Sternum and Heart

[saint21]

How can a doctor diagnose your sternum resting on your heart?

[skydnsr]

Oh, wow.  I am so sorry.  I don't know which blood vessels a CT scan can show, other than the great vessels, so I don't know if it would have made a difference in this case, but that is terrible.  Open-heart surgery does have a small number of unavoidable fatalities, simply because it involves such major trauma to the body.  Successive open-heart surgeries are almost always more risky than the first one.  That is just so sad, though.  Please accept my condolences.

[saint21]

I know someone that was having a second bypass.  When the doctor used the saw to crack her chest an artery was trapped by scar tissue in the sternum.  Doctor severed the artery and she did not survive. She was not given a CT scan.  

[skydnsr]

And I would think that a CT would show it, since with a CT scan you ought to be able to get an idea of the total amount of surface area of the heart that is directly adjacent to the sternum.  From what I understand, this is an unusual, maybe even rare, complication of multiple open-heart surgeries.  If a particular surgeon or a particular surgical center does not do a high volume of OHS re-ops, then perhaps there is a not a high index of suspicion for this.  

Luvusam, I'm sorry that this happened to your daughter.  If you'll check your PMs, I have a link for you to look at.  Other than that, I just don't know too much about it.

[ed34]

Most chest x-rays are done from the front elevation, I would have thought a side elevation would show it?

[luvusam]

When this happened to my 11 yo daughter, I questioned why noone knew her heart/pericardium had attached to her sternum before they sawed through her sternum.  They told me there was no way they could know prior to surgery.  Cath wouldn't show and xray wouldn't really show either.  I ask because we have friends who will eventually go through the same thing and I would love nothing more than to spare them the nightmare and panic.  

[ed34]

Yes the pericardium can get attached by scar tissue, what I'm trying to say is that it's not the heart itself.

[Occupant]

There is no question that it can happen due to prior surgery. In my case it wasn't the heart, but some of the intestines attached themselves to the abdominal wall due to surgery not relatad to the heart. I wound up twice in the ER because the intestines twisted around the attachment point and  got totally blocked.

[skydnsr]

It can get attached by scar tissue, adhesions, or whatever, in cases where there has been a previous open-heart surgery.  Then, if another surgery is needed, one of the things that the next surgeon checks for in the presurgical work-up is that he's not going to cut right into the heart, as soon as the sternum is sawed open.  This is my understanding, anyway, from reading the posts on another forum of a couple of people that this happened to.  They stated that their re-op surgeon discussed with them, prior to the procedure, that it could be a problem.  It was only a couple of people, and they had both had had previous OHS.  

[ed34]

This is confusing. The heart isn't attached to anything really, it's inside a double layered sac called the pericardium and there is a small amount of fluid between the two layers to reduce friction.

[skydnsr]

CTscan.

[saint21]

How may a doctor diagnose how close your sternum is to your heart?  OR How may a doctor diagnose if your sternum is attached to your heart?