101
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Abdallah H, El Boghdadi S, Ibrahim A, Moursi I, Alkhamees K. Uncommon Location of a Papillary Fbroelastoma: Case Report. CJC Open 2020; 3:121-123. [PMID: 33458640 PMCID: PMC7801223 DOI: 10.1016/j.cjco.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/30/2020] [Indexed: 11/24/2022] Open
Abstract
An elderly man, with a history of diabetes and hypertension presented to our hospital complaining of attack of syncope and palpitations. Echocardiogram revealed the presence of a pedunculated mass attached to the interventricular septum. Sternotomy was performed and ascending aorta was opened transversely, aortic valve leafets were retracted, and a tumour was resected. The postoperative course was uneventful; the patient was discharged after 1 week from the operation. This case demonstrates atypical location for fibroelastoma on the interventricular septum, thus underpinning the need for proper assessment of all patients with a history of systemic embolization to rule out any unusual intracardiac causes.
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Affiliation(s)
- Hassane Abdallah
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Sherif El Boghdadi
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ahmed Ibrahim
- Department of Research and Biostatistics, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ihab Moursi
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
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102
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Sultan FAT, Ahmed SW. Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography. J Clin Imaging Sci 2020; 10:57. [PMID: 33024612 PMCID: PMC7533085 DOI: 10.25259/jcis_137_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT). Material and Methods: We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis of cardiac mass on CMR were included in the study. Results: A total of 27 patients were referred for CMR from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Four patients were excluded as no cardiac mass was found on CMR. Out of 23 cases, majority (n = 15, 65%) were female, age ranging from 3 months to 70 years, with a mean age of 40 ± 22 years. Shortness of breath was the main presenting symptom (n = 19, 83%). Echocardiogram was the initial imaging modality done in all the patients while CT was also performed in 6 patients (26%). Out of 23 patients, 4 (17%) were diagnosed to have thrombus on CMR. In two cases, it was in the left ventricle with evidence of myocardial infarction on late gadolinium images. Myxoma was the most common tumor diagnosed on CMR in 6 patients (26%) followed by rhabdomyoma (n = 3, 13%) and fibroma (n = 2, 8.7%). There were three malignant primary tumors of the heart based on CMR appearances and one with tumor thrombus extension of hepatocellular carcinoma in the right atrium from inferior vena cava. Two patients were diagnosed to have non-neoplastic lesions – one with large intracardiac hydatid cyst and one with possible large fungal vegetation. Among 23 patients, 9 patients (39%) underwent surgery, 5 with myxoma, 2 with rhabdomyoma, 1 with fibroma, and 1 with fibroelastoma. Findings on surgery and histopathology matched the CMR diagnosis in all the patients except the one with the CMR diagnosis of myxoma in which histopathology was consistent with thrombus. Conclusion: CMR can play an important role in confirming the presence or absence of a mass in the heart. It can also provide differentiation of non-neoplastic and neoplastic lesions and among different types of neoplastic lesions with reasonable accuracy. However, the limitations of CMR must be recognized.
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Affiliation(s)
- Fateh Ali Tipoo Sultan
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Waqar Ahmed
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
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103
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Savage HO, Albanese A, Caruso V, Gedela S, Dungu J. Coronary embolization from aortic valve fibroelastoma. Clin Case Rep 2020; 8:1610-1612. [PMID: 32983460 PMCID: PMC7495835 DOI: 10.1002/ccr3.2954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
Papillary fibroelastomas have a range of clinical presentations. The surgical removal of these tumors should always be considered as best alternative to a conservative approach.
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Affiliation(s)
- Henry O. Savage
- Department of Cardiology Medicine and Cardiothoracic SurgeryBasildon and Thurrock University HospitalBasildonUK
| | - Alberto Albanese
- Department of Cardiology Medicine and Cardiothoracic SurgeryBasildon and Thurrock University HospitalBasildonUK
| | | | - Swamy Gedela
- Department of Cardiology Medicine and Cardiothoracic SurgeryBasildon and Thurrock University HospitalBasildonUK
| | - Jason Dungu
- Department of Cardiology Medicine and Cardiothoracic SurgeryBasildon and Thurrock University HospitalBasildonUK
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104
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Lak HM, Kerndt CC, Unai S, Maroo A. Cardiac papillary fibroelastoma originating from the coumadin ridge and review of literature. BMJ Case Rep 2020; 13:13/8/e235361. [PMID: 32847879 DOI: 10.1136/bcr-2020-235361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Papillary fibroelastomas represent the second most common benign cardiac tumour, secondary only to cardiac myxoma. A majority of patients are asymptomatic on presentation. The most common clinical manifestations include stroke, transient ischaemic attack, myocardial infarction and angina. Echocardiography remains the primary imaging modality for identification of these tumours. The majority of papillary fibroelastomas arise from the valves. Simple surgical excision is the mainstay of treatment, carrying an excellent prognosis. We present an unusual case of cardiac papillary fibroelastoma originating from the coumadin ridge (CR) in a 70-year-old woman. The patient exhibited increasing paroxysms of her atrial fibrillation and was pursuing a MAZE procedure. Preoperatively, a transesophageal echocardiogram revealed a 0.7×1 cm intracardiac mass that had echocardiographic appearance of a fibroelastoma. Surgical resection and MAZE procedures were performed. The gross specimen and histopathology findings were consistent with papillary fibroelastoma. This case reports the seventh documented case of fibroelastoma originating from the CR.
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Affiliation(s)
| | | | - Shinya Unai
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anjli Maroo
- Cardiovascular Medicine, Fairview Hospital, Cleveland, Ohio, USA
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105
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Ahern S, Khan MEA, McLoughlin J, Mellerick L, Burke L, Hinchion J. A rare case of a pulmonary valve papillary fibroelastoma. J Card Surg 2020; 35:3208-3210. [PMID: 32789895 DOI: 10.1111/jocs.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CASE A 67-year-old female presented with an exceedingly rare cardiac neoplasm - papillary fibroelastoma. This is made rarer still as it occurred on the pulmonary valve. The patient complained of a prolonged history of chest discomfort. Magnetic resonance imaging and echocardiography revealed a pulmonary valve papillary fibroelastoma. Surgical excision proved curative and the patient remains asymptomatic to date. DISCUSSION The literature surrounding papillary fibroelastomas is discussed. Primary cardiac tumours are uncommon. Papillary fibroelastomas occurring the right side of the heart comprise less than 0.05% of these. They have a characteristic macroscopic appearance which allow them to be easily identified with echocardiography and at surgical excision. They can present in a variety of ways including classical cardiac symptoms, embolic complications or as an incidental finding. Surgical excision is the definitive treatment.
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Affiliation(s)
- Shane Ahern
- Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Muhammad E A Khan
- Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Joseph McLoughlin
- Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Lisa Mellerick
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - John Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland
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106
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Tsuto K, Imai K, Hamanaka M, Yamamoto A, Ioku T, Hino Y. [Autopsy case of cerebral embolism with lung cancer and atrial fibrillation in which the left atrium may have become an incubator for a tumor embolus]. Rinsho Shinkeigaku 2020; 60:597-602. [PMID: 32779594 DOI: 10.5692/clinicalneurol.cn-001406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 82-year-old man with advanced lung cancer who had declined aggressive therapy was transferred to our hospital due to sudden-onset consciousness disturbance, global aphasia, and right hemiplegia. An electrocardiogram showed atrial fibrillation, and brain MRI and MRA revealed acute ischemic lesions of the left hemisphere and occlusion of the left internal carotid artery (ICA), respectively. We diagnosed acute ischemic stroke due to left ICA occlusion and performed endovascular thrombectomy, which resulted in complete recanalization of the left ICA after retrieval of the culprit embolus. Pathological examination of the retrieved thrombus revealed the presence of tumor tissue, as well as fibrin or red blood cells. Treatment was continued after admission, but the patient died of respiratory failure on day 40 of hospitalization. Autopsy revealed invasion of the tumor in the pulmonary vein, but not in the wall of the left atrium where thrombi were present. However, pathological examination of these thrombi in the left atrium revealed tumor tissue, along with fibrin or red blood cells. These findings suggest that the wall of the left atrium, in which lung cancer had not invaded, may be an incubator of a mixed embolus containing tumor tissue and thrombi in a case of cerebral embolism associated with both lung cancer and atrial fibrillation.
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Affiliation(s)
- Kazuma Tsuto
- Department of Neurology and Stroke Treatment of Kyoto First Red Cross Hospital
| | - Keisuke Imai
- Department of Neurology and Stroke Treatment of Kyoto First Red Cross Hospital
| | - Masashi Hamanaka
- Department of Neurology and Stroke Treatment of Kyoto First Red Cross Hospital
| | - Atsushi Yamamoto
- Department of Neurology and Stroke Treatment of Kyoto First Red Cross Hospital
| | - Tetsuya Ioku
- Department of Neurology and Stroke Treatment of Kyoto First Red Cross Hospital
| | - Yoko Hino
- Department of Clinical Pathology of Kyoto First Red Cross Hospital
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107
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Chung ES, Lee JH, Seo JK, Kim BG, Kim GS, Lee HY, Byun YS, Kim HJ. Early surgical intervention for unusually located cardiac fibroelastomas. Yeungnam Univ J Med 2020; 37:345-348. [PMID: 32759628 PMCID: PMC7606954 DOI: 10.12701/yujm.2020.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 12/04/2022] Open
Abstract
Papillary fibroelastomas are the second most common primary cardiac tumor in adults. Over 80% of fibroelastomas occur on the cardiac valves, usually on the left side of the heart, while the remaining lesions are typically scattered throughout the atria and ventricles. Although the optimal timing for surgery is controversial and depends on tumor size and location, prompt surgical resection is warranted in patients at high risk of embolism. A tumor on the cardiac valve can be removed using the slicing excision technique without leaflet injury. Here we present two cases of papillary fibroelastomas occurring on the ventricular surface of the aortic valve and in the right ventricle.
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Affiliation(s)
- Eui Suk Chung
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jong Kwon Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
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108
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Pilato G, Argirò A, Barletta G, Del Bene MR. Papillary fibroelastoma of the right atrial appendage: Is it that rare? Echocardiography 2020; 37:1308-1311. [DOI: 10.1111/echo.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Giuseppe Pilato
- Diagnostic Cardiology, Cardiothoracic Vascular Department Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Alessia Argirò
- Diagnostic Cardiology, Cardiothoracic Vascular Department Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Giuseppe Barletta
- Diagnostic Cardiology, Cardiothoracic Vascular Department Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Maria Riccarda Del Bene
- Diagnostic Cardiology, Cardiothoracic Vascular Department Azienda Ospedaliero‐Universitaria Careggi Florence Italy
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109
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Lionnet A, Cueff C, de Gaalon S, Manigold T, Sévin M, Testard N, Guillon B. Cause cardiache di embolia cerebrale. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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110
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Ajiboye O, Racoma JM, Hussain K, Mba B. Double valve involvement: papillary fibroelastoma in a patient with severe mitral and aortic valve regurgitation. BMJ Case Rep 2020; 13:13/7/e234828. [PMID: 32675116 DOI: 10.1136/bcr-2020-234828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac papillary fibroelastoma is a benign neoplasm that arises in the endocardium. It commonly presents as an incidental finding on transthoracic echocardiography or as emboli to the coronary, cerebral or pulmonary vasculature. Clinical manifestations described in the literature have generally been related to a sequelae of the associated embolic phenomenon of these lesions. Valve regurgitation is less common with papillary fibroelastoma and when found, it is not known to cause severe regurgitation requiring valve replacement. We report a case of papillary fibroelastoma in a patient with severe mitral and aortic valve regurgitation in association with mobile masses requiring double valve replacement. This patient managed initially as infective endocarditis with severe double valve regurgitation, was found to have valvular masses concernng for papillary fibroelastoma and subsequently confirmed on pathology.
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Affiliation(s)
- Oyintayo Ajiboye
- Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Jan Michael Racoma
- Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Kifah Hussain
- Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Benjamin Mba
- Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
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111
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Pradella S, Grazzini G, Letteriello M, De Amicis C, Grassi R, Maggialetti N, Carbone M, Palumbo P, Carotti M, Di Cesare E, Giovagnoni A, Cozzi D, Miele V. Masses in right side of the heart: spectrum of imaging findings. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:60-70. [PMID: 32945280 PMCID: PMC7944673 DOI: 10.23750/abm.v91i8-s.9940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
Primary heart tumors are rare, benign tumors represent the majority of these. If a cardiac mass is found, the probability that it is a metastasis or a so-called “pseudo-mass” is extremely higher than a primary tumor. The detection of a heart mass during a transthoracic echocardiography (TE) is often unexpected. The TE assessment can be difficult, particularly if the mass is located at the level of the right chambers. Cardiac Computed Tomography (CCT) can be useful in anatomical evaluation and Cardiac Magnetic Resonance (CMR) for masses characterization as well. We provide an overview of right cardiac masses and their imaging futures. (www.actabiomedica.it)
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Affiliation(s)
- Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Mayla Letteriello
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | | | - Roberta Grassi
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Nicola Maggialetti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Mattia Carbone
- Department of Radiology, S. Giovanni and Ruggi D'Aragona Hospital, Salerno, Italy.
| | - Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Marina Carotti
- Università politecnica delle Marche, School of Medicine and University Hospital "Umberto I-Lancisi-Salesi", Department of Radiology, Ancona, Italy.
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Giovagnoni
- Università politecnica delle Marche, School of Medicine and University Hospital "Umberto I-Lancisi-Salesi", Department of Radiology, Ancona, Italy.
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy.
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112
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Abstract
PURPOSE OF REVIEW Cardiac imaging after ischemic stroke or transient ischemic attack (TIA) is used to identify potential sources of cardioembolism, to classify stroke etiology leading to changes in secondary stroke prevention, and to detect frequent comorbidities. This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke. RECENT FINDINGS Echocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary information in selected stroke patients. Cardiac imaging after ischemic stroke or TIA reveals a potential causal condition in a subset of patients. Whether systematic application of cardiac imaging improves outcome after stroke remains to be established.
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Affiliation(s)
- S Camen
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research) (partner site Hamburg/Kiel/Luebeck), Berlin, Germany
| | - K G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - R B Schnabel
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
- DZHK (German Center for Cardiovascular Research) (partner site Hamburg/Kiel/Luebeck), Berlin, Germany.
- University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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113
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Duymun S, Nasir A. Papillary Fibroelastoma of the Right Ventricle in the Setting of Multifocal Pulmonary Hemorrhages and Pulmonary Embolization in a 39-Year-Old Man: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923074. [PMID: 32544147 PMCID: PMC7319075 DOI: 10.12659/ajcr.923074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Male, 39-year-old Final Diagnosis: Papillary fibroelastoma Symptoms: Chest pain • fever • hemoptysis • weight loss Medication: — Clinical Procedure: — Specialty: Cardiac Surgery • Cardiology • Critical Care Medicine • Pulmonology
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Affiliation(s)
- Shahnaz Duymun
- Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, USA
| | - Asad Nasir
- Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, USA
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114
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Albitar HA, Almodallal Y, Nishimura R, Iyer VN. Mobile Mitral and Aortic Valvular Masses in Patients With Hereditary Hemorrhagic Telangiectasia Receiving Intravenous Bevacizumab. Mayo Clin Proc Innov Qual Outcomes 2020; 4:460-463. [PMID: 32793873 PMCID: PMC7411168 DOI: 10.1016/j.mayocpiqo.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bevacizumab is now an emerging treatment option for severe hereditary hemorrhagic telangiectasia–related bleeding including epistaxis and gastrointestinal tract bleeding. The impact of long-term intravenous bevacizumab therapy on cardiac structure and function is unknown. We describe 3 patients receiving intravenous bevacizumab therapy for severe hereditary hemorrhagic telangiectasia–related bleeding who were found to have abnormal mobile masses on the mitral valve (n=2) and aortic valve (n=1). The clinical impact of these findings is unknown and requires further study.
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Affiliation(s)
| | - Yahya Almodallal
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Rick Nishimura
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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115
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Casavecchia G, Lestuzzi C, Gravina M, Corrado G, Tusa M, Brunetti ND, Manuppelli V, Monte IP. Cardiac Tumors. J Cardiovasc Echogr 2020; 30:S45-S53. [PMID: 32566466 PMCID: PMC7293869 DOI: 10.4103/jcecho.jcecho_7_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
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Affiliation(s)
| | - Chiara Lestuzzi
- Department of Cardiology, Aviano Hospital, Pordenone, Aviano, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Maurizio Tusa
- Department of Cardiology, Milano San Donato Hospital, Milano, Italy
| | | | | | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
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116
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Tsugu T, Nagatomo Y, Murata M, Iwanaga S. Giant Papillary Fibroelastoma Attached to the Left Atrial Septum, Near the Foramen Ovale. Tex Heart Inst J 2020; 47:175-176. [PMID: 32603456 DOI: 10.14503/thij-17-6516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology, Tachikawa Hospital, 190-8531 Tachikawa
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, 359-8513 Tokorozawa
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, 160-8582 Tokyo
| | - Shiro Iwanaga
- Department of Cardiology, Saitama International Medical Center, 350-1298 Hidaka; Japan
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117
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Valikulova FY, Fomin IV, Polyakov DS, Antsygina LN, Muradova FN, Kozina MB. [Papillary fibroelastoma in the cardiologist's practice]. ACTA ACUST UNITED AC 2020; 60:145-148. [PMID: 32375628 DOI: 10.18087/cardio.2020.3.n1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
The article presents a clinical case of diagnosis and treatment of a rare disease, multiple papillary fibroelastoma associated with a relapse and a complication in the form of cardioembolic stroke. The authors stressed difficulties in diagnostics of this disease and a special role of the physician-patient interaction.
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Affiliation(s)
- F Yu Valikulova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - I V Fomin
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - D S Polyakov
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - L N Antsygina
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - F N Muradova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - M B Kozina
- State Healthcare Institution "Cardiac surgery clinical hospital" of Nizhny Novgorod region
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118
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Mirić D, Baković Kramarić D, Bulat C, Bukarica K, Tičinović Kurir T, Giunio L. Cardiac papillary fibroelastoma and kidney infarction. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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119
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de Klerk S, Dogon C, Grossman M, Adler JE, McFalls J, Furukawa S, Goldberg S. Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion. ACTA ACUST UNITED AC 2020; 4:278-282. [PMID: 32875195 PMCID: PMC7451855 DOI: 10.1016/j.case.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A patient presented with reduced effort tolerance and abnormal stress test. He was subsequently found to have a left ventricular mass. Multimodal imaging was utilized; however, diagnostic certainty remained limited. Cardiac surgery was pursued, wherein a single left ventricular mass was resected. Biopsy was consistent with cardiac papillary fibroelastoma. On follow-up, the patient reported a return to prior functioning.
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Affiliation(s)
- Storm de Klerk
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Calli Dogon
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Moshe Grossman
- Department of Radiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy E Adler
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeanne McFalls
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Satoshi Furukawa
- Cardiovascular Surgery, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Sheldon Goldberg
- Cardiovascular Education, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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120
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Topal B, Hindori V, Pouwels S, Riezebos R. The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve. Cureus 2020; 12:e7136. [PMID: 32257681 PMCID: PMC7105234 DOI: 10.7759/cureus.7136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A cardiac papillary fibroelastoma (CPFE) is reported to be the second most common cardiac neoplasm after myxoma cordis. CPFEs are histologically benign, frequently asymptomatic, but highly thrombogenic, which could lead to systemic and peripheral embolization. We present a case of a 68-year-old-patient, with a history of angioosteohypertrophy syndrome, who presented at our emergency department (ED) with symptoms of transient ischemic attacks. A thorough investigation, including echocardiography, revealed a neoplasm on the left coronary cusp (LCC) of the aortic valve. The neoplasm was resected via a valve-sparing shave via the right anterior thoracotomy (RAT). The pathological assessment confirmed it to be CPFE. CPFE is a rare but treatable cause of thromboembolism. The removal of CPFEs has classically been performed through a full median sternotomy. We like to present the first case of a valve-sparing removal of a CPFE on the aortic valve through a RAT approach.
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Affiliation(s)
- Besir Topal
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | - Vikash Hindori
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | | | - Robert Riezebos
- Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
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121
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Vieira MJ, Craveiro N, Alves M, Pitta L. Unusual place… unusual number. Echocardiography 2020; 37:467-468. [PMID: 32077509 DOI: 10.1111/echo.14616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 11/28/2022] Open
Abstract
Cardiac papillary fibroelastoma is a rare, benign cardiac tumor. It often arises from the valvular endocardium and is usually solitary. Nonvalvular location is rare and even more rare is the presentation as multiple masses. A 71-year-old female patient was referred for echocardiographic evaluation due to progressive fatigue. The presence of multiple left atrial masses was observed on echocardiographic evaluation. The patient was treated surgically for the prevention of embolic complications, and the histologic diagnosis of multiple nonvalvular papillary fibroelastoma was made. This case highlights the need to consider this unusual location and presentation for this type of tumor.
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Affiliation(s)
| | - Nuno Craveiro
- Cardiology Department, Hospital de Santarém, Santarém, Portugal
| | - Miguel Alves
- Cardiology Department, Hospital de Santarém, Santarém, Portugal
| | - Luz Pitta
- Cardiology Department, Hospital de Santarém, Santarém, Portugal
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122
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Sugimura Y, Rellecke P, Reinecke P, Lichtenberg A, Akhyari P. Video-assisted minimally invasive resection of papillary fibroelastoma. Asian Cardiovasc Thorac Ann 2020; 28:179-181. [PMID: 31964148 DOI: 10.1177/0218492320901962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac papillary fibroelastoma is a rare cause of embolic events, especially seen in young patients. A 38-year-old woman with a transient ischemic attack underwent cardiac diagnostic workup. Transesophageal echocardiography and magnetic resonance imaging identified a tumor on the anterior leaflet of the mitral valve as the only potential source of embolization. Video-assisted minimally invasive resection of the tumor and reconstruction of the mitral valve were performed. Postoperative transthoracic echocardiography showed no residual tumor or mitral valve insufficiency. Histology identified a papillary fibroelastoma. The patient was discharged on the 9th postoperative day in good physical condition and without any postoperative limitations.
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Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Petra Reinecke
- Department of Pathology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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123
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Subaortic Membrane Papillary Fibroelastoma. Case Rep Cardiol 2020; 2020:2586730. [PMID: 32089895 PMCID: PMC6977332 DOI: 10.1155/2020/2586730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022] Open
Abstract
A 61-year-old male presented for an annual exam and received a transthoracic echocardiogram (TTE) which revealed a mobile mass arising from a subaortic membrane. Further investigations with a transesophageal echocardiogram (TEE) and cardiac computerized tomography angiography (CTA) confirmed the presence of a mobile 9 mm × 3 mm mass on a subaortic membrane. Cardiothoracic surgery was performed with an open operation removing the mass and subaortic membrane. Upon visual inspection, the mass was likened to a sea anemone and immunohistochemical staining performed pathologically confirmed the diagnosis of cardiac papillary fibroelastoma. This case represents the first reported example of a cardiac papillary fibroelastoma (PFE) arising from a subaortic membrane. Although PFEs are benign cardiac tumors, proper identification and consideration for excision of these lesions may be indicated to prevent thromboembolic complications.
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124
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Tan YH, Chien CY. Papillary fibroelastoma of the aortic valve. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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125
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Nakanaga H, Matsumoto S, Tabata M. Papillary fibroelastoma entangled with tendinous chords: gap between echocardiographic and operative findings. Int J Cardiovasc Imaging 2019; 36:457-458. [PMID: 31863238 DOI: 10.1007/s10554-019-01740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
This papillary fibroelastoma case showed the imaging gap between echocardiography and operative findings. Use of 4K endoscopy enabled us to visualize the details of the tumor and to excise it safely.
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Affiliation(s)
- Hiroshi Nakanaga
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-Shi, 279-0001, Chiba, Japan
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-Shi, 279-0001, Chiba, Japan.
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126
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Taha ME, Kumaresan J. Aortic Valve Papillary Fibroelastoma: A Sea Anemone in the Heart, A Case Report. Cardiol Res 2019; 10:378-381. [PMID: 31803336 PMCID: PMC6879048 DOI: 10.14740/cr818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/01/2019] [Indexed: 11/11/2022] Open
Abstract
Cardiac papillary fibroelastomas are benign primary cardiac tumors usually arising from the normal components of the endocardium. Grossly they have a characteristic short pedicle and multiple papillary fronds similar to sea anemone. Clinically they have varying presentations ranging from asymptomatic to severe ischemic or embolic complications. We hereby present a case of a middle-aged man who presented with exertional dyspnea and palpitations and was discovered to have papillary fibroelastoma involving the aortic valve. The described case illustrates some of the presenting features, the workup and some of the management modalities that need to be implicated in cases of papillary fibroelastomas.
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Affiliation(s)
- Mohamed E Taha
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV, USA.,These authors contributed equally to the work
| | - Janani Kumaresan
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV, USA.,These authors contributed equally to the work
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127
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Çöllüoğlu T, Önalan O. An unusual cause of lacunar infarcts: Lambl's excrescences on aortic valve shown in detail by 3D transesophageal echocardiography. Oxf Med Case Reports 2019; 2019:omz110. [PMID: 31798923 PMCID: PMC6878198 DOI: 10.1093/omcr/omz110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/02/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022] Open
Abstract
Lambl’s excrescences (LE) are rare cardiac structures. They are associated with catastrophic thromboembolic and coronary events. Despite resulting in such important events, 2D echocardiographic imaging modalities may overlook LE owing to very thin cardiac structures. So, 3D echocardiographic imaging modalities may fully offer this cardiac mass and provide us to more accurately guess the complication rate related to LE due to the fact that 3D echocardiographic imaging techniques have higher spatial resolution and are not based on the geometric assumption. Indeed, another benefit of 3D echocardiographic imaging modalities in this population is that these imaging modalities clearly provide the relationship to adjacent structures of LE and its movement over a cardiac cycle in 3D space. In our case report, we aim to present the usefulness of 3D echocardiography as a modality to clearly offer all features of LE, furthermore to give valuable information about management in patients with thromboembolic events leading to LE.
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Affiliation(s)
- Tuğçe Çöllüoğlu
- Department of Cardiology, Karabuk University Educational and Research Hospital, Karabük, Turkey
| | - Orhan Önalan
- Department of Cardiology, Karabuk University Educational and Research Hospital, Karabük, Turkey
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128
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Lu N, Wei N, Wang L, Yuan Y. Cardiac papillary fibroelastoma arising from the opening of the left inferior pulmonary vein in left atrium: A rare case report. Medicine (Baltimore) 2019; 98:e18281. [PMID: 31804369 PMCID: PMC6919405 DOI: 10.1097/md.0000000000018281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cardiac papillary fibroelastoma is a small, benign endocardial tumor, while it is clinically important because of its strategic position and propensity for causing embolic events and hemodynamic complications. PATIENT CONCERNS A 59-year-old female presented our hospital for investigation and treatment of a sudden onset of syncope lasted about 2 minutes. DIAGNOSES Cardiac papillary fibroelastoma arising from left inferior pulmonary vein in left atrium. INTERVENTIONS The tumor was successfully removed by cardiac surgery. OUTCOMES The patient's postoperative course was uneventful, and she was discharged 10 days after surgery. The patient remained free of neurologic deficits and had no evidence of residual or recurrence of tumor with echocardiography during 1 year of follow-up. LESSONS Cardiac papillary fibroelastoma is a benign tumor, with increased risk of thromboembolic events. It is often diagnosed in patients with echocardiography by chance or after a neurologic event. Complete surgical resection should be considered when the patient is indicated and the long-term postoperative prognosis is excellent.
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Affiliation(s)
- Na Lu
- The Department of Pediatrics
| | - Na Wei
- The Department of Operation Room
| | - Lei Wang
- The Department of Cardiovascular Surgery
| | - Ye Yuan
- The Department of Anesthesiology, the First hospital of Jilin university, Changchun, China
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129
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Kolek M, Dvorackova J, Motyka O, Brat R. Cardiac papillary fibroelastomas: A 10-year single-center surgical experience and long-term echocardiographic follow-up study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:84-91. [PMID: 31748759 DOI: 10.5507/bp.2019.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/18/2019] [Indexed: 12/30/2022] Open
Abstract
AIMS Limited contemporary data are available on the clinical and echocardiographic outcomes after surgery for cardiac papillary fibroelastoma (CPF). The aim of this study was to review the clinical manifestations, pathological characteristics, surgical management, and prognoses of patients with histologically verified CPF, who underwent surgery at our cardiac surgery center from 2008 to 2018. METHODS AND RESULTS Twelve patients of median age 62 years (28 to 77 years) were treated. Embolic stroke or transient ischemic attack (five patients, 42%) were the only CPF clinical manifestations. Eleven (92%) tumors were localized on the valves, with the aortic valve being the most common tumor site (seven patients; 58%). Multiple factor analysis revealed no independent predictor of CPF-related embolization. Simple shave tumor excision was sufficient in most patients (10 patients, 83%). No operative or tumor-related late mortality during the median follow-up period of 4.7 years (1.1 to 10.2 years) was recorded. Asymptomatic metachronous valve tumor recurrence (in a location different from that of the original tumor) was revealed in two patients (17%) by transesophageal echocardiography (TEE), not detected by transthoracic echocardiography (TTE). One of these two patients underwent repeated surgery for CPF but later suffered a recurrent embolic stroke, due to another tumor recurrence. CONCLUSION CPF can be safely and effectively treated surgically. TEE is superior to the TTE option in CPF post-operative recurrence detection. There is a clear need for a prospective study to determine criteria for embolization risk stratification and optimum management in patients with CPF.
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Affiliation(s)
- Martin Kolek
- Department of Clinic Subjects, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | | | | | - Radim Brat
- Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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130
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Nellis JR, Wojnarski CM, Fitch ZW, Andersen NA, Turek JW. Minimally Invasive Pulmonary Fibroelastoma Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:577-580. [DOI: 10.1177/1556984519884308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pulmonary fibroelastomas are a rare primary cardiac tumor with less than 50 cases reported in the literature to date. We performed a minimally invasive valve-sparing tumor resection through a left anterior mini-incision (LAMI). The procedure was performed without cardiac arrest or aortic cross clamp, expediting postoperative recovery and allowing for an uncomplicated discharge on postoperative day 5. LAMI is a safe and reliable alternative to median sternotomy for patients requiring interventions on the right ventricular outflow tract and main pulmonary artery, including pulmonary fibroelastoma resection and pulmonary valve replacement when needed.
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Affiliation(s)
- Joseph R. Nellis
- Department of Surgery, Duke University Hospitals, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Charles M. Wojnarski
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
| | - Zachary W. Fitch
- Department of Surgery, Duke University Hospitals, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Nicholas A. Andersen
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
- Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Joseph W. Turek
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
- Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
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131
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Guo DC, Yang YH, Liu Y, Sun LL, Zhu WW, Lu XZ, Li YD. Incidental finding of an asymptomatic pulmonary valve papillary fibroelastoma: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:568-571. [PMID: 31392732 DOI: 10.1002/jcu.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.
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Affiliation(s)
- Di-Chen Guo
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan-Hua Yang
- Department of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lan-Lan Sun
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Wei Zhu
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lu
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi-Dan Li
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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132
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Indruchová P, Petr R, Benešová M, Zemanová I, Línková H. (A young patient with large myxoma in the right atrium). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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133
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Nisivaco SM, Patel B, Balkhy HH. Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach. J Card Surg 2019; 34:1492-1497. [DOI: 10.1111/jocs.14291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah M. Nisivaco
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
| | - Brooke Patel
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
| | - Husam H. Balkhy
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
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134
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Giant Tricuspid Valve Fibroelastoma Incidentally Diagnosed During Routine Stress Testing. JACC Case Rep 2019; 1:564-568. [PMID: 34316879 PMCID: PMC8289157 DOI: 10.1016/j.jaccas.2019.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/11/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022]
Abstract
Papillary fibroelastomas (PFEs) are the most common valvular tumor, typically occurring on left-sided valves. We describe the evaluation and treatment of a giant tricuspid PFE in a healthy 43-year-old police officer who was referred for evaluation of frequent premature ventricular contractions during job-related treadmill stress testing. (Level of Difficulty: Beginner.).
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135
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Abstract
About 20–25% of all ischemic strokes are of cardioembolic etiology, with atrial fibrillation and heart failure as the most common underlying pathologies. Diagnostic work-up by noninvasive cardiac imaging is essential since it may lead to changes in therapy, e.g., in—but not exclusively—secondary stroke prevention. Echocardiography remains the cornerstone of cardiac imaging after ischemic stroke, with the combination of transthoracic and transesophageal echocardiography as gold standard thanks to their high sensitivity for many common pathologies. Transesophageal echocardiography should be considered as the initial diagnostic tool when a cardioembolic source of stroke is suspected. However, to date, there is no proven benefit of transesophageal echocardiography-related therapy changes on the main outcomes after ischemic stroke. Based on the currently available data, cardiac computed tomography and magnetic resonance imaging should be regarded as complementary methods to echocardiography, providing additional information in specific situations; however, they cannot be recommended as first-line modalities.
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Affiliation(s)
- S Camen
- Department of General and Interventional Cardiology, Building O70, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - R B Schnabel
- Department of General and Interventional Cardiology, Building O70, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany.
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136
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Abstract
Intracardiac masses are classified as neoplastic or non-neoplastic. Prognosis varies based on the diagnosis of the mass since treatment options differ greatly. As novel imaging techniques emerge, a multimodality approach to the evaluation of intracardiac masses becomes an important part of non-invasive evaluation prior to potential surgical planning or oncological treatment. The purpose of this article is to compare the available imaging modalities-echocardiography, cardiovascular magnetic resonance, cardiac computed tomography, nuclear imaging, and emerging novel hybrid imaging techniques for future clinical applications-and to review the characteristic features seen on those modalities for the most common intracardiac masses.
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137
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Memtsas V, Sharma N, Lynch M. Echocardiographic and radiological evaluation of an unusual aortic root mass in an asymptomatic patient: a case report. Eur Heart J Case Rep 2019; 3:ytz152. [PMID: 31660509 PMCID: PMC6764540 DOI: 10.1093/ehjcr/ytz152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/18/2019] [Accepted: 07/09/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Incidental echocardiographic findings in the asymptomatic patient can present a diagnostic challenge to the clinician. This case report demonstrates that both natural occurring and iatrogenic causes should be considered in the differential diagnosis of isolated aortic root masses.
Case Summary
A patient presenting for a routine transthoracic echocardiogram to evaluate worsening breathlessness on exertion is found to have an unexpected aortic root mass. Due to the unusual appearances of the aortic root mass, it is further evaluated with additional imaging modalities, including transoesophageal echocardiogram and computed tomography coronary angiography. The mass is fully characterized following the computed tomography coronary angiography as a right coronary artery stent, from a previous coronary angioplasty, protruding into the lumen of the aortic root. No further investigation or intervention is required.
Discussion
A wide differential diagnosis of focal aortic root masses is presented. The non-invasive characterization of such masses can present a challenge. This case demonstrates the value of a multimodality imaging approach, including transthoracic, transoesophageal echocardiography, and computed tomography coronary angiography, in the evaluation of such masses.
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Affiliation(s)
- Vassilios Memtsas
- Department of Cardiology, Lister Hospital, Coreys Mill Ln, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Naveen Sharma
- Department of Radiology, Lister Hospital, Coreys Mill Ln, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Mary Lynch
- Department of Cardiology, Lister Hospital, Coreys Mill Ln, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
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138
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Reis VS, Tsang DC, Williams DB, Carrillo RG. Symptomatic Aortic Valve Mass - Cardiac Work-Up Challenges and Role of Computed Tomography Angiography: A Case Report. Braz J Cardiovasc Surg 2019; 34:499-502. [PMID: 31454208 PMCID: PMC6713383 DOI: 10.21470/1678-9741-2018-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to
lethal complications from embolization or valvular dysfunction if left
untreated. When working up symptomatic tumors with concomitant angina,
traditional diagnostic studies such as cardiac catheterization may predispose
the patient to embolic complications if the mass is located in the path of the
catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic
resonance imaging or dynamic computed tomography angiography, may be considered
in lieu of invasive approaches to avoid potentially devastating complications.
We herein present a case report of a 77-year-old female with a symptomatic
aortic valve tumor and describe our diagnostic strategy and management.
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Affiliation(s)
- Victor S Reis
- University of Miami Miller School of Medicine Division of Cardiothoracic Surgery Miami Florida Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Darren C Tsang
- University of Miami Miller School of Medicine Division of Cardiothoracic Surgery Miami Florida Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Donald B Williams
- University of Miami Miller School of Medicine Division of Cardiothoracic Surgery Miami Florida Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Roger G Carrillo
- University of Miami Miller School of Medicine Division of Cardiothoracic Surgery Miami Florida Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida
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139
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Mashicharan M, El-Dean Z, Zlocha V, Khoo J. Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events. Echo Res Pract 2019; 6:K13-K17. [PMID: 31413862 PMCID: PMC6689122 DOI: 10.1530/erp-19-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/18/2019] [Indexed: 11/24/2022] Open
Abstract
Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source.
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Affiliation(s)
- Mary Mashicharan
- Department of Cardiology, University Hospital Leicester, Leicester, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Viktor Zlocha
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Jeffrey Khoo
- Department of Cardiology, University Hospital Leicester, Leicester, UK
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140
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Dénes S, Daron B, Behaeghe M, Seghaye MC. Cardiac papillary fibroelastoma of a bicuspid aortic valve in an adolescent: A case report. Clin Pract 2019; 9:1135. [PMID: 31579491 PMCID: PMC6766684 DOI: 10.4081/cp.2019.1135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023] Open
Abstract
Cardiac papillary fibroelastomas (CPFE) are exceptional primary benign cardiac tumours affecting the heart valves. We report here the case of a 15-year-old boy in whom echocardiography performed for non-specific chest pain during follow-up for bicuspid aortic valve showed as accidental finding the presence of a round mobile mass without stalk attached on the inferior side of the aortic valve. The mass did not cause any outflow tract obstruction or aortic insufficiency. Electrocardiogram-gated cardiac computed tomography and magnetic resonance imaging allowed to suspect CPFE. Although the patient was asymptomatic, open cardiac surgery with elective surgical resection of the tumour was performed to avoid systematic emboli. Histology confirmed the diagnosis of CPFE. This is an exceptional case of acquired CPFE in a young patient with bicuspid aortic valve. Due to the risk of systemic embolization, aortic or coronary ostium obstruction, elective excision of such lesions is recommended.
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Affiliation(s)
- Sarah Dénes
- Pediatric Cardiology, Department of Pediatrics, University Hospital of Liège
| | - Benoît Daron
- Department of Pediatrics, Regional Hospital Verviers
| | - Marie Behaeghe
- Department of Anatomic Pathology, University Hospital of Leuven, Belgium
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141
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Roberts CS, Carry MM, Choi JW, Grayburn PA, Roberts WC. Papillary fibroelastoma in the left atrium. Proc (Bayl Univ Med Cent) 2019; 32:247-248. [PMID: 31191142 DOI: 10.1080/08998280.2018.1553439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022] Open
Abstract
Described herein is a 71-year-old woman with previous angina pectoris who suddenly developed slurred speech and right-arm weakness. She was found to have significant coronary narrowing, a small mass in the left atrium attached to the endocardium near the orifice of the appendage, and multifocal punctate cerebral lesions in the distribution of the left middle cerebral artery. The left atrial mass was excised and confirmed to be a papillary fibroelastoma. Coronary bypass was also performed. It is believed that fibrin thrombus developed within the fronds of the fibroelastoma and embolized to the brain. Such lesions in the left atrium are exceedingly uncommon. She had no further emboli events.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac and Thoracic Surgery, Baylor University Medical CenterDallasTexas.,Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Melissa M Carry
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - James W Choi
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
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142
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Giusca S, Buss S, Lasitschka F, Karck M, Korosoglou G. Syncope in a female patient. Echocardiography and cardiac computed tomography reveal an unexpected diagnosis. Clin Case Rep 2019; 7:1167-1170. [PMID: 31183087 PMCID: PMC6552931 DOI: 10.1002/ccr3.2164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/14/2019] [Accepted: 03/23/2019] [Indexed: 11/21/2022] Open
Abstract
Papillary fibroelastoma is a benign cardiac tumor with a high potential of embolization. Coronary computed tomography is a valuable tool for the work-up of patients with papillary fibroelastoma, providing accurate information regarding the coronary circulation and morphology of the cardiac mass.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology & Vascular MedicineGRN Hospital WeinheimWeinheimGermany
| | | | | | - Matthias Karck
- Department of Cardiac SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Grigorios Korosoglou
- Department of Cardiology & Vascular MedicineGRN Hospital WeinheimWeinheimGermany
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143
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Kamimura T, Tanaka K, Yamagami H, Koga M. Cerebral Embolism due to a Large Papillary Fibroelastoma arising from the Coumadin Ridge. Clin Case Rep 2019; 7:1267-1268. [PMID: 31183110 PMCID: PMC6552954 DOI: 10.1002/ccr3.2178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/05/2019] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
A 70-year-old woman developed acute cerebral infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium, suggesting cardiac myxoma as the most likely diagnosis. Surgical exploration revealed a papillary fibroelastoma originating from the coumadin ridge, which is fairly rare but important as a source of cerebral embolization.
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Affiliation(s)
- Teppei Kamimura
- Department of NeurologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Kanta Tanaka
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Hiroshi Yamagami
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Masatoshi Koga
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
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144
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Logan N, Islam MS, Chughtai JZ, Murphy NF. An atypical cause of myocardial infarction: case report of an obstructing papillary fibroelastoma of the aortic valve. Eur Heart J Case Rep 2019; 3:5485821. [PMID: 31449619 PMCID: PMC6601164 DOI: 10.1093/ehjcr/ytz058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 04/08/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Papillary fibroelastomas are rare primary cardiac tumours with a prevalence of 0.01% at autopsy. They are histologically benign tumours but have been demonstrated through case series to confer an increased risk of thrombo-embolism resulting in: transient ischaemic attack, stroke, myocardial infarction, and pulmonary and systemic embolization. CASE SUMMARY A 54-year-old woman presented with central chest pain radiating to her left arm. At presentation there was a significant troponin rise; initial high-sensitivity troponin-I (hsTn-I) 660 pg/mL increased to 3340 pg/mL at 6 h. Coronary angiogram did not reveal any obstructing coronary artery disease. Echocardiography revealed a rounded, mobile mass on the left coronary cusp of the aortic valve suspicious for papillary fibroelastoma. The patient underwent shave excision of the lesion. Intra-operatively it was noted that the mass intermittently sat within the ostium of the left main resulting in its occlusion. Histology confirmed a papillary fibroelastoma. DISCUSSION Primary cardiac tumours are rare but can cause life-threatening complications such as stroke, myocardial infarction, and cardiac arrest. In the literature, the mechanism of these complications is mainly attributed to thrombo-embolism. This case demonstrates the utility of echocardiogram in investigating and diagnosing a rare cause of myocardial infarction and highlights an unusual mechanism, that is tumour causing obstruction of the coronary ostium.
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Affiliation(s)
- Niamh Logan
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
| | - Mohammad Sirajul Islam
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
| | - Jehan Zeb Chughtai
- Cardiothoracic Department, Mater Misericordiae University Hospital, Eccles St, Dublin, D07 R2WY, Ireland For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
| | - Niamh F Murphy
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
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145
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Iqbal I, Ullah W, Khan MAA, Haq S, Cheema MA. A Case of Fibroelastoma with Widespread Embolism to the Brain, Kidney, and Spleen. Cureus 2019; 11:e4798. [PMID: 31404349 PMCID: PMC6679706 DOI: 10.7759/cureus.4798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiac papillary fibroelastoma (CPF) is the second most common primary cardiac tumor, which is diagnosed incidentally or with embolic phenomena, mostly in the form of a transient ischemic attack (TIA) and stroke. We present a case of a 58-year-old female who presented with fatigue and low-grade fever and was found to have multiple systemic infarcts. Her blood cultures and transthoracic echocardiography (TTE) were negative, ruling out infective endocarditis. However, transesophageal echocardiography (TEE) revealed a mobile mass at the aortic valve. The mass was surgically removed, and the aortic valve was repaired. The histological examination of the mass finally revealed a papillary fibroelastoma. To our knowledge, this is the first reported case where fibroelastoma presented with splenic and renal infarcts in combination with the cerebral infarcts. Since cardiac fibroelastoma can cause embolization to the cerebral, splenic, and renal vessels, we, therefore, advocate that it should be considered as one of the possible causes of widespread embolism. We also stress upon the importance of doing TEE in case of a suspected cardiac mass, as the TTE is more likely to give false-negative results.
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Affiliation(s)
- Iqra Iqbal
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | | | - Shujaul Haq
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
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146
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Tsugu T, Nagatomo Y, Endo J, Kawakami T, Murata M, Yamazaki M, Shimizu H, Fukuda K, Mitamura H, Lancellotti P. Multiple papillary fibroelastomas attached to left ventricular side and aortic side of the aortic valve: A report of new case and literature review. Echocardiography 2019; 36:1194-1199. [PMID: 31116464 DOI: 10.1111/echo.14350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022] Open
Abstract
The aortic valve (AV) is the most commonly affected site in multiple papillary fibroelastomas, but the frequency of embolism caused by the attachment side of the AV has not been elucidated. According to the review of the previous literature, 16 cases have been found attached to the AV. Of these, 6 of these have been found to be attached on the aortic side and 4 on the left ventricular side, 1 was bilateral, and 5 cases were unknown. Of the cases found on the aortic side, embolism occurred in 3 of them, and of the left ventricular side cases, embolism occurred in 2 of them. The frequency of embolism is equivalent even if papillary fibroelastoma attached to either side of the AV.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa Hospital, Tachikawa, Japan.,Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liege, Belgium.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Jin Endo
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kawakami
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Mitsushige Murata
- Center for Preventive Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masataka Yamazaki
- Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hideo Mitamura
- Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa Hospital, Tachikawa, Japan
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liege, Belgium
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147
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Bonavia L, Jackson J, Pui-Yee Law J, Yii M, Joshi D. Brainstem stroke caused by left atrial cardiac papillary fibroelastoma: an increasingly recognized rare cause of stroke. Cardiovasc Pathol 2019; 40:65-67. [DOI: 10.1016/j.carpath.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022] Open
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148
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Al-Azizi KM, Hamandi M, Baxter R, Krueger A, Crawford AW, William M, Good C, Mead N. Papillary Fibroelastoma of the Ascending Aorta. J Investig Med High Impact Case Rep 2019; 7:2324709619840377. [PMID: 31010309 PMCID: PMC6480984 DOI: 10.1177/2324709619840377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Papillary fibroelastomas are rare benign primary cardiac tumors. They are typically found on valvular surfaces, most commonly, the aortic valve. In this article, we report a case of papillary fibroelastoma arising from the sinotubular junction of the ascending aorta, a rare and unusual site causing an embolic stroke.
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Affiliation(s)
- Karim M. Al-Azizi
- Baylor Scott & White, the Heart Hospital, Plano, TX, USA
- Karim M. Al-Azizi, MD, Baylor Scott & White, the Heart Hospital, 1100 Allied Drive, Plano, TX 75093, USA.
| | | | - Ronald Baxter
- Baylor Scott & White, the Heart Hospital, Plano, TX, USA
| | - Anita Krueger
- Baylor Scott & White, the Heart Hospital, Plano, TX, USA
| | | | | | - Christopher Good
- Geisinger Medical Center, Danville, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Nicolas Mead
- Geisinger Medical Center, Danville, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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149
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Cardiac Excrescences of Unusual Origin. Case Rep Cardiol 2019; 2019:8285304. [PMID: 31110823 PMCID: PMC6487126 DOI: 10.1155/2019/8285304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022] Open
Abstract
Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) are a rare finding that are most often discovered incidentally either upon echocardiography or invasive cardiovascular procedures. In total, less than 50 known cases have been reported since first being discovered over 30 years ago. They are typically benign lesions; however, there has been a reported case of cardiac MICE being responsible for severe cardiopulmonary compromise and another case of the lesion embolizing leading to cerebral infarctions and ultimately death. Cardiac papillary fibroelastomas are also uncommon lesions found in the heart though they are not as rare as cardiac MICE. They are also benign and are typically attached to valvular surfaces; however, they also can be found as mobile masses. Just as cardiac MICE, they are capable of causing turbulent flow and thrombus formation and have been reported as the cause of ischemic events due to their ability to embolize. We present a case of cardiac MICE and cardiac papillary fibroelastoma in an individual who initially presented with neurologic symptoms concerning for a cerebrovascular accident. The patient was found to have a left ventricular mass composed of both cardiac MICE and cardiac papillary fibroelastomas.
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150
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Maludum O, Ugoeke N, Mahida H, Ajam F, Alrefaee A, Calderon D, Stone J, Neibart R. Papillary fibroelastoma on the aortic valve presenting as multiple cardiac arrests from electrical storm due to ischemia in patient without previous cardiac history. HeartRhythm Case Rep 2019; 5:134-137. [PMID: 30891409 PMCID: PMC6404163 DOI: 10.1016/j.hrcr.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Obiora Maludum
- Section of Cardiovascular Disease, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Nene Ugoeke
- Section of Cardiovascular Disease, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Hetavi Mahida
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Firas Ajam
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Anas Alrefaee
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Dawn Calderon
- Section of Cardiovascular Disease, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Jay Stone
- Shore Cardiac Institute, Toms River, New Jersey
| | - Richard Neibart
- Section of Cardiothoracic Surgery, Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
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