Acute Type A Aortic Dissection After Sternal Bone Marrow Puncture

Sternal Bone Marrow Harvesting and Culturing Techniques from Patients Undergoing Cardiac Surgery

“…The collection of bone marrow using a surgical curettage or a blunt-tip syringe from an open sternum bypasses the ethical challenge of causing additional risk to the patient, as they are already scheduled to undergo cardiac surgery. Biopsy or collection of bone marrow from sternums via aspirations in humans have been described previously as an alternative to iliac crest aspirations [ 26 , 28 , 29 ]; however, the possibility of serious complications such an aortic dissection [ 30 ] and pericardial tamponade [ 31 ] have limited this practice to experienced clinicians. It was also reported to induce significant anxiety and pain among patients [ 32 ].…”

A safe area for sternal puncture in children: an MSCT study based on sternal development

“…Due to the distinct individual difference in sternum shape, it can be compared with the image of the deceased to confirm their gender [ 11 , 12 ]. Complete fusion of each segment of the sternum is usually completed at the age of 25 years [ 7 , 13 ]. In this study, complete fusion of the mesosternum mostly occurred in the 15–20 age group, and ossification of segment IV and xiphoid process varied greatly among individuals [ 7 , 13 ].…”

“…Complete fusion of each segment of the sternum is usually completed at the age of 25 years [ 7 , 13 ]. In this study, complete fusion of the mesosternum mostly occurred in the 15–20 age group, and ossification of segment IV and xiphoid process varied greatly among individuals [ 7 , 13 ]. In this study, unossification of segment IV was the most common, with an incidence of 45.7%, its most common adjacent tissue was pericardium (67.9%), followed by lung tissue (31.4%).The presence of section III unossified tissue was in 2.5% of children, its common adjacent tissues were lung tissue (46.7%) and pericardium (40.0%).…”

“…If it is too shallow, it cannot penetrate the sternum; if it is too deep, it may penetrate the sternum and enter the posterior sternum tissue, causing damage to the internal organs in the chest [7][8][9]. One case of acute A-type aortic dissection after sternal puncture was reported in the literature [7], and one case of sternal puncture with a 90 mm puncture needle through the second and third intercostals was reported in the literature, and aneurysm ruptured due to the penetration of the weak sternal puncture needle through the sternum, resulting in the death of the patient [9]. Bone marrow aspiration needles are available in different types and sizes with replaceable safety plugs.…”

“…However, there are many developmental changes in the sternum in children, such as the ossification centers have not been ossified, and there are still gaps between ossification centers because they have not been fused. If these developmental changes are ignored, there are potential risks of cardiac tamponade, pneumothorax and mediastinal emphysema caused by needle puncture into the sternal tissue [7][8][9]. Therefore, it is necessary to correctly understand the development and ossification characteristics of the sternum in children, and to know the thickness of the sternum and subcutaneous soft tissue as well as the posterior adjacent tissues of the sternum.…”