This document describes the clinical case of a 68-year-old male patient who presented with a history of multivessel coronary artery disease and underwent cardiac catheterization. The catheterization found 70% lesion in one artery, 95% in another, and 100% in a third. The patient was scheduled for myocardial revascularization surgery. Pre-operative testing found no issues. The document then provides information on coronary artery anatomy and physiology as well as the causes of coronary artery disease.

1. CLINICAL CASE
MYOCARDIAL
REVASCULARIZATION

2. CLINICAL CASE
FELIPE ARDILA ORTIZ, 68 years old, male, weight 85kg and height 1.62
cm, with a history of multivessel coronary artery disease, ischemic heart
disease, dm type ii, mixed dysplemia, obesity, ex-smoker, with a three-
month history of oppressive precordial pain with exercise, radiating to the
neck.
no deterioration of functional class, no dyspnea. stress echo was positive
for ischemia in the inferior, posterior, mesial and distal wall of the lateral
wall.

3. CARDIAC CATHETERIZATION
Lesion da 70%, cx 95%, cd 100%. scheduled for
rvm attends preanesthesia evaluation as pre-
surgical protocol

4. PARACLINICS

5. PARACLINICS
Vertebral: within normal
limits venous doppler of
lower limbs: within normal
limits arterial doppler of
lower limbs within normal
limits tt echo: heart of normal
struture low probability of
htp, systolic and diastolic
function well

6. ANALYSIS AND PLAN

7. ANATOMY

8. ANATOMY

10. PHYSIOLOGY
The coronary arteries are divided into
epicardial arteries, which are vessels
that offer little resistance to flow
(conductance arteries) and
intramyocardial arteries, where the
greatest resistance to flow occurs and
which are fundamental in the
regulation of coronary flow.

11. PHYSIOLOGY

12. ETIOLOGY OF CORONARY
ARTERIES
Además del colesterol alto, también se puede
producir daño en las arterias coronarias.
• Diabetes o resistencia a la insulina
• Presión arterial alta
• No hacer suficiente ejercicio (estilo de
vida sedentario)
• Fumar o consumir tabaco

13. HIGH-COST DEVICES
BREAST SEPARATOR
CLIP LEAGUE
CLIP
OSCILLATING
SEPARATOR
WIRE

14. SURGICAL
TECHNIQUE

15. SURGICAL PROCESS INSTRUMENTATION PROCESS
Perform Saphenous Vein Graft Harvestof the left leg
and closure of theleaks and permeabilization.An
incision is made for a sternotomy.
Scalpel handle #3 blade 15, electrosurgery,
scissorsmetzembaum, weitlaner separator, clips
200.clammp bull dog , precut silk 4/0,
polypropylene2/0, monocrylic 3/0.
Incise the pericardium, hemostasis and fixation of
thepericardium for complete visualization of the
heart,especially the ascending aorta, placement of
theFinochietto or sternal autostatic retractor.
Scalel Handle #7, Blade 15. Electrocautery,Farebeuf
retractor, dissection forceps without
claw.Reciprocating saw. .Electroscalpel, dissection
forcepsvascular, Silk 0 with needle, Mayo Scissors.
Separatorautostatic Finochietto.
Perform the extraction of the internal mammary
arteryand leave repaired.
Breast separator, clips 100, electrosurgical unit,
cannulafrazier with CO2 rubber.
Perform the stitches for the purse string in the aorta,
insuperior and inferior vena cava, superior pulmonary
veinright for the placement of the grommet
turnstilesand it is repaired.
Polyester 2/0, vascular needle holder,
dissectionvascular, mayonnaise, curved Kelly clamp,
tourniquetsand pass threads.
Perform arteriotomy and venotomy, to
performsubsequently cannulation with each of
thecorresponding cannulas. and fix the cannulas.
Scalpel handle 7 # 15, vascular dissectionforceps,pre-
cut silk 0, venous catheter, arterial catheter,left line
catheter, mayo scissors.
The connection of the circuit tubes is
madeextracorporeal, in order to start the
circulationextracorporeal.
Extracorporeal circuit tubes passed to us by the
perfucian
Start saphenous vein graft fixationfirst anastomosis in
descending arteryback and placement of straight
stitches.
Polyester 2/0 with ptfeMayo scissors, Aguaja holder,
polypropylene 7/0,fine dissection forceps, frazier
cannula, rubberof CO2.polypropylene 6/0
Mobilization of the heart from the apex tosaphenous
vein graft fixation and anastomosiswith circumflex
artery.

16. BIBLIOGRAPHY
https://www.mayoclinic.org/es-es/diseases-conditions/coronary-artery-
disease/symptoms-causes/syc-20350613
https://www.my-ekg.com/bases/arterias-coronarias.html
https://www.sciencedirect.com/science/article/pii/S1134009618301232
https://www.google.com/search?q=cateterismo+cardiaco&source=lmns&bih=657&bi
w=1366&rlz=1C1ONGR_esCO1044CO1044&hl=es-419&sa=X&ved=2ahUKEwi-
xp_n5KL9AhVEdzABHROBAB4Q_AUoAHoECAEQAA