Page 93 - BH-2-2

Brain & Heart

CASE REPORT
Patent foramen ovale closure in a patient with

extensive lipomatous hypertrophy of the
septum secundum: A case report

Sergey Terekhin , Dmitry Shchekochikhin , Alexandr G. Osiev , and
2
1
1
Eustaquio Maria Onorato *
3
1 Department of Cardiology, Ilynskaya Hospital JSC, Moscow, Russia
2 Department of Endovascular Cardiology, JSC Hospitals Medsi, Moscow, Russia
3 Department of Cardiology University Hospital, I.R.C.C.S. Ospedale Galeazzi - Sant’Ambrogio,
Milan, Italy

Abstract

Lipomatous hypertrophy of the septum secundum (LHSS) is a benign disorder
characterized by the accumulation of fat in the interatrial septum, presenting with
an hourglass appearance that spares the fossa ovalis on echocardiography. Typically
asymptomatic, LHSS is often incidentally detected through two-dimensional
transthoracic echocardiography/transesophageal echocardiography, computed
tomography, and cardiac magnetic resonance imaging. It primarily affects elderly
and obese individuals, with a higher prevalence among females, and may cause atrial
arrhythmias, syncope, and heart failure. Transcatheter closure of patent foramen
ovale (PFO) associated with LHSS has traditionally posed challenges due to the lack of
*Corresponding author:
Eustaquio Maria Onorato specifically designed devices and the risk of suboptimal results. Our case report details
(eustaquio.onorato@gmail.com) the off-label implantation of a flexible atrial septal defect closure device for a PFO closure
in an elderly patient presenting with an embolic stroke of undetermined source, severe
Citation: Terekhin S,
Shchekochikhin D, Osiev AG, kyphosis, platypnea-orthodeoxia syndrome, and a large LHSS. In addition, strategies
Onorato EM. Patent foramen ovale adopted to enhance the success of percutaneous closure are discussed.
closure in a patient with extensive
lipomatous hypertrophy of the
septum secundum: A case report. Keywords: Lipomatous hypertrophy of the septum secundum; Patent foramen ovale;
Brain & Heart. 2024;2(2):2190.
doi: 10.36922/bh.2190 Atrial septal defect; Platypnea-orthodeoxia syndrome; Thoracic kyphosis; Transcatheter
closure
Received: November 6, 2023
Accepted: December 29, 2023
Published Online: May 2, 2024 1. Background
Copyright: © 2024 Author(s).
This is an Open-Access article Patent foramen ovale (PFO) is associated with various medical conditions, including
distributed under the terms of the platypnea-orthodeoxia syndrome (POS), which is characterized by dyspnea and
Creative Commons Attribution hypoxemia in the sitting or standing position, usually resolved by lying down. With
1,2
License, permitting distribution,
and reproduction in any medium, aging, spondylosis and severe kyphosis of the thoracic spine, as observed in our patient,
provided the original work is alter intrathoracic relationships and may contribute to increased venous blood shunting
properly cited. into the left atrium, exacerbating hypoxemia, and requiring oxygen support. Notably,
Publisher’s Note: AccScience percutaneous PFO closure has been demonstrated to alleviate symptoms and may offer
Publishing remains neutral with a potential cure. In PFO patients with lipomatous hypertrophy of the septum secundum
regard to jurisdictional claims in
published maps and institutional (LHSS), catheter-based closure procedures are often considered technically demanding.
affiliations. Prominent LHSS hinders a proper coaptation of the leaflets with traditional occluders,

Volume 2 Issue 2 (2024) 1 doi: 10.36922/bh.2190