Resection of a cardiac lipoma and reconstruction wall of right atrium: A case report.

Rationale: Cardiac lipomas are known to cause functional disturbances and symptoms by compressing adjacent tissues or organs, leading to potential complications such as dyspnea, palpitations, and cardiac arrhythmias. We report a case of a 52-year-old female with a large, well-circumscribed lipoma in the right atrium. This rare condition required a comprehensive diagnostic approach and therapeutic strategy for effective management.

Patient Concerns: A 52-year-old female patient presented to the hospital with complaints of palpitations and fatigue lasting for 1 month, accompanied by the recent discovery of a cardiac mass via echocardiography over the past 2 days. In addition, she reported occasional episodes of a dry cough.

Diagnoses: Both echocardiography and cardiac computed tomography imaging revealed an isoechoic mass within the right atrium, characterized by a regular shape and close attachment to the right atrial wall, displaying noticeable mobility. Histopathological analysis following surgical intervention confirmed that the tumor was predominantly comprised of adipocytes.

Interventions: The patient underwent successful resection of the right atrial lipoma, followed by reconstruction of right atrium using a bovine pericardial patch under extracorporeal circulation with a beating heart.

Outcomes: Postoperative recovery was complete, with resolution of symptoms including palpitations and fatigue. A follow-up echocardiogram on the 66th day postsurgery confirmed the absence of any residual tumor.

Lessons: Patients with small lipoma often remain asymptomatic. However, large or rapidly progressing tumors may elicit symptoms such as chest pain, dyspnea, and palpitations. For asymptomatic patients with small tumors, regular observation and follow-up are typically advised to monitor tumor growth and the emergence of symptoms. Conversely, patients with large tumors or overt symptoms should be recommended for prompt surgical intervention. In this case, preoperative anatomical evaluation for the lipoma involves the right atrial free wall, which is crucial to prevent excessive resection, damage to the lateral bundle branch, and subsequent postoperative cardiac dysfunction or arrhythmia, as exemplified in this patient.