Cardiac Papillary Fibroelastoma Research Articles

Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review

Background Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group. Methods We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023. Results In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b–3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients. Conclusion While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.

Cardiac Papillary Fibroelastoma, an Unusual Localization in an Asymptomatic Patient with Lieberkühn Type Adenocarcinoma of the Rectum: A Case Report

Cardiac papillary fibroelastoma is histologically a benign endocardial neoplasm. Though CPF has long been reported as the second most common primary cardiac neoplasm, it has since been pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. We present a case of CPF originating from an unusual localization; the junction of the posterior mitral valve and endocardium of the left ventricle measuring 15 x 20mm, which was detected by a routine pre-evaluation transthoracic echocardiography before chemotherapy and treated by surgical mass excision in an asymptomatic female patient diagnosed with a Lieberkühn type adenocarcinoma of the rectum with a locoregional extension.

Cardiac papillary fibroelastoma: a rare cause of ST-segment elevation myocardial infarction: a case report

Introduction and importance: Primary tumors of the heart are extremely rare occurrences. Among them, cardiac papillary fibroelastoma (CPF) is the second most common type. Although these tumors are usually benign, they can pose a risk of embolization, which may lead to severe complications like sudden death or embolization affecting the neurological, systemic, or coronary vasculature. Such complications can be life-threatening. Case presentation: In this report, the authors present the case of a 68-year-old woman who experienced ST-segment elevation myocardial infarction due to embolization from a large papillary fibroelastoma. To address the issue, the authors performed a minimally invasive surgical removal and resection of the aortic valve, followed by a histological examination to confirm the diagnosis. Clinical discussion: This case report discusses a rare occurrence of myocardial infarction caused by tumor embolization from a CPF. The patient presented with complete blockage of a coronary artery in the absence of atherosclerotic disease. Through a comprehensive workup, including transesophageal echocardiography, the CPF was identified as the source of embolization. Surgical resection of CPFs is curative, and recurrence has not been documented. Clinicians should consider CPFs in cases of coronary artery occlusion without atherosclerotic disease and employ transesophageal echocardiography for diagnosis. Prompt surgical intervention leads to an excellent prognosis and prevents recurrent embolization. Conclusion: This report emphasizes the importance of recognizing the potential complications associated with papillary fibroelastoma-induced embolization to the coronary arteries and highlights the need to mitigate the risk of such complications occurring.

Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study.

Primary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps. Medical records at the University of Florida Health Shands Hospital between 1996 and 2021 were screened to identify patients with CMs or CPFEs. Clinical features, echocardiographic reports, and CVE outcomes were quantitatively assessed. A total of 55 patients were included in the study: 28 CM (50.9%) and 27 CPFE (49.1%) patients. Baseline patient characteristics were similar among patients. The neutrophil-lymphocyte ratio was correlated (p < 0.005 in all cases) to three metrics of tumor size in both CM (r = 64-67%) and CPFE (r = 56-59%). CVEs were the presenting symptom in 30 (54.5%) patients. CVE recurrence was high; the 5-year CVE recurrence rate in patients with tumor resection was 24.0% compared to 60.0% without resection. No baseline patient characteristics or tumor features were associated with an initial presentation of CVEs compared to any other indication. Univariate analysis indicated that prolonged duration to surgical resection, left atrial enlargement, male sex, and a neutrophil-lymphocyte ratio >3.0 at the follow-up were significantly associated with 5-year CVE recurrence. Left atrial enlargement and a neutrophil-lymphocyte ratio >3.0 at the follow-up remained significantly associated with 5-year CVE recurrence in multivariate analysis. The neutrophil-lymphocyte ratio may prognosticate tumor size and recurrence of neurologic events. An increased risk of CVE within 5 years of mass resection is almost exclusive to patients initially presenting with CVEs.

Combined neurological and cardiac rehabilitation:a tale of cardiac tumour operation during inpatient rehabilitation care

Purpose: To encourage screening for cardiac tumours in embolic stroke and improve awareness of cardiac papillary fibroelastoma (PEFs), its treatment and prognosis. Materials and methods: We report the case of a 55 year old lady who was referred for neurological rehabilitation with a diagnosis of ischaemic stroke following right sided hemiparesis and dysarthria. Echocardiogram showed non valvular left atrial tumour. Histopathology confirmed the cardiac tumour to be a cardiac papillary fibroelastoma. Her neurological rehabilitation was recommenced afterwards along with her cardiac rehabilitation with improvement in ability to manage basic activities of daily living with adaptations. Results: Transthoracic echocardiogram revealed ejection fraction of 55% and a bright mobile echogenic structure in the left atrium. Transoesophageal echocardiogram showed possible left atrial myxoma 1.3 cm x 0.96 cm. Surgical excision showed a friable and jelly like mass containing blood deposits. Histology showed papillary fibroelastoma of the left atrium. Conclusion: Cardiac causes, including Papillary fibroelastomas should be considered whilst investigating patients for secondary causes of ischaemic strokes even when they have been transferred for their neurological rehabilitation phase of their care.

Cardiac Papillary fibroelastoma (CPF): a rare underrecognized etiology of cardioembolic stroke. (P2-5.019)

Cardiac Papillary fibroelastoma (CPF): a rare underrecognized etiology of cardioembolic stroke. (P2-5.019)

Retrocardiac Opacities Detected on Chest Radiographs and their Imaging Workup: A Pictorial Review

AbstractThe retrocardiac space is a tricky area in the chest radiograph, where abnormal densities are frequently missed out. Lesions in this area produce late pressure symptoms compared with those in the upper mediastinum. Early detection and proper evaluation of retrocardiac opacities can help the radiologist to establish the diagnosis before clinical signs and symptoms become apparent. We present a case series of 10 patients with incidentally detected retrocardiac opacities in the frontal chest radiograph, which were further evaluated with other imaging modalities such as lateral chest radiograph, computed tomography (CT) or magnetic resonance imaging (MRI) to establish the diagnosis. The final diagnosis included congenital conditions like esophageal duplication cyst and bronchogenic cyst; inflammatory conditions like spondylodiscitis, lung abscess, and lobar pneumonia; vascular conditions like aortic aneurysm; diaphragmatic pathologies like hiatus hernia; and rare tumors like cardiac papillary fibroelastoma, pulmonary neuroendocrine tumor, and ganglioneuroma. Cardinal signs that aid in the diagnosis of retrocardiac opacities are also discussed.

Abstract 11716: A Systematic Review on Cardiac Papillary Fibroelastoma Presenting With Cerebrovascular Events

Introduction: Cardiac papillary fibroelastomas (CPF) are rare, benign endocardial tumors with embolic complications like cerebrovascular events. The objective of this systematic review is to identify the clinical profile, diagnostic approach, tumor characteristics, and treatment modalities of patients with CPF presenting with stroke or TIA. Methods: We performed a systematic review using PUBMED and EMBASE databases involving all the published case reports and case series of CPF with TIA or stroke as presentation until April 2022. Viewpoints, editorials, and review articles were excluded. Results: A total of 161 cases were identified from 133 case reports and 11 case series. The mean age was 54.8 ± 15.6 years with 53.4% females. The proportion of patients with TIA and stroke was 32.3% and 67.8% respectively. Neuroimaging demonstrated the involvement of multiple sites (36.6%) and middle cerebral artery territory (35.6%) as major sites of stroke. The primary imaging tool for the diagnosis of CPF was echocardiogram. The size of the tumor varied from 2 to 47 mm (mean 11.8 ± 7.1). Left-sided valves were the most common location of the tumor (73.2%). Mitral valve was the most common valve involved (38.9%) with the anterior leaflet being the more common site (61.3%). The aortic valve was involved in 32.5% with non-coronary cusp being the more common site (37.5%). About 10.6% of cases were missed by TTE (mean size of valvular tumors missed by TTE was 5.6 ± 1.9 mm). Most of the tumors (91.4%) showed independent mobility. Surgical excision was performed in 89.5% cases with histopathological confirmation. Medical management prior to surgery included antiplatelets (87.9%) and anticoagulation (12.1%). Simple excision, excision with valve repair and excision with valve replacement were done in 66.7%, 16.7% and 16.7% respectively. Most patients (97.8%) had uneventful post-operative course. Conclusions: CPFs are potential differential diagnosis for cryptogenic stroke. TEE serves as a better diagnostic modality for cardiac workup of cryptogenic stroke if the initial TTE is negative. While the consensus for CPF management remains controversial, the results of our study support surgical management as the primary approach for left-sided tumors presenting as stroke/TIA.

Operative management of cardiac papillary fibroelastomas

ObjectivePapillary fibroelastomas are associated with an increased risk of embolic strokes. Excision of papillary fibroelastomas may be the primary indication for surgery (primary) or performed during other cardiac operations (secondary). The present study summarizes our experience with primary and secondary fibroelastoma surgery. MethodsWe analyzed the medical records of patients who underwent surgical excision of papillary fibroelastoma between January 1998 and February 2020. Patient characteristics, indications for operation, tumor size and location, and operative and long-term outcomes were evaluated. ResultsAmong the 294 patients (median age: 66 years, 62% female), papillary fibroelastoma was the primary indication for surgery in 136 patients (46%), and 51% of patients had a history of stroke or transient ischemic attack. When papillary fibroelastoma was a secondary indication for surgery (158 patients, 54%), the lesion was identified preoperatively in 39%. Papillary fibroelastomas were located most commonly on the aortic valve and least commonly in the right side of the heart. For valvular papillary fibroelastoma resected from a normal valve, valve shave was sufficient in 96% (196/205). Operative mortality was low in both groups (primary, 0% vs secondary, 2.5%, P = .13), and early neurologic events occurred in 1.3%. Recurrence rate was 15.8% at 10 years. The estimated survival for patients with primary papillary fibroelastoma at 10 years was 78.4%, whereas for secondary papillary fibroelastoma removal it was 53.6% (log rank, P = .003). ConclusionsResection of papillary fibroelastomas can be performed safely, with preservation of the native valve, and with low rates of neurologic events. Operative and long-term outcomes after fibroelastoma resection are excellent.

Cardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 8Cardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextCardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease Milos Brankovic, MD, PhD, MSc, Parul Kakar, MD, Nebojsa Markovic, MD, Luka Petrovic, MD, Volodymyr Vulkanov, DO and Alfonso H. Waller, MD Milos BrankovicMilos Brankovic Correspondence to: Milos Brankovic, MD, PhD, MSc, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4730-957X Department of Medicine (M.B., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Parul KakarParul Kakar Division of Cardiology, Department of Medicine (P.K., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author , Nebojsa MarkovicNebojsa Markovic Department of Cardiology, Icahn School of Medicine, Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NJ (N.M., L.P.). Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Luka PetrovicLuka Petrovic Department of Cardiology, Icahn School of Medicine, Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NJ (N.M., L.P.). Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Volodymyr VulkanovVolodymyr Vulkanov Department of Neurology (V.V.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author and Alfonso H. WallerAlfonso H. Waller Department of Medicine (M.B., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Division of Cardiology, Department of Medicine (P.K., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author Originally published30 Jun 2022https://doi.org/10.1161/CIRCIMAGING.122.013978Circulation: Cardiovascular Imaging. 2022;15FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.013978.For Sources of Funding and Disclosures, see page 627.Correspondence to: Milos Brankovic, MD, PhD, MSc, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103. Email [email protected]rutgers.edu

Acute Ischemic Stroke Caused by Detachment of Cardiac Papillary Fibroelastomas

Cardiac papillary fibroelastomas are associated with a high risk of systemic embolization in spite of benign nature. We report a case of 85-year-old patient with left supraclinoid internal carotid artery occlusion who treated with aspiration thrombectomy. Despite of the absence of residual mass on echocardiography, we could analyze pathologic specimens using retrieved embolus and confirmed cardiac papillary fibroelastoma as a rare cause of stroke.

Cardiac papillary fibroelastoma – different locations, the same suspect

Cardiac papillary fibroelastoma – different locations, the same suspect

Unusual Localization of Fibroelastoma of the Heart in Patient with Previous Chest Radiotherapy

Cardiac papillary fibroelastoma is a rare, benign, slow –growing tumor of endocardium that my have a malignant propensity for live-threatening complications. The histogenesis remains controversial; an iatrogenic origin has been suggested. Localization in the left ventricular outflow tract is extremely rare. We describe a case of left ventricle fibroelastoma in patient with previous chest radiotherapy, seeming to support the iatrogenic hypothesis.

Imaging of Cardiac Masses: An Updated Overview.

Studying cardiac masses is one of the most challenging tasks for cardiac imagers. The aim of this review article is to focus on the modern imaging of cardiac masses proceeding through the most frequent ones. Cardiac benign masses such as myxoma, cardiac papillary fibroelastoma, rhabdomyoma, lipoma, and hemangioma are browsed considering the usefulness of most common cardiovascular imaging tools, such as ultrasound techniques, cardiac computed tomography, cardiac magnetic resonance, and in the diagnostic process. In the same way, the most frequent malignant cardiac masses, such as angiosarcoma and metastases, are highlighted. Then, the article browses through nontumoral masses such as cysts, mitral caseous degenerative formations, thrombi, and vegetations, highlighting the differential diagnosis between them. In addition, the article helps in recognizing anatomic normal variants that should not be misdiagnosed as pathological entities.

Two Cases of Suspected Cardiac Papillary Fibroelastoma Detected by Transesophageal Echocardiography During Transcatheter Aortic Valve Implantation

Two Cases of Suspected Cardiac Papillary Fibroelastoma Detected by Transesophageal Echocardiography During Transcatheter Aortic Valve Implantation

New insights into the pathogenesis of cardiac papillary fibroelastomas.

Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac tumors typically found on the heart valves. The previously published data on the CPF focused on its clinical presentation, optimal management, and prognosis. However, histogenesis of these lesions remains controversial. Accordingly, the aim of this study was to establish the role of endocardial endothelium (EE) in CPF formation. Four CPF tumors removed from the right atrioventricular valves were analyzed using hematoxylin & eosin, orcein, and Masson trichrome staining together with immunochemistry for CD-34, CD-68, vimentin, vWF and a-SMA. Moreover, conventional transmission electron microscopy was used for morphological analysis and a-SMA presence confirmation. Ultrastructural morphology, immunohisto- and immunocytochemical analyses indicated that cells covering collagenous core have an endothelial origin. Some endocardial endothelium cells have the potential to undergo a transition to mesenchymal cells. Moreover, the abundant presence of extracellular vesicles may indicate an active intercellular communication. Within the intermediate translucent zone, amorphous substances with monocytes/macrophage-like cells and fibroblastic cells were found. Finally, within collagenous core activated (myo)fibroblasts were observed. Our study demonstrated that the endocardial endothelium of the CPF was "double-sided", i.e., it presented both endothelial and mesenchymal cell characteristics. Another finding was the presence of monocytes, and macrophages which were integrated into CPF core and displayed features of a fibroblast that have been shown to contribute to extracellular matrix production. This could be interpreted as being attributed to the CPF histogenesis.

A Case of Multiple Cardiac Papillary Fibroelastoma in the Aortic Valve

A Case of Multiple Cardiac Papillary Fibroelastoma in the Aortic Valve

Giant and multiple cardiac papillary fibroelastomas masquerading as acute cerebrovascular events.

Cardiac papillary fibroelastomas are rare benign cardiac tumors. Their clinical significance results from their very high propensity for embolization. We present two such cases, which are rare regarding the size and multiplicity of these tumors.

A rare cause of left ventricular outflow tract mass in infancy: Cardiac papillary fibroelastoma.

Primary cardiac tumors are one of the rare causes of intracardiac masses in pediatric population. Cardiac papillary fibroelastomas are benign cardiac tumors with predilection for valvular endocardium, and the presentation is dictated by the cardiac structure involved and the tumor characteristics. We report an infant with cardiac papillary fibroelastoma manifesting as an asymptomatic left ventricular outflow tract mass. This case is being presented to emphasize the rare occurrence of cardiac papillary fibroelastoma in pediatric population and to be cognizant of this entity when considering differential diagnosis of intracardiac masses in this subgroup.

Valvular fibroelastomas complicated by Coxiella burnetti endocarditis

Cardiac papillary fibroelastoma (CPF) is a valvular tumor that may be mistaken for infective endocarditis (IE). We describe a case of CPF complicated by Coxiella burnetti IE. According to Duke's criteria, a diagnosis of IE was repeatedly considered as excluded or established during the clinical course, highlighting the criteria limitations.