Atrial Septal Defect Device Closure in a Patient With Lipomatous Hypertrophy of the Atrial Septum
A 74-year-old, moderately obese woman was referred to our institution for percutaneous closure of a 19-mm atrial septal defect (ASD). Her preprocedural transesophageal echocardiogram also revealed lipomatous hypertrophy of the atrial septum, an uncommon condition, characterized by deposition of unencapsulated fat cells in the atrial septum (Figure 1). The septum displayed the distinctive asymmetrical “dumbbell”-shaped involvement of the cepha-lad and caudal regions with sparing of the fossa ovalis. Although lipomatous hypertrophy of the atrial septum has been associated with supraventricular arrhythmias, there are no reports in the literature of an association with ASDs. After balloon sizing, a 26-mm Amplatzer Septal Occluder device (AGA Medical) was successfully deployed (Figure 2). This embraced the thick lipomatous cephalad rim as well as the thin “normal” caudal rim of the fossa ovalis abolishing the left-to-right shunt.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.