Lipomatous hypertrophy of the interatrial septum: indication for surgery?

Abstract

A fortuitous finding during open heart surgery of lipomatous hypertrophy of the interatrial septum is described in a 65-year old man with ischaemic heart complaints due to coronary artery disease and with premature ventricular contractions. An incision biopsy confirmed the diagnosis. The choice of treatment of lipomatous hypertrophy of the interatrial septum is controversial. Indications for surgery and surgical techniques are discussed.

Lipomatous Hypertrophy of the Interatrial Septum With Cutaneous Lipomatosis

“…Only in rare cases is an interatrial mass large enough to produce altered hemodynamics and congestive heart failure and severe rhythmic disorders, in which case surgical correction should be considered, depending on the growth and size of tumor and its relation to the great vessels. 12,13 Besides LHIS, diffuse lipomatosis is a rare condition defined as a diffuse overgrowth of mature fat affecting a large portion of an extremity or portions of the trunk. 14 Two disease types are recognized: in 1, disease usually begins in infant under 2 years of age, but in some cases it becomes apparent in adult.…”

Lipomatous Hypertrophy of the Interatrial Septum

“…So it is said Ôwhat is outside the heart is inside the heart'. LHIS is usually an incidental finding and mostly asymptomatic, however, it can be associated with atrial arrhythmias, altered P-wave configurations, chronic pulmonary disease, recurrent pericardial effusions; sudden cardiac death is also reported [1,7]. LHIS presents with characteristic features in imaging studies.…”

“…In the setting of LHIS, operative intervention should be limited to patients with severe superior vena cava or right atrium obstruction or severe rhythm disorders necessitating surgical removal. If complete excision is attempted, reconstruction of the interatrial septum, with either pericardium or Dacron, must be undertaken [5,7,9,12,13].…”

Intracardiac Echocardiography-Guided Biopsy of a Lipomatous Cardiac Tumor Arising From the Interatrial Septum

“…Histology indicated traces of adipose tissue without any atypia among the trapped myocardial fibers, suggesting lipomatous hypertrophy of the interatrial septum (LHIS; Figure 2D). 1 Surgery was not carried out for the cardiac tumor because the tumor did not affect cardiac function. Six months after the biopsy, transthoracic echocardiography and MRI showed no change in cardiac tumor size, and the patient had no symptoms.…”