Case report : Post-Operative mitral valve replacement complicating with a large cardiac mass and role of TEE in decision making
Description
Post operative complications are elements of valve surgery which requires early detection. However, these complications are likely to worsen hemodynamic stability requiring quick assessment and management. TTE and TEE imaging are diagnostic modality of choice in detection of cardiac complications. Echocardiography is indicated if there is suspicion based on the onset of new symptoms like new onset of murmur, breathlessness or fever. Therefore patients undergoing valve replacement require careful follow up even when the symptoms do not manifest. Unlike the abovementioned complications, this case had an unusual presentation of hematoma that extrinsically compressed the right atrium with no evidence of pericardial tamponade. Hence we believe a thorough echocardiographic examination through multiple windows postoperatively is essential. The hematoma surrounding the RA was difficult to be distinguished as intrapericardial/extracardiac hematoma from adjacent tissues on TTE which required TEE as guidance for surgeons on table thereby minimizing anticoagulation and need of CPB. This case report provides insights into the importance of TEE and its utility both operatively and postoperatively, aiding surgeons in resolving this dilemma and considering appropriate management. Hence, we believe that TEE-guided re-exploration has enormously guided surgeons in making notable decisions.