A case of intraoperative subadventitial hematoma during minimally invasive cardiac surgery

Abstract

　Iatrogenic aortic dissection induced by an aortic clamp during cardiac surgery is rare but can lead to severe complications. Herein, a case of intraoperative subadventitial hematoma (SAH) during minimally invasive cardiac surgery has been reported. Transesophageal echocardiography (TEE) revealed a widespread circumferential hematoma extending from the ascending aorta to the descending aorta. However, TEE could not distinguish between SAH and intramural hematoma due to the atypical presentation of SAH. Following an emergent median sternotomy under total circulatory arrest, SAH was identified. The suspected cause of SAH was an injury to the ductus arteriosus caused by the aortic cross clamp. Ascending aortic replacement and mitral valve replacement were performed. The definitive diagnosis of SAH was confirmed based on pathological findings. Although TEE could not provide a definitive diagnosis of SAH, it was crucial in guiding the decision to perform ascending aortic replacement.