Case presentation
A 3‐month‐old female infant presented to our hospital with one month
history of dyspnea.Transthoracic echocardiography demonstrated a large
tumor mass(50mm×42mm) originated from the interventricular septum and
filled the bilateral ventricular chambers(Figure 1). The patient
underwent surgical resection of the tumor via the median sternotomy
under cardiopulmonary bypass(CPB). During the operation, we found the
tumor infiltrated the myocardium and the border between the tumor and
the myocardium was unclear.
Eventually we completely resected the tumor including part of
myocardium. Interventricular septum was repaired with a bovine
pericardium patch. The patient was weaned from the CPB and a
postoperative transthoracic echocardiography confirmed no residual tumor
and good ventricular function. Pathological examination revealed
fibrosarcoma.
At one month follow up
transthoracic echocardiography
revealed a cystic dissection(43mmx32mm) located in the interventricular
septum(Figure 2).This cystic dissection connected to the left ventricle
through a 4.5mm defect,and to the right ventricle through several small
holes of its thin walls(Figure 3,Movie S1).We defined this case as
ventricular septal intramyocardial cystic dissection
with residual shunts within the
ventricular chambers due to the separation of myocardial layers and
communication with ventricular
chambers after operation. we performed conservative
strategy, because of the high
surgical risk, difficulty of interventional therapy and hemodynamic
stability. At 9 months of follow-up, transthoracic
echocardiography demonstrated the
original cystic dissection was slightly reduced and the shunts between
the cystic dissection and right
ventricle disappeared. There was bidirectional shunt between the cystic
dissection and left ventricle through the defect(Figure 4,Movie S2).The
patient was asymptomatic and cardiac function was good. We continue to
follow up the patient.