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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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2
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Wittersheim M, Heydt C, Hoffmann F, Büttner R. KRAS mutation in papillary fibroelastoma: a true cardiac neoplasm? JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2017; 3:100-104. [PMID: 28451458 PMCID: PMC5402176 DOI: 10.1002/cjp2.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
Primary cardiac tumours are rare and mostly benign lesions. Recent publications report that cardiac papillary fibroelastomas are the most common benign primary heart tumour, outnumbering myxomas. However, there is no consensus about their aetiology. We investigated the molecular profile of these tumours using next generation sequencing in a cohort of 16 cases. Eleven of 14 (79%) analysable tumours showed mutations of the KRAS oncogene. Our results provide unambiguous evidence that a significant proportion of these lesions are genuine neoplastic tumours caused by an oncogenic driver mutation.
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Affiliation(s)
| | - Carina Heydt
- Institute of PathologyUniversity Hospital of CologneCologneGermany
| | - Fabian Hoffmann
- Department of Internal Medicine III, Heart CenterUniversity Hospital of CologneCologneGermany
| | - Reinhard Büttner
- Institute of PathologyUniversity Hospital of CologneCologneGermany
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3
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Val-Bernal JF, Mayorga M, Garijo MF, Val D, Nistal JF. Cardiac papillary fibroelastoma: Retrospective clinicopathologic study of 17 tumors with resection at a single institution and literature review. Pathol Res Pract 2013; 209:208-14. [DOI: 10.1016/j.prp.2013.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/15/2013] [Accepted: 02/04/2013] [Indexed: 12/30/2022]
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4
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Haron H, Yusof MRM, Maskon O, Ooi J, Rahman MRA. Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma. Heart Surg Forum 2012; 15:E59-60. [PMID: 22360910 DOI: 10.1532/hsf98.20111000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.
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Affiliation(s)
- Hairulfaizi Haron
- Heart and Lung Centre, Universiti Kebangsaaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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5
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Kin H, Koizumi J, Yoshioka K, Okabayashi H. Papillary fibroelastoma of the aortic valve visualized by 320-slice computed tomography: report of a case. Ann Thorac Cardiovasc Surg 2011; 17:518-20. [PMID: 21881385 DOI: 10.5761/atcs.cr.10.01604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old man presented with a papillary fibroelastoma on the non-coronary cusp of the aortic valve. He was asymptomatic, with a history of hypertension and paroxysmal atrial fibrillation. Echocardiography revealed a mobile, round mass (13 × 15 mm) on the non-coronary cusp of the aortic valve. Scanning with 320-slice multi-detector row computed tomography (MDCT) also revealed a mass on the non-coronary cusp of the aortic valve. The tumor was subsequently excised from the aortic valve. In this case, the MDCT images were extremely clear and provided useful information like that obtained with echocardiography.
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Affiliation(s)
- Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Morioka, Iwate, Japan
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6
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Kurobe H, Kanbara T, Yoshida H, Motoki T, Sugano M, Nakayama T, Kitaichi T, Kitagawa T. Successful early resection of cardiac papillary fibroelastomas. Gen Thorac Cardiovasc Surg 2011; 59:191-4. [PMID: 21448798 DOI: 10.1007/s11748-010-0654-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 05/30/2010] [Indexed: 11/29/2022]
Abstract
Two adult patients with previous transient cerebral ischemic attacks (TIAs) or chest oppression were referred for further investigation. A swaying pedicled tumor was detected in the left atrium of the former patient and in the left coronary cusp of the latter by echocardiography. The TIA, or angina-like attack, was anticipated to be caused by thromboembolism of the tumor. Both patients underwent tumor extirpation. The histological findings demonstrated that both tumors were benign papillary fibroelastoma limited to the endocardium/endothelium layer. In conclusion, early surgical resection of a cardiac papillary fibroelastoma should be performed.
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Affiliation(s)
- Hirotsugu Kurobe
- Department of Cardiovascular Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
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7
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Mariscalco G, Bruno VD, Borsani P, Dominici C, Sala A. Papillary Fibroelastoma: Insight to a Primary Cardiac Valve Tumor. J Card Surg 2010; 25:198-205. [DOI: 10.1111/j.1540-8191.2009.00993.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Ben Jmaa H, Masmoudi S, Hadj Kacem A, Abdennadher M, Mhiri C, Trabelsi I, Kammoun S, Chikhrouhou H, Frikha I. [Papillary fibroelastoma of mitral leaflet revealed by a cerebrovascular accident. Case report]. Ann Cardiol Angeiol (Paris) 2009; 58:53-56. [PMID: 18707673 DOI: 10.1016/j.ancard.2008.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 05/18/2008] [Indexed: 05/26/2023]
Abstract
Papillary fibroelastoma is a benign primitive cardiac tumour, which can be associated with serious embolic complications. We report on a 37-year-old woman admitted for a cerebrovascular accident. Transthoracic and transesophageal echocardiography revealed a small and pedunculated mass attached to the anterior mitral leaflet. Because of the severity of its symptoms and its high embolic potential, the tumour was surgically excised and histologically diagnosed as a papillary fibroelastoma. The postoperative period was uneventful and the patient was discharged at the third day. Papillary fibroelastoma must be surgically treated because of its high embolic potential and its severe prognosis.
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Affiliation(s)
- H Ben Jmaa
- Service de chirurgie cardiovasculaire et thoracique, CHU Habib Bourguiba-Sfax, route Elain-km-0,5, 3029 Sfax, Tunisie.
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9
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Late diagnosis of multiple fibroelastomas in a 41-year-old woman with hypertrophic cardiomyopathy and atrial fibrillation. J Am Soc Echocardiogr 2008; 21:1391.e1-3. [PMID: 19041583 DOI: 10.1016/j.echo.2008.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Indexed: 11/21/2022]
Abstract
A 39 year old woman with hypertrophic cardiomyopathy with severe latent obstruction and mitral regurgitation, presented with symptoms of dyspnea and atrial fibrillation, and developed an acute embolic stroke. After thrombolysis and complete neurologic recovery, a transesophageal echo revealed six mobile densities, on her mitral and aortic valves, and in the outflow tract. Surgical resection of multiple fibroelastomas, with septal myectomy, aortic and mitral valve replacement, and pulmonary vein ablation, led to clinical improvement. The etiology and pathogenesis of fibroelastomas are unknown; we speculate that their formation may be promoted by endocardial injury from surgery, radiation therapy, or the high velocity turbulent flow of valve dysfunction or outflow tract obstruction.
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Yuan SM, Shinfeld A, Kostiuk O, Nass D, Raanani E. Cardiac papillary fibroelastoma of the mitral chorda. Heart Lung Circ 2007; 17:428-32. [PMID: 17723320 DOI: 10.1016/j.hlc.2007.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 05/18/2007] [Accepted: 05/24/2007] [Indexed: 11/29/2022]
Abstract
We describe a case of cardiac papillary fibroelastoma in a 33-year-old man. The diagnosis was established by echocardiography. Computerised tomographic angiography gave no evidence of coronary stenosis, but illustrated a radiopaque filling defect in the left ventricle. The papillary fibroelastoma was removed together with the involved chorda, and an artificial chord was implanted under cardiopulmonary bypass. Histological study confirmed the diagnosis of papillary fibroelastoma. Due to the potentials of cerebral and coronary embolisation, surgical management to the patients with a papillary fibroelastoma is highly recommended.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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11
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Czekajska-Chehab E, Tomaszewski A, Wójcik M, Drop A. Papillary fibroelastoma as an accidental finding in a multislice computed tomography of coronary arteries. Can J Cardiol 2006; 22:1155-7. [PMID: 17102834 PMCID: PMC2569048 DOI: 10.1016/s0828-282x(06)70953-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Papillary fibroelastomas represent less than 10% of all primary cardiac tumours. They are usually incidental autopsy or surgical findings, or detected during echocardiography or catheterization. The case of a 58-year-old man with typical exertional chest pain hospitalized for an elective multislice computed tomography (MSCT) scan of the coronary arteries is described. The MSCT scan showed a pathological, mobile lesion within the aorta lumen only, not obstructing the ostia of the coronary arteries, and was confirmed by echocardiography. The typical features of the tumour in the MSCT scan and on echocardiography were the basis for the diagnosis of papillary fibroelastomas in the patient. Surgical excision was proposed, but the patient declined.
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Affiliation(s)
| | | | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
- Correspondence: Dr M Wójcik, Department of Cardiology, Medical University of Lublin, SPSK Nr 4, ulica Jaczewskiego 8, 20-090 Lublin, Poland. Telephone 48-606-37-98-98, fax 48-81-724-41-51, e-mail
| | - Andrzej Drop
- Department of Radiology, Medical University of Lublin, Lublin, Poland
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12
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Gabbieri D, Rossi G, Bavutti L, Corghi F, Zacà F, Sarandria D, Pierangeli A, Ghidoni I. Papillary fibroelastoma of the right atrium as an unusual source of recurrent pulmonary embolism. J Cardiovasc Med (Hagerstown) 2006; 7:373-8. [PMID: 16645419 DOI: 10.2459/01.jcm.0000223263.77674.db] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Papillary fibroelastoma is the most common primary tumour of cardiac valves, with the potential for embolic events and obstructive effects. Location in non-valvular endocardium is extremely rare. Transthoracic and transoesophageal echocardiography have greatly increased the ability to make the diagnosis of these surgically treatable tumours in a timely fashion. We report the case of a 70-year-old woman with symptoms and ventilation-perfusion scan evidence of pulmonary embolization from a papillary fibroelastoma of the right atrium. Initial transthoracic echocardiography failed to identify the tumour, whereas transoesophageal echocardiography demonstrated a mobile echodense mass attached to the right atrial free wall. After surgical excision, histopathology revealed papillary fibroelastoma. The epidemiology, aetiology, localization, macroscopy, histopathology, immunohistochemistry, clinical presentation, diagnosis and management of cardiac papillary fibroelastoma are reviewed. The case is unusual with respect to the site of origin of the papillary fibroelastoma as well as its clinical presentation, which is clearly related to pulmonary embolization.
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Affiliation(s)
- Davide Gabbieri
- Divisions of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy.
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13
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Borsani P, Mariscalco G, Blanzola C, Leva C, Bruno VD, Cozzi G, Casnedi S, Dainese E, Sala A. Asymptomatic cardiac papillary fibroelastoma: diagnostic assessment and therapy. J Card Surg 2006; 21:77-80. [PMID: 16426355 DOI: 10.1111/j.1540-8191.2006.00174.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Papillary fibroelastoma is a rare benign cardiac tumor with elevated risk for embolization. This report describes the case of a 65-year-old man, admitted for the occasional finding of a round, pedunculate mass adherent to the chordae of the anterior mitral valve leaflet, mimicking an endocarditic mass. Appropriate diagnostic evaluations lead to the suspect of a papillary fibroelastoma. Because of the elevated risk of thromboembolism, surgery was emergently performed with complete removal of the mass and preservation of the integrity of the mitral valve. Histologic evaluation confirmed the diagnosis. Papillary fibroelastoma should be always considered in the differential diagnosis of intracardiac masses.
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Affiliation(s)
- Paolo Borsani
- Cattedra di Cardiochirurgia, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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14
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Tanaka H, Narisawa T, Mori T, Masuda Y, Kishi D. Double primary left ventricular and aortic valve papillary fibroelastoma. Circ J 2004; 68:504-6. [PMID: 15118297 DOI: 10.1253/circj.68.504] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Papillary fibroelastomas of the heart are relatively rare benign tumors and although they can be symptom free, symptoms such as cerebral ischemia and cardiac infarction can be lethal. It is important to diagnose this tumor using echocardiography, because lethal embolisms can be prevented by surgical resection. Recurrence of this tumor has not been reported and multiple tumors are rare. The present report is a case of double primary aortic valve fibroelastoma with aortic regurgitation diagnosed 4 years after surgery for a left ventricular fibroelastoma with mitral valvular disease.
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Affiliation(s)
- Hiroyuki Tanaka
- Department of Thoracic Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
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15
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Vora TR. Unusual Presentation of Papillary Fibroelastoma: Utility of Serial Transesophageal Echocardiograms. Echocardiography 2004; 21:69-71. [PMID: 14717725 DOI: 10.1111/j.0742-2822.2004.03046.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Papillary fibroelastomas are uncommon benign tumors usually involving heart valves that may be potential sources of emboli. Transesophageal echocardiography has greatly enhanced the ability to make the diagnosis of these surgically treatable tumors in a timely fashion. We describe an unusual presentation of a 62-year-old man with suspected bacterial endocarditis, in whom initial transesophageal echocardiogram suggested the presence of pacemaker lead infection but a repeat study after extraction of the pacemaker lead revealed a large pedunculated mass arising from the superior vena cava. The mass was surgically removed and histopathology revealed papillary fibroelastoma. This case is unusual with respect to the size and site of origin of the papillary fibroelastoma as well as its echocardiographic presentation mimicking vegetations on a pacemaker wire.
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Affiliation(s)
- Tushar R Vora
- Department of Cardiology, Cardiothoracic Division, State University of New York at Buffalo, Buffalo, NY, USA.
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16
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Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 2003; 146:404-10. [PMID: 12947356 DOI: 10.1016/s0002-8703(03)00249-7] [Citation(s) in RCA: 448] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the advent of echocardiography, cardiac papillary fibroelastoma (CPF) is being increasingly reported. The demographics, clinical characteristics, pathological features, treatment, and prognosis of CPF are examined. DATA COLLECTIONS Cases, case series and related articles on the subject in all languages were identified through a comprehensive literature search. RESULTS AND CONCLUSIONS Seven hundred twenty-five cases of CPF were identified. Males comprised 55% of patients. Highest prevalence was in the 8th decade of life. The valvular surface was the predominant locations of tumor. The most commonly involved valve was the aortic valve, followed by the mitral valve. The left ventricle was the predominant nonvalvular site involved. No clear risk factor for development of CPF has been reported. Size of the tumor varied from 2 mm to 70 mm. Clinically, CPFs have presented with transient ischemic attack, stroke, myocardial infarction, sudden death, heart failure, presyncope, syncope, pulmonary embolism, blindness, and peripheral embolism. Tumor mobility was the only independent predictor of CPF-related death or nonfatal embolization. Symptomatic patients should be treated surgically because the successful complete resection of CPF is curative and the long-term postoperative prognosis is excellent. The symptomatic patients who are not surgical candidates could be offered long-term oral anticoagulation, although no randomized controlled data are available on its efficacy. Asymptomatic patients could be treated surgically if the tumor is mobile, as the tumor mobility is the independent predictor of death or nonfatal embolization. Asymptomatic patients with nonmobile CPF could be followed-up closely with periodic clinical evaluation and echocardiography, and receive surgical intervention when symptoms develop or the tumor becomes mobile.
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Affiliation(s)
- Ramesh M Gowda
- Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA
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17
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Eslami-Varzaneh F, Brun EA, Sears-Rogan P. An unusual case of multiple papillary fibroelastoma, review of literature. Cardiovasc Pathol 2003; 12:170-3. [PMID: 12763558 DOI: 10.1016/s1054-8807(03)00033-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Primary neoplasms of the cardiac valves are extremely rare. However, papillary fibroelastoma is the third most common primary tumor of the heart [Ann Thorac Surg 52 (1991) 1127]. These tumors can be found anywhere in the heart, but most commonly involve the cardiac valves [Ann Thorac Surg 52 (1991) 1127; McAllister HA, Fenoglio JJ. Tumors of the cardiovascular system. In: Atlas of tumor pathology, 2nd series, vols. 1-3. Washington (DC): Armed Forces Institute of Pathology; 1978. p. 20-5]. Most papillary fibroelastomas do not cause symptoms and are usually incidental findings by routine echocardiography or at autopsy. However, early diagnosis of this condition is important, since it represents a surgically correctable cause of systemic emboli, stroke, myocardial infarction, and sudden cardiac death [Ann Thorac Surg 52 (1991) 1127; Ann Thorac Surg 68 (1999) 1881; J Am Soc Echocardiogr 9 (1996) 353; Tex Heart Inst J 22 (1995) 327; Tex Heart Inst J 26 (1999) 298]. The echocardiographic findings should be confirmed by histology, since the clinical differential diagnosis includes myxoma, vegetation, thrombi, lipoma, and pseudopapillary fibroelastoma [Tex Heart Inst J 26 (1999) 298; J Am Soc Echocardiogr 11 (1998) 92; J Natl Med Assoc 87 (1995) 68]. Review of the literature reveals that multiple papillary fibroelastomas are extremely rare [Am Heart J 125 (1993) 1443; J Am Soc Echocardiogr 7 (1994) 315; Ann Thorac Surg 48 (1989) 119]. Li Manduri et al. [J Am Soc Echocardiogr 7 (1994) 315] reported multiple masses on the tricuspid valve, the larger of which was 1 cm in diameter. De Virgilio et al. [Ann Thorac Surg 48 (1989) 119] reported a case of multiple 1-cm papillary fibroelastomas located on mitral valve, left ventricular outflow tract, and along septum. We report an unusual case of multiple papillary fibroelastomas in a woman, who initially was admitted because of a shortness of breath and recent cerebrovascular accident.
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Affiliation(s)
- Fatima Eslami-Varzaneh
- Department of Pathology, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010-2975, USA
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18
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Kurup AN, Tazelaar HD, Edwards WD, Burke AP, Virmani R, Klarich KW, Orszulak TA. Iatrogenic cardiac papillary fibroelastoma: a study of 12 cases (1990 to 2000). Hum Pathol 2002; 33:1165-9. [PMID: 12514783 DOI: 10.1053/hupa.2002.130105] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac papillary fibroelastoma (PFE) is a rare, benign, slow-growing tumor of the endocardium. Whether it represents a reactive tumoral lesion or a true neoplasm remains a matter of debate. However, an anecdotal association of PFEs with previous cardiac surgery has been reported. The current study was undertaken to determine the frequency and nature of iatrogenic events associated with PFEs and to provide a comprehensive review of the topic. The study group comprised 12 cases seen between 1990 and 2000, with specimens from 7 women and 5 men. Six developed postoperatively and 6 developed after thoracic irradiation. The 9 Mayo cases represented 18% of all surgically excised PFEs during the study period. The mean age at operation was 54 years (range, 29 to 79 years). The mean interval between the iatrogenic event and excision of the tumor was 18 years (range, 9 to 31 years). In 58% of cases, the presence of multiple tumors was either confirmed pathologically (41.7%) or strongly suggested by echocardiography (16.6%). Among patients who had undergone previous cardiac surgery, PFEs were found in the chamber closest to the procedure. Similarly, in patients who had received radiation therapy, tumors developed in the left atrium, in the right ventricle and atrium, and on the tricuspid valve within the radiation field. In conclusion, iatrogenic PFEs may be relatively common among all such tumors, are frequently multiple, and often involve nonvalvular endocardial surfaces.
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Affiliation(s)
- Anil N Kurup
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
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19
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Gologorsky E, Gologorsky A. Aortic valve fibroelastomas as an incidental intraoperative transesophageal echocardiographic finding. Anesth Analg 2002; 95:1198-9, table of contents. [PMID: 12401593 DOI: 10.1097/00000539-200211000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPLICATIONS We report incidental findings of aortic valve fibroelastomas during routine intraoperative transesophageal echocardiography examination in cardiac surgery. Preoperative echocardiography failed to identify this potentially devastating pathology. The echocardiographic features of this lesion are reviewed, and the importance of diligence and complete examination are emphasized.
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Affiliation(s)
- Edward Gologorsky
- Department of Anesthesiology, Memorial Regional Hospital, 3501 Johhson Street, Hollywood, FL 33021, USA.
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20
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Saad RS, Galvis CO, Bshara W, Liddicoat J, Dabbs DJ. Pulmonary valve papillary fibroelastoma. A case report and review of the literature. Arch Pathol Lab Med 2001; 125:933-4. [PMID: 11419980 DOI: 10.5858/2001-125-0933-pvpf] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Papillary fibroelastomas are rare and benign cardiac tumors that typically affect the cardiac valves. To the best of our knowledge, the English literature contains only 1 case report of pulmonary valve fibroelastoma diagnosed by echocardiogram and confirmed by surgical resection. There is a paucity of pathology literature on this subject. We describe an additional case of pulmonary valve fibroelastoma diagnosed by transesophageal echocardiography and magnetic resonance imaging confirmed by pathologic examination in a patient who also had a thymoma.
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Affiliation(s)
- R S Saad
- Department of Pathology, Allegheny General Hospital, Pittsburgh, PA, USA
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21
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Sun JP, Asher CR, Yang XS, Cheng GG, Scalia GM, Massed AG, Griffin BP, Ratliff NB, Stewart WJ, Thomas JD. Clinical and echocardiographic characteristics of papillary fibroelastomas: a retrospective and prospective study in 162 patients. Circulation 2001; 103:2687-93. [PMID: 11390338 DOI: 10.1161/01.cir.103.22.2687] [Citation(s) in RCA: 296] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac papillary fibroelastoma (CPF) is a primary cardiac neoplasm that is increasingly detected by echocardiography. The clinical manifestations of this entity are not well described. METHODS AND RESULTS In a 16-year period, we identified patients with CPF from our pathology and echocardiography databases. A total of 162 patients had pathologically confirmed CPF. Echocardiography was performed in 141 patients with 158 CPFs, and 48 patients had CPFs that were not visible by echocardiography (<0.2 cm), leaving an echocardiographic subgroup of 93 patients with 110 CPFs. An additional 45 patients with a presumed diagnosis of CPF were identified. The mean age of the patients was 60+/-16 years of age, and 46.1% were male. Echocardiographically, the mean size of the CPFs was 9+/-4.6 mm; 82.7% occurred on valves (aortic more than mitral), 43.6% were mobile, and 91.4% were single. During a follow-up period of 11+/-22 months, 23 of 26 patients with a prospective diagnosis of CPF that was confirmed by pathological examination had symptoms that could be attributable to embolization. In the group of 45 patients with a presumed diagnosis of CPF, 3 patients had symptoms that were likely due to embolization (incidence, 6.6%) during a follow-up period of 552+/-706 days. CONCLUSIONS CPFs are generally small and single, occur most often on valvular surfaces, and may be mobile, resulting in embolization. Because of the potential for embolic events, symptomatic patients, patients undergoing cardiac surgery for other lesions, and those with highly mobile and large CPFs should be considered for surgical excision.
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Affiliation(s)
- J P Sun
- Cardiovascular Imaging Center, Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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22
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23
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Abstract
Papillary fibroelastomas are rare benign neoplasms, predominantly involving cardiac valves, that have been discovered with increasing frequency through the use of echocardiography. Most are papillary lesions, less than 1 cm in size, connected to the valve or mural endocardium by a small stalk. Although often asymptomatic, embolization from the lesion or attached thrombus may cause serious neurological or cardiac events. All symptomatic papillary fibroelastomas should be removed unless there are compelling contraindications, in which case anticoagulation is an acceptable but unreliable alternative. Surgical removal is safe, simple, effective, and permanent. Asymptomatic lesions of the left side of the heart should be removed because of their potentially serious or fatal consequences, whereas those arising from the right side of the heart may be observed.
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Affiliation(s)
- D M Shahian
- Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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24
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Toda R, Iguro Y, Moriyama Y, Matsumoto H, Taira A. Papillary fibroelastoma on the mitral valve. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:132-4. [PMID: 10769998 DOI: 10.1007/bf03218108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
A 78-year-old woman was admitted with transient unknown fever and old cerebral infarction. An echocardiogram demonstrated mild mitral valve regurgitation and high echogenic mass on the mitral posterior leaflet. Surgery was performed with the diagnosis of a healed infective endocarditis. A sea anemone-like appearance tumor, 8 mm in diameter, was located on the mitral posterior leaflet. Annuloplasty was performed following removal of the tumor. A pathological examination confirmed the lesion was a papillary fibroelastoma. No evidence of infective endocarditis was seen. The cause of the fever remained unknown. The tumor was very fragile. Surgical removal was mandatory for preventing embolism despite the advanced age.
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Affiliation(s)
- R Toda
- Second Department of Surgery, Faculty of Medicine, Kagoshima University, Japan
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25
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Küçükoğlu S, Arat A, Mutlu H, Okçün B, Bakay C, Oz B, Uner S. A cardiac papillary fibroelastoma with chordal location. J Am Soc Echocardiogr 1999; 12:1001-4. [PMID: 10552364 DOI: 10.1016/s0894-7317(99)70156-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Papillary fibroelastomas, which were initially incidental findings at autopsy and surgery, are now being recognized with increasing frequency with the widespread use of echocardiography. Because of their embolic potential, an aggressive treatment approach is generally accepted. We report a papillary fibroelastoma located at the chorda of the anterior mitral leaflet that underwent conservative follow-up for 8 years without any complications. Because most of the cardiac papillary fibroelastoma cases reported are incidental findings, the question of whether symptomless fibroelastomas must be removed or other factors contribute to the embolic nature of the selected cases remains a challenge for the future.
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Affiliation(s)
- S Küçükoğlu
- Istanbul University, Institute of Cardiology, Turkey
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26
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Howard RA, Aldea GS, Shapira OM, Kasznica JM, Davidoff R. Papillary fibroelastoma: increasing recognition of a surgical disease. Ann Thorac Surg 1999; 68:1881-5. [PMID: 10585089 DOI: 10.1016/s0003-4975(99)00860-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Papillary fibroelastomas are uncommon benign tumors usually involving the heart valves, which historically have been diagnosed at autopsy. With the advent of echocardiography, however, the number of patients diagnosed in life has increased. Papillary fibroelastomas represent a surgically treatable cause of cerebrovascular and cardiovascular ischemia and infarction making their identification clinically important. We report three unusual cases of papillary fibroelastoma; two patients presenting with symptoms of cerebrovascular ischemia and one presenting with myocardial infarction. We also present a comprehensive review of the literature and provide a compilation of all case reports to date.
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Affiliation(s)
- R A Howard
- Department of Medicine, Boston Medical Center, Massachusetts 02118, USA
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27
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Grinda JM, Couetil JP, Chauvaud S, D'Attellis N, Berrebi A, Fabiani JN, Deloche A, Carpentier A. Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization. J Thorac Cardiovasc Surg 1999; 117:106-10. [PMID: 9869763 DOI: 10.1016/s0022-5223(99)70474-5] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We have reviewed the case histories of 4 patients who underwent operations between September 1994 and November 1997 at Broussais Hospital for cardiac valvular papillary fibroelastoma. METHODS Diagnosis was strongly suggested by echocardiography. Tumor locations were mitral (1), tricuspid (1), and aortic (2). Indications for operation were previous stroke for the mitral tumor, prophylaxis for the tricuspid tumor, syncopal episodes for the first aortic tumor, and transient ischemic attack and mesenteric ischemia for the second aortic tumor. RESULTS Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, aortic valve reconstruction was achieved with part of a cryopreserved aortic homograft cusp. Intraoperative transesophageal echocardiography showed no evidence of valvular regurgitation after excision in all cases. All patients had uneventful postoperative recoveries. No evidence of regurgitation or recurrence was seen on echocardiography at follow-up. CONCLUSIONS Despite their histologically benign aspect, cardiac papillary fibroelastomas should be excised because of potential embolic complications. A conservative, valve-sparing approach is recommended, however, because of the absence of recurrence after total excision.
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Affiliation(s)
- J M Grinda
- Department of Cardiovascular Surgery of Broussais Hospital [1], Paris, France
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28
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Di Mattia DG, Assaghi A, Mangini A, Ravagnan S, Bonetto S, Fundarò P. Mitral valve repair for anterior leaflet papillary fibroelastoma: two case descriptions and a literature review. Eur J Cardiothorac Surg 1999; 15:103-7. [PMID: 10077384 DOI: 10.1016/s1010-7940(98)00271-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiac papillary fibroelastomas are rare cardiac tumors and have been considered a 'benign' incidental finding that may have significant clinical manifestations. In this paper we report two cases of mitral valve fibroelastoma: one was discovered by chance with transthoracic echocardiography in a young healthy man, the other was an intraoperative incidental finding in a middle aged man with a recent history of acute myocardial infarction. The mitral valve was repaired in both cases after excising the tumor. The patients did well and remain asymptomatic. A literature review was compiled which comprises previous case reports of 34 patients with mitral valve papillary fibroelastomas. Most were asymptomatic, but when symptoms occurred, they could be disabling, such as stroke, cardiac heart failure, myocardial infarction, and sudden death. Papillary fibroelastoma is amenable to simple surgical excision or in addition to mitral valve repair or replacement. Recurrence has not been reported.
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Affiliation(s)
- D G Di Mattia
- Department of Thoracic and Cardiovascular Surgery, Luigi Sacco Hospital, Milan, Italy
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29
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Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB. Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation. J Am Coll Cardiol 1997; 30:784-90. [PMID: 9283541 DOI: 10.1016/s0735-1097(97)00211-8] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We sought to determine the clinical and echocardiographic characteristics of papillary fibroelastoma (PFE). BACKGROUND PFE is a rarely encountered cardiac tumor about which relatively little is known. METHODS Institutional records were reviewed for the years 1980 to 1995 for patients with pathologic or echocardiographic diagnosis of PFE. Group 1 included 17 patients with the pathologic diagnosis of PFE who also underwent echocardiography. Echocardiographic features of PFE were established in group 1. Group 2 included 37 patients with only echocardiographic evidence of PFE. RESULTS In group 1, 7 (41.2%) of 17 patients had symptoms related to PFE. Neurologic events occurred in 5 (29.4%) of 17 patients. All patients had the tumor surgically removed. During follow-up, no new embolic events occurred. Echocardiographic characteristics of PFE included a small tumor (12.1 +/- 6.5 x 9.0 +/- 4.3 mm), usually pedunculated (14 [94%] of 17 patients) and mobile, with a homogeneous speckled pattern and a characteristic stippling along the edges. PFEs were most common on valvular surfaces (12 [60%] of 20 PFEs) but were not uncommon on other endocardial surfaces (8 [40%] of 20 PFEs). The tumor did not cause valvular dysfunction. In group 2, 16 (43%) of 37 patients were asymptomatic. Five patients (13.5%) had a previous neurologic event. During follow-up (mean 31 months, range 1 to 77), nine neurologic events occurred. CONCLUSIONS PFEs are associated with embolism, can be diagnosed with echocardiography, are often an incidental clinical finding and do not cause valvular dysfunction.
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Affiliation(s)
- K W Klarich
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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30
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Joffe II, Jacobs LE, Owen AN, Ioli A, Kotler MN. Rapid Development of a Papillary Fibroelastoma with Associated Thrombus: The Role of Transthoracic and Transesophageal Echocardiography. Echocardiography 1997; 14:287-292. [PMID: 11174957 DOI: 10.1111/j.1540-8175.1997.tb00724.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are frequently utilized in patient's with suspected cerebral vascular ischemia. We describe a patient with suspected cerebral vascular ischemic event whom was found to have a mobile valvular mass by TTE and TEE. The lesion was unusual due to its rapid development over a period 6 months, which was documented on serial echocardiography. The mass was excised surgically and pathology showed a papillary fibroelastoma with extensive thrombus. The differential diagnosis of a cardiac valvular mass and the treatment of cardiac fibroelastomas are reviewed. In this case, both TTE and TEE were valuable in diagnosis and facilitating surgical management of a cardiac fibroelastoma.
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Affiliation(s)
- Ian I. Joffe
- Albert Einstein Medical Center, Suite 363, Klein Building, 5401 Old York Road, Philadelphia, PA 19141
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31
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Abstract
We experienced a case of papillary fibroelastoma of the left ventricular outflow tract in a patient with severe valvular heart disease that was detected only by transesophageal echocardiography. Preoperative detection of this lesion altered the surgical procedure to include resection of the mass through the aortic valve annulus along with repair/replacement of the valves. The literature documents sufficient morbidity/mortality to support excision of these lesions regardless of symptoms or location.
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Affiliation(s)
- K Minatoya
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyusyu, Japan
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32
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Pasteuning WH, Zijnen P, van der Aa MA, Peters JH, van Geldorp TR. Papillary fibroelastoma of the aortic valve in a patient with an acute myocardial infarction. J Am Soc Echocardiogr 1996; 9:897-900. [PMID: 8943456 DOI: 10.1016/s0894-7317(96)90488-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a patient with a myocardial infarction in whom a tumor near the aortic valve was identified by routine transthoracic echocardiography. Transesophageal echocardiography proved to be particularly useful in identifying the attachment of the tumor to the aortic valve and enabled a surgical approach through the ascending aorta. On microscopic examination, the tumor appeared to be a papillary fibroelastoma.
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Affiliation(s)
- W H Pasteuning
- Department of Cardiology, Sint Elisabeth Ziekenhuis, Tilburg, The Netherlands
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33
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Joffe II, Jacobs LE, Owen AN, Ioli A, Kotler MN. Noninfective valvular masses: review of the literature with emphasis on imaging techniques and management. Am Heart J 1996; 131:1175-83. [PMID: 8644598 DOI: 10.1016/s0002-8703(96)90094-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- I I Joffe
- Division of Cardiovascular Diseases, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
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34
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Hicks KA, Kovach JA, Frishberg DP, Wiley TM, Gurczak PB, Vernalis MN. Echocardiographic evaluation of papillary fibroelastoma: a case report and review of the literature. J Am Soc Echocardiogr 1996; 9:353-60. [PMID: 8736022 DOI: 10.1016/s0894-7317(96)90152-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Papillary fibroelastomas comprise approximately 7.9% of benign primary cardiac tumors. Although papillary fibroelastomas were at first discovered incidentally at autopsy or during heart surgery, these tumors are increasingly being identified by echocardiography. This article reviews those papillary fibroelastomas detected by transthoracic or transesophageal echocardiography and discusses the echocardiographic features of these tumors, associated symptoms, and management. Echocardiography is important in influencing management decisions regarding excision, valve replacement, and valve repair.
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Affiliation(s)
- K A Hicks
- Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA
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35
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Jobic Y, Etienne Y, Quintin-Roué I, Dewilde J, Cornec P, Gilard M, Le Bras Y, Barra JA, Loire R, Boschat J. Left ventricular papillary fibroelastoma: two-dimensional echocardiographic detection and surgical resection. J Am Soc Echocardiogr 1995; 8:756-8. [PMID: 9417224 DOI: 10.1016/s0894-7317(05)80395-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a patient with a papillary fibroelastoma arising from the left ventricular posterior wall. The tumor was detected incidentally during echocardiography undertaken to evaluate aortic stenosis. Possible complication from tumor embolization was avoided by surgical resection during aortic valve replacement.
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Affiliation(s)
- Y Jobic
- Department of Cardiology, Morvan Hospital, Brest, France
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36
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Abstract
Papillary fibroelastomas are rare cardiac tumors, but they are the most common primary tumor of the heart valves. These lesions occur on any of the valves or endothelial surfaces of the heart and may be detected by echocardiography, cardiac catheterization, during open heart operation for other conditions, or at autopsy. Because of their potential for cerebral and coronary embolization, even small papillary fibroelastomas should be excised.
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Affiliation(s)
- D M Shahian
- Department of Thoracic and Cardiovascular Surgery, Lahey Clinic, Burlington, Massachusetts 01805
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37
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LiMandri G, Homma S, Di Tullio MR, Hodges D, Arora R, Marboe C, Smith CR. Detection of multiple papillary fibroelastomas of the tricuspid valve by transesophageal echocardiography. J Am Soc Echocardiogr 1994; 7:315-7. [PMID: 8060649 DOI: 10.1016/s0894-7317(14)80403-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 66-year-old man without symptoms, referred for the treatment of moderate hypertension, was found to have a right atrial mass by two-dimensional echocardiography. On transesophageal echocardiography two masses were detected on the tricuspid valve, the first one on the posterior leaflet and the second smaller one on the anterior leaflet. These findings were confirmed at surgery. Histologic analysis revealed that the masses represented papillary fibroelastomas.
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Affiliation(s)
- G LiMandri
- Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY 10032
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