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A Mediastinal Hematoma after the Bentall Operation Detected by Transthoracic Echocardiography.

ABSTRACT: A round, well-defined mass was incidentally detected at follow-up transthoracic echocardiography in an asymptomatic 36-year-old man with a history of Bentall operation 8 months earlier. Computed tomography angiography of the aorta demonstrated a mediastinal hematoma below the pulmonary artery in the mid-mediastinum. Although mediastinal hematomas are hard to detect after cardiac surgery via transthoracic echocardiography, the probable presence of this complication should be kept in mind during echocardiography.

SUBMITTER: Hosseinsabet A

PROVIDER: S-EPMC8388318 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundInterventricular 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 presentationTransesophageal 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.ConclusionsWe 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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A Mediastinal Hematoma after the Bentall Operation Detected by Transthoracic Echocardiography.

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