From the Guidelines
A lipomatous atrial septum is a benign condition that typically doesn't require any specific treatment or intervention, and patients can usually maintain normal activities without restrictions. This condition is characterized by excessive fat accumulation in the wall separating the heart's upper chambers (atria), and it's usually asymptomatic, often discovered incidentally during cardiac imaging studies 1. The key is to distinguish it from other, potentially more serious cardiac masses. According to the 2019 ACC/AHA/ASE key data elements and definitions for transthoracic echocardiography, a lipomatous atrial septum is referred to as "Hyperlipomatous" and is defined as increased interatrial septal thickness caused by lipid deposition 1.
Some key points to consider in the diagnosis and treatment of lipomatous atrial septum include:
- Distinguishing it from other cardiac masses, such as atrial septal defects or abnormalities, which can have different treatment approaches 1
- Monitoring patients periodically to ensure there are no changes or complications, such as interference with cardiac function or electrical conduction
- Informing healthcare providers about the condition during routine check-ups or if any cardiac symptoms develop
- Maintaining normal activities without restrictions, unless otherwise advised by a healthcare provider
It's essential to note that the diagnosis and treatment of lipomatous atrial septum should be guided by the most recent and highest-quality evidence, and patients should be managed on a case-by-case basis, taking into account their individual needs and medical history 1.
From the Research
Diagnosis of Lipomatous Atrial Septum
- Lipomatous hypertrophy of the atrial septum (LHAS) is a rare entity characterized by mass-forming deposition of fatty tissue within the atrial septum 2.
- The clinical presentation of LHAS varies from incidental asymptomatic mass to severe life-threatening cardiovascular complications necessitating emergency cardiac surgery 2.
- Diagnosis can be made using transesophageal echocardiography (TEE), which is the method of choice in the diagnosis of LHS 3.
- Other techniques such as MRI or CT-scan can be useful only in selected patients with large fatty infiltration of the atrial wall or marked hypertrophy of the interatrial septum 3.
- Imaging studies typically reveal a right atrial mass with a mean size of 6 cm (range, 2.5-10 cm) 4.
Treatment of Lipomatous Atrial Septum
- Surgical intervention may be justified to avoid later outflow obstructions 2.
- Partial resection of the tumour and pericardial patch-reconstruction of the superior caval vein (SCV) can be performed in combination with coronary artery bypass grafting due to coronary artery disease (CAD) 5.
- Atrial reconstruction can alleviate not only the obstruction but also help control a challenging arrhythmia 6.
- Surgical excision of LHAS is possible and has a distinctive histologic appearance marked by the presence of abundant multivacuolated fat and hypertrophied myocytes 4.