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<h2 class="tl3-title">Mitral Valve <em>Repair</em><br>OR-3 · 08:14:22</h2>
<div class="tl3-patient">
<strong>PT · ID-449201 · M · 58y</strong><br>
ASA III · BMI 27.4<br>
Lead surgeon: Dr. A. Okafor<br>
Anesthesia: GA · ETT
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</header>
<div class="tl3-monitor">
<div class="tl3-readouts">
<div class="tl3-readout tl3-hr">
<div class="tl3-lbl">Heart Rate</div>
<div class="tl3-val">72<span class="tl3-unit">bpm</span></div>
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<div class="tl3-readout tl3-sp">
<div class="tl3-lbl">SpO₂</div>
<div class="tl3-val">99<span class="tl3-unit">%</span></div>
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<div class="tl3-readout tl3-bp">
<div class="tl3-lbl">BP · MAP</div>
<div class="tl3-val">118/74<span class="tl3-unit"> · 89</span></div>
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<div class="tl3-readout tl3-tp">
<div class="tl3-lbl">Core Temp</div>
<div class="tl3-val">36.4<span class="tl3-unit">°C</span></div>
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<div class="tl3-timeline">
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<div class="tl3-time">07:42<span class="tl3-elapsed">T−00:32</span></div>
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<h4 class="tl3-step-title">Pre-op briefing & timeout</h4>
<p class="tl3-step-body">Patient identity, procedure, and site confirmed by surgical team per WHO checklist. Blood products on standby (2u PRBC, 2u FFP). Cardiac echo reviewed.</p>
<div class="tl3-tags"><span class="tl3-tag tl3-ok">CHECKLIST CLEAR</span><span class="tl3-tag">ECHO ✓</span></div>
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<div class="tl3-time">08:14<span class="tl3-elapsed">T+00:00</span></div>
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<h4 class="tl3-step-title">Induction & intubation</h4>
<p class="tl3-step-body">Propofol 200mg / fentanyl 200mcg / rocuronium 50mg. ETT 8.0 placed without difficulty, confirmed by capnography and bilateral breath sounds. Arterial line right radial.</p>
<div class="tl3-tags"><span class="tl3-tag tl3-ok">AIRWAY ✓</span><span class="tl3-tag">A-LINE R RADIAL</span></div>
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<div class="tl3-step">
<div class="tl3-time">08:46<span class="tl3-elapsed">T+00:32</span></div>
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<h4 class="tl3-step-title">Median sternotomy</h4>
<p class="tl3-step-body">Skin incision and sternal split with oscillating saw. Retractor placed. Pericardium opened in inverted-T fashion, sutured to drapes. Heparin 30,000u administered.</p>
<div class="tl3-tags"><span class="tl3-tag">ACT pending</span><span class="tl3-tag tl3-ok">HEMOSTASIS</span></div>
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<div class="tl3-step tl3-alert">
<div class="tl3-time">09:11<span class="tl3-elapsed">T+00:57</span></div>
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<h4 class="tl3-step-title">Transient hypotension on aortic cannulation</h4>
<p class="tl3-step-body">MAP fell to 52 momentarily during cannulation; corrected with 100mcg phenylephrine bolus and 250ml volume. ACT now 480s, on bypass within 90 seconds.</p>
<div class="tl3-tags"><span class="tl3-tag tl3-crit">ALERT · MAP 52</span><span class="tl3-tag tl3-ok">CORRECTED</span><span class="tl3-tag">CPB INITIATED</span></div>
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<div class="tl3-time">09:24<span class="tl3-elapsed">T+01:10</span></div>
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<h4 class="tl3-step-title">Cross-clamp & cardioplegia</h4>
<p class="tl3-step-body">Aortic cross-clamp applied. Antegrade cold blood cardioplegia delivered, asystole achieved within 60s. Cooling to 32°C systemic.</p>
<div class="tl3-tags"><span class="tl3-tag">XCL 09:24</span><span class="tl3-tag tl3-ok">ARREST CONFIRMED</span></div>
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<div class="tl3-step">
<div class="tl3-time">10:02<span class="tl3-elapsed">T+01:48</span></div>
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<h4 class="tl3-step-title">Triangular resection + annuloplasty ring</h4>
<p class="tl3-step-body">P2 segment resected and reapproximated with 4-0 prolene. Cosgrove 32mm annuloplasty band placed with interrupted 2-0 ethibond. Saline test: no regurgitation.</p>
<div class="tl3-tags"><span class="tl3-tag tl3-ok">REPAIR ✓</span><span class="tl3-tag tl3-ok">SALINE TEST DRY</span></div>
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<div class="tl3-time">10:34<span class="tl3-elapsed">T+02:20</span></div>
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<h4 class="tl3-step-title">Wean from bypass · TEE confirms</h4>
<p class="tl3-step-body">Cross-clamp off, spontaneous sinus rhythm. Weaning slow with low-dose epi (0.03 mcg/kg/min). TEE shows trace MR, mean gradient 3mmHg. Sternum closed in standard fashion.</p>
<div class="tl3-tags"><span class="tl3-tag tl3-ok">OFF BYPASS</span><span class="tl3-tag tl3-ok">TEE: TRACE MR</span><span class="tl3-tag">EPI 0.03</span></div>
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