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Ann Thorac Surg 1999;68:1890
© 1999 The Society of Thoracic Surgeons

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Correspondence

Operative excision of atrial septal fat

^a Baylor Cardiovascular Institute, Baylor University Medical Center, Dallas, TX 75246, USA

To the Editor

In the March 1999 issue of The Annals, Oxorn and colleagues [1] from Toronto, Canada, described a 69-year-old man with massive hypertrophy of the atrial septum (62 mm in maximal diameter). Although the transesophageal echocardiogram showed that the lumen of the superior vena cava was narrowed as it entered the right atrium, there were no symptoms of superior vena caval obstruction and no hemodynamic data to indicate a pressure gradient between superior vena cava and right atrium. The diagnosis of lipomatous hypertrophy of the atrial septum was clear preoperatively by transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Operative intervention was to "debulk" the fatty mass in the atrial septum. Exactly how much fat was removed from the atrial septum was not described. The patient remained in the hospital for 3 weeks after operation. Although the patient’s weight was not mentioned in the report, I suspect the patient was quite obese. The patient did have chronic obstructive lung disease, and I suspect was on corticosteroid therapy for some time, a drug that increases cardiac deposits of fat [2].

My question concerns whether or not lipomatous hypertrophy of the atrial septum is an operative lesion. I think not. There was no evidence in the present patient that a gradient existed between superior vena cava and right atrium. Furthermore, the patient had chronic obstructive lung disease, and I suspect was greatly overweight. These "comorbidities" certainly do not favor median sternotomy. What the report does show is that a patient can survive after having some fat removed from the atrial septum. It does not indicate whether the operation was indicated or what the long-term effect of the intervention may be. The best therapy of lipomatous hypertrophy of the atrial septum might be simply considerable weight loss.

References

1. Oxorn D.C., Edelist G., Goldman B.S., Joyner C.D. Echocardiography and excision of lipomatous hypertrophy of the interatrial septum. Ann Thorac Surg 1999;67:852-854.[Abstract/Free Full Text]
2. Shirani J., Roberts W.C. Clinical, electrocardiographic and morphologic features of massive fatty deposits ("lipomatous hypertrophy") in the atrial septum. J Am Coll Cardiol 1993;22:226-238.[Abstract]

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