Atrial septal hematoma: after minimally invasive aortic valve replacement.

Interatrial septal hematoma is a very rare complication after mitral valve surgery. Unusually, it is the result of aortic valve disease, including aortic dissection. We report a case wherein interatrial septal hematoma followed minimally invasive aortic valve replacement in a 68-year-old woman. The hematoma was recognized upon intraoperative transesophageal echocardiography, but there was no evidence of accompanying aortic dissection. The interatrial septal hematoma was at first drained by needle, but recurrence prompted reoperation and plication of the interatrial septum. Finally, the hematoma resolved after correction of the coagulopathy. Catheter injury to the coronary sinus exacerbated by the retrograde administration of cardioplegic solution is thought to have caused the origin of the interatrial septal dissection.