Lipomatous Hypertrophy of the Inter-Atrial Septum and Stroke

Abboud, Halim; Brochet, Éric; Amarenco, Pierre

doi:10.1159/000079740

Cited by 6 publications

(3 citation statements)

References 2 publications

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“…As we all know, most cases of LASH are benign; nevertheless, patients with significant hypertrophy may develop obstruction of right atrial filling, dyspnea, or symptoms similar to congestive heart failure ( 15 ). A massive LASH larger than 20 mm may alter the nearby atrial musculature, leading to disturbed atrial conduction, resulting in arrhythmias ( 16 – 18 ). Heyer et al ( 19 ) and Breuer et al ( 6 ) reported that the obstruction of the right atrium by massive septal hypertrophy potentially requires surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report

Yu,

Ding,

Chen

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD, and follow-up.Case summaryA 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imaging revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography showed a “dumbbell”-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with a brightness feature is an uncommon condition characterized by the deposition of unencapsulated fat cells in the atrial septum. Real-time four-dimensional transesophageal echocardiography reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. Cardiac computer tomography angiography later confirmed this finding. The patient achieved a good clinical response with an ASD percutaneous occlusion guided by intracardiac echocardiography (ICE).ConclusionThis case demonstrates a LASH combined with ASD. Multimodality imaging can provide an accurate diagnosis and may guide the procedure for precise occlusion.

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Section: Discussionmentioning

confidence: 99%

Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report

Yu,

Ding,

Chen

et al. 2023

Front. Cardiovasc. Med.

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“…In one particular series of 28 patients identified by multi‐slice CT, the median thickness of the septum was 35 mm (range 20–62 mm, although inclusion criterion was >20 mm atrial septal hypertrophy) [4]. Although lipomatous hypertrophy of the atrial septum has been reported to be associated with atrial fibrillation and other atrial arrhythmias [4, 6, 8, 9], both older age and obesity are thought to contribute to lipomatous hypertrophy of the atrial septum, and both are risk factors for the development of atrial fibrillation. As such, a systematic multivariate analysis would be required to elucidate the contribution of atrial septal hypertrophy to the development of atrial arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

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

Lin¹,

Balzer²,

Lasala³

2011

Cathet Cardio Intervent

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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.

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“…They have to be differentiated from lipomatous hypertrophy, usually localized in the atrial septum 9 and sometimes associated with atrial septal defects and with stroke on a few occasions. [10][11] The tumors arising from the right atrium present with constitutional symptoms, right heart failure, arrhythmias, syncope or ischemic heart symptoms. 12 To our knowledge, stroke has been related to right atrial tumors only in three cases: in a primary cardiac lymphoma, 13 in a cardiac hemangioma 14 and in a myxoma, 15 two of them coexisting with PFO.…”

Section: Brief Communicationsmentioning

confidence: 99%

Anterior Thalamic Infarction as Initial Manifestation of a Right Atrial Lipoma

Erro

Ajuria

Olaz

et al. 2009

Can. J. Neurol. Sci

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Cardiac tumors are an infrequent source of embolism to the brain in young adults. Myxomas are the most common among them and they are mainly located in the left atrium.1 Cardiac lipomas are a very rare benign neoplasm of the heart usually located in the right atrium.2,3 Its etiological relationship with stroke is not well established. We describe the case of a thalamic stroke probably caused by paradoxical embolism from a right atrial lipoma through a patent foramen ovale. CASE REPORTA 46-year-old male with mild hypertension, presented with speech and behavioral alterations first noticed on awakening without a previous Valsalva manoeuvre. On admission his blood pressure was 150/90 mm Hg, with a pulse of 70 beats/min and O 2 saturation of 97%. He was apyretic and cardiac and cervical auscultation was unremarkable. On neurologic examination, a non-fluent dysphasia with word finding difficulties, right facial paresis and a left Horner's syndrome was observed. He also presented mild right hemiparesis and myoclonic-dystonic movements in lower limbs (NIHSS 7). Cervical and Transcranial Doppler (TCD) were normal. Cranial computerized tomography was normal. A cranial magnetic resonance (MR) demonstrated on diffusion sequences the presence of an acute non-hemorrhagic infarction involving the anterior area of the left thalamus ( Figure 1A). Perfusion MR sequences and cerebral magnetic angioresonance were normal. The patient was admitted to the stroke unit. Conservative treatment was initiated. No arrhythmia was registered during hospitalization. Duplex sonography excluded atherosclerotic lesions in the carotid arteries. The next day, a right to left massive shunt was found on TCD bubble study ( Figure 1B). This test was performed using agitated saline as a contrast agent. Thrombophilic screening, neoplastic markers and autoimmune assays were negative. Transthoracic and transesophageal echocardiograms (TEE) were performed showing a mobile mass of homogeneous density attached to the free wall of the right atrium ( Figure 1C). No other cardioembolic lesions such as aortic plaques or dysfunctional left ventricle were found. The mass could be optimally assessed by cardiac MR as a well defined, slightly lobulated and homogeneous lesion, strongly hyperintense on T1 sequences, with low signal intensity on Fat-suppressed sequences (T2 STIR) and without contrast enhancement after gadolinium administration ( Figure 1D), highly suggestive of a lipoma. A patent foramen ovale (PFO) without associated aneurysmal septum could also be seen on TEE. The mass and the foramen ovale were surgically removed THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 379

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Lipomatous Hypertrophy of the Inter-Atrial Septum and Stroke

Cited by 6 publications

References 2 publications

Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report

Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report

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

Anterior Thalamic Infarction as Initial Manifestation of a Right Atrial Lipoma

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