A single 5 mm punch aortotomy was created and the

clamp placed. A single 5 mm punch aortotomy was created, and the vein graph was
anastomosed to the aorta with 6-0 Prolene running suture. The vein graft was de-aired as the
partial occluding clamp was removed.
The patient responded with the paced rhythm, as she was intermittently paced preoperatively
and was slowly weened for bypass. Patient had a significant amount of reperfusion arrhythmias,
which required time and patience to allow this massively hypertrophic ventricle to reperfuse.
Again, with time and rewarming, patient did respond with a sinus paced rhythm, and she was
slowly and easily weaned from bypass.
TEE did confirm adequate deairing and good prosthetic valve function before coming off bypass.
Once off bypass, protamine sulfate was given to reverse the effects of heparin. All cannulae
were then removed, and pursestrings were secured down. One final inspection of all suture
lines, all anastomoses, and all pursestrings revealed adequate hemostasis. Before closing,
ventricular pacing wires x2 were placed as well as 2 mediastinal drainage tubes.
Again, once hemostasis was assured, patient was then closed. The pericardium was
reapproximated with 2-0 silk suture. The sternum was closed with #6 sternal wire. The lenia
alba and pectoralis fascia were closed with #1 Vicryl running suture. The subcutaneous tissue
and skin were closed with running Vicryl suture. Count correct x2. Antibiotic ointment and
sterile dressings were placed on all incisions.
DISPOSITION OF PATIENT
Patient tolerated this procedure well, was hemodynamically stable throughout, and was
transferred to the surgical intensive care unit, intubated, sedated, in fair condition, and on low
doses of dopamine and nitroglycerin.
___________________________________
Emily Adkins, MD, Surgical Resident for
Jeffrey Wolfe, MD, Cardiac Surgery
EA:ad
D: 08/14/----
T: 08/15/----

Chapter 3; TE #4; Consultation: Wound Infection
Forrest General Medical Center
1038 Superior Street NW
Nashville, TN 37189
Phone [phone]
INFECTIOUS DISEASES CONSULT
Patient Name: Donald Gardener PCP : Anderson Phipps, MD
Patient ID: 000128 Sex/Age: M/69 DOB: 17 September, ----
Date of Admission: 3 June, ---- Date of Consultation: 4 June, ----
HISTORY OF PRESENT ILLNESS: Briefly, the patient is 69-year-old white gentlemen, a practicing
attorney. He was last hospitalized at Forrest General from 30 June to 3 July of last year. At that
time, he presented with a chest discomfort and shortness of breath. The patient had a cardiac
catherization on 1 July of last year that showed a severely diseased distal left anterior
descending artery with total occlusion of the circumflex artery. The patient was discharged
home on 3 July. Then, I am told, he was re-admitted in Memphis and had a quadruple coronary
bypass surgery. I have requested a Discharge Summary from the hospitalization. From my
understanding, the patient’s stay was complicated by sternal dehiscence and what sounds like a
sternal wound infection. This was treated with a muscle flap closure. The patient told me that
he had a PICC line placed at that time, but at the time of discharge he was not prescribed
parenteral antibiotics. Having said that, the patient developed multiple draining sinuses on the