Postoperative interventricular septal haematoma following tetralogy of Fallot repair and perimembranous ventricular septal defect repair

Abstract

Interventricular septal haematoma is a rare postoperative complication in congenital heart surgery. We present one case of a 6-month-old after tetralogy of Fallot repair and 1 case of a 10-month-old after ventricular septal defect repair. Both were noted to have interventricular septal haematoma on intraoperative transoesophageal and postoperative echocardiogram. Although multiple previous reports, mainly in adults, have suggested aggressive intervention, both these cases were managed conservatively, highlighting the management and evolution of a rare postoperative complication in the paediatric population.

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.…”

Evolution of Interventricular Septal Hematoma: Echocardiographic Diagnosis

“…In the pediatric literature, IVSH has been reported following procedures such as isolated VSD closure, VSD closure along with repair of interrupted aortic arch, coarctation of aorta, transposition of great arteries, and repair of tetralogy of Fallot as well as after relief of pulmonary atresia/critical pulmonary stenosis with intact ventricular septum. [5][6][7][8][9][10] The etiology is speculated to be due to the insult to the septal perforator branches of the left anterior de-scending artery during the placement of the VSD patch, specifically the first septal perforator branch, which is in close proximity to the anterior rim of the VSD. This results in subendocardial bleeding, and further expansion of the hematoma occurs due to anticoagulation.…”

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

“… 8 presented one case and reviewed similar pediatric case reports; other recent reports in addition to our case give a total of 16 cases reported thus far in the literature. 9 , 10 , 11 , 12 …”