Fig. 1

Real-time cine images of a patient with previous tetralogy of Fallot repair with transannular patch. The arrow points to the attachment of the RVOT to the posterior aspect of the sternum. On the left, during deep inspiration, the sternum and RVOT maintain the same position as on expiration (right). Furthermore, during inspiration the RVOT appears deformed and elongated. This suggests that the RVOT is adhered to the sternum by dense adhesions, limiting independent movement