Multiple synchronous atrial lipomas
Maurice A. Smith
Medical College of Georgia, 1120 Fifteenth Street, Augusta, GA 30901, USA
Received 6 August 2006; received in revised form 1 October 2006; accepted 16 October 2006
The incidence of primary tumors of the heart is low. Three quarters of cardiac neoplasms are benign. Cardiac lipomas are a mostly
asymptomatic benign tumor that makes up less than 10% of primary heart tumors. There have been 60 reported cases of atrial lipomas and
only two cases of multiple lesions. We present a case of multiple synchronous atrial lipomas causing obstruction of the tricuspid valve and
partial occlusion of the coronary sinus requiring reconstruction. D 2007 Elsevier Inc. All rights reserved.
Keywords: Cardiac; Neoplasms; Benign
The incidence of primary tumors of the heart and
pericardium is 0.02–28% according to the report of an
autopsy series . Cardiac lipomas account for 8.4 % of
these neoplasms . Cardiac lipomas are benign neoplasms
composed of mature adipose tissue and are histologically
similar to extra cardiac soft tissue lipomas . In one of the
early German pathology textbooks in 1887, Orth mentioned
lipoma of the heart as a rarity . More than 100 years later,
there have been 60 reported cases . We present a case of
multiple synchronous atrial lipomas causing obstruction of
the tricuspid valve and partial occlusion of the coronary
sinus requiring reconstruction.
2. Case report
A 53-year-old black woman presented with the chief
complaint of fatigue and increasing shortness of breath. Her
medical history was significant for hypertension and
hypercholesteremia. She was a nonsmoker with no personal
or family history of lipomatous disease. Physical exam was
significant for obesity, with a body mass index of 47, and no
lipomatous lesions. She was evaluated with an echocardio-
gram where there appeared to be a large mass originating
from the right side of the atrial septum with obstruction of
the tricuspid valve. Subsequent cardiac catheterization
found normal coronaries with a normal ejection fraction
and no valvular disease.
The decision was made to operate based on symptoms.
The chest was entered, and patient was heparinized,
cannulated and cardiopleged. The right atrium was entered,
and the first lipoma was shelled out en mass. This left a
region of thinning near the fossa ovalis that required repair
with a 4-0 Prolene suture. The second lipoma was transmural
and extended into the left atrium. Removal of this lipoma left
a defect in the atrium near the tricuspid valve. This was
repaired with a running double layer closure of Prolene
suture. The transmural lipoma and the lipoma in the vicinity
of fossa ovalis both impinged on the opening of the tricuspid
valve causing obstruction and narrowing of the lumen. The
third lipoma in the inferior portion of the atrium partly
pinched off the opening of the coronary sinus. This was
removed and the coronary sinus opening was repaired by
placing pledgetted sutures around an 18-gauge catheter
placed in the opening. The right atrium was closed, and
atrial and ventricular wires were placed. The patient was
warmed, weaned off bypass, and decannulated and closed in
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Cardiovascular Pathology 16 (2007) 187 – 188