Defect closure in the lipomatous hypertrophied atrial septum with the amplatzer muscular ventricular septal defect closure device: A case series

Abstract

Variations in the anatomy of the atrial septum can confound the transcatheter closure of atrial septal defects and patent foramen ovale. While lipomatous hypertrophy of the atrial septum is not frequently encountered, attempts to use standard atrial septal occlusion devices in such patient can lead to malapposition and continued shunt. Some operators have suggested that atrial septal hypertrophy is a relative contraindication to transcatheter-based closure techniques. We present a novel technique exploiting the features of the Amplatzer muscular ventricular septal defect occluder to treat atrial septal defects in the setting of lipomatous hypertrophy of the atrial septum in two patients.

Traumatic pulmonary arteriovenous fistula may be misdiagnosed with residual shunt after patent foramen ovale closure

“…An excessively thick septum will limit the ability of the closure device to straddle the interatrial septum and will predispose it to inappropriate seating and residual shunting 1. The use of a usual device for our patient, in combination with inappropriate positioning of the device, was first mistakenly deemed to have complicated the case.…”

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

“…Interatrial septal thickening can occur on either side of the septum with the greatest thickness usually superior to and sparing the fossa ovalis . Criteria for diagnosing LHIS includes septal thickness between 15 and 20 mm (more commonly 20 mm) although the septal thickness range is highly variable and has been observed up to 150 mm . LHIS occurs in the age range of 22–91 years (average age at diagnosis of 70 years old) .…”

“…Criteria for diagnosing LHIS includes septal thickness between 15 and 20 mm (more commonly 20 mm) although the septal thickness range is highly variable and has been observed up to 150 mm . LHIS occurs in the age range of 22–91 years (average age at diagnosis of 70 years old) . LHIS has an association with obesity and has a higher incidence in women .…”

“…LHIS is almost always restricted to the IAS and imaging of LHIS shows a pathognomonic “dumbbell” shape (Fig. ) due to hypertrophy of the septum primum and septum secundum without affecting the fossa ovalis . A classic ECG finding has been reported in which an abnormal P‐wave configuration in leads II, III, and aVF leads to a “dome and dip” pattern, which can be seen in a minority of patients presumably due to fat deposition in the septum .…”

“…Rarely, LHIS can be diffuse with intra‐cavitary or intramural extensions into the heart chambers . The symptoms of LHIS include the following: a variety of atrial arrhythmias including supraventricular arrhythmias, conduction disturbances (AV block), heart failure, altered hemodynamic cardiac function, recurrent pericardial effusions, congestive heart failure, and rare unexpected sudden cardiac death . Histology of LHIS shows an unencapsulated lesion of mature fat cells, and fat cells that resemble brown fat cells (fetal fat cells) interspersed throughout cardiomyocytes that are often hypertrophied with oddly shaped nuclei without mitosis present .…”