Evolution of Interventricular Septal Hematoma: Echocardiographic Diagnosis

Akam‐Venkata, Jyothsna; Lemler, Matthew S.; Pirolli, Timothy J.; Thankavel, Poonam P.; Ikemba, Catherine

doi:10.1016/j.case.2020.10.003

Cited by 5 publications

(9 citation statements)

References 16 publications

(22 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Mongé

Kalb

Ramlogan

et al. 2023

World J Pediatr Congenit Heart Surg

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Interventricular septal hematoma is a rare and life-threatening complication of pediatric cardiac surgery. Commonly seen following ventricular septal defect repair, it has also been associated with ventricular assist device (VAD) placement. Although conservative management is usually successful, operative drainage of interventricular septal hematoma occurring in pediatric patients undergoing VAD implantation should be considered.

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Section: Discussionmentioning

confidence: 99%

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

Mongé

Kalb

Ramlogan

et al. 2023

World J Pediatr Congenit Heart Surg

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“…Treatment options range from open surgical repair to needle aspiration to support with extracorporeal membrane oxygenation as a bridge to hematoma resolution. 14 The mortality rate without emergent surgical repair is as high as 78%, due to progression secondary to further avulsion of vessels and reduced perfusion of the IVS. 15 The natural course of IVSH varies from complete resolution within 6 to 12 weeks 2 to remaining unchanged in size.…”

Section: Discussionmentioning

confidence: 99%

“…Notable complications are septal rupture, VSD formation, conduction abnormalities, biventricular dysfunction, LV/RV outflow obstruction, abscess formation, pericardial tamponade, cardiogenic shock, and death. 5,14…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Interventricular Septal Hematoma After Left Ventricular Assist Device Implantation: Role of Transesophageal Echocardiogram in Diagnosis and Management

Arain,

Singh

2023

A&A Practice

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Interventricular septal hematoma (IVSH) is a rare complication after cardiac surgical procedures. We describe a case of a left ventricular assist device (LVAD) implantation, in which an IVSH causing LVAD-flow obstruction was diagnosed with intraoperative transesophageal echocardiogram (TEE), leading to urgent surgical management of the IVSH.Written consent and Health Insurance Portability and Accountability Act authorization were obtained from the patient in the writing of this article.

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“…The septal perforating branch passes toward the base of the medial papillary muscle and outlet septum of the right ventricle (RV) from the superior interventricular artery. In a perimembranous VSD, the septal perforating arteries are near the anterior-superior margin of VSD [7,8] (Fig. 6).…”

Section: Discussionmentioning

confidence: 99%

Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report

2021

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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.

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Evolution of Interventricular Septal Hematoma: Echocardiographic Diagnosis

Cited by 5 publications

References 16 publications

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

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

Rare Case of Interventricular Septal Hematoma After Left Ventricular Assist Device Implantation: Role of Transesophageal Echocardiogram in Diagnosis and Management

Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report

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