Journal of Pediatric Cardiology and Cardiac Surgery

We present a 5-month-old girl who had interventricular septal hematoma (IVSH) after repair of ventricular septal defect. Intraoperative transesophageal echocardiogram showed that a giant hematoma occupied the interventricular septum immediately after coming off cardiopulmonary bypass. The patient was conservatively treated because hemodynamics was stable. Subsequently, the IVSH disappeared 3 weeks after the surgery. Follow-up cardiac catheterization 1 year after the operation showed normal coronary arteries including septal branches, but left ventricular function remained impaired. Transthoracic echocardiogram demonstrated thinning of the ventricular septum and hypokinetic motion of the septal wall. Myocardial perfusion scintigraphy and cardiac magnetic resonance demonstrated myocardial infarction in the mid-septal area consistent with the resolved IVSH. This suggested atypical ischemic cardiomyopathy. At the last follow-up (2 years after surgery), she has no symptoms of cardiac failure on oral administration of β-blocker, angiotensin-converting enzyme inhibitors, and diuretics for ventricular dysfunction. Patients with IVSH should be carefully followed even after hematoma disappeared.