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Banuls L, Iglesias RJO, de Vasconcelos Papa F, Deng MX, Latter DA. Decision-Making in a Pulmonary Valve Fibroelastoma: The Role of Intraoperative Transesophageal Echocardiography. CASE (PHILADELPHIA, PA.) 2023; 7:288-291. [PMID: 37546358 PMCID: PMC10403633 DOI: 10.1016/j.case.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•CFEs on the pulmonary valve are rare and management is not covered by guidelines. •Echocardiographic assessment of fibroelastomas on the pulmonary valve is challenging. •TEE is a mainstay to assist in decision-making and postsurgical evaluation.
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Affiliation(s)
- Lorrain Banuls
- Department of Cardiovascular Anesthesia, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
| | - Rafa Jireh O. Iglesias
- Department of Cardiovascular Anesthesia, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
| | - Fábio de Vasconcelos Papa
- Department of Cardiovascular Anesthesia, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
| | - Mimi Xiaoming Deng
- Department of Cardiovascular Surgery, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
| | - David A. Latter
- Department of Cardiovascular Surgery, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
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2
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Extremely rare rapid development of a papillary fibroelastoma on the left ventricular anterior papillary muscle. J Cardiol Cases 2022; 26:404-406. [PMID: 36506498 PMCID: PMC9727561 DOI: 10.1016/j.jccase.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
Papillary fibroelastoma (PFE) is a rare, slow-growing cardiac tumor. We encountered an 80-year-old man with PFE accidentally revealed by transthoracic echocardiography (TTE) to evaluate cardiac function before a non-cardiac operation. A 10-mm mass lesion adhered to the anterior papillary muscle of the left ventricle, which had not been detected with TTE performed nine months before. Emergency cardiac surgery to remove the mass was performed, and the mass was diagnosed as a PFE. The PFE grew to 10 mm in a maximum of 9 months; to our knowledge, this is the fastest growth of PFE in the left ventricle reported to date. Learning objective Papillary fibroelastoma (PFE) is a rare, slow-growing cardiac tumor. The surgical indication of PFE is sometimes controversial. The rapid growth of PFE might be considered as a criterion for surgery because this might result in the rapid progression of symptoms and complications.
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3
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Kadiyani L, Ramakrishnan S, Verma M, Kumar S, Hote M. Unusual large mass on aortic valve in an infant. Ann Pediatr Cardiol 2022; 15:529-532. [PMID: 37152505 PMCID: PMC10158467 DOI: 10.4103/apc.apc_240_21] [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: 12/28/2021] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 03/02/2023] Open
Abstract
Mass on the aortic valve is extremely rare in children, and the differential diagnosis includes vegetation, thrombus, and primary cardiac tumors. A rise in infective endocarditis in infants is seen due to increasing survival of children with congenital heart diseases and sick newborn infants with prolonged hospitalization. We report a 4-month-old infant born prematurely with early-onset sepsis requiring prolonged antibiotic treatment and valvular aortic stenosis presenting with sudden hemodynamic compromise due to aortic vegetation extending into the ascending aorta eroding through its posterior wall. The report details management of our case and a brief description of available alternative treatment strategies.
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Affiliation(s)
- Lamk Kadiyani
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mansi Verma
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Milind Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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4
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Kashiwagi Y, Yoshida J, Itakura R, Nagoshi T, Hoshino S, Ito T, Kunihara T, Yoshimura M. Lung ventilation/perfusion scintigraphy shows the efficacy of anticoagulant therapy and surgical treatment for papillary fibroelastoma originating from the tricuspid valve. J Cardiol Cases 2021; 24:280-283. [PMID: 34917210 DOI: 10.1016/j.jccase.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022] Open
Abstract
Papillary fibroelastoma (PFE) is a cardiac tumor that is mainly found on the heart valve and the endocardium of the atria and ventricles. Symptoms such as stroke and myocardial infarction are usually caused by embolization of either the tumor itself or associated thrombus. PFE is known to originate mainly from the left side of the heart, and these cases are-in principle-candidates for surgical resection. On the other hand, cases in which PFE originates from the right side of the heart are rare and reports are limited; thus, the surgical indication is unclear. We herein report a case of symptomatic PFE originating from the tricuspid valve of the heart. In this case, contrast enhanced computed tomography did not show pulmonary embolism; however, lung perfusion scintigraphy showed multiple perfusion defects. The patient was treated by anticoagulant therapy followed by surgical resection. Thereafter, the symptoms disappeared and the multiple perfusion defects improved on lung perfusion scintigraphy, demonstrating the efficacy of the anticoagulant therapy and surgical resection for PFE in the right side of the heart. <Learning objective: Papillary fibroelastoma (PFE) originating from the tricuspid valve of the heart is rare and reports on this topic are limited. Thus, the surgical indication is unclear. In the present case, lung perfusion scintigraphy indicated pulmonary embolism due to PFE, while contrast enhanced computed tomography did not. Anticoagulant therapy and subsequent surgical resection were considered effective for PFE in the right side of the heart.>.
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Affiliation(s)
- Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Yoshida
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Itakura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Hoshino
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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5
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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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6
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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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7
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Cardiac papillary fibroelastoma: Report of a surgical series. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Rodrigues JD, Ferreira J, Almeida J, Campelo M, Maciel MJ, Pinho P. Cardiac papillary fibroelastoma: Report of a surgical series. Rev Port Cardiol 2018; 37:981-986. [DOI: 10.1016/j.repc.2018.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/12/2018] [Accepted: 02/18/2018] [Indexed: 11/26/2022] Open
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9
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Anand S, Sydow N, Janardhanan R. Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature. BMJ Case Rep 2017; 2017:bcr-2017-219327. [PMID: 28794051 DOI: 10.1136/bcr-2017-219327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a woman presenting with transient ischaemic attack, who was found to have a papillary fibroelastoma arising from the aortic wall, an extremely rare location. We describe the multimodality imaging techniques used in diagnosing this patient and review the most recent literature on evaluation and management of patients with cardiac papillary fibroelastomas.
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Affiliation(s)
- Senthil Anand
- Cardiology, Sarver Heart Centre, Tucson, Arizona, USA
| | - Nicole Sydow
- Cardiology, Sarver Heart Centre, Tucson, Arizona, USA
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10
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Miller A, Perez A, Pabba S, Shetty V. Aortic valve papillary fibroelastoma causing embolic strokes: a case report and review. Int Med Case Rep J 2017; 10:109-112. [PMID: 28435328 PMCID: PMC5386611 DOI: 10.2147/imcrj.s119353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Papillary fibroelastomas (PFEs) are the second most common benign neoplasms of the cardiac valves and are being recognized more frequently because of higher resolution imaging technology. PFEs are associated with substantial complications that are secondary to systemic embolism. Surgical resection should be offered to all patients who have symptoms and to asymptomatic patients who have pedunculated lesions or tumors larger than 1 cm in diameter. Herein, we present a patient who presented for a second time in 2 months with stroke symptoms. During his first admission, a transthoracic echocardiogram was performed and he was sent home after resolution of his symptoms and a grossly negative workup. During his second admission, a transesophageal echocardiogram was performed and the PFE was found and later excised. While this discussion reviews the literature with regard to detection and management, it will hopefully serve as a reminder to keep this on the differential when the workup has remained without an obvious source.
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Affiliation(s)
- Avraham Miller
- Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Audrik Perez
- Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Swathi Pabba
- Chalmeda Anand Rao Institute of Medical Sciences, Telangana, India
| | - Vijay Shetty
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
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11
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Ohya Y, Fujimoto S, Kanazawa M, Tagawa N, Osaki M, Kitazono T. A case of cardioembolic stroke due to intracardiac papillary fibroelastoma evaluated by using transesophageal echocardiography. Rinsho Shinkeigaku 2017; 57:9-13. [PMID: 28049884 DOI: 10.5692/clinicalneurol.cn-000932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 62-year-old woman had a prior ischemic stroke in the right temporal lobe with dysarthria and dysesthesia of the left hand. Embolic stroke of undetermined source (ESUS) was diagnosed and warfarin was administered. However, transient ischemic attack recurred upon admission to our hospital. Paroxysmal atrial fibrillation and cerebral arterial stenotic lesions were absent. Transesophageal echocardiography revealed a mobile hyperechoic structure on the aortic valve indicating papillary fibroelastoma. She was diagnosed with a brain embolism due to the intracardiac tumor which was surgically excised and pathologically confirmed as papillary fibroelastoma. This type of tumor is relatively rare but it is important as an embolic source especially in ESUS. Transesophageal echocardiography was indispensable for detecting the embolic source in this patient with ESUS.
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Affiliation(s)
- Yuichiro Ohya
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
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12
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Li W, Zheng J, Zhao H, Xu H, Ni Y. Beating-heart surgical treatment of tricuspid valve papillary fibroelastoma: A case report. Medicine (Baltimore) 2016; 95:e4690. [PMID: 27559977 PMCID: PMC5400344 DOI: 10.1097/md.0000000000004690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cardiac papillary fibroelastomas are rare. And only 15% of the papillary fibroelastomas are located on tricuspid valve. However, the treatment of papillary fibroelastomas varies. CASE SUMMARY We report a 75-year-old Chinese male who was hospitalized because of a right atrial mass found by echocardiography. Complete tumor excision along with Kay's tricuspid valvuloplasty surgery on beating heart under cardiopulmonary bypass was performed to the patient. Pathologic examination confirmed the definite diagnosis of cardiac papillary fibroelastoma. The recovery of the patient was uneventful and echocardiographic examination performed 6 months after surgery revealed no recurrence of the tumor. CONCLUSIONS Beating-heart surgical excision is an effective and safe treatment of tricuspid papillary fibroelastomas.
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Affiliation(s)
| | | | | | | | - Yiming Ni
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- Correspondence: Yiming Ni, Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (e-mail: )
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13
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Lai MM, Li TC, Lin CL, Sung FC, Lin CC, Liu CS, Kao CH. Benign Neoplasm of the Heart Increases the Risk of First Ischemic Stroke: A Population-Based Cohort Study. Int J Stroke 2014; 10:202-6. [PMID: 25055877 DOI: 10.1111/ijs.12314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
Abstract
Objective: The study aims to investigate the incidence of first ischemic stroke in patients with benign cardiac tumors who did or did not undergo operations. Methods: We used the National Health Insurance Research Database of Taiwan to conduct the research. The exposure cohort comprised 587 adult patients with benign cardiac tumors. Each patient was randomly frequency matched by age, index month, and index year with 10 participants from the general population who exhibited no history of benign cardiac tumors before the index date (control group). Cox's proportion hazard regression analyses were conducted to determine the relation between benign cardiac tumors and the risk of ischemic stroke. Results: Based on clinical diagnoses, the prevalence of benign cardiac tumors was 0·004%. Patients with benign cardiac tumors exhibited an increased risk of first ischemic stroke [adjusted hazard ratio: 1·77; (95% confidence interval, 1·20–2·63)], particularly at young ages (adjusted hazard ratio: 22·9, 95% confidence interval: 4·17–126·0). We observed no significant difference in the risk of ischemic stroke between men with and without benign cardiac tumors (adjusted hazard ratio: 1·29, 95% confidence interval: 0·63–2·63). Among patients with benign cardiac tumors, the adjusted hazard ratio of first ischemic stroke was 0·48 (95% confidence interval: 0·23–1·04) in the operation group compared with the nonoperation group. Conclusion: Younger patients (<50 years) with benign cardiac tumors exhibit an increased risk of first ischemic stroke.
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Affiliation(s)
- Ming-May Lai
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics & Chinese Medical Science, China Medical University, Taichung, Taiwan
- Biostatistics Center, China Medical University, Taichung, Taiwan 5Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University College of Public Health, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University College of Public Health, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Institute of Healthcare Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and the School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Paroxysmal sneezing at the onset of syncopes and transient ischemic attack revealing a papillary cardiac fibroelastoma. Case Rep Neurol Med 2014; 2014:734849. [PMID: 25045556 PMCID: PMC4086253 DOI: 10.1155/2014/734849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/06/2014] [Indexed: 12/02/2022] Open
Abstract
Sneezing can at times be associated with neurological disorders. The “sneeze center” is localized in the lateral medulla. We report the case of a 50-year-old man who presented three episodes of sneezing, two of them followed by an episode of transient gait instability and dizziness and the third one followed by an episode of transient left hemiparesis due to fibroelastoma of the aortic cardiac valve. To the best of our knowledge, this is the first description of a transient ischemic attack due to cardiac papillary fibroelastoma and revealed by violent episodes of sneezing.
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15
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Owais K, Montealegre-Gallegos M, Mahmood F. Three-dimensional echocardiography: raising questions and providing answers. J Cardiothorac Vasc Anesth 2014; 28:850-1. [PMID: 24746596 DOI: 10.1053/j.jvca.2014.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Khurram Owais
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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16
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Seto T, Takano T, Otsu Y, Terasaki T, Wada Y, Fukui D, Amano J. Cardiac Papillary Fibroelastoma: Report of Three Cases. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:893-6. [DOI: 10.5761/atcs.cr.13-02284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Cardiac fibroelastoma: a rare cause of stroke in young adults. Case Rep Cardiol 2013; 2013:250808. [PMID: 24826279 PMCID: PMC4007804 DOI: 10.1155/2013/250808] [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: 02/19/2013] [Accepted: 04/03/2013] [Indexed: 11/25/2022] Open
Abstract
A 26-year-old man presenting with a transient episode of dysarthria and dizziness, 3 weeks prior to admission, was referred to our center to be evaluated for transient ischemic attack (TIA). The patient had been previously admitted to a different hospital and echocardiography was reported normal at that center, but upon presenting to our institution strand-like masses in the left ventricle (LV) were detected. Transesophageal echocardiography (TEE) revealed two distinct mobile LV masses suggesting a diagnosis of papillary fibroelastoma. CT angiography and histopathological studies confirmed this diagnosis.
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18
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Harling L, Athanasiou T, Ashrafian H, Kokotsakis J, Brown V, Nathan A, Casula R. Minimal access excision of aortic valve fibroelastoma: a case report and review of the literature. J Cardiothorac Surg 2012; 7:80. [PMID: 22943845 PMCID: PMC3494536 DOI: 10.1186/1749-8090-7-80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
Papillary fibroelastomas are rare primary tumours of cardiac origin accounting for approximately 10% of all primary cardiac neoplasms. Due to a high thromboembolic risk, surgical excision is the mainstay of treatment in these patients and median sternotomy the most widely used approach. We describe the case of a 43 year-old lady presenting with acute myocardial infarction secondary to aortic valve papillary fibroelastoma subsequently excised using a minimal access technique. From our experience mini-sternotomy offers excellent exposure and allows for safe resection in such cases, improving cosmesis without compromising either intra or post-operative outcome.
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Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, St. Mary's Campus, London, UK.
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20
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Spiliopoulos S, Gürsoy D, Serrano M, Koerfer R, Tenderich G. Zwei atypisch lokalisierte papilläre Fibroelastome. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-012-0926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Karapanagiotidis GT, Lees N, Howlett P, Zakkar M, Sarsam M. Tricuspid valve papillary fibroelastoma: an unusual case of dizzy spells. Perfusion 2011; 27:156-9. [PMID: 22143091 DOI: 10.1177/0267659111431124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 81-year-old woman with recurrent episodes of dizzy spells was found to have a mass in the right atrium on transthoracic echocardiography. The patient underwent successful surgery to excise the mass, which was arising from the anterior leaflet of the tricuspid valve. Histology showed a papillary fibroelastoma. Although management is still controversial when such tumours are found incidentally in asymptomatic patients, surgery may be considered, especially if the tumour is large, due to the high risk of embolism.
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22
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Sisu RC, Lanzillo G, Benea DC, Cerin G, Vinereanu D. A rare association between mitral valve fibroelastoma and myxomatous disease with severe mitral regurgitation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:179-181. [PMID: 21387331 DOI: 10.1002/jcu.20758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 08/30/2010] [Indexed: 05/30/2023]
Abstract
We report a rare case of association between mitral valve fibroelastoma and myxomatous disease in a patient with long history of asymptomatic myxomatous disease and progressive severe mitral regurgitation. The tumor was an intraoperative transesophageal echocardiographic finding and was confirmed during surgery. The differential diagnosis of the echocardiographic image was infective endocarditis.
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23
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Domenech A, de Arenaza DP, Rivello HG, Patrucco L, Bracco D. Surgery for papillary fibroelastoma with uncommon location in left ventricle. Asian Cardiovasc Thorac Ann 2010; 18:174-6. [PMID: 20304854 DOI: 10.1177/0218492310361391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
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Affiliation(s)
- Alberto Domenech
- Division of Cardiovascular Surgery, Hospital Italiano, Buenos Aires, Argentina.
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Jain D, Maleszewski JJ, Halushka MK. Benign cardiac tumors and tumorlike conditions. Ann Diagn Pathol 2010; 14:215-30. [DOI: 10.1016/j.anndiagpath.2009.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
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25
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Massarenti L, Benassi F, Gallerano A, Stefanelli G. Papillary fibroelastoma of the tricuspid anterior leaflet. J Cardiovasc Med (Hagerstown) 2010; 10:933-5. [PMID: 19623082 DOI: 10.2459/jcm.0b013e32832fa0d1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The case of a 50-year-old woman with an occasional diagnosis of cardiac tumor of the tricuspid valve is reported. At surgery, a single 2 cm x 2 cm polypoid gelatinous neoplasm infiltrating the anterior leaflet of the valve was resected and a tricuspid valve reconstruction along with annuloplasty was accomplished. The postoperative period was uneventful. A diagnosis of papillary fibroelastoma was made at pathology. This neoplasm, which represents a rare pathological entity, is more frequently localized on the mitral valve and usually stays asymptomatic for a long time. Only a few cases involving the tricuspid and pulmonary valves have been reported. Indication for surgery is related to a certain incidence of pulmonary embolism. Surgical removal of papillary fibroelastoma is a low-risk and definitive operation, as only one case of recurrence of the tumor has been reported so far in the literature.
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Affiliation(s)
- Luca Massarenti
- Cardiac Surgery Department, Hesperia Hospital, Modena, Italy
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26
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Sasaki A, Sato M, Jikuya T. Surgical treatment for papillary fibroelastoma of the aortic valve. Gen Thorac Cardiovasc Surg 2009; 57:481-3. [PMID: 19756936 DOI: 10.1007/s11748-009-0429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 02/06/2009] [Indexed: 10/20/2022]
Abstract
Although cardiac papillary fibroelastomas are benign tumors, they have the potential to cause life-threatening complications such as stroke and myocardial infarction and may even lead to sudden cardiac death. We report a case of surgical treatment for a papillary fibroelastoma of the aortic valve. The patient was a 62-year-old woman who was asymptomatic for cardiac papillary fibroelastoma. Echocardiography demonstrated a mobile, rounded mass on the left coronary cusp of the aortic valve. The patient underwent surgical excision, had an uneventful recovery, and was discharged 10 days after the operation. Pathology examination confirmed papillary fibroelastoma. Surgical excision of the tumor is recommended for patients with symptoms, but the treatment of asymptomatic patients is controversial. We believe that surgical treatment should be performed if the tumor is mobile.
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Affiliation(s)
- Akinobu Sasaki
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
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27
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Saloura V, Grivas PD, Sarwar AB, Gorodin P, Ledley GS. Papillary fibroelastomas: innocent bystanders or ignored culprits? Postgrad Med 2009; 121:131-8. [PMID: 19491551 DOI: 10.3810/pgm.2009.05.2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac papillary fibroelastomas (PFEs) are the most common tumors of the cardiac valves and the third most common cardiac tumor. They are usually detected accidentally on echocardiography, but have the potential to manifest with catastrophic embolic phenomena, resulting in stroke and myocardial infarction. Echocardiography is currently the preferred diagnostic modality, while magnetic resonance imaging and computed tomography are helpful in the differential diagnosis of cardiac tumors. The management of PFEs is empiric, as no large randomized trials have been conducted to support specific treatment guidelines. The treatment of choice for PFEs with high-risk features for peripheral embolization is surgical resection. Anticoagulation is recommended in patients who are poor surgical candidates or who refuse surgery, although its duration and intensity are debatable. This review summarizes current knowledge on the epidemiology, pathology, pathophysiology, clinical manifestations, diagnosis, and treatment of PFEs. It also highlights the need for large randomized clinical trials that would delineate more specific guidelines for managing PFEs with anticoagulation.
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Affiliation(s)
- Vassiliki Saloura
- Department of Internal Medicine, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, USA
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Abstract
Papillary fibroelastomas are rare, benign, primary cardiac tumors. They are, however, the most common primary tumor of the cardiac valves and may cause great morbidity risk from embolization. This paper reports the case of a healthy 34-year-old man who presented with symptoms of a right occipital embolic stroke. Transesophageal echocardiography revealed a papillary fibroelastoma on the anterior leaflet of the mitral valve. The papillary fibroelastoma was surgically excised and he has had no recurrent symptoms. This case illustrates the importance of obtaining a transesophageal echocardiogram to investigate a possible embolic source in patients with ischemic stroke.
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Affiliation(s)
- M Shing
- Department of Internal Medicine, Scripps Clinic, La Jolla, California 92037, USA
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30
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Vizzardi E, Faggiano P, Antonioli E, Zanini G, Chiari E, Nodari S, Cas LD. Thrombus or tumor? a case of fibroelastoma as indicated during the submission process. CASES JOURNAL 2009; 2:31. [PMID: 19133150 PMCID: PMC2647911 DOI: 10.1186/1757-1626-2-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 01/08/2009] [Indexed: 11/10/2022]
Abstract
We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 x 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.
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Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Disease, Department of Applied Experimental Medicine, Brescia University, Brescia, Italy.
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31
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Yamauchi S, Ogasawara H, Suzuki S, Kuwabara W. Case report of a papillary fibroelastoma arising from the left ventricular outflow septum just beneath the aortic valve. J NIPPON MED SCH 2008; 75:239-41. [PMID: 18781049 DOI: 10.1272/jnms.75.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiac papillary fibroelastomas are rare benign tumors with frond-like growths that typically involve the native valve tissue. Papillary fibroelastomas originate less commonly in the ventricular septum. We report a rare case of fibroelastoma arising from the left ventricle.
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Affiliation(s)
- Shigeo Yamauchi
- Department of Cardiovascular Surgery and Cardiology, Shirakawa Hospital, Fukushima, Japan.
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32
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Yavuz Balci A, Kayacioglu I, Vural U, Alkan P, Ates M, Tuygun AK, Yekeler I. Cardiac papillary fibroelastoma as a reason of transient ischemic attack for a young patient. Int J Cardiol 2008; 127:e86-8. [PMID: 17706802 DOI: 10.1016/j.ijcard.2007.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
Abstract
Cardiac papillary fibroelastoma is a rare primary cardiac tumor. It occurs mainly in the endothelium of cardiac valves. Although cardiac papillary fibroelastomas are benign tumors, they have potential life threatening complications such as sudden death, stroke, and myocardial infarction. A young man who presented two syncope attacks referred to our hospital for cardiac examination. A mass was found attached to the anterior mitral leaflet, detected by transthoracic echocardiography. We planned an urgent surgery for the patient. During operation, we found out the cauliflower shaped mass on the atrial side of the anterior mitral leaflet. We excised the tumor completely without damage to the mitral valve. We confirmed the diagnosis histopathologically. Intracardiac tumors must be excised urgently due to severe complications. It's so important to protect native valve leaflets during the excision of papillary fibroelastoma with low rates of recurrence.
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33
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Mutlu H, Demir IE, Leppo J, Levy WK. Nonsurgical management of a left ventricular pedunculated papillary fibroelastoma: a case report. J Am Soc Echocardiogr 2008; 21:877.e4-7. [PMID: 18191538 DOI: 10.1016/j.echo.2007.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Indexed: 11/29/2022]
Abstract
Papillary fibroelastoma (PFE) is a benign cardiac tumor that has the potential to cause life-threatening embolic events. Surgical excision of the tumor is recommended for all patients who develop symptoms, but the treatment of asymptomatic patients with an echocardiographically identified PFE is still controversial. Our case report describes a 63-year-old patient with the incidental finding of a probable left ventricular PFE. The patient was not a candidate for surgical excision of this tumor because of comorbidities and refusal to undergo surgery. The patient was followed up during a period of 4 years and was kept on anticoagulation with warfarin. During this follow-up period, the patient developed no symptoms or complications attributable to the cardiac tumor. This is the first case reported in the literature with left ventricular mobile PFE conservatively managed for a duration of more than 4 years. Randomized controlled trials regarding the best management for such incidental PFEs may be needed.
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Affiliation(s)
- Halil Mutlu
- Department of Medicine, Berkshire Medical Center, Pittsfield, Massachusetts 01201, USA.
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34
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Je HG, Kim YS, Jung SH, Lee JW. Resection of left ventricular papillary fibroelastoma through thoracoscopic-assisted minithoracotomy. Interact Cardiovasc Thorac Surg 2008; 7:320-1. [PMID: 18184675 DOI: 10.1510/icvts.2007.165423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although a mobile papillary fibroelastoma in the left ventricle should be excised to prevent systemic embolism, difficulties in surgical exposure of a left ventricular mass are not uncommon. Herein, we report a minimally invasive approach for resecting left ventricular papillary fibroelastoma using thoracoscopic assistance.
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Affiliation(s)
- Hyung Gon Je
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-040, South Korea
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35
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Totsugawa T, Kuinose M, Yoshitaka H, Tsushima Y, Ishida A, Minami H. Papillary fibroelastoma of the tricuspid valve chordae. ACTA ACUST UNITED AC 2006; 54:547-9. [PMID: 17236660 DOI: 10.1007/s11748-006-0052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Papillary fibroelastoma (PFE) commonly involves the native valve tissue, especially that of the left side of the heart. PFE originates less commonly from the valve of the right side of the heart and rarely from the valve chordae. A 69-year-old man was admitted to our hospital complaining of chest discomfort in October 2005. Transthoracic echocardiography showed a highly mobile round mass measuring approximately 10mm in diameter in the right ventricle. He underwent urgent surgery. The tumor was located at the middle of the tricuspid valve chordae and was excised under cardiopulmonary bypass with cardiac arrest. He had an uneventful recovery and was discharged from the hospital 15 days after surgery. The patient has been asymptomatic and remains well without tumor recurrence 7 months after surgery.
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Affiliation(s)
- Toshinori Totsugawa
- Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, 2-1-10 Marunouchi, Okayama 700-0823, Japan.
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36
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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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37
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Tobe S, Yoshida K, Yamaguchi M, Nishimura H, Kawata M. Primary pulmonary valve papillary fibroelastoma. ACTA ACUST UNITED AC 2006; 54:308-10. [PMID: 16898647 DOI: 10.1007/pl00022260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Papillary fibroelastoma (PFE) is a rare and benign cardiac tumor typically found on the valvular endocardium. In most cases, PFE is identified incidentally on echocardiography or during cardiac surgery. The patient was a 73-year-old man who had been treated for hepatocellular carcinoma for 5 years. On echocardiography, a 2.5-cm diameter mass was detected in the pulmonary trunk just above the pulmonary valve. Through a transpulmonary arterial approach with cardiopulmonary bypass, the mass identified on the commissure of the right and posterior pulmonary cusp was surgically excised together with the attached endocardium. Despite the benign histology of PFE, lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. To prevent such complications, tumor identification and surgical excision are essential.
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Affiliation(s)
- Satoshi Tobe
- Department of Cardiovascular Surgery, Akashi Medical Center, Akashi, Hyogo, Japan
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38
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Nonvalvular cardiac papillary fibroelastoma. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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39
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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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40
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Roberts WC. Neoplasms involving the heart, their simulators, and adverse consequences of their therapy. Proc (Bayl Univ Med Cent) 2006; 14:358-76. [PMID: 16369647 PMCID: PMC1305901 DOI: 10.1080/08998280.2001.11927789] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Primary cardiac tumors involving the heart may be either benign or malignant. Most of the benign tumors are myxomas, which are most commonly located in the left atrium. Primary malignant neoplasms usually involve the myocardium and the interior of the cardiac cavities, whereas neoplasms metastatic to the heart most commonly involve pericardium, and pericardial effusion and constriction are the most common consequences. Computed tomography and magnetic resonance imaging are becoming the most useful instruments of precision for the diagnosis of cardiac tumors. Pericardial cysts, teratomas, lipomatous hypertrophy of the atrial septum, papillary fibroelastomas, thrombi, and sarcoid are frequently mistaken for cardiac neoplasms. There are a number of cardiac consequences of malignancy, including radiation heart disease, cardiac hemorrhages, cardiac infection, cardiac adiposity or the corticosteroid-treated heart, cardiac hemosiderosis, and toxicity due to anthracycline chemotherapy.
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Affiliation(s)
- W C Roberts
- Baylor Heart and Vascular Center, Baylor University Medical Center, Dallas, Texas 75246, USA.
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41
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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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42
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Saw W, Nicholls S, Trim G, Thomson D, Hughes C, Mitchell S, Leitch J. Papillary fibroelastoma, a rare but potentially treatable cause of embolic stroke: report of three cases. Heart Lung Circ 2006; 10:105-7. [PMID: 16352047 DOI: 10.1046/j.1444-2892.2001.00082.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Papillary fibroelastomas are rare benign tumours that are seldom diagnosed during life. We report three cases of this tumour; two patients had recurrent embolic events, and one was diagnosed incidentally. Although rare, these tumours are a potentially treatable cause of cardiac emboli. Prompt identification allows excision, which generally is curative.
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Affiliation(s)
- W Saw
- John Hunter Hospital, Newcastle, New South Wales, Australia
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43
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Martin M, Lozano I, Morís C, Rondán J, Avanzas P, Suárez E, Simarro C, Díaz-Molina B. An incidental finding during cardiac catheterization. Int J Cardiol 2006; 106:137-8. [PMID: 16321682 DOI: 10.1016/j.ijcard.2004.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2004] [Accepted: 12/31/2004] [Indexed: 11/26/2022]
Abstract
Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.
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Affiliation(s)
- Maria Martin
- Hospital Universitario Central de Asturias, Department of Cardiology, Oviedo, Spain.
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44
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Abstract
Cardiac papillary fibroelastomas are rare primary cardiac tumors of unknown prevalence. As intraoperative transesophageal echocardiography has become widely used, fibroelastomas are increasingly detected as incidental findings. There are multiple reports of surgical excision, but none describing incomplete excision with long-term surveillance. We report a case of incomplete excision of an aortic valve fibroelastoma subsequently followed-up for 6.5 years without regrowth.
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Affiliation(s)
- Satoshi Sumino
- Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
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45
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Kim HK, Kim YJ, Chang SA, Kim KB, Sohn DW, Park YB. Cardiac papillary fibroelastoma manifested as a left ventricular cystic mass. Int J Cardiol 2005; 101:507-8. [PMID: 15907426 DOI: 10.1016/j.ijcard.2004.03.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2004] [Revised: 02/18/2004] [Accepted: 03/06/2004] [Indexed: 11/24/2022]
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46
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Fumoto H, Yoshikai M, Ohnishi H, Furutachi A. Papillary fibroelastoma of the tricuspid valve. ACTA ACUST UNITED AC 2005; 52:538-41. [PMID: 15609648 DOI: 10.1007/s11748-004-0007-1] [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: 11/25/2022]
Abstract
A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.
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Affiliation(s)
- Hideyuki Fumoto
- Department of Cardiovascular Surgery, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, Fukuoka 830-8577, Japan
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47
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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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48
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Mahadevan VS, Ali N, Campalani G, Dalzell GW. Aortic valve fibroelastoma presenting with anginal symptoms in a patient with hypothyroidism. Int J Cardiol 2002; 84:95-6. [PMID: 12104072 DOI: 10.1016/s0167-5273(02)00048-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boukriche Y, Guiti C, Logeart D, Vissuzaine C, Masson C. [Papillary fibroelastoma: a rare but treatable cause of cerebral infarction]. Rev Med Interne 2001; 22:745-8. [PMID: 11534360 DOI: 10.1016/s0248-8663(01)00420-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Papillary fibroelastoma is a benign cardiac tumor which can be associated with serious embolic complications. EXEGESIS We report on a 42-year-old man admitted for an ischemic stroke in the left middle cerebral artery region. Transesophageal echocardiography revealed a mitral valve tumor. Surgical excision and histological examination showed a papillary fibroelastoma. Clinical course was uneventful. CONCLUSION We consider the high embolic potential of this tumor, which represents a surgically treatable cause of ischemic stroke.
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Affiliation(s)
- Y Boukriche
- Service de neurologie, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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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: 295] [Impact Index Per Article: 12.8] [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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