container
5.Aseptojeringa
6.Coke for serum
7.Chest tube
8.Arterial cannula
9.Venous cannulae
10.Nelaton catheter
11.Pericardial aspiration cannulae
12.Sample bottle
13.Syringe
14.Sutures
15.Bone wax
16.Coca
17.Needle holder
18.Lister scissors
19.Wire needle holder
20.Wire cutter
21.Y connectors
22.Hypodermic needle
23.Bakey vascular clamp
24. Wire passing forceps
25. Cardioplegia cannula
26. Cushing's retractor
27. Hook
28.Vascular dissection
29.Allix forceps
30.Dissecting forceps with claw
31. Sternal retractor
32. Tegaderm
33.Electrobistoury
34. MOSAIC Mitral Valve Gauges
35.Iobam surgical field
36.Suction rubber + cannula
37.Clothes package
38. Reciprocating saw
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2.2. Patient position

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2.3. Location of surgical equipment

1. Surgeon
2. Surgical instrumentation
3. Surgical assistant

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3. Execution stage
a. Type of anesthesia: General
b. Approach: anterior-Incision: sternotomy
c. Steps and instruments used in the surgical technique:
INITIAL COUNT OF COMPRESSES, GAUZE,...
The surgeon begins by performing a sternotomy
Incision of the subcutaneous cellular tissue and hemostasis are made.
The surgeon makes cut of the sternum and opening of the thoracic cavity
Hemostasis of the sternum and cavity
Protection is placed on the sternum and the thoracic cavity is opened.
Dissection and elevation of the epicardium is done to expose the heart
Repair stitches are made to the epicardium to expose the heart
A loop is made in the aorta artery for the respective cannulation
A loop is made in the superior vena cava for the respective cannulation
A loop is made in the inferior vena cava for the respective cannulation
An incision is made in the ascending aorta artery and a canula is inserted.
A tobacco pouch is made and the arterial cannula is adjusted.
An incision is made in the superior vena cava and a canula is inserted.
A tobacco pouch is made and the venous cannula is adjusted.
An incision is made in the inferior vena cava and a canula is inserted.
A tobacco pouch is made and the venous cannula is adjusted.
An incision is made in the aorta artery distal to the arterial cannula in order
to perform cardioplegia on the patient.
Make a tobacco pouch and adjust the cardioplegia cannula
The arterial and venous cannulas are connected to the lines of the heart-lung
machine and numbered.
The cardioplegia cannula is connected to the extracorporeal circulation
machine
SURGICAL INSTRUMENTATION PROGRAM
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#7 scalpel handle with #15 blade
Electroscalpel, compress, Farabeuf separators
Reciprocating saw, compresses
Electroscalpel, bone wax
Plastic probes, sternal separator
Fine dissecting forceps
Silk 4-0 RB-1, May scissors, dissecting forceps
Silk 4-0 RB-1, May scissors, dissecting forceps
Silk 4-0 RB-1, May scissors, dissecting forceps
Silk 4-0 RB-1, May scissors, dissecting forceps
#7 Scalpel Handle with #11 Blade, 18 Fr Aortic Arterial Cannula plus Guide
Tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula
#7 Scalpel Handle with #11 Blade, Venous Cannula with 28Fr Metal Tip
Tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula
#7 Scalpel Handle with #11 Blade, Venous Cannula with 24Fr Metal Tip
Tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula
#7 Scalpel Handle with #11 Blade, Cannula for Cardioplegia
Tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula
Y connector 3/8
Male connector

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The patient's Pump time begins and the heart becomes asystole, and total
clamping of the aorta is performed in the middle of the two cannulas.
The left atrium is opened to address the tricuspid and mitral valves.
The mitral valve is checked to know what type of plasty can be performed
Insufficiency in the mitral valve (anterior leaflet) is sutured
A Valsalva maneuver is performed to check if the defect has improved with
the previous suture.
Insufficiency in the mitral valve (posterior leaflet) is sutured
A Valsalva maneuver is performed to check if the defect has improved with
the posterior suture.
As no improvement is seen with these sutures, it is decided to perform
tendon cord repair, measure it with the cord meter and tie 6 knots to adjust
the suture with the help of a felt pad.
A final Valsalva maneuver is performed and complete correction of the mitral
valve is observed.
The interatrial septum is opened to correct the tricuspid valve defect.
The surgeon measures the mitral valve annulus
It is decided to place the #34 valve ring, starting by suturing from the edges
to the commissures, first the anterior row and then the posterior row, the
suture pad must be removed, gloves changed and accessory fields placed on
the surgical field .
The sutures are cut, and the ring is lowered, each suture is attached and
knotted to adjust it completely, finally the plastic support is removed from
the ring
A Valsalva test is performed to check the correct functioning of the tricuspid
valve after ring placement.
SURGICAL INSTRUMENTATION PROGRAM
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Bakey Clamp
#7 scalpel handle with #15 blade, vascular dissection forceps and
pericardial aspiration cannula
Cusching Retractor and Hook, Vascular Dissection Forceps
Prolene 4-0 2 RB-1, needle holder, May scissors and dissecting forceps
Aseptosyringe, saline solution, yankawer aspiration cannula
Prolene 4-0 2 RB-1, needle holder, May scissors and dissecting forceps
Aseptosyringe, saline solution, yankawer aspiration cannula
String gauge, Gore-Tex CV-5 suture, needle holder, May scissors,
Aseptosyringe with saline solution, plush, protected mosquito clamp
Aseptosyringe, saline solution, yankawer aspiration cannula
#7 Scalpel Handle with #11 Blade, Vascular Dissection Forceps, Pericardial
Aspiration Cannula
Valve Gauges #32 and #34
Needle holder, Ti-Cron polyester suture 2-0 Y-5 26 mm
Gloves
Fields of leather accessories
Aseptosyringe, saline, cusching separator , dissecting forceps
Aseptosyringe, saline solution, cannula yankawer

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The interatrial septum is sutured
The left atrium is sutured
The removal of the cannulas begins: first the inferior vena cava, then the
superior vena cava, the aortic arterial cannula , and finally the cardioplegia
cannula . Clamp is removed from the aorta.
The silk is cut and the tourniquets are removed
A bubble check test is done with the lungs functioning with the help of a
perfusionist and anesthesiologist
The epicardium repair stitches are removed, hemostasis is checked.
The heart is checked to beat again, the patient's vital signs are checked
The tube is passed to the chest in the mediastinum, an incision is made in the
xiphoid process.
Sternal separator is removed, final count is done before closing the sternum
Closure is done: first suture the sternum and then the subcutaneous cellular
tissue , the patient's tissue is infiltrated
skin suture
Cleaning the surgical wound, placing a dressing, cleaning the patient,
removing the surgical field IOBAM
Removal of fields and arrangement of instruments
SURGICAL INSTRUMENTATION PROGRAM
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Needle holder, long May scissors, prolene 4-0 2-SH 26 mm, Aseptosyringe
and saline solution
Needle holder, long May scissors, prolene 4-0 2-SH-1 22 mm, Aseptosyringe
and saline solution
Scalpel handle #7 blade #15, vascular dissection forceps, prolene 4-0 2-SH-1
22 mm, fine long mayo scissors
Mayo scissors, Yankawer cannula and dissecting forceps
#34 chest tube, Kocher clamp, #7 scalpel handle with #15 blade, compress
Curved Rochester forceps, #6 wire suture, wire cutter, wire needle holder
Syringe with 0.5% bupivacaine taken to 100%
Fine Needle Holder, VICRYL Plus 0 CT-1 36.4mm, Clawless Dissecting
Forceps, Short May Scissor, Compress
Fine needle holder, MONOCRYL 3-0 PS-2 26 mm, dissecting forceps with
claw
Compress, saline solution, DERMABOND, gauze, dressing and transparent
fixomull
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES
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STUDENT SIGNATURE: ISIS ROJAS TEACHING SIGNATURE: __________________________