SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE: PRACTICE LEVEL:

DANI SOFIA BENITEZ SANCHEZ 01210021015 III

TEACHER'S NAME: Lidy Higuera PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE:

CARDIOVASCULAR DR. GIRALDO 10-04-2024

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

SURGICAL PROCEDURE TO PERFORM

MYOCARDIAL REVASCULARIZATION

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:
 SURGICAL INSTRUMENTATION PROGRAM

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1. SURGICAL OBJETIVE
 Myocardial revascularization, commonly known as coronary bypass, is restoring adequate blood flow to the heart muscle that has been
compromised due to blocked coronary arteries. This is achieved by creating new pathways for blood flow around the blockages, using
blood vessels taken from other parts of the body, such as the internal mammary artery or saphenous veins. By restoring blood flow,
the goal is to relieve symptoms of coronary artery disease, such as chest pain, and reduce the risk of serious complications, such as
heart attack.

2. ANATOMY

 The coronary arteries arise from the root of the ascending aorta. The main divisions of the coronary arteries usually travel just below
the epicardium of the heart.

 Their branches can embed deeply in the myocardium as they pass through the cardiac sulci. The proximal end of the coronary arteries
ranges between 1.5 and 5.5mm in diameter; but the left coronary artery is usually larger than the right one in most cases.
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 These arteries have a characteristic anatomy that varies slightly between people, but in general, they can be described as follows:

LEFT CORONARY ARTERY

- The left coronary artery originates from the left aortic sinus (of Valsalva) of the ascending aorta.
- The initial portion is also known as the trunk of the left coronary artery, until its bifurcation.
- This is located between the atrium of the left atrium and the pulmonary trunk and supplies the left atrium, most of the left
ventricle and the interventricular septum.

RIGHT CORONARY ARTERY

- The right coronary artery originates from the right coronary sinus (of Valsalva).
- This runs between the appendage of the right atrium and the pulmonary trunk, in an anterior direction to access the right
half of the atrioventricular sulcus.
- Once in said groove, the vessel continues an inferior path, to cross the right heart border, until it reaches the cross of the
heart, which it crosses to anastomose with the circumflex artery branch of the ICA.

-
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VASCULARIZATION
- The right coronary artery originates from the right coronary sinus (of Valsalva).
- This runs between the appendage of the right atrium and the pulmonary trunk, in an anterior direction to access the right half of the
atrioventricular sulcus.
- Once in said groove, the vessel continues an inferior path, to cross the right heart border, until it reaches the cross of the heart, which it
crosses to anastomose with the circumflex artery branch of the ICA.

CIRCULATION CORONARY
The coronary circulation has three main characteristics:
1 The heart has a fundamentally aerobic metabolism, so the coronary contribution of O2 to the myocardium must be constant.
2 The coronary arteries supply the myocardium, which is the organ that generates blood pressure and determines blood flow in the
different tissues of the body.
3 Obstruction of the coronary arteries by an atheromatous plaque, a thrombus or an increase in coronary tone (vasospasm) leads to
an imbalance between coronary supply and myocardial O2 demands, called ischemic heart disease, which represents the main
cause of mortality in the most advanced countries
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3. CHECK LIST
INSTRUMENTAL MEDICAL DEVICES SUTURES SOLUTIONS / MEDICINES
 Extracorporeal  Cardiovascular  Precut silk 4/0  Warm saline solution
Equipment disposable clothing  Polyglactin 910 0  Bupivacaine withepinephrine
 Dr. Giraldo's coronary package Needle 1/2  Nitroglycerin
team  Gauze container roundcircle
 Accessory equipment  Sharps container  Poliglactin 910 3/0
 Reciprocating saw  Handlebars -round needle1/2
 Dr. Giraldo's Sternal Accessory skin fields round circle
Retractor  Sterile gloves  Monocryl 3/0
 Dr. Giraldo's breast  Electro scalpel Needle 3/8 sharp
separator  Gauze (10)  Silk 0 needle 1/2
 Garter clips 100 - 200  Compresses (20) round circle
 Suction rubber Precutsilk 1.
 Ioban
 Sterile dressing
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 Tegaderm  Polyester 2/0

 Yankawer cannula needle 1/2
 Pathology bottle10 & roundcircle
20 cc siringe  Polypropylene 6/0 -
 Pericardial aspiration round
cannula doubleneedle 1/2
 Scalpel blades # 11 & circle 17
15  Silk 4/0 - round
 Chest tube #34 needle 1/2
 Nelaton 8Fr probe roundcircle
 Nelaton 18Fr probe  Ti-cron suture
(suctiontubes) (Polyester) 2/0 -
 Asepto siringe needle1/2 circle
 CO2 rubber double needle
 Cardioplegia with  Polypropylene 7/0 -
antegradecannula3- round
way stopcock doubleneedle1/2
 Hypodermic needle cutting circle.
#18  Steel wire #6
 Dermabond  4/0 polypropylene -
 Alligators round
doubleneedle 1/2
 Cardiovascular
cutting circle.
tourniquet kit
 Pacemaker wire
 Clips LT 100 and 20
 Crocodile cables.
 Venous cannula
 Arterial cannula
 Sternal protector
 Intra-aortic punch 3/8
3/8 connector
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 Accessory gown
 EOPA cannula
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES
 SURGICAL INSTRUMENTATION PROGRAM

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STUDENT SIGNATURE: DANI SOFIA BENITEZ SANCHEZ TEACHING SIGNATURE: __________________________

CARDIOVASCULAR SURGERY