Papillary Fibroelastoma Research Articles

Resection of Lambl's Excrescence on the Aortic Valve in a Patient with Rheumatic Mitral Valve Disease and a Left Atrial Thrombus

Lambl's excrescences (LEs) are filiform strands that form on heart valves and are associated with an increased risk of stroke due to embolization. Although resection of these strands is generally recommended in patients who present with a stroke and no other identifiable cause, the management of incidentally discovered LEs in patients without an adverse cardioembolic event is less clear. We report a case of a patient with severe mitral valve stenosis from rheumatic heart disease and a large left atrial thrombus who was incidentally found to have multiple LEs on her aortic valve. In addition to replacing her mitral valve and removing the left atrial thrombi, we resected the LEs from her aortic valve due to their potential to cause a stroke and the relatively low associated morbidity in resecting them while keeping the aortic valve leaflets and valve function intact.

Left Atrial Papillary Fibroelastoma Accidentally Diagnosed with Gastric Cancer

Papillary fibroelastoma is a rare but benign cardiac tumor and usually originates from the cardiac valve. We describe a 78-year-old woman who was initially diagnosed with gastric cancer, and was incidentally found to have a mass in the free wall of her left atrium between the left atrial appendage and the left superior pulmonary vein. An excision was performed through the left atrial appendage under cardiopulmonary bypass. The histopathologic examination of the resected tissue revealed a papillary fibroelastoma. The unusual localization of this papillary fibroelastoma was discussed.

EComment. Isolated valvular myxoma

We read with great interest the report by Fernandez et al [1]. They presented a case of a 28-year old male patient with a sessile myxomatous tumour localized on the ventricle aspect of the right and left cusps of the aortic valve. Valve-sparing aortic root reconstruction was impossible, therefore a mechanical aortic valve was implanted. Myxomas are the most common primary cardiac tumours, typically located in the left atrium at the level of the fossa ovalis (three-quarters of these tumours) [2]. Valvular myxomas are extremely rare, atrio-ventricular valves being more involved than the aortic or pulmonary valves. The mitral valve is the most frequently affected structure, followed by the tricuspid, the aortic, and the pulmonary valves [3]. This case provides the possibility to discuss the clinical and pathologic features of valvular myxomas. Myxomas of the aortic valve are usually located at the ventricle side, involving one or two aortic cusps. The mean age at diagnosis is 44 (range 15-72). Ten cases of aortic valve myxomas have been published in the English literature [1, 4, 5], and they all showed a unique feature, that is, an isolated myxoma on the aortic valve. None of these patients presented with Carney's complex, therefore we can conclude that, to date, familial myxomas do not involve aortic valves. Recently, an additional case report was published on the same subject [4]. A 10x8-mm myxoma attached to the non-coronary cusp of the aortic valve from the ventricle side was incidentally found during an echocardiogram. The 72-year old man was operated under cardiopulmonary bypass, the tumour was resected, and the aortic valve was successfully repaired. The postoperative course was uneventful. This is the oldest patient operated on with an aortic valve myxoma. We completely concur with the statement that the main differential diagnosis is made with papillary fibroelastoma, which is generally described as arising from the ventricle aspect of the aortic valve, that a surgical approach should be considered in all these patients, and that echocardiogram follow-up must be recommended [5]. Conflict of interest: none declared.

Triple papillary fibroelastomas in an asymptomatic patient : case report - online article

Papillary fibroelastoma is the third most common type of primary cardiac tumour. Even though the majority of patients with these tumours are asymptomatic, they may present with embolic phenomena, syncope and death. This report describes a patient with papillary fibroelastomas affecting all three cusps of the aortic valve, with accompanying transoesophageal echocardiography and images of surgical specimens of the tumours.

A Rare Case of Diffuse Mitral Valve Fibroelastoma

Papillary fibroelastomas are uncommon in daily cardiac surgery practice. They typically arise from the valvular endocardium, affecting the atrioventricular and semilunar valves equally [1]. Upon diagnosis, prompt resection should be undertaken because of possible devastating complications such as stroke. A young patient came to the emergency unit with partial left-sided hemiplegia. The patient’s history showed partial loss of sight with spontaneous recovery. Transesophageal echocardiography identified a solitary structure attached to the mitral valve suggestive of fibroelastoma (Fig 1). Intraoperatively, we were confronted with diffusely spread fibroelastomas on the anterior leaflet of the mitral valve (Fig 2), leaving no other option than to replace the valve. Histologic examination confirmed the diagnosis of fibroelastoma (Fig 3; hematoxylin and eosin staining). The patient’s postoperative recovery was uneventful. She was discharged on the eighth postoperative day. Cardiac fibroelastomas are rare tumors, typically involving the heart valves. The preferred therapy is to perform repair of the valve whenever possible. If the tumor has a diffuse character, this is not an acceptable option, and replacement of the valve should be performed.

The Heart of the Matter

b l PRESENTATION In this case, a man with multiple cardiac symptoms suffers cardiac arrest during his medical evaluation, is revived, and is then treated for a very unusual tumor. The patient was a 46-year-old, previously healthy man who presented with complaints of shortness of breath and chest heaviness. Further inquiry revealed generalized fatigue and numerous episodes of profuse sweating over the preceding 2 months. A review of systems was otherwise negative.

The competent isolated double orifice mitral valve: an incidental finding during excision of a papillary fibroelastoma

The double orifice mitral valve is associated with a number of congenital abnormalities and comprises two mitral orifices separated by an accessory bridge of fibrous tissue and surrounded by a single fibrous annulus. We present our management of a case of a double orifice mitral valve associated with a papillary fibroelastoma.

Primary Cardiac Tumours: A Single-Center 41-Year Experience

Primary cardiac tumours are extremely rare with the most commonest being left atrial myxomas. In general, surgical resection is indicated, whenever the tumour formation is mobile and embolization can be suspected. Within 17280 patients receiving heart surgery at the Innsbruck Medical University, 78 patients (0.45%) underwent tumourectomy of primary cardiac tumours. The majority of patients (63) suffered from a left or right atrial myxoma, 12 showed a papillary fibroelastoma of the valves at echocardiographical or histological examination, 1 suffered from a hemangioma, 1 from a chemodectoma, and another one from a rhabdomyosarcoma. The mean age of cardiac tumour patients was 54.29 ± 13.28 years (ranging from 18 to 83 years). 67.95% of the patients were female and 32.05% were male. The majority of tumours were found incidentally; 97.44% of the patients showed no tumour recurrence.

Multimodality Imaging in the Diagnosis of Coexisting Left Atrial Myxoma and Aortic Valve Papillary Fibroelastoma

We present the case of a 77-year-old Cambodian woman with a 3-day history of dyspnea on exertion. Physical examination revealed a murmur of mitral regurgitation and decompensated heart failure. The ECG was remarkable for atrial fibrillation with rapid ventricular response. Transthoracic echocardiography showed severe left atrial dilation, a large (5×8 cm) mobile mass attached to the anterior left atrial wall, and several small, mobile aortic masses on the noncoronary cusp of the aortic valve (Figure 1 and online-only Data Supplement Movie I). Figure 1. Transthoracic echocardiogram shows small, mobile aortic masses on noncoronary cusp of aortic valve (blue arrow) and large mobile mass attached to the anterior left atrial wall (red arrow). LV indicates left ventricle; LA, left atrium; AO, aorta. Three-dimensional transesophageal echocardiography showed a large multilobular mass being displaced by the central jet of moderate to severe mitral regurgitation during systole and prolapse of the mass through the mitral valve during diastole (Figures 2 and 3 and online-only Data Supplement Movies II and III). The atrial mass was attached with a stalk to the anterior atrial wall and appeared lobulated and deformable, consistent with the …

Papillary fibroelastoma of mitral leaflet

stv.2012.0712 Auteur(s) : Amor Bouferrouk amorbouferrouk@yahoo.fr, Soraya Boutamine Hopital Bebbaatouche Abdel Ali, service de cardiologie, BP61 C, Nouvelle Ville Constantine Algerie Tires a part : A. Bouferrouk Observation clinique Madame X, patiente de 47 ans, est suivie depuis trois mois a titre externe pour la decouverte d’un thrombus intra-auriculaire gauche lors d’un examen echocardiographique, pratique lors d’un bilan systematique a la suite d’un accident vasculaire cerebral ischemique [...]

Multimodality imaging of a papillary fibroelastoma of the mitral valve

Multimodality imaging of a papillary fibroelastoma of the mitral valve

Surgical Experience With Cardiac Papillary Fibroelastoma Over a 15-Year Period

Papillary fibroelastomas are rare, benign cardiac tumors. They are predominantly asymptomatic. However, they can lead to serious complications, namely thromboembolic events. Symptomatic lesions can be managed primarily with surgical excision and valvular preservation. Controversy exists as to the management of asymptomatic lesions. All patients diagnosed with cardiac papillary fibroelastoma between 1996 and 2012 at a single institution were queried for clinical and pathologic characteristics. Twenty-three patients with 29 lesions were identified. Most lesions were solitary, less than 1.0 cm in diameter, and occurred in patients greater than 60 years of age. The most common presentation was thromboembolic complication. All were managed successfully with surgical excision. One patient developed a recurrence or metachronous lesion within 3 months of initial surgical intervention. Papillary fibroelastomas are rare, benign, predominantly asymptomatic cardiac tumors that can cause potentially serious complications. The natural history and etiology of papillary fibroelastomas are largely unknown. Controversy exists over the management of asymptomatic lesions. However, there is consensus that symptomatic lesions should undergo surgical excision with valvular preservation when possible. A unique case of a possible papillary fibroelastoma recurrence is also described.

Echocardiographic, Cardiac Magnetic Resonance Imaging, Surgical and Pathological Findings of an Unusual Right Atrial Tumor: a Giant Papillary Fibroelastoma

Echocardiographic, Cardiac Magnetic Resonance Imaging, Surgical and Pathological Findings of an Unusual Right Atrial Tumor: a Giant Papillary Fibroelastoma

An unusual case of giant cardiac fibroelastoma mimicking left atrial myxoma in a patient presenting with syncope

Cardiac papillary fibroelastomas are the most common primary valvular tumors. Generally benign, they account only for about 10% of all primary cardiac neoplasms, can occur in normal or diseased hearts, and are associated strongly with open heart surgery and radiotherapy. They are, in most cases, incidental findings, but can be discovered after syncope. We report the case of an elderly female, who was referred for syncope and was found to have a large fibroelastoma at the mitral valve annulus, intermittently obstructing the left ventricular inflow tract, and mimicking the presentation of left atrial myxoma. This case illustrates another potential mechanism of syncope in patients with fibroelastomas.

Simultaneous papillary fibroelastomas of the pulmonary and aortic valves

Cardiac papillary fibroelastomas (PFEs) are uncommon valve tumors. Multiple PFEs at the same or different locations in the heart account for less than 10% of patients with PFE. We herein describe a case of an asymptomatic PFE of both pulmonary and aortic valves which was incidentally diagnosed by echocardiography in a 60-year-old woman. Both PFEs were removed surgically without valve replacement. To our knowledge, this combination of lesions has not been previously reported. Even though PFEs are classified as benign cardiac tumors, they can present serious complications, such as embolic episodes, mechanical obstruction or valvular dysfunction. Valve-sparing shave excision of the lesions can be readily accomplished in most instances with good long-term results. All surgically removed valvular lesions should be histopathologically examined to confirm the echocardiographic diagnosis.

Fibrous Cyst Arising From the Cordae Tendiniae of the Mitral Valve

A 43-year-old man, suffering from shortness of breath revealed in the echocardiography and magnetic resonance imaging (Fig 1) a 4 × 3-cm tumor fixed at the anterior papillary muscle and the chordae tendinae prolapsing into the left ventricular outflow tract, causing a high-degree obstruction. Intraoperatively, a blood filled tumor prolapsing through the mitral valve was found (Fig 2A) and resected (Fig 2B). Prolapse of the anterior leaflet in the area of A2 was treated with two neochordae and ring dilatation with a closed annuloplasty ring. Postoperative course was uneventful, and no mitral valve regurgitation was documented in echocardiography. Histologic examination in Masson-Goldner stain (original magnification, ×20) showed a papillary endothelial fibroelastoma of the endocardium with fronds of acellular collagen lined by endothelial cells (Fig 3).Fig 3View Large Image Figure ViewerDownload (PPT)

Left atrial myxoma mimicking papillary fibroelastoma.

A 67-year-old woman was referred to our hospital with a diagnosis of deep vein thrombosis due to surgery for left patellar fracture. Deep vein thrombosis resolved with thrombolytic therapy. Transthoracic echocardiogram revealed a mobile left atrial tumor. Transesophageal echocardiography showed a fragile tumor with multiple fronds, implying a papillary fibroelastoma. Because this patient had a history of cerebral embolism, urgent surgery was scheduled. The excised tumor showed a sea anemone-like appearance in saline, which was similar to that of a papillary fibroelastoma. However, histological examination revealed the features of a myxoma and not papillary fibroelastoma. Herein, we illustrate a very rare case of left atrial myxoma with papillary fibroelastoma-like features in terms of both echocardiographic and gross findings.

Tricuspid Valve Papillary Fibroelastoma: A Rare Tumor with a Diagnostic Dilemma

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.

Aortic valve repair for active infective endocarditis

Aortic valve repair for active infective endocarditis

Papillary Fibroelastoma of the Aortic Valve with Atypical Chest Pain: Late Presentation with Acute Myocardial Infarction and Cardiac Arrest

We report a case of a 54-year-old female with papillary fibroelastoma of the aortic valve who presented with ST-elevation myocardial infarction and cardiac arrest. Though her initial symptom was only atypical chest pain, life-threatening complications such as acute myocardial infarction and cardiac arrest developed. After cardiopulmonary resuscitation, we promptly resected the fibroelastoma on cardiopulmonary bypass, and the patient was discharged without any other complications.