Lipomatous Hypertrophy Of The Interatrial Septum Research Articles

Combined surgery for lipomatous hypertrophy of the interatrial septum and pulmonary carcinoma

J Thorac Cardiovasc Surg 2002;123:564-6

Can cardiac magnetic resonance imaging reliably differentiate between benign and neoplastic fat?

Magnetic resonance imaging is currently frequently used to differentiate lipomatous hypertrophy of the interatrial septum from other cardiac lesions involving abnormal fatty tissue including lipomatous neoplasms. This report discusses potential problems with this approach by emphasizing the variable appearance of lipomatous hypertrophy of the interatrial septum on magnetic resonance imaging.

Echocardiography and excision of lipomatous hypertrophy of the interatrial septum

We present a case of massive lipomatous hypertrophy of the interatrial septum, in which transesophageal echocardiography was used to guide surgical resection. Tissue removal was undertaken without entering either the left or right atrium, thereby obviating the need for atrial septal reconstruction.

Surgical Treatment of Lipomatous Hypertrophy of the Interatrial Septum

We report a case of lipomatous hypertrophy of the interatrial septum in a patient with a recent syncopal episode and shortness of breath. Preoperative transesophageal echocardiography demonstrated a large tumor protruding from the interatrial septum. In addition, the patient was found to have significant coronary artery disease and a right internal carotid artery stenosis. The patient underwent successful resection of the mass with septal reconstruction, aortocoronary bypass, and right carotid endarterectomy. Histology of the mass was consistent with lipomatous hypertrophy.

Cardiac and Paracardiac Masses: Complementary Role of Echocardiography and Magnetic Resonance Imaging.

The objective of this study was to compare the roles of echocardiography and magnetic resonance imaging (MRI) in the evaluation of patients suspected of having cardiac and paracardiac masses. Echocardiography is a widely available and useful technique for characterizing cardiac and paracardiac abnormalities but suffers from a limited field of view and restricted acoustic access to mediastinal structures. MRI is an alternative noninvasive imaging technique for investigation of these abnormalities. Fourteen consecutive patients suspected of having cardiac or paracardiac masses on echocardiography were referred for cardiac MRI. MRI gave more complete visualization in four patients with infiltrating lung tumors and in one patient with intracardiac metastases who had a technically inadequate echo. Echo showed a rapidly moving Chiari network not seen on MRI. Both echo and MRI were helpful in patients with hiatal hernias (2); lipomatous hypertrophy of the interatrial septum (2); left atrial myxoma (1); and calcified mitral annulus (3). We conclude that echocardiography and MRI should be used together to investigate patients with cardiac and paracardiac masses.

CT appearance of lipomatous hypertrophy of the interatrial septum.

We undertook this study to determine the CT findings of lipomatous hypertrophy of the interatrial septum, an asymptomatic and underrecognized benign proliferation of fat within the atrial septum. We retrospectively identified 12 cases of lipomatous hypertrophy of the interatrial septum by searching the radiology records at our institution from 1991 to 1995. We reviewed the CT scans of these patients to determine the distribution and morphology of fat within the interatrial septum. In all patients with lipomatous hypertrophy, a mass of fat attenuation extended from the coronary sinus to just above the level of the aortic root with relative sparing of the fossa ovalis, which resulted in a dumbbell configuration. Average dimensions were 7 cm for craniocaudal extent (range, 6-9 cm), 4.5 cm along the interatrial septum (range, 3.6-6.2 cm), and 2.7 cm perpendicular to the septum (range, 1.5-4.8 cm). Increased epicardial fat was seen on CT scans in 10 patients (83%). CT revealed mediastinal lipomatosis in six patients (50%). No patients had undergone corticosteroid treatment or total parenteral nutrition. No electrocardiographic or functional cardiac abnormalities were seen. On standard, high-resolution, and enhanced CT images, lipomatous hypertrophy of the interatrial septum is shown as a nonenhancing smoothly marginated homogeneous dumbbell-shaped mass of fat attenuation confined to the interatrial septum. These characteristic morphologic features allow confident diagnosis and help differentiate this benign condition from other cardiac masses.

Lipomatous hypertrophy of the interatrial septum: indication for surgery?

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.

Clinical and morphologic features of lipomatous hypertrophy ("massive fatty deposits") of the interatrial septum.

Lipomatous hypertrophy of the interatrial septum ("massive fatty deposits in the atrial septum") may represent an incidental autopsy finding or may be associated with atrial arrhythmias, obstructive symptoms, or sudden death. Antemortem diagnosis is becoming much more common. In a literature review and in a review of our 12 cases, this condition was found to occur more frequently in obese middle-aged or elderly subjects, who frequently demonstrated atherosclerotic coronary artery disease. The unencapsulated mass generally occurred anterior or superior to the fossa ovalis, and histologically was characterized by mature fat with varying quantities of fetal fat, inflammation and fibrosis, and entrapment of myocardial fibers with cytologic atypia. Cases were included that had a minimum atrial septal thickness of 1.0 cm. The septum ranged up to 7.0 cm in maximum thickness (2.6 cm average). In our cases, no deaths were directly attributed to this disorder. It is important that forensic pathologists become more generally aware of this condition. To further delineate the true pathological significance, the atrial septum should be routinely examined by palpation and sectioning to determine its thickness and fat content.

Lipomatous Hypertrophy of Interatrial Septum

Transthoracic and transesophageal echocardiography were utilized to diagnose a patient with lipomatous hypertrophy of the interatrial septum (LHIS). The role of other imaging techniques including computerized tomography (CT) and magnetic resonance imaging (MRI) for differentiating it from other interatrial masses is discussed.

Atrial septal lipomatous hypertrophy and ischemic heart disease: an unusual presentation

Lipomatous hypertrophy of the interatrial septum consists of the abnormal accumulation of fatty tissue. We report a patient with unsuspected massive lipomatous hypertrophy of the interatrial septum scheduled to undergo coronary artery surgery. This patient had experienced atrial arrhythmias and obstructive symptoms preoperatively that were ascribed to her coronary artery disease (CAD). The perioperative anesthetic and surgical management of patients with lipomatous hypertrophy of the interatrial septum and CAD is discussed.

Lipomatous Hypertrophy of the Interatrial Septum

Lipomatous hypertrophy of the interatrial septum is a clinicopathological entity defined as an accumulation of fatty tissue exceeding 15 mm in thickness in the interatrial septum above the fossa ovalis. It is clinically associated with atrial electric abnormalities, interference with venous return, and sudden death. Transesophageal echocardiography is superior to transthoracic echocardiography for the study of the interatrial septum. We describe one case of lipomatous hypertrophy of the interatrial septum in which transesophageal echocardiography was used, we believe for the first time, to study the interatrial septal anatomy.

Lipomatous hypertrophy of the interatrial septum: an unusual intraoperative finding.

Lipomatous hypertrophy of the interatrial septum was an incidental finding in a man of 45 undergoing coronary artery bypass grafting for unstable angina. He was not overweight and did not have any rhythm disturbances. The diagnosis was made on frozen section.

Étude échographique prospective : hypertrophie lipomateuse du septum inter-auriculaire

Within this one-year echocardiographic prospective study, we collected 11 cases of lipomatous hypertrophy of the inter atrial septum (LHIS) (prevalence : 2.2 %). 45 % of them had inter-atrial block at ECG and we found a strong link with atrial arythmias. This link implies a search for atrial vulnerability in case of stroke without any other cause than LHIS.

Hypertrophie lipomateuse du septum inter-auriculaire et nutrition parentérale totale

Between October 1989 and January 1990, seven patients on home parenteral nutrition (PN) were investigated prospectively by echocardiography. Mean age was 57 ± 8.8 years. We found a high prevalence of lipomatous hypertrophy of the interatrial septum (57 %), instead of only 2.2 % int the general population. Further investigations are necessary to assess the clinical incidence of LHIS in patients on long-term PN.

Lipomatous hypertrophy of the interatrial septum diagnosis by magnetic resonance imaging

A surgically proved case of lipomatous hypertrophy of the interatrial septum is demonstrated on magnetic resonance imaging. The intensity on T 1-weighted images and characteristic distribution of the lesion may make the diagnosis possible without surgical intervention.

Lipomatous hypertrophy of the interatrial septum: in vivo diagnosis.

Lipomatous hypertrophy of the interatrial septum (LHIS), a finding associated with obesity and advancing age, consists of the accumulation of adipose tissue, including fetal adipose tissue, in the interatrial septum cephalad and caudad to the fossa ovalis. Previous descriptions of this entity have been limited to autopsy examination. We report a patient in whom the diagnosis of LHIS was established during life by the use of computed tomographic cardiac imaging. As is often the case in patients discovered at autopsy to have LHIS, this patient had atrial fibrillation and, while in normal sinus rhythm, an abnormal P-wave morphology. This patient represents the first patient in whom the diagnosis of LHIS has been established during life. LHIS should be considered in the differential diagnosis of atrial fibrillation and other supraventricular rhythm/conduction disturbances, particularly in obese, elderly patients.

Abnormal atrial activity in lipomatous hypertrophy of the interatrial septum

Five cases of lipomatous hypertrophy of the interatrial septum were found in a prospective study of 445 necropsies. All five patients had abnormal atrial activity. Two patients had atrial fibrillation, one patient had a wandering atrial pacemaker, and two patients had a pathological P vector with negative P waves in Leads II, III, and aV F . The changes seen in the latter three cases might be caused by interatrial conduction disturbances, shift of pacemaker site, or both.

Atrial arrhythmias and lipomatous hypertrophy of the cardiac interatrial septum

Excessive accumulation of fat in the interatrial septum, termed lipomatous hypertrophy of the interatrial septum, was found at postmortem examination in ten elderly patients. All patients had atrial arrhythmias. Seven patients had unusual arrhythmias including multifocal atrial tachycardia, wandering atrial pacemaker, paroxysmal atrial tachycardia, and sinus arrest, all of which proved refractory to therapy. In five patients an unusual “dome and dip” P-wave configuration was noted in Leads II, III, and aV F of the electrocardiogram. It is suggested that these arrhythmias may be related to the excessive accumulation of fat in the interatrial septum and that the described P-wave morphology may be an indicator of interatrial block due to such accumulation.

The Wolff-Parkinson-White syndrome: Report of a case with fatal arrhythmia and autopsy findings of myocarditis, interatrial lipomatous hypertrophy, and prominent right moderator band

A case of WPW syndrome with atrial fibrillation resulting in death is presented. Autopsy revealed lipomatous hypertrophy of the interatrial septum, diffuse interstitial myocarditis, and an abnormal muscle bundle within the right ventricular cavity. A possible etiologic relationship of ventricular pre-excitation to myocardial hypertrophy is proposed. The mortality rate hazard of WPW syndrome is discussed.