Dissecting Intramyocardial Hematoma After Robotic Mitral Valve Repair

Intramyocardial dissecting hematoma: Two case reports and a meta‐analysis of the literature

“…Mean age was 60, 28 men and 12 women. Thirty-two developed intramyocardial dissecting hematoma after myocardial infarction, in 8 patients intra myocardial dissecting hematoma developed following trauma, 5,6 during percutaneous coronary angioplasty, 7 during ablation of ventricular tachycardia, 8 and as a complication of cardiac surgery: mitral valve surgery [9][10][11] and coronary artery bypass grafting. 12 Anterior myocardial infarction [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] , and 2 our cases occurred in most patients with MI 66%.…”

Interventricular Septal Hematoma Associated with Surgical Mitral Valve Repair in Four Dogs

“…In these reports of IVSH following MVR in humans, suspected etiologies included damage to the left atrium during retraction, damage to the interatrial or IVS during venous cannulation, and damage to the right trigone during mitral annuloplasty. 5 This type of interoperative damage (which occurred during robotic surgery with no tactile sensation) seems unlikely in the dogs reported here. There was careful manipulation of the cardiac structures during retraction, and venous cannulation was performed in the right auricle, with care taken to prevent damage to the surrounding area.…”

“…3,4 There are a handful of reports of hematoma formation following mitral valve surgery in humans, in both the free wall and the IVS. 5,6 The etiology is likely different from VSD repair, as surgical damage of the septum at the ventricular level seems less likely. In MVR, during artificial chord placement in dogs, the needle enters the tip of the papillary muscle but was not intentionally inserted into the IVS in any of the cases reported here, although damage to the IVS as the needle is manipulated inside the ventricle could not be ruled out.…”

“…Injury of the right trigone during mitral annuloplasty was also suspected and remains a possibility in these dogs. 5 Damage to the coronary artery (i.e., septal branch in dogs) could also occur as a result of excessive cardioplegia perfusion pressure, inadequate myocardial protection, or reperfusion injury. 5,7 Cardioplegia pressures were unremarkable during these cases, and there was successful cardiac quiescence with a standard cardiac ischemic time (67-88 min), making these causes also unlikely.…”

“…5 Damage to the coronary artery (i.e., septal branch in dogs) could also occur as a result of excessive cardioplegia perfusion pressure, inadequate myocardial protection, or reperfusion injury. 5,7 Cardioplegia pressures were unremarkable during these cases, and there was successful cardiac quiescence with a standard cardiac ischemic time (67-88 min), making these causes also unlikely. Despite review of the human literature, it is therefore not possible at this stage to hypothesize the exact cause of the development of IVSH in dogs undergoing MVR.…”