conleyclan
Guru
I know this is simple. Must be the Friday and my brain cannot read anything else.
OPERATIVE NOTE: Once the patient was brought to operating suite, he was
prepped and draped in sterile fashion. Sternotomy was made. Both mammary
arteries were taken down from the level of first rib to xiphoid. Endoscopic
vein harvesting was completed. The RIMA was measured and sewn to the LIMA
using 8-0 Prolene. The right mammary was used as inflow for the vein. The
portion of the vein was not ideal, and we extended with an extra portion of
right mammary to reach the PDA. Then, we were able to sublux the heart, it
exposed the PDA. Initially, he did not tolerate manipulation of this vessel,
and also we abandoned this approach. We then placed the LIMA to the LAD
which improved his hemodynamics significantly. This was done with no snare
and 8-0 Prolene suture in the Estech stabilizer. Then the PDA was completed
with an extension graft. At this time, he tolerated the manipulation well,
and finally the RIMA limb was placed to the OM. Once this was done, the
flows were interrogated. There are satisfactory, and then protamine was
administered. Once hemostasis had been achieved, the chest was closed in a
standard fashion. As mentioned above, EEG had returned to baseline. SSEPs
remained normal throughout the case. I was present for the entire duration
of this operation.
OPERATIVE NOTE: Once the patient was brought to operating suite, he was
prepped and draped in sterile fashion. Sternotomy was made. Both mammary
arteries were taken down from the level of first rib to xiphoid. Endoscopic
vein harvesting was completed. The RIMA was measured and sewn to the LIMA
using 8-0 Prolene. The right mammary was used as inflow for the vein. The
portion of the vein was not ideal, and we extended with an extra portion of
right mammary to reach the PDA. Then, we were able to sublux the heart, it
exposed the PDA. Initially, he did not tolerate manipulation of this vessel,
and also we abandoned this approach. We then placed the LIMA to the LAD
which improved his hemodynamics significantly. This was done with no snare
and 8-0 Prolene suture in the Estech stabilizer. Then the PDA was completed
with an extension graft. At this time, he tolerated the manipulation well,
and finally the RIMA limb was placed to the OM. Once this was done, the
flows were interrogated. There are satisfactory, and then protamine was
administered. Once hemostasis had been achieved, the chest was closed in a
standard fashion. As mentioned above, EEG had returned to baseline. SSEPs
remained normal throughout the case. I was present for the entire duration
of this operation.