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.

A right aortic arch with aberrant left innominate artery is a rare vascular ring. There have been no successful surgical reports of extremely low-birth weight infants with this anomaly. A 1-month-old girl weighing 0.9 kg was referred to our hospital for surgical treatment of a patent ductus arteriosus. Echocardiography and three-dimensional reconstruction of enhanced chest computed tomography indicated right aortic arch with aberrant left innominate artery encircling the esophagus and the trachea. Transection of the duct, but not clipping, was successfully performed, and the postoperative course was uneventful. This report describes the first successful surgical case of an extremely low-birth weight infant with the very rare vascular ring.

Infected splenic artery aneurysm (SAA) is a rare but serious complication associated with infective endocarditis or endarteritis (IE), which could cause sudden death due to aneurysm rupture. In some occasions, surgical or endovascular treatment is urgently required to prevent rupture. No recommended therapeutic strategy has been established in children with infected SAA, since only a few pediatric patients have been reported. Here, we report a case in which we detected a 10 mm SAA due to IE in a 10-year-old patient with familial supravalvular aortic stenosis. The patient had not been on any antibiotics before visiting our hospital; being afebrile and complaining pain in his extremities. Transthoracic echocardiography revealed multiple vegetations in the aortic arch. Blood culture results indicated the presence of Abiotrophia defectiva. Multiple embolisms were detected in his spleen and both kidneys on abdominal contrast-enhanced computed tomography (CT). After surgery to remove those vegetations, penicillin therapy was continued. A SAA was noted serendipitously on follow-up contrast CT. We successfully coil-embolized the SAA on a semi-urgent basis; no rupture of the aneurysm nor recurrence of IE. This report documents IE due to Abiotrophia defectiva causing an arterial aneurysm, e.g. at the splenic artery, and suggests a treatment option for pediatric SAA.