Pre Re-do Sternotomy

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Report:
Technique: [Non-contrast/Contrast enhanced/Contrast enhanced, prospective/retrospective cardiac gated/4d contrast enhanced] Previous surgery: [Type of valve replacement/CABG - which vessels/aortic surgery - type] Adhesions: [Yes/No] Right ventricular distance to sternum: [> 1 cm/< 1 cm/Adherent] Right ventricular outflow tract to sternum: [> 1 cm/< 1 cm/Adherent] Graft distance to sternum: [> 1 cm/< 1 cm/Adherent] Aortic distance to sternum: [> 1 cm/< 1 cm/Adherent] Distance of brachiocephalic veins from sternum: [] Degree of aortic atheromatous/calcific disease: [None/Mild/Moderate/Severe]. Lungs: [] Lymphadenopathy: [Yes/No.] Bones: [] Other soft tissues: []

Explantory notes

Heading	Options	Reason
Technique:	Non-contrast/Contrast enhanced/Contrast enhanced, prospective/retrospective cardiac gated/4d contrast enhanced	Non contrast scans may give distances to major structures, but graft patency and precise location may be missed. Retrospective gating with cine images allows better identification of adhesions.
Previous surgery:	Type of valve replacement/CABG - which vessels/aortic surgery - type	Previous coronary artery bypass grafting may expose grafts to injury.
Adhesions:	Yes/No.	These may be seen as bands extending to the sternum or as deformation of the structures deep to the sternum (see below for key measurements indicative of adhesions). Also, movement is inhibited on cine images where structures are adherent.
Right ventricular distance to sternum:	> 1 cm/< 1 cm/Adherent	Structures < 10 mm from the sternum are likely to be adherent or at high risk of damage. These include the right ventricle or any grafts that cross the midline. It is often appropriate to state the level in relation to the sternal wires. Also, a LIMA graft within 1 cm of the midline is at risk of injury as it may have an associated adhesion.
Right ventricular outflow tract to sternum:	> 1 cm/< 1 cm/Adherent
Graft distance to sternum:	> 1 cm/< 1 cm/Adherent
Aortic distance to sternum:	> 1 cm/< 1 cm/Adherent
Distance of brachiocephalic veins from sternum:
Degree of aortic atheromatous/calcific disease:	None/Mild/Moderate/Severe	Heavy calcification may preclude aorto-pulmonary bypass via aortic cannulation. State the anatomy of alternative sites.
Lungs:
Lymphadenopathy:	Yes/No.
Bones:
Other soft tissues:

References:

1. Am Heart J. 2010 Feb;159(2):301-6. doi: 10.1016/j.ahj.2009.11.005. Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography. Maluenda G¹, Goldstein MA, Lemesle G, Weissman G, Weigold G, Landsman MJ, Hill PC, Pita F, Corso PJ, Boyce SW, Pichard AD, Waksman R, Taylor AJ.
2. Hrvoje Gasparovic, Frank J. Rybicki, John Millstine, Daniel Unic, John G. Byrne, Kent Yucel, Tomislav Mihaljevic; Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization, European Journal of Cardio-Thoracic Surgery, Volume 28, Issue 2, 1 August 2005, Pages 244–249, https://doi.org/10.1016/j.ejcts.2005.03.024
3. Dynamic Four-dimensional Computed Tomography (4D CT) Imaging for Re-entry Risk Assessment in Re-do Sternotomy - First experience Narayanan, Harish et al. Heart, Lung and Circulation , Volume 24 , Issue 10 , 1011 - 1019
4. Static and cine CT imaging to identify and characterize mediastinal adhesions as a potential complication for patients underdoing "redo sternotomy" (Article) Malguria, N., Hanley, M., Steigner, M., Kumamaru, K.K., Wake, N., Zenati, M., Rybicki, F.J. American Journal of Roentgenology Volume 201, Issue 1, July 2013, Pages W72-W74
5. Rajiah P, Schoenhagen P. The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention. Insights Imaging. 2013;4(5):671-89.