PATIENT: DEL FINNIO, MARTA ACCOUNT/EHR #: DELFMA001 Surgeon: Esperanza Martine,

PATIENT: DEL FINNIO, MARTA ACCOUNT/EHR #: DELFMA001 Surgeon: Esperanza Martine, MD Asst. Surgeon: Maureen O’Connell, MD Preop DX: Coronary artery disease Unstable angina pectoris Left carotid artery disease Postop DX: Same Operative Procedure: Cardiac bypass grafting Anesthesiologist: Mitchell Polichek, MD Anesthesia: General INDICATIONS: This is a 61-year-old female who was admitted at another hospital with unstable angina. At that time, the patient underwent cardiac catheterization. There was some anterior apical hypokinesis. The left anterior descending had an 85% proximal narrowing. The right coronary artery had proximal 75% narrowing. Carotid ultrasound, arteriogram revealed very significant, severe disease in the carotids. INTRAOPERATIVE FINDINGS: Cardiac-wise, there were no intrapericardial adhesions. They were normal without palpable plaque. The ventricular function was quite preserved. The left anterior descending measured 2.2 mm in diameter and had excellent brisk flow through the left internal mammary artery. The right coronary artery measured 2.4 mm in diameter and the right internal mammary artery had excellent brisk flow. OPERATION: With satisfactory insertion of monitoring line, induction of anesthesia, standard prepping and draping, for the chest operation, a median sternotomy was performed. We dissected both internal mammary arteries and their pedicles, opened the pericardium, and heparinized and cannulated routinely. Cardiopulmonary bypass central was initiated. Temperature dropped to 32 degrees. Myocardium was immediately arrested with aortic cross-clamping and infusion of aortic root blood cardioplegia initially, supplemented by retrograde cardioplegia through the coronary sinus. We performed two end-to-side distal anastomoses, using the mammary artery. The left internal mammary artery was passed toward the left anterior descending through a vent made on the left side of the pericardium. As we did with the right internal mammary artery passing through a vent on the right side of the pericardium. Both distal anastomoses were done with continuous running suture of 7-0 Prolene. Rewarming was in progress. Cross-clamp released. Myocardial activity resumed spontaneously. Temporary atrial and ventricular wires were placed and pleural and mediastinal cavities drained appropriately with chest tubes. There was satisfactory hemostasis. Decannulation followed. Heparinization reversed with protamine sulfate. Sternotomy approximated with interrupted #6 wires. The linea alba, fascia, subcutaneous tissue, and skin were closed in the usual manner with continuous and interrupted sutures. The patient was transported to the ICU in satisfactory condition. Esperanza Martine, MD

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