Dynamic four-dimensional computed tomography (4D CT) imaging for re-entry risk assessment in re-do sternotomy - first
Harish Narayanan1, Fabiano F Viana2, Julian A Smith2
1Department of Diagnostic Imaging, Monash Health, Melbourne, Vic, Australia.
Insights
Dynamic four-dimensional CT (4D CT) imaging effectively assesses cardiac structure tethering before repeat sternotomy. This technique helps surgeons plan procedures, minimizing re-entry injuries and improving patient safety.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Thoracic Surgery
Background:
- Repeat cardiac surgeries carry increased complication risks, often due to injuries during re-do sternotomy.
- Computed tomography (CT) aids pre-operative assessment but cannot quantify functional tethering.
- Dynamic four-dimensional CT (4D CT) offers a solution for assessing tethering.
Purpose of the Study:
- To evaluate the utility of dynamic 4D CT in assessing sternal-cardiac structure tethering.
- To determine if 4D CT can improve pre-operative planning for re-do sternotomy.
Main Methods:
- Nineteen patients undergoing re-do cardiac surgery were imaged using dynamic 4D CT during regulated respiration.
- Datasets were analyzed in cine mode to detect differential motion between the sternum and underlying structures.
- This motion assessment indicates the degree of tethering.
Main Results:
- Pre-operative 4D CT imaging demonstrated excellent correlation with intraoperative findings.
- The technique allowed for meticulous procedural planning, successfully avoiding re-entry injuries.
- Dynamic 4D CT proved superior to non-dynamic assessment for retrocardiac tethering.
Conclusions:
- Dynamic 4D CT is valuable for risk stratification before re-do sternotomy.
- It accurately determines the presence or absence of tethering by assessing differential motion.
- This imaging modality enhances surgical safety in repeat cardiac procedures.
Background:
Repeat cardiac surgeries are well known to have higher rates of complications, one of the important reasons being injuries associated with re-do sternotomy. Routine imaging with CT can help to minimise this risk by pre-operatively assessing the anatomical relation between the sternum and the underlying cardiovascular structures, but is limited by its inability to determine the presence and severity of functional tethering and adhesions between these structures. However, with the evolution of wide area detector MD CT scanners, it is possible to assess the presence of tethering using the dynamic four-dimensional CT (4D CT) imaging technique.
Methods:
Nineteen patients undergoing re-do cardiac surgery were pre-operatively imaged using dynamic 4D CT during regulated respiration. The datasets were assessed in cine mode for presence of differential motion between sternum and underlying cardiovascular structures which indicates lack of significant tethering.
Results:
Overall, there was excellent correlation between preoperative imaging and intraoperative findings. The technique enabled our surgeons to meticulously plan the procedures and to avoid re-entry related injuries.
Conclusions:
Our initial experience shows that dynamic 4D CT is useful in risk stratification prior to re-do sternotomy by determining the presence or absence of tethering between sternum and underlying structures based on assessment of differential motion. Furthermore we determined the technique to be superior to non-dynamic assessment of retrocardiac tethering.
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