AccScience Publishing / BH / Volume 2 / Issue 2 / DOI: 10.36922/bh.2190

Patent foramen ovale closure in a patient with extensive lipomatous hypertrophy of the septum secundum: A case report

Sergey Terekhin1 Dimtry Shchekochikhin1 Alexandr G. Osiev2 Eustaquio Maria Onorato3*
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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
Brain & Heart 2024, 2(2), 2190
Submitted: 6 November 2023 | Accepted: 29 December 2023 | Published: 2 May 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

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 specifically designed devices and the risk of suboptimal results. Our case report details 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 kyphosis, platypnea-orthodeoxia syndrome, and a large LHSS. In addition, strategies adopted to enhance the success of percutaneous closure are discussed.

Lipomatous hypertrophy of the septum secundum
Patent foramen ovale
Atrial septal defect
Platypnea-orthodeoxia syndrome
Thoracic kyphosis
Transcatheter closure
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Conflict of interest
Eustaquio Maria Onorato is a consultant for Occlutech. The remaining authors declare no conflicts of interest.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing