Papillary Fibroelastoma Research Articles

Papillary Fibroelastoma: Insight to a Primary Cardiac Valve Tumor

Papillary fibroelastomas are rare benign cardiac tumors. Although they have minimal hemodynamic effects, their propensity for embolization can result in serious morbidity. The pathophysiology and management of these tumors is the subject of this review.

Multidetector Computed Tomography Findings of a Papillary Fibroelastoma of the Aortic Valve: A Case Report

Papillary fibroelastoma is a rare benign cardiac tumor that represents 10% of all primary cardiac tumors. Diagnosis is accomplished incidentally by echocardiography that is usually performed for another purpose. Most papillary fibroelastomas are asymptomatic, but the lesions are recognized as a cause of embolisms. To the best of our knowledge, there has been no case report of computed tomography findings of a papillary fibroelastoma. We report a case of a papillary fibroelastoma in a 78-yr-old woman who had dyspnea and chest tightness. Echocardiography revealed a small lobulated mobile echogenic mass attached to the aortic valve, and CT demonstrated a lobulated soft tissue density mass with a thin stalk at the sinotubular junction of the aortic valve.

AVC isquémico embolígeno secundario a fibroelastoma papilar cardíaco

We present the case of a 37-year-old man with an embolic stroke. In the diagnostic evaluation, a mobile cardiac tumour in the atrial aspect of the mitral valve, suggestive of a papillary fibroelastoma, was found. Surgical excision of the tumour confirmed the diagnosis. There were no complications. Papillary Fibroelastoma is an uncommon benign cardiac tumour. Symptoms are varied including systemic embolism, as in our patient. The most common location is the aortic valve; it is less frequently seen in the mitral valve. An echocardiogram is the best diagnostic tool and surgical excision the preferred treatment method.

Papillary Fibroelastoma Presenting as a Left Ventricular Mass

Cardiac papillary fibroelastoma (CPF) is a benign cardiac tumor that usually affects cardiac valves. It is usually discovered incidentally on routine echocardiography. However, left ventricular CPF is rare. This report describes the case of a 73-year-old female, referred to a cardiology department for evaluation of a mass of the left ventricle. The mass was found routine echocardiography. The transthoracic echocardiography revealed a 2.2x1.3 cm highly oscillating mass, attached by stalk on the inferior wall of the left ventricle. Cardiac magnetic resonance imaging demonstrated a non-enhanced, 1.8x1.0 cm mass on the inferior wall of the left ventricle. The patient underwent surgical resection of the mass, histopathologic examination of the mass confirmed the diagnosis of a CPF.

Cardiac papillary fibroelastoma as a cause of recurrent stroke

Cardiac papillary fibroelastoma as a cause of recurrent stroke

A case of papillary fibroelastoma arising from chordae tendineae of mitral valve

A case of papillary fibroelastoma arising from chordae tendineae of mitral valve

Prospective assessment of multiple cardiac papillary fibroelastomas

Multiple cardiac papillary fibroelastomas (PFEs) are thought to account for less than 10% of patients with PFE. We aimed at evaluating the frequency and location of multiple PFEs and the reliability of transthoracic (TTE) and transoesophageal (TEE) echocardiography in diagnosing multiple PFEs. Twenty-six consecutive patients (52±14 years, 65% males) with pathologically confirmed PFE had 21 PFEs diagnosed by TTE, 33 by TEE, and 62 at surgery. Eight patients (31%) had multiple PFEs found either by TEE or at surgery. Aortic valve was involved in 75% of patients with multiple PFEs and left ventricle in 38% of patients. The sensitivity of TTE in diagnosing any PFEs was 51.3% and 76.9% for TEE. Our study emphasizes the high frequency of multiple PFEs, the need of TEE for all presumed PFE and the need for careful assessment of left-sided endocardial surfaces, especially of the aortic valve, during PFE excision.

An unusual location of a papillary fibroelastoma

A 72-year-old woman was hospitalized with recurrent acute coronary syndrome after initial successful treatment of acute ST-elevation myocardial infarction with percutaneous coronary intervention. Echocardiography demonstrated unexpectedly a 9 x 8 mm pendulating structure attached to the anterior, proximal interventricular septum in the left ventricular outflow tract 6 mm beneath the aortic valve annulus. Magnetic resonance imaging of the heart yielded the same findings. The patient underwent coronary artery bypass grafting and tumour excision. The histopathological findings were typical for papillary fibroelastoma (PFE) with a central zone of connective tissue and some elastic fibres without blood vessels and covered by endocardium. PFE is the third most common type of primary cardiac tumours, second to myxoma and lipoma. PFEs are avascular papillomas that predominantly occur on the aortic and mitral valves (90%). However, the present case demonstrates that PFE occasionally can be attached to the ventricular wall endocardium.

Tumors and tumor-like lesions of the heart valves

Valvular tumors and tumor-like lesions may have similar morphological and clinical characteristics, and may place the patients at a high risk of stroke in different ways. From January 2004 to June 2008, 11 patients underwent surgery for a suspected valvular tumor. Valvular tumor and tumor-like lesions accounted for 0.32% of adult cardiac operations. Five (45.5%) valvular lesions were papillary fibroelastomas, one (9.1%) was myxoma, 2 (18.2%) were organized thrombi, and 3 (27.3%) were calcification lesions. There was a total of 5 (45.5%) atrioventricular valve lesions, 4 arising from the atrial side of the leaflets, and one from the ventricular side. All 5 (45.5%) semilunar valvular lesions were from the aortic valve. One (9.1%) lesion originated from the chorda tendinea of the mitral valve. All leaflet lesions were resected by a simple shave technique, and all the patients recovered favorably. Valvular tumor and tumor-like lesions are rare. Pre-operative differential diagnoses among these valvular lesions pose important clinical implications for appropriate treatment for the underlying diseases. Prompt therapeutic measures in view of the underlying diseases of the valvular lesions are essential to prevent potential embolic events.

Mitral and tricuspid valve papillary fibroelastomas: A rare cause of multiple intracardiac masses

A 55-year-old woman with no cardiac history presented with increasing shortness of breath on exertion, worsening cough and orthopnea for three weeks. A transthoracic echocardiogram identified two intracardiac masses. Transesophageal echocardiography demonstrated a 1.8 cm × 1.5 cm mass attached to the base of the posterior tricuspid leaflet (Figure 1A) and a 1.0 cm × 0.5 cm mass attached to the atrial side of the left mitral leaflet (Figure 1B). Both masses displayed indistinct surface features and neither was attached to the atrial wall or interatrial septum. No other intracardiac pathology was identified. The differential diagnosis included primary cardiac tumour, metastatic malignancy, thrombus or vegetation. After an extensive workup, the patient ultimately went on to have surgical excision of these masses. Surgical pathology confirmed the diagnosis: mitral and tricuspid valve cardiac papillary fibroelastomas (CPFs). Figure 1 CPFs are the second most common primary cardiac tumour in adults. They are benign avascular tumours made of papillary elastin fibrils in a hyaline stroma covered with a single layer of endothelium. These tumours occur most frequently on the aortic and mitral valves, and infrequently on the tricuspid and pulmonic valves. On echocardiography, CPFs are typically small, well-demarcated, highly mobile masses attached to the endocardium by a pedicle. They can have a highly refractive appearance, often with areas of echolucency and a ‘speckled’ appearance around the perimeter. Multiple CPFs are an exceedingly rare finding. While typically asymptomatic, CPFs can present with stroke, sudden death, myocardial infarction, heart failure, syncope, pulmonary embolism or peripheral infarction. To date, no recurrences of CPFs after surgical excision have been reported, and the long-term prognosis of these patients appears to be excellent (1–4).

Papillary fibroelastoma of the tricuspid anterior leaflet

The case of a 50-year-old woman with an occasional diagnosis of cardiac tumor of the tricuspid valve is reported. At surgery, a single 2 cm x 2 cm polypoid gelatinous neoplasm infiltrating the anterior leaflet of the valve was resected and a tricuspid valve reconstruction along with annuloplasty was accomplished. The postoperative period was uneventful. A diagnosis of papillary fibroelastoma was made at pathology. This neoplasm, which represents a rare pathological entity, is more frequently localized on the mitral valve and usually stays asymptomatic for a long time. Only a few cases involving the tricuspid and pulmonary valves have been reported. Indication for surgery is related to a certain incidence of pulmonary embolism. Surgical removal of papillary fibroelastoma is a low-risk and definitive operation, as only one case of recurrence of the tumor has been reported so far in the literature.

Multiple Papillary Fibroelastomas of the Heart

We report the case of a 41-year-old woman who presented with extensive papillary fibroelastomas of the heart after multiple previous surgical procedures for hypertrophic cardiomyopathy. This case is significant because of the locally aggressive nature of the cardiac papillary fibroelastoma.

EComment: Cardiac papillary fibroelastoma: a current assessment

eComment: Cardiac papillary fibroelastoma: a current assessment

Heterogeneous Double Cardiac Tumor: Myxoma Concomitant with Papillary Fibroelastoma

Heterogeneous double cardiac tumor is rarely encountered. We present a case of simultaneous resection of myxoma and papillary fibroelastoma. Transesophageal echocardiography showed typical characteristics of each tumor. The myxoma was completely excised with a surgical margin, and the papillary fibroelastoma was shaved, preserving the cusp of the aortic valve. Pathohistologic examination confirmed the diagnosis. We discuss the echocardiographic characteristics and preferred surgical approaches for the two tumors.

Nonsurgical management of a tricuspid valvular pedunculated papillary fibroelastoma

A 25-year-old woman with a history of kidney transplantation for lupus nephritis was referred for the evaluation and management of a mass incidentally found on echocardiography. An oval and pedunculated mass attached to the tricuspid valve was managed with nonsurgical treatment. No symptoms and complications attributable to the mass developed. Three years later, the size of the mass decreased. Here we report the case of a probable cardiac papillary fibroelastoma (PFE), a mobile mass, with a stalk on the septal leaflet of the tricuspid valve that was managed for three years without surgical treatment.

Asymptomatic papillary fibroelastoma of the Aortic valve in a young woman - a case report

Echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic derangement.A 29-year-old asymptomatic young woman with incidental transthoracic echocardiographic (TTE) discovery of an aortic valve mass is presented. The 2-dimensional TTE showed a mobile, pedunculated mass, attached by a thin stalk to the aortic surface of the right coronary aortic cusp at the junction of its base with the anterior aortic wall. The importance of valve sparing tumour resection even in asymptomatic patients is emphasised.

Surgical treatment for papillary fibroelastoma of the aortic valve

Although cardiac papillary fibroelastomas are benign tumors, they have the potential to cause life-threatening complications such as stroke and myocardial infarction and may even lead to sudden cardiac death. We report a case of surgical treatment for a papillary fibroelastoma of the aortic valve. The patient was a 62-year-old woman who was asymptomatic for cardiac papillary fibroelastoma. Echocardiography demonstrated a mobile, rounded mass on the left coronary cusp of the aortic valve. The patient underwent surgical excision, had an uneventful recovery, and was discharged 10 days after the operation. Pathology examination confirmed papillary fibroelastoma. Surgical excision of the tumor is recommended for patients with symptoms, but the treatment of asymptomatic patients is controversial. We believe that surgical treatment should be performed if the tumor is mobile.

Multiple papillary fibroelastoma in left ventricle associated with obstructive hypertrophic cardiomyopathy

A 68-year-old man was referred to our hospital with a left ventricular (LV) mass and obstructive hypertrophic cardiomyopathy (HOCM). Although he was treated for the LV thrombosis and received anticoagulation therapy, the mass did not decrease in size for three years. His past history was colon cancer which was resected in its early phase. Laboratory studies revealed the absence of any inflammatory and tumor marker symptoms. Transthoracic and transesophageal echocardiography revealed a mass of 24x11 mm in diameter attached to the septal wall of LV and another two or three masses detected in LV wall. He received surgical treatment with complete mass excision with LV dissection and hypertrophied ventricular muscle was resected. Surgical resection of these LV masses and septal myectomy was performed. The histological examination showed that the lesions had a papillary configuration with an avascular connective tissue core lined by a single layer of endothelial cells, which was sufficient for a diagnosis of cardiac papillary fibroelastoma (CPF). The patient recovered without any complications.

Rapid development of a papillary fibroelastoma in the aortic valve: Report of a case

We report a case of a fast-growing cardiac papillary fibroelastoma (CPF) arising in the aortic valve. A 71-year-old woman was referred to a cardiologist for investigation of palpitations. Cardiac catheterization, coronary angiography, and echocardiography showed no stenosis of the coronary arteries, nor any other cardiovascular abnormalities. However, 12 months later she was referred to our hospital for further investigations when she began experiencing chest discomfort on exertion. This time, echocardiography showed an abnormal mass arising from the aortic valve, floating between the left sinus of Valsalva and the ascending aorta. Considering the risk of an embolic event, we performed semi-emergency surgery to remove the tumor, preserving the aortic valve. The resected tumor was 16 x 7 mm, and sea anemone-like, with many villus projections. It was diagnosed as papillary fibroelastoma. Such rapid development of CPF is rare.

Papillary fibroelastoma of the left atrial wall: a case report

Cardiac papillary fibroelastoma is a rare, benign cardiac tumor. It often arises from valvular endocardium, and non-valvular endocardial location is rare. Although transthoracic echocardiography is usually sufficient for the diagnosis of most cardiac tumors, small tumors such as papillary fibroelastoma may be missed. Transesophageal echocardiography is superior to transthoracic echocardiography in diagnosing these tumors. Despite their benign histology, and independent of their size, they should be resected surgically because of their high potential for embolization.In this report, we present a case of papillary fibroelastoma located on the left atrial wall, presenting with symptoms of cerebral ischemia. The patient was treated surgically for the prevention of further embolic complications. Pertinent literature is also reviewed for this rare and benign cardiac tumor.