Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy

Author:

Abou Zahr RiadORCID,Gooty Vasu,Tandon Animesh,Greil Gerald,Pirolli Timothy,Davies Ryan,Jaquiss Robert,Ramaciotti Claudio,Hussain Tarique

Abstract

Abstract Background Injury to vital structures posterior to the sternum is a complication associated with redo sternotomy in congenital cardiac surgery. The goal of our study was a novel evaluation of real-time cine cardiovascular magnetic resonance (CMR) to predict the presence of significant retrosternal adhesions of cardiac and vascular structures prior to redo sternotomy in patients with congenital heart disease. Methods Twenty-three patients who had prior congenital heart surgery via median sternotomy had comprehensive CMR studies prior to redo sternotomy. The real time cine (RTC) sequence that was used is an ungated balanced steady-state free precession (bSSFP) sequence using SENSitivity Encoding for acceleration with real-time reconstruction. Spontaneously breathing patients were instructed to take deep breaths during the acquisition whilst increased tidal volumes were delivered to mechanically ventilated patients. All patients underwent redo cardiac surgery subsequently and the presence and severity of retrosternal adhesions were noted at the time of the redo sternotomies. Results Median age at the time of CMR and operation were 5.5 years (range, 0.2–18.4y) and 6.1 years (range, 0.3–18.8y) respectively. There were 15 males and 8 females in the study group. Preoperative retrosternal adhesions were identified on RTC in 13 patients and confirmed in 11 (85%) at the time of surgery. In only 2 patients, no adhesions were identified on CMR but were found to have significant retrosternal adhesions at surgery; false positive rate 15% (CI 0.4–29.6%), false negative rate 20% (CI 3.7–36.4%). The total classification error of the real time cine sequence was 17% (CI 1.7–32.4%) with an overall accuracy of 83% (CI 67.7–98.4%). Standard breath-hold cine images correlated poorly with surgical findings and did not increase the diagnostic yield. Conclusions RTC imaging can predict the presence of significant retrosternal adhesions and thus help in risk assessment prior to redo sternotomy. These findings complement the surgical planning and potentially reduce surgical complications .

Funder

Pogue Family Fund

Publisher

Springer Science and Business Media LLC

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,Radiological and Ultrasound Technology

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Pre- and Postoperative Imaging in Transposition of Great Arteries;CT and MRI in Congenital Heart Diseases;2020-12-19

2. Cardiac MR Evaluation of Repaired Tetralogy of Fallot;Seminars in Roentgenology;2020-07

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