jtb57chevy
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Would appreciate any & all help with the following:
DESCRIPTION OF PROCEDURE:..... I cutdown in the left groin. There was no palpable pulse in the right groin. I exposed the right femoral artery and placed in an arterial line here. Next, redo median sternotomy was done without incident. I then proceeded to dissect out the aorta. The distal aortic arch, as well as the aortic arch was completely calcified. There was a vein graft to an obtuse marginal in the middle portion of the ascending aorta. This portion of the aorta was soft and I thought it was clampable. Once I dissected out the heart, both common carotid arteries were exposed through bilateral neck incisions. At this point, the patient was fully Heparinized. A side biting clamp was placed on the mid0ascending aorta with care being taken to preserve the previous vein graft. Then, a trifurcated Vascutek graft was used with the proximal portion being 12 mm and the distal portion being 8 mm. Then, an end to side anastomosis was done using a 4-0 Prolene. This graft was flushed out. Both smaller limbs were then tunneled up to the common carotids. The remaining 12 mm distal limb was then used for perfusion for the coronary artery bypass grafting surgery. Prior to this, the right carotid anastomosis was done. This was completely occluded. The left common carotid was anastomosed to the graft using 5-0 Prolene, end to side. Stump pressures were checked and were noted to be over 50. Once these anastomoses were completed, an aortic cannula was placed in the limb of the trifurcated graft and connected to the cardiopulmonary bypass circuit.xx had a tremendously large heart that was completely covered with Adipose tissue. There was no visible myocardium. Pursestring sutures were placed in the right atrium and this was cannulated. The previous left internal mammary artery to the left anterior descending artery was identified. This was occluded. The rest of the left anterior descending artery was completely calcified and not able to be bypassed. Once I obtained appropriate ACT, the patient was placed on full cardiopulmonary bypass. I was then able to dissect out the left side of the heart and identify the previous vein graft to the obtuse marginal. The distal target was approximately 1 mm. Using the off-pump stabilizers, I then anastomosed a vein graft to the distal obtuse marginal using a 7-0 Prolene. The proximal was then anastomosed to the Vascutek graft. The patient was placed .....
I'm thinking
33510
33530
33870
Thanks in advance for your help!
DESCRIPTION OF PROCEDURE:..... I cutdown in the left groin. There was no palpable pulse in the right groin. I exposed the right femoral artery and placed in an arterial line here. Next, redo median sternotomy was done without incident. I then proceeded to dissect out the aorta. The distal aortic arch, as well as the aortic arch was completely calcified. There was a vein graft to an obtuse marginal in the middle portion of the ascending aorta. This portion of the aorta was soft and I thought it was clampable. Once I dissected out the heart, both common carotid arteries were exposed through bilateral neck incisions. At this point, the patient was fully Heparinized. A side biting clamp was placed on the mid0ascending aorta with care being taken to preserve the previous vein graft. Then, a trifurcated Vascutek graft was used with the proximal portion being 12 mm and the distal portion being 8 mm. Then, an end to side anastomosis was done using a 4-0 Prolene. This graft was flushed out. Both smaller limbs were then tunneled up to the common carotids. The remaining 12 mm distal limb was then used for perfusion for the coronary artery bypass grafting surgery. Prior to this, the right carotid anastomosis was done. This was completely occluded. The left common carotid was anastomosed to the graft using 5-0 Prolene, end to side. Stump pressures were checked and were noted to be over 50. Once these anastomoses were completed, an aortic cannula was placed in the limb of the trifurcated graft and connected to the cardiopulmonary bypass circuit.xx had a tremendously large heart that was completely covered with Adipose tissue. There was no visible myocardium. Pursestring sutures were placed in the right atrium and this was cannulated. The previous left internal mammary artery to the left anterior descending artery was identified. This was occluded. The rest of the left anterior descending artery was completely calcified and not able to be bypassed. Once I obtained appropriate ACT, the patient was placed on full cardiopulmonary bypass. I was then able to dissect out the left side of the heart and identify the previous vein graft to the obtuse marginal. The distal target was approximately 1 mm. Using the off-pump stabilizers, I then anastomosed a vein graft to the distal obtuse marginal using a 7-0 Prolene. The proximal was then anastomosed to the Vascutek graft. The patient was placed .....
I'm thinking
33510
33530
33870
Thanks in advance for your help!