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Cardiac general: Baris Caynak, Frank Van Praet, Nicholas Walcot, and Hugo Vanermen Excision of lipomatous hypertrophy of the interatrial septum via port-access Interactive CardioVascular and Thoracic Surgery published on Mar 12, 2008 as doi:10.1510/icvts.2007.170753 [Abstract] [Journal Format PDF]

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eComment. Lipomatous hypertrophy of the interatrial septum: surgical indications refined

Salvatore Lentini, Fabrizio Tancredi, Francesco Monaco, Roberto Gaeta   (5 May 2008)

eComment. Lipomatous hypertrophy of the interatrial septum: surgical indications refined 5 May 2008
Salvatore Lentini Cardiac Surgery Unit, Policlinic Hospital, University of Messina, 98100 Messina, Italy, Fabrizio Tancredi, Francesco Monaco, Roberto Gaeta Send ecomment to journal: Re: eComment. Lipomatous hypertrophy of the interatrial septum: surgical indications refined salvolentini{at}alice.it Salvatore Lentini, et al.	Interactive CardioVascular and Thoracic Surgery 2008, doi:10.1519/icvts.2007.170753A © 2008 European Association of Cardio-Thoracic Surgery We read with interest the article by Caynak and colleagues [1]. Lipomatous hypertrophy of the interatrial septum (LHIAS) is a benign cardiac disorder characterised by an encapsulated accumulation of adipose tissue. It is a quite rare condition, with few cases of surgical excision reported in the literature or described by echocardiography. This condition, generally asymptomatic, may constitute an incidental post mortem finding. Data from several post mortem surveys report how the disorder represents 0.6% of all benign cardiac tumours. Incidence of supraventricular arrhythmias is increased in this population, and occasionally the disorder may at times lead to haemodynamic deficits associated with congestive heart failure or determine an abnormal heart rhythm leading even to sudden death. This may be due to significant obstruction of the cardiac chambers or cavo-atrial junction as in the case reported by Caynak. Lipomatous hypertrophy can at times lead to problems in differential diagnosis of the disorder from other tumours or heart diseases. Echocardiography, both transthoracic or transoesophageal is important in the diagnosis, and especially in determining the amount of obstruction created by the tumour. This, in case of isolated pathology as in the described report will be of help in the decision making for surgery. Surgical removal produces excellent short- and long-term results. We agree with the diagnostic steps and with the surgical option of the port access surgery performed by Caynak and coworkers. We agree that indication for surgical resection of LHIAS includes SVC obstruction or intractable rhythm disturbances. However, this condition may be an incidental finding in patients referred for cardiac surgery for other cardiac pathology. Our working group described a case of LHIAS associated with coronary disease diagnosed by means of transoesophageal echocardiography and surgically treated [2]. In patients referred for surgical treatment of other cardiac pathology bearing incidental finding of LHIAS, the concomitant treatment should be considered even in the absence of obstructive symptoms or rhythm disturbances. References [1] Caynak B, Van Praet F, Walcot N, Vanermen H. Excision of lipomatous hypertrophy of the interatrial septum via port-access. Interact CardioVasc Thorac Surg doi:10.1510/icvts.2007.170753 [2] Riva L, Banfi C, Gaeta R, Vigaṇ M. Lipomatous hypertrophy of the interatrial septum. Description of a clinical case and literature review. Minerva Cardioangiol 2006;54:789-92