Diagnosis and Observational Management of a Postoperative Interventricular Septal Hematoma in a Pediatric Patient

Abstract

Graphical abstract

Extracorporeal membrane oxygenation as a novel management strategy for interventricular septal hematoma following ventricular septal defect repair

“…The true incidence of IVSH after VSD repair is unknown, with approximately 17 cases reported in the literature. [1][2][3][4][5][6][7][8][9][10][11][12] See Table 2 for a summary of cases with interventricular septal hematoma post-VSD repair published in the literature. The etiology of IVSH is unclear; however, it has been speculated that septal perforator trauma during placement of the VSD patch may cause subendocardial bleeding, often accompanied by signs of myocardial infarction.…”

Interventricular Septal Hematoma Complicating Ventricular Assist Device Placement in an Infant: Case Report and Review of the Literature

“…This complication is commonly associated with ventricular septal defect repair 1 and may be due to injury to the septal perforator artery, which courses across the lower border of the anterior limb of the septomarginal trabeculation and terminates at the base of the medial papillary muscle of the tricuspid valve. 5 However, this complication has also been reported in cases where the septal perforator is theoretically not at risk. Microvascular sheering from surgical trauma, high cardioplegia perfusion pressure, and high preoperative right ventricular pressure has also been implicated.…”

“…IVSH is a rare and potentially lethal complication of pediatric cardiac surgery, with 36 cases reported in the literature since the initial report by Drago and colleagues in 2005. [1][2][3][4][5][6][7][8][9][10][11][12] The IVSH can cause ventricular outflow tract obstruction, arrhythmias, ventricular dysfunction, and myocardial rupture leading to hemodynamic compromise. This complication is commonly associated with ventricular septal defect repair 1 and may be due to injury to the septal perforator artery, which courses across the lower border of the anterior limb of the septomarginal trabeculation and terminates at the base of the medial papillary muscle of the tricuspid valve.…”

Interventricular Septal Hematoma after Congenital Cardiac Defects Repair at a Single Institution

“…It was first reported after patch closure of VSD in 2005. Since then, a few cases of IVSH have been reported [2][3][4][5][6][7][8][9][10][11][12][13]. Here we present our own series of five cases and discuss its etiology, management and prognosis.…”