Lipomatous hypertrophy of the interatrial septum: An unexpected finding complicating a routine CABG

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Lipomatous hypertrophy of the interatrial septum and multivessel coronary artery disease (n=1). Intervention: Coronary artery bypass grafting with partial surgical resection of interatrial septal mass and patch reconstruction. Primary outcome: Relief of superior vena cava obstruction and clinical recovery.

Q: What does this research mean for the field?

Partial resection of obstructive lipomatous hypertrophy of the interatrial septum can successfully relieve superior vena cava obstruction when encountered during coronary artery bypass grafting. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kiriti S. Vattikonda; Courtney Barth; Christopher Peterson; Michael Stump; John C. Lystash

doi:10.12746/swjm.v14i61.1693

October 20, 2026The Southwest Journal of MedicineOpen Access

Lipomatous hypertrophy of the interatrial septum: An unexpected finding complicating a routine CABG

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Why the study?

Although lipomatous hypertrophy of the interatrial septum is typically a benign incidental finding requiring no specific therapy, its size and location can complicate cardiac surgery or structural heart interventional procedures.

Key Points

To describe a case where lipomatous hypertrophy of the interatrial septum unexpectedly complicated routine coronary artery bypass grafting due to right atrial obstruction.
Clinical and imaging evaluation of a 76-year-old man presenting with acute coronary syndrome and multivessel coronary artery disease who underwent preoperative transesophageal echocardiography.
Modification of surgical bypass technique using innominate vein cannulation instead of right atrial cannulation due to mass obstruction, accompanied by mass resection and histopathology.
Preoperative transesophageal echocardiography revealed an obstructive right atrial mass that was not visualized on initial transthoracic echocardiography showing an ejection fraction of 60-65%.
Histopathologic analysis confirmed a benign mass composed of mature adipose tissue, hypertrophic myocytes, and vacuolated brown fat cells.
Surgical resection successfully relieved superior vena cava obstruction and turbulence, resulting in improved activity tolerance without subsequent hospital readmissions or major adverse events.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient aged 76 years with multivessel coronary artery disease and an incidental 3.52 cm obstructive lipomatous hypertrophy of the interatrial septum undergoing coronary artery bypass grafting and partial mass resection.

I

Intervention

Double coronary artery bypass grafting (left internal mammary artery graft to LAD and radial artery graft to the first obtuse marginal branch of the LCX) with modified venous cannulation at the innominate vein and inferior vena cava, combined with extensive partial resection of the infiltrating interatrial septal mass and reconstruction of the right atrial free wall defect using an 8 cm × 5 cm Aziyo intestinal submucosal patch.

O

Outcome

Relief of superior vena cava obstruction, reduction of turbulent flow across the SVC, and post-operative clinical recovery (improved functional and activity tolerance with no further admissions or major adverse events).

Limitations

Single-patient case report
Total resection was not pursued due to the patient's advanced age, underlying ischemic heart disease, and the infiltrative nature of the mass

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Implication

Although typically a benign incidental finding, large lipomatous hypertrophy of the interatrial septum can cause superior vena cava obstruction and complicate routine cardiac surgery by obstructing standard right atrial venous cannulation, requiring modified cannulation strategies and surgical resection.

Abstract

Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac non-neoplastic mass. In the vast majority of cases, LHIS is an incidental finding found on cardiac imaging requiring no specific therapy. However, due to its size and location, LHIS can complicate cardiac surgery or structural heart interventional procedures.

Discussion

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Cite This Study

Vattikonda et al. (2026) conducted a case report in Lipomatous hypertrophy of the interatrial septum and multivessel coronary artery disease (n=1). Coronary artery bypass grafting with partial surgical resection of interatrial septal mass and patch reconstruction was evaluated on Relief of superior vena cava obstruction and clinical recovery.

synapsesocial.com/papers/6ae28e94cbadf70daf6c4350 https://doi.org/10.12746/swjm.v14i61.1693

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Lipomatous hypertrophy of the interatrial septum: An unexpected finding complicating a routine CABG

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Lipomatous hypertrophy of the interatrial septum: An unexpected finding complicating a routine CABG

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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