PMC5467313_01
CT angiography 6 years post-CABG demonstrating sternal closure with wire cerclage (short arrow) and Kryptonite bone cement (long arrows).
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In preparation for surgical aortic valve replacement (SAVR), CT angiography was performed revealing extensive heterotopic ossification along the posterior margin of the prior sternotomy (Figure 1).
An intraoperative image demonstrating the appearance of Kryptonite (arrow) as it is peeled away from the cut-edge of the sternum after sternotomy (a). Hematoxylin and eosin staining demonstrating Kryptonite (clear granular filled "spaces" within the fibroconnective tissue; black arrows) and foreign body type giant cells (red arrow; 20x) (b). Grocott silver staining highlighting the fibrillary structure of Kryptonite (10x) (c).
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The sternum was found to be stable and intact with good callous formation along its length (Figure 2(a)). The Kryptonite adhesive was visible as an opaque white solid material along the edges of the periosteum (Figure 2(a)) and was dissected away from the bone using DeBakey forceps and an oscillating saw. The Kryptonite was arranged in round and ovoid circumscribed clusters, occasionally surrounded by giant cells, which appeared to engulf the Kryptonite (Figure 2(b)). Silver staining highlighted the microscopic fibrillary structure of the Kryptonite (Figure 2(c)).