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 .

中文翻译：

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实时电影心脏磁共振成像在重做胸骨切开术之前预测明显胸骨后粘连的存在的可行性。


背景技术胸骨后重要结构损伤是先天性心脏手术中重做胸骨切开术相关的并发症。我们研究的目标是对实时电影心血管磁共振（CMR）进行新的评估，以预测先天性心脏病患者在重做胸骨切开术之前是否存在明显的心脏和血管结构胸骨后粘连。方法 23 名之前通过胸骨正中切开术接受过先天性心脏病手术的患者在重做胸骨切开术之前进行了全面的 CMR 研究。所使用的实时电影 (RTC) 序列是非门控平衡稳态自由进动 (bSSFP) 序列，使用 SENSitivity 编码进行实时重建加速。指导自主呼吸患者在采集过程中进行深呼吸，同时向机械通气患者提供增加的潮气量。所有患者随后均接受了重做心脏手术，并在重做胸骨切开术时记录胸骨后粘连的存在和严重程度。结果 CMR 和手术时的中位年龄分别为 5.5 岁（范围，0.2-18.4 岁）和 6.1 岁（范围，0.3-18.8 岁）。研究组中有 15 名男性和 8 名女性。 13 名患者术前在 RTC 上发现胸骨后粘连，并在手术时确认了 11 名患者（85%）存在粘连。只有 2 名患者在 CMR 上未发现粘连，但在手术中发现有明显的胸骨后粘连；假阳性率15%（CI 0.4-29.6%），假阴性率20%（CI 3.7-36.4%）。实时电影序列的总分类误差为 17% (CI 1.7-32.4%)，总体准确率为 83% (CI 67.7-98.4%)。 标准屏气电影图像与手术结果的相关性较差，并且没有提高诊断率。结论 RTC 成像可以预测明显的胸骨后粘连的存在，从而有助于在重做胸骨切开术之前进行风险评估。这些发现补充了手术计划并有可能减少手术并发症。