cular rupture after sternal dehiscence following coronary artery bypass

‘Spontaneous right ventricular rupture after sternal dehis-cence following coronary artery bypass grafting ’ [2]. Dr Al-Although that study has demonstrated significantly better Letters to the Editor / European Journal of Cardio-thoracic Surgery 36 (2009) 603—607 605and had a difficult respiratory wean owing to poor preopera-tive pulmonary function tests. On day 4, it was found that the patient’s sternum was unstable, but without any evidence of deepmediastinitis.Onday 8, itwasnoticed thathehad signs of hypovolaemia with decreasing haemoglobin. An echocardio-gramandcomputed tomography (CT) scanwasdone to ruleout any collection. This revealed that, in fact, one of the sternal wires was broken and was pointing posteriorly, causing a ‘spontaneous ’ rupture of the right ventriclewith a consequent retro-sternal haematoma and a haemorrhagic collection in the left pleura,whichwas openedearlier during the initial surgery. The patient was taken to the operation theatre and a ‘spontaneous ’ perforation was found in the right ventricle, whichwas then successfully repaired. Aswecan see, the initial injurywas not induced in anywaybutwasmainly due tobroken sternal wires. Unfortunately, the patient died 4 days later, succumbing to multi-organ failure.The paEbrahim mentions that he thinks that this injury is induced rather than spontaneous. We disagree with that statement because although the injury did not present with the typical picture of exsanguination and shock similar to the patient Dr Al-Ebrahim mentioned in his letter, the injury of the right ventricle in our case was also spontaneous. tient had a coronary artery bypass grafting (CABG)emphasises the concept of a proper sternal closure, especially in the elderly, following a coronary bypass where some patients may need reinforced sternal closure to avoid some of the dreadful, preventable complications of cardiac surgery caused by the sternal wound [2,3]