Transcatheter Relief for Lipomatous Hypertrophy of an Interatrial Septum Obstructing Superior Vena Cava in an Elderly Patient

Figures

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  Figure 1. Tissue Characterization by CMR (A) T1-weighted imaging (A) with high signal of the mass (∗) and (B) T2-weighted imaging with fat saturation showing signal nulling, all consistent with adipose tissue and diagnosis of lipomatous hypertrophy of the interatrial septum. CMR = cardiac magnetic resonance.

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  Figure 2. Computed Tomography of LHIS With SVC Obstruction (A, B) Lipomatous hypertrophy of the interatrial septum causing superior vena cava obstruction (see yellow arrow). Ao = aorta; LA = left atrium.

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  Figure 3. Multiplanar Reconstruction of the Superior Vena Cava, Showing Obstruction Worsening Per Segment Stenosis was quantified to 71%.

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  Figure 4. Transesophageal Echocardiography-Guided Intervention to Exclude LHIS From SVC With Stent Graft (A) Stent graft before deployment (∗), with LHIS causing significant obstruction. (B) Deployed stent graft (∗) relieving the obstruction. LHIS = lipomatous hypertrophy of the interatrial septum; SVC = superior vena cava.

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  Figure 5. Multiplanar Reconstruction of the Superior Vena Cava Post Stent Graft Placement, Showing Complete Relief of Obstruction

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  Figure 6. Changes in Left Atrium Dimensions When comparing A with B, changes are noticeable in the left atrial size after relief of SVC obstruction, with B post stent graft placement showing an increase in the left atrial size.

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  Figure 7. Aortic Phase Contrast Showing Improvement in Stroke Volume and Cardiac Output After SVC Stent Graft Implantation Stroke volume and cardiac output increased from 37.3 mL/beat and 2.98 L/min to 59.2 mL/beat and 4.44 L/min as evidenced by cardiac magnetic resonance–derived phase contrast flow quantification. SVC = superior vena cava.

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  Visual Summary. Three-Dimensional Reconstruction of Computed Tomographic Images Showing Complete Relief of Superior Vena Cava Obstruction Using Stent Graft