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Summary
A sterile calcified granuloma near a heart surgery site was found in a child. Surgical removal resolved the murmur, suggesting a reaction to silk sutures.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Surgical Pathology
Background:
- Ventricular septal defects are common congenital heart abnormalities requiring surgical repair.
- Silk sutures have been historically used in cardiac procedures but can elicit foreign body reactions.
Observation:
- A sterile calcified granuloma was identified on the external surface of a right ventriculotomy scar in an 8-year-old boy.
- The boy was asymptomatic four years post-ventricular septal defect closure.
- A systolic ejection murmur was noted pre-operatively.
Findings:
- The granuloma was successfully resected.
- The systolic ejection murmur resolved completely after the granuloma resection.
- A history of multiple silk suture sinuses in a prior thoracotomy incision suggested sensitivity to silk.
Implications:
- This case highlights a rare foreign body reaction to silk sutures presenting as a sterile granuloma years after cardiac surgery.
- Early recognition and surgical excision are crucial for symptom resolution.
- Consideration of alternative suture materials in pediatric cardiac surgery may be warranted to prevent such late complications.