LIPOMATOUS HYPERTROPHY OF THE INTERATRIAL SEPTUM - A BENIGN HEART ANOMALY CAUSING UNEXPECTED PROBLEM IN ELECTROPHYSIOLOGY (CASE REPORT).

Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is an unusual and benign condition characterized by the excessive deposition of adipose tissue in the interatrial septum, which is most often detected as an incidental finding on echocardiography. The classic finding is a homogenous, bi-lobed configuration of the interatrial septum with sparing of the fossa ovalis. LHIS has been associated with various atrial arrhythmias, including multifocal atrial tachycardia, multiple premature atrial contractions, atrial fibrillation and rarely sudden death. The prevalence of LHIS is estimated to be between 1-8%. The incidence increases with age, body mass and chronic corticosteroid therapy. There may be a higher incidence in women. Here the authors describe a case report of a 73 year-old obese female who visited the cardiology department for planned cryoablation of paroxysmal atrial fibrillation. Difficulties raised during transseptal punction, a bidimensional tranthoracic echocardiography (TTE) showed the typical findings of LHIS. A 73 year-old asymptomatic woman was found to have an incidental cardiac mass, TTE findings were consistent with lipomatous hypertrophy of the interatrial septum. Given the characteristic appearance on TTE, biopsy or surgery was not indicated, the procedure of cryoablation has been stopped and the patient was managed conservatively.

VERY LATE STENT THROMBOSIS 2 YEARS AFTER IMPLANTATION OF A DRUG-ELUTING STENT (CASE REPORT).

A serious long-term complication of drug-eluting stent (DES) implantation is the occurrence of very late stent thrombosis (VLST) beyond 1 year after implantation. While VLST has been observed as late as 1 year following the initial procedure, it remains unknown whether DES thrombosis is a finite phenomenon that abates over time or is a risk that persists indefinitely. Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of a 40-year-old man who sustained an ST-segment-elevation myocardial infarction 2 years after initial paclitaxel-eluting stent implantation. Focal incomplete endothelialization of the stent struts is the likely cause of VLST; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. According to the current guidelines 12 months of dual antiplatelet therapy (DAPT) is recommended following DES implantation. However, there are uncertainties surrounding the optimal duration of dual antiplatelet therapy in patients who suffer from drug-eluting very late stent thrombosis. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of dual antiplatelet therapy.