Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehakno, Jongnogu, Seoul, 110-744, Republic of Korea.
Eur J Med Res. 2021 Aug 25;26(1):97. doi: 10.1186/s40001-021-00552-4.
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.
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 [Formula: see text] 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.
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.
室间隔血肿是先天性心脏手术后一种极为罕见的并发症。在心脏手术中，只能通过术中经食管超声心动图检测到室间隔血肿。在这里，我们报告了一例有趣的室间隔血肿病例，该血肿是在一名婴儿行室间隔缺损（VSD）修补术后意外发现的。
一名 1 个月大的男孩，因大型（6.5mm）膜周流出道 VSD 接受了外科修复术，术中发现室间隔变平，随后进行了经食管超声心动图检查。手术采用自体心包和 7-0 prolene 缝线进行修补。患者成功脱离体外循环，经食管超声心动图显示无 VSD 渗漏和良好的心室功能。然而，大约 30 分钟后，在室间隔内发现两个无回声肿块，疑似室间隔血肿；较大的肿块大小为 1.51 [公式：见文本] 1.48cm。肿胀的室间隔收缩力下降，两侧心室均受压。然而，在 30 分钟的观察期间，血肿大小没有变化，也没有出现明显的血流动力学不稳定。因此，我们预计血肿会自行溶解，未对室间隔进行探查，并将患者从体外循环中撤出。术后第 4 天，经胸超声心动图显示血栓填充血肿。术后第 15 天患者出院，并进行定期超声心动图评估。
我们描述了一例 VSD 修补术后室间隔血肿的独特病例。室间隔肌部 VSD 的外科操作和间隔穿通动脉的损伤可能导致室间隔血肿的发生。此外，在血流动力学稳定的患者中，保守治疗和连续超声心动图评估通常显示血肿逐渐溶解。儿科心脏麻醉医生应该意识到这种 VSD 修补术后罕见的并发症。
