Heart fusing to the sturnum?

[Danny]

I dont know if this is true, but someone told me after you have open heart surgery, your heart fuses to your breast bone. Is this true?

 

[nngbwh]

Do you mean it's gonna blow up ? like a ticking time bomb ?

 

[Danny]

No i was told it sticks to your sturnum. Just wondering how true it is.

 

[Nancy]

It's called adhesions and you can Google that term and add heart and get an explanation. Any surgical procedure or even accidental injury can cause adhesions. It is a form of scar tissue that binds two things together that should normally be separate.

I can't say how often they form between the heart and sternum, but it can happen. Does it cause problems, sometimes, sometimes not. It is one of the complications of having multiple surgeries especially multiple surgeries in one particular area causing multiple trauma to tissues there.

 

[Danny]

Thanks Nancy. I appreciate your response.

 

[Star54]

Oh great something else for me to worry about.....

 

[neil]

dont worry its rare...................gulp...i hope lol

 

[njean]

I believe this is a rare occurrence Danny but one of our members, Lynlw, her son Justin, had this happen to him. I believe Justin has had 5 or 6 OHS already......a very brave & rare young man and luckily still going strong.

Perhaps Lynn will come around & explain the situation later.

 

[Lily]

Maybe this is as good a place as any to post my experience, for others who may read this thread in the future? My surgeon placed a surgical material between my heart and my sternum, in hopes of diminishing this potential issue in a future OHS.

 

[tobagotwo]

This is uncommon, but it can happen. I would suggest moving around after surgery and gentle stretching. Don't stay in one position for long periods of time. Might or might not help with adhesions, but it's good in general.

I would provide the "someone" who told you with a swift, unexpected kick in the groin when you feel more agile. What possible good did they think would come of telling you that? It's not likely and the thought of it is only causing you worry. The statistics on second and later operations would not be nearly as good if a lot of people's hearts were glued to their breastbones, nor would we have so many runners and hikers and people just going back to living their regular lives after valve replacement. There would also be a lot more discussion of it and a great market for surgical add-ons to avoid it. The material Lily is talking about may help, but is not widely used, because it isn't a common issue.

Best wishes,

 

[Superbob]

Great response from Bob H! To be honest, I had never even heard of this kind of possibility until this thread, and while I am no expert, I have read a lot of material about heart surgery over the past five years. I agree -- it's best not to stress out over something so unlikely. Gentle stretching sounds like a good idea in general.

 

[Lynlw]

Thanks for the PM,(and I agree with Bob's response ) But yes Justin's heart was fused to his sternum before his 4th and 5th OHS It is pretty rare even in poeple that have had multiple REDOS, Justin's surgerons operate mainly on kids/adults that have had usually 3 or more surgeries and they still don't have alot of patients whose heart fuse to their sternum. part of the reason Justin does, is because of the way his heart was built and rebuilt with a pulmonary conduit ontop of his heart, his heart is very forward in his chest so lays right below his sternum, most people have a bigger space, so even if they have internal scarring their hearts don't fuse to their sternum. It doesn't cause any problems with day to day living, but becomes an issue if you need another heart surgery. Since the surgeon has to be very experienced opening the sternum as safe as possible and cutting thru the scarring to get to your heart with out causing damage. Since we knew from his cath that Justin's heart was fused to his sterun, a couple years before his 4th surgery. that was one of the main things we discussed when deciding who to let operate on him. One of the things they told us was they just use the saw on the top layers of sternum, but then cut thru the bottom of the bone with sissors, They also might put you on bypass thru your groin or neck area before they open you so there is less blood, in your heart ect. We talked about that possibility before Justin's 4th and 5th OHS and during the preop testing they checked his veins and arteries in those places with ultrasound to make sure they could use them, his 4th surgery they didn't need to use that but they did his 5th.

 

[Lily]

. . . The material Lily is talking about may help, but is not widely used, because it isn't a common issue. . .

Danny, I think what Bob says here may be true; and I have also wondered how common the possible adhesion issue may be, because I don't recall reading about any other member here mentioning having the surgical mesh like mine.

So I spent some time researching it yesterday, though with little specific success. (And please remember I'm just a patient and am not a medical professional.) But here is some of what I found (though bear in mind some of the info was found on manufacturers' sites):

Apparently: 1) the scarring or possible fusing can be called different things, such as, postoperative retro-sternal adhesions, pericardial adhesions, or postoperative cardiac adhesions, etcetera; and 2) the mesh or other type of adhesion barrier can be called a number of different things also; and 3) there are different ways for surgeons to address the possible adhesion issue.

Apparently there are sprays being trialed or studied (edit - I stumbled across several trials or studies on various types of animals also), and used for adhesion barriers also, including bioresorbable films. When I read about the sprays, I wondered if more patients [even possibly here] have had them used during their OHS without actually realizing it.

Here is a definition I found: "pericardial adhesion [-kär′dē·əl] Etymology: Gk, peri, around, kardia, heart; L, adhesio, sticking to an attachment of the pericardium to the heart muscle, sometimes restricting the muscle's action. In some cases a previous inflammation or surgery may result in dense fibrous adhesions that obliterate the pericardium. The condition may be general or localized and may involve adhesion between the two layers of pericardium (internal adhesive pericarditis), obstructing the pericardial cavity, or between one layer and surrounding tissues such as the diaphragm, mediastinum, or chest wall (external adhesive pericarditis) as a result of an inflammatory process. Also called adherent pericardium."

For anyone interested in reading further about this, I found this link: http://icvts.ctsnetjournals.org/cgi...&searchid=1&FIRSTINDEX=228&resourcetype=HWFIG

And here is an excerpt from that link: "Each year, thousands of children undergo complex cardiac surgeries for the repair of congenital heart defects. Among the many complications that characterize these challenging forms of surgery, the formation of cardiac adhesions remains prominent. Cardiac adhesions present a major problem to surgeons upon sternal re-entry to carry out staged cardiac repair [1–6]. Estimates of the incidence of injury to cardiac structures upon resternotomy in patients with adhesions on the large vessels range from 0.7% [4] to 10% [7] of operations."

Another pericardial adhesions paper, entitled "Reducing the Incidence and Severity of Pericardial Adhesions with a Sprayable Polymeric Matrix," which was on that manufacturer's site, said: "It is recognized that after open cardiac surgery, the right ventricle and right atrium often become adherent to the sternum, as may the aorta and innominate vein, thereby placing all these structures at risk during resternotomy."

The following excerpt is from this [manufacturer's] link: http://www.synthemed.com/postop_challenge.html
"Complications associated with cardiac adhesions
Adhesion formation after open-heart surgery is a well-documented, significant complication encountered during secondary procedures. Secondary procedures account for 15% to 20% of the approximately 450,000 open-heart surgeries performed annually in the United States and the 350,000 open-heart surgeries performed annually throughout the European Union. After virtually every open-heart procedure, extensive adhesions form between the epicardial surface of the heart and the inner surface of the sternum. These adhesions make sternal re-entry and accessing the heart a time-consuming and dangerous process in secondary procedures.

Sternal re-entry and dissection of post-operative cardiac adhesions expose the patient to critical risks, such as injury to the innominate vein and aorto-coronary bypass grafts.1 A 2% to 6% incidence of major vascular injury, often including the right ventricle, right atrium, or aorta has been reported.2

Removing adhesions, while essential, is a tedious and risky process that can extend the length of cardiac procedures by 60 minutes or more, entailing greater risk to the patient due to prolonged exposure to anesthesia."

Hope the information is helpful to anyone interested in this subject.

 

[Kathleen]

I had a mitral repair and 5 years later St Judes mitral and aortic valves put in. My heart had fused to my sternum and towards my backbone. It was a long and difficult surgery. I was given a slim chance of making through the night....that was 25 years ago.
Kathleen

 

[Gail in Ca]

Glad I didn't know about all this scar tissue business until just before my 3rd OHS. According to my surgeon, I had severe mediastinal adhesions and dense scarring around the coronary tongues! This is why redos take so long! Four hours just to get through the sternum!

 

[tobagotwo]

Reading the ad quote in Lily's post bothered me, so I have been digging. The result appears to be that the ad (not surprisingly) overstated, and I understated. As such, I can't let my response rest, as it always needs to be as right as possible on the forum. Crow isn't all that bad, if you serve it up with some good sauce.

The answer seems to be that most people have some sternal adhesions after OHS (as opposed to "virtually every" patient and "extensive adhesions"). However, the further dividing lines seem to be with the type of adhesions (as in problematic or not problematic) and the type of adhesions tends to be associated with the type of OHS.

As could be expected, childhood heart surgeries often lead to problem adhesions because of the sheer amount of reconstruction that often goes into them. Also, surgeries involving CABG (coronary artery bypass grafts) can cause problematic adhesions because the grafted arteries themselves can adhere to the sternum as they heal. CABG surgeries are far and away the bulk of open heart surgeries. Fortunately, CAT scans can now give a partial picture of the adhesions, and give a talented surgeon an idea of what he's facing in the surgery, and reduce the unknown factor.

Simple valve surgery doesn't tend to lead to the problematic types of adhesions. It can, but it's not that common.

I still say that person deserves a quick Nike to the groin for making you worry about something that's not likely to be the case, and which you can't do anything about anyway. It was just mean.

Best wishes,

 

[Lynlw]

Reading the ad quote in Lily's post bothered me, so I have been digging. The result appears to be that the ad (not surprisingly) overstated, and I understated. As such, I can't let my response rest, as it always needs to be as right as possible on the forum. Crow isn't all that bad, if you serve it up with some good sauce.

The answer seems to be that most people have some sternal adhesions after OHS (as opposed to "virtually every" patient and "extensive adhesions"). However, the further dividing lines seem to be with the type of adhesions (as in problematic or not problematic) and the type of adhesions tends to be associated with the type of OHS.

As could be expected, childhood heart surgeries often lead to problem adhesions because of the sheer amount of reconstruction that often goes into them. Also, surgeries involving CABG (coronary artery bypass grafts) can cause problematic adhesions because the grafted arteries themselves can adhere to the sternum as they heal. CABG surgeries are far and away the bulk of open heart surgeries. Fortunately, CAT scans can now give a partial picture of the adhesions, and give a talented surgeon an idea of what he's facing in the surgery, and reduce the unknown factor.

Simple valve surgery doesn't tend to lead to the problematic types of adhesions. It can, but it's not that common.

I still say that person deserves a quick Nike to the groin for making you worry about something that's not likely to be the case, and which you can't do anything about anyway. It was just mean.

Best wishes,

I was surprised by the number in Lily article too, since I've been talking to surgeons about this for years and even in multiple CHD surgery, from what I've been told it is relatively rare to end up with your heart fused to your sternum that causes problems for surgeons. I could see where many heart get SOME scarring, but to your point not all scaring causes problems. or even a concern with opening the chest and from what I understand the hearts position in the chest plays some part into it fusing to your sternum. I do know of one beautiful child, whose surgeon didn't realize his heart was fused to his sternum and the surgeon cut it opening his chest sending air to his brain, it was awful and why I asked so many questions about opening Justin's chest knowing his heart was fused to his sternum for his 4th and 5th OHS (his 1st 3 didn't have the problem) when we were interviewing surgeons.
Just one more reason why I pray percutaneous valve replacements do well.

 

[tobagotwo]

It's mostly just the use of terms.

There's a big difference between having some sternal adhesions and having your hear fused to your sternum. Those conditions, while theoretically related, are not at all synonymous. Having a heart or a major coronary artery actually fused to the sternum does indeed present a danger and a challenge. And the heart's position in the chest, the size of the other thoracic organs, and the depth of the ribcage could certainly be contributing factors.

But an adhesion can be a scar tissue link from the pericardium to the sternum that spans a gap and actually holds the two apart, rather than close together. It can be small or large, and in terms of most valve surgery, is usually insignificant to the person's activities after healing or opening his or her chest the next time.

The proof is in the pudding. Look at the many, highly athletic people we have on the forum, competing in triathalons and Iron Man competitions. Look too at the highly successful statistics for secondary and tertiary surgeries, and the rapidly increasing success rates, now approaching initial surgery risk in several studies.

Best wishes,