Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report
Abstract Background Interventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interve...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-021-00552-4 |
| _version_ | 1818661667231236096 |
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| author | Young-Eun Jang Jin-Tae Kim Ji-Hyun Lee |
| author_facet | Young-Eun Jang Jin-Tae Kim Ji-Hyun Lee |
| author_sort | Young-Eun Jang |
| collection | DOAJ |
| description | Abstract Background Interventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interventricular septal hematoma that was accidentally found in an infant following ventricular septal defect (VSD) closure. Case presentation Transesophageal echocardiography images were acquired from a 1-month-old boy after surgical repair of a large (6.5 mm) perimembranous outlet VSD with interventricular septal flattening. Surgical correction was performed with auto-pericardium and 7–0 Prolene sutures. The patient was successfully weaned from cardiopulmonary bypass, and transesophageal echocardiography showed no VSD leakage and good ventricular function. However, approximately 30 min later, two anechoic masses were found within the interventricular septum, which were suspected to be interventricular septal hematomas; the larger mass measured 1.51 $$\times $$ × 1.48 cm. The swollen interventricular septum showed decreased contractility and compressed both the right and left ventricles. However, there was no change in the size of hematomas or a significant hemodynamic instability for 30 min of observation. Therefore, expecting spontaneous resolution of the hematomas, the interventricular septum was not explored, and the patient was removed from cardiopulmonary bypass. On postoperative day 4, follow-up transthoracic echocardiography revealed thrombi filling the hematomas. The patient was discharged on postoperative day 15 and followed up with regular echocardiographic evaluations. Conclusions We describe a unique case of interventricular septal hematoma after VSD closure. Surgical manipulation of perimembranous VSD and injury of the septal perforating artery may contribute to the development of an interventricular septal hematoma. Moreover, conservative treatment and serial echocardiographic evaluation generally show gradual hematoma resolution in hemodynamically stable patients. Pediatric cardiac anesthesiologists should be aware of this rare complication after VSD repair. |
| first_indexed | 2024-12-17T04:48:42Z |
| format | Article |
| id | doaj.art-a843b6b67ca649feba83661bfee144f4 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-12-17T04:48:42Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-a843b6b67ca649feba83661bfee144f42022-12-21T22:02:59ZengBMCEuropean Journal of Medical Research2047-783X2021-08-012611710.1186/s40001-021-00552-4Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case reportYoung-Eun Jang0Jin-Tae Kim1Ji-Hyun Lee2Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineAbstract Background Interventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interventricular septal hematoma that was accidentally found in an infant following ventricular septal defect (VSD) closure. Case presentation Transesophageal echocardiography images were acquired from a 1-month-old boy after surgical repair of a large (6.5 mm) perimembranous outlet VSD with interventricular septal flattening. Surgical correction was performed with auto-pericardium and 7–0 Prolene sutures. The patient was successfully weaned from cardiopulmonary bypass, and transesophageal echocardiography showed no VSD leakage and good ventricular function. However, approximately 30 min later, two anechoic masses were found within the interventricular septum, which were suspected to be interventricular septal hematomas; the larger mass measured 1.51 $$\times $$ × 1.48 cm. The swollen interventricular septum showed decreased contractility and compressed both the right and left ventricles. However, there was no change in the size of hematomas or a significant hemodynamic instability for 30 min of observation. Therefore, expecting spontaneous resolution of the hematomas, the interventricular septum was not explored, and the patient was removed from cardiopulmonary bypass. On postoperative day 4, follow-up transthoracic echocardiography revealed thrombi filling the hematomas. The patient was discharged on postoperative day 15 and followed up with regular echocardiographic evaluations. Conclusions We describe a unique case of interventricular septal hematoma after VSD closure. Surgical manipulation of perimembranous VSD and injury of the septal perforating artery may contribute to the development of an interventricular septal hematoma. Moreover, conservative treatment and serial echocardiographic evaluation generally show gradual hematoma resolution in hemodynamically stable patients. Pediatric cardiac anesthesiologists should be aware of this rare complication after VSD repair.https://doi.org/10.1186/s40001-021-00552-4Cardiopulmonary bypassEchocardiography,Transesophageal echocardiographyHematomaPediatricVentricular septal defect |
| spellingShingle | Young-Eun Jang Jin-Tae Kim Ji-Hyun Lee Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report European Journal of Medical Research Cardiopulmonary bypass Echocardiography, Transesophageal echocardiography Hematoma Pediatric Ventricular septal defect |
| title | Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report |
| title_full | Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report |
| title_fullStr | Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report |
| title_full_unstemmed | Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report |
| title_short | Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report |
| title_sort | interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant a case report |
| topic | Cardiopulmonary bypass Echocardiography, Transesophageal echocardiography Hematoma Pediatric Ventricular septal defect |
| url | https://doi.org/10.1186/s40001-021-00552-4 |
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