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The purpose of this paper is to discuss sternal instability a problem occasionally associated with midline sternotomy, including the etiology, predisposing conditions, diagnosis and management. Among the methods of repair, sternal weaving and pectoralis muscle advancement are thought to be especially effective.

Background-The downward movement of the aortic root during the cardiac cycle may be responsible for producing the circumferential tear observed in aortic dissections. Methods and Results-Contrast injections were investigated in 40 cardiac patients, and a finite element model of the aortic root, arch, and branches of the arch was built to assess the influence of aortic root displacement and pressure on the aortic wall stress. The axial displacement of the aortic root ranged from 0 to 14 mm. It was increased in patients with aortic insufficiency (22Ϯ13% of the sino-tubular junction diameter versus 12Ϯ9%) and reduced in patients with hypokinesis of the left ventricle (10Ϯ9% of sino-tubular junction versus 17Ϯ12%). The largest stress increase due to aortic root displacement was found approximately 2 cm above the sino-tubular junction, where the longitudinal stress increased by 50% to 0.32 Nmm Ϫ2 when 8.9-mm axial displacement was applied in addition to 120-mm Hg luminal pressure. A similar result was observed when the pressure load was increased to 180 mm Hg without axial displacement. Conclusions-Both

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