Double trouble during the left atrial appendage occlusion procedure.

Percutaneous structural interventions are being performed at increased numbers and rare findings or complications occur more frequently. Lipomatous hypertrophy of the interatrial septum (LHIS) is a relatively uncommon finding on transthoracic echocardiogram (TTE). The major challenge is the difficulty in performing transseptal puncture. We aimed to report the difficulties that were experienced during the left atrial appendage (LAA) closure in a case with an extreme form of LHIS.