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Eur J Cardiothorac Surg 1998;13:650-654
© 1998 Elsevier Science NL

Thoracic computed tomography prior to redo coronary surgery

Jochen Cremera, Omke E. Teebkena, Andrè Simona, Alfred Hutzelmannb, Martin Hellerb, Axel Havericha

a Department of Cardiovascular Surgery, Christian-Albrechts-University, Arnold-Heller-Strasse 7, 24105 Kiel, Germany
b Department of Radiology, Christian-Albrechts-University, Arnold-Heller-Strasse 9, 24105 Kiel, Germany

Received 8 December 1997; received in revised form 16 March 1998; accepted 24 March 1998.

Corresponding author. Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; Tel.: +49 511 5326583; fax: +49 511 5325404.

Objective: Median resternotomy in coronary redo surgery represents a specific risk for injury of adjacent retrosternal structures. Aiming at improved preoperative evaluation of retrosternal structures, computed tomography (CT) techniques were routinely applied in redo cases. Methods: Of 99 patients undergoing coronary reoperations since April 93, thoracic CT scans were retrospectively analyzed for retrosternal vicinity of cardiovascular structures, condition of the ascending aorta and structural abnormalities of the sternum. Results: The minimal median distance between the posterior sternum surface and the anterior aortic wall was measured at 1.9±0.9 cm, whereas the mean closest distance to the anterior right ventricular wall was 0.4±0.5 cm. In 28 cases, the distance between sternum and aorta was smaller than or equal to 1 cm. No measurable distance between the sternum and the right ventricle was noted in 41 patients. Calcification of the ascending aorta became obvious 56 times. With respect to potential injury of the ascending aorta or the right ventricle, a safe reentry by resternotomy was facilitated in all cases. However, following complete sawing, the innominate vein became injured during retrosternal dissection in two cases. Preventive femoral vessel exposure was not performed and urgent femoral cannulation (n=1) was infrequent. Conclusions: Thoracic CT scanning prior to redo coronary surgery allows for detailed assessment of retrosternal relations and facilitates reopening of the sternum. Preventive femoral vessel exposure and lateral thoracotomies may be avoidable in many cases.

Key Words: Cardiac surgery • CT scanning • Sternotomy






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Copyright © 1998 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.