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Mazur P, Kurmann R, Klarich KW, Dearani JA, Arghami A, Daly RC, Greason K, Schaff HV, Ahmad A, El-Am E, Sorour A, Bois MC, Viehman J, King KS, Maleszewski JJ, Crestanello JA. Operative management of cardiac papillary fibroelastomas. J Thorac Cardiovasc Surg 2024; 167:1088-1097.e2. [PMID: 35989118 DOI: 10.1016/j.jtcvs.2022.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Papillary fibroelastomas are associated with an increased risk of embolic strokes. Excision of papillary fibroelastomas may be the primary indication for surgery (primary) or performed during other cardiac operations (secondary). The present study summarizes our experience with primary and secondary fibroelastoma surgery. METHODS We analyzed the medical records of patients who underwent surgical excision of papillary fibroelastoma between January 1998 and February 2020. Patient characteristics, indications for operation, tumor size and location, and operative and long-term outcomes were evaluated. RESULTS Among the 294 patients (median age: 66 years, 62% female), papillary fibroelastoma was the primary indication for surgery in 136 patients (46%), and 51% of patients had a history of stroke or transient ischemic attack. When papillary fibroelastoma was a secondary indication for surgery (158 patients, 54%), the lesion was identified preoperatively in 39%. Papillary fibroelastomas were located most commonly on the aortic valve and least commonly in the right side of the heart. For valvular papillary fibroelastoma resected from a normal valve, valve shave was sufficient in 96% (196/205). Operative mortality was low in both groups (primary, 0% vs secondary, 2.5%, P = .13), and early neurologic events occurred in 1.3%. Recurrence rate was 15.8% at 10 years. The estimated survival for patients with primary papillary fibroelastoma at 10 years was 78.4%, whereas for secondary papillary fibroelastoma removal it was 53.6% (log rank, P = .003). CONCLUSIONS Resection of papillary fibroelastomas can be performed safely, with preservation of the native valve, and with low rates of neurologic events. Operative and long-term outcomes after fibroelastoma resection are excellent.
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Affiliation(s)
- Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Reto Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Ahmed Sorour
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn
| | - Melanie C Bois
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn
| | - Jason Viehman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Joseph J Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn
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2
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Verma R, Nwakoby A, Yanagawa B. Commentary: Papillary fibroelastoma resection-one and done? J Thorac Cardiovasc Surg 2024; 167:1098-1099. [PMID: 35989121 DOI: 10.1016/j.jtcvs.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Raj Verma
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Akachukwu Nwakoby
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
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3
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Funaishi K, Kasahara H, Oki N, Nakatogawa T, Yamanoi K. Papillary fibroelastoma originating from the atrial septum touching the mitral valve leading to infective endocarditis: a case report. J Cardiothorac Surg 2024; 19:79. [PMID: 38336753 PMCID: PMC10858540 DOI: 10.1186/s13019-024-02584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cardiac papillary fibroelastoma is a rare benign tumor, which is often mistaken for a vegetation. Predominantly asymptomatic, it can cause life-threatening complications. Although rare, mobile papillary fibroelastoma movement between affected valves may hamper valve closure and damage the valve, leading to valvular regurgitation. Endothelial damage increases the risk of developing infective endocarditis. We report a rare case of a highly mobile papillary fibroelastoma originating from the atrial septum touching the mitral valve, leading to mitral regurgitation and, eventually, infective endocarditis. CASE PRESENTATION A 26-year-old woman with suspected infective endocarditis was referred to us from a previous hospital after having experienced intermittent fever for a month. Before the fever, she had been experiencing exertional dyspnea. In addition, she had undergone a cesarean section two weeks before this admission. A transthoracic echocardiogram showed a mobile mass originating from the atrial septum touching the mitral valve with severe mitral regurgitation. Computed tomography revealed an occluded right profunda femoris artery with an embolus. Infective endocarditis associated with a mobile vegetation with high embolic risk was diagnosed, and urgent surgery was performed. Following the surgery, examinations revealed papillary fibroelastoma originating from the atrial septum and infective endocarditis of the mitral valve. The histopathological examination confirmed that a mass initially thought to be a mobile vegetation was a papillary fibroelastoma. The postoperative course was uneventful except for pericarditis. There has been no recurrence of infective endocarditis or papillary fibroelastoma. CONCLUSIONS The highly mobile papillary fibroelastoma was thought to have caused both chronic mitral regurgitation and infective endocarditis. Mobile papillary fibroelastomas can cause endothelial damage to nearby valves and predispose patients to infective endocarditis.
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Affiliation(s)
- Koji Funaishi
- Department of Cardiovascular Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.
| | - Hirofumi Kasahara
- Department of Cardiovascular Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan
| | - Naohiko Oki
- Department of Cardiovascular Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan
| | - Tomoyori Nakatogawa
- Department of Cardiology, Chigasaki Municipal Hospital, 5-15-1 Honson, Chigasaki, Kanagawa, 253-0042, Japan
| | - Kazuhiro Yamanoi
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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4
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Papillary fibroelastoma causing severe aortic stenosis. J Cardiol Cases 2023; 27:120-123. [PMID: 36910032 PMCID: PMC9995653 DOI: 10.1016/j.jccase.2022.11.006] [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: 06/18/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Herein, we present a rare case of papillary fibroelastoma of the aortic valve, which caused severe aortic stenosis. The papillary fibroelastoma developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure. The patient underwent an urgent surgical treatment, which resulted in a successful outcome. To the best of our knowledge, this is the first case of papillary fibroelastoma in which aortic stenosis was so severe as to cause congestive heart failure. Learning objective Papillary fibroelastoma (PFE) is the most commonly observed primary cardiac tumor in adults that commonly involves left heart chambers. While PFEs often cause embolisms, they rarely cause valvular dysfunction. In a case presented herein, a PFE developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure.
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5
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Polo López ML, Rey Lois J, Sánchez Pérez R, Ramchandani Ramchandani B, González Rocafort Á, Centella Hernández T, Lamas Hernández MJ, Salas Mera D, Verdú Sánchez C, Aroca Peinado Á. Operaciones inusuales en cirugía cardiaca infantil: resección de masas intracardiacas. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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6
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Iosifescu AG, Enache R, Văleanu L, Timisescu AT, Iliescu VA. Ten Tumors in the Heart: Papillary Fibroelastoma with Triple Valve Involvement. Ann Thorac Surg 2022; 114:e269-e272. [PMID: 35051394 DOI: 10.1016/j.athoracsur.2021.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
Cardiac papillary fibroelastoma (CPF) is a benign tumor of endocardial origin, most frequently solitary, which commonly affects the aortic valve. We report the case of a 62-years-old woman with ten separate tumors that developed on the mitral, tricuspid, and pulmonary cusps, atrioventricular valve chordae, and left ventricular endocardium. Surgical treatment included valve-sparring resection of the pulmonary cusp tumors and bioprosthetic replacement of the mitral and tricuspid valves, which exhibited extensive tumor invasion. The postoperative course was unremarkable. The high number of CPFs and triple-valve tumor involvement are both exceptional. CPF should be considered whenever multiple cardiac masses are discovered.
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Affiliation(s)
- Andrei George Iosifescu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; Department of Cardiac Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest 022322, Romania.
| | - Roxana Enache
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; Department of Cardiology, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest 022322, Romania
| | - Liana Văleanu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; Departments of Cardiovascular Anesthesia and Intensive Care, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest 022322, Romania
| | - Alina Teodora Timisescu
- Department of Cardiac Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest 022322, Romania
| | - Vlad Anton Iliescu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; Department of Cardiac Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest 022322, Romania
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7
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Tumors of the cardiovascular system: heart and blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Clinical and echocardiographic characteristics of patients with pathology proven right-sided papillary fibroelastomas. Int J Cardiol 2021; 349:123-126. [PMID: 34871621 DOI: 10.1016/j.ijcard.2021.11.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Papillary fibroelastoma (PFE) are one of the most common primary cardiac neoplasms. They are most commonly found on cardiac valves especially on the left side of the heart and have been associated with an increased risk of embolization. To date, no large studies looked at the clinical significance of right-sided PFE (R-PFE). Therefore, we sought to better characterize patients with R-PFE and its clinical sequelae. METHODS We retrospectively identified patients with pathology-proven PFEs at a single center between January 1995 and December 2018 (n = 279). Patients with R-PFE were analyzed. Medical records and echocardiograms were reviewed for clinical and PFE characteristics. RESULTS Twenty-nine patients with R-PFE (mean age 70 ± 11 years; 62% women) were included in the analysis. PFEs were located on the right atrial (RA) wall in 31%, tricuspid valve in 34%, right ventricular (RV) wall in 7%, RV outflow tract in 4%, and pulmonary valve in 10% of patients. The remaining patients (14%) had multifocal PFEs. Around 38% of patients had cancer diagnosed before PFE diagnosis, and 34% had associated congenital heart disease. Seventeen (59%) patients had angina or dyspnea at the time of the presentation, and 3 (10%) had embolic symptoms. One patient with PFE located on the RA with associated patent foramen ovale had a stroke at time of presentation. Two patients, one with PFE on the RA wall and another patient with PFE at the tricuspid valve, had pulmonary embolism at the time of presentation. Median maximal length for PFE varied by location, ranging from a media of 8 mm to 16 mm. Of the 12 patients with follow up echocardiogram 1 year after PFE removal; 3/12 (25%) had documented PFE recurrence. CONCLUSION R-PFE can be present in patients thromboembolic events when there is a right-to-left shunt. They can be a rare cause of pulmonary embolism, and at least in those that had follow-up echocardiograms, had a significant recurrence rate.
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9
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Johnson JN, Mandell JG, Christopher A, Olivieri LJ, Loke YH, Campbell MJ, Darty S, Kim HW, Clark DE, Frischhertz BP, Fish FA, Bailey AL, Mikolaj MB, Hughes SG, Oneugbu A, Chung J, Burdowski J, Marfatia R, Bi X, Craft J, Umairi RA, Kindi FA, Williams JL, Campbell MJ, Kharabish A, Gutierrez M, Arzanauskaite M, Ntouskou M, Ashwath ML, Robinson T, Chiang JB, Lee JCY, Lee MSH, Chen SSM. Society for Cardiovascular Magnetic Resonance 2020 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:108. [PMID: 34629101 PMCID: PMC8504030 DOI: 10.1186/s12968-021-00799-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/26/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website ( https://www.scmr.org ) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason G Mandell
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Adam Christopher
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Steve Darty
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Han W Kim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank A Fish
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison L Bailey
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Michael B Mikolaj
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jina Chung
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
| | | | - Ravi Marfatia
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Xiaoming Bi
- Siemens Medical Solutions, Los Angeles, CA, USA
| | - Jason Craft
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | | | - Faiza A Kindi
- Department of Radiology, The Royal Hospital, Muscat, Oman
| | - Jason L Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Kharabish
- Radiology Department, Cairo University Hospitals, Cairo, Egypt
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manuel Gutierrez
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Monika Arzanauskaite
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular Research Center-ICCC, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Marousa Ntouskou
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mahi L Ashwath
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Tommy Robinson
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Jeanie B Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Jonan C Y Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - M S H Lee
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Sylvia S M Chen
- Department of Cardiology and Adult Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Australia.
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10
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Alozie A, Zimpfer A, Erbersdobler A, Neßelmann C, Öner A, Dohmen PM. Surgery for Valvular and Nonvalvular Papillary Fibroelastomas. Semin Thorac Cardiovasc Surg 2021; 34:560-568. [PMID: 34022368 DOI: 10.1053/j.semtcvs.2021.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Papillary fibroelastomas (PFE) are benign neoplasms, mostly located on valvular surfaces with high embolic potential. This study presents a 27-year single institutional experience on surgical treatment of PFE in an adult patient- cohort with long-term follow-up. This study was approved by the institutional review board. Date and number of IRB approval: 11/23/2017, Institutional Review Board approval number A2014-0149. The need for individual patient consent was waived. We retrospectively evaluated all patients who underwent cardiac surgery for suspected space-occupying lesions in the observation period between June 1991 and June 2018 at our hospital. Clinicopathological features, imaging characteristics, surgical procedures and disease outcome were analyzed. 120 patients were diagnosed with various primary/secondary cardiac tumors and histology confirmed 21 PFEs were found in 16 patients. There was no significant age difference between patients with valvular vs nonvalvular PFEs (P = 0.26). Valvular lesions were found in aortic valve (n = 6), mitral valve (n = 2) and tricuspid valve (n = 1). Nonvalvular PFEs were found in right atrium (n = 2), left ventricle (n = 2), left atrial appendage (n = 2) and aortic wall (n = 1). Valvular lesions were significantly smaller in size compared to non-valvular lesions (P = 0.0013). Left-side PFEs were associated with a high embolization episodes (10/13 patients, 77%) not related to the size. One patient died in-hospital. All other patients were discharged out of the hospital postoperative. Follow-up was performed regularly for a median of 2.8 years (range 0.1-11 years) postoperative. Nonvalvular PFE tended to be larger in size and at least when located on the left sided heart had equally high propensity to embolize compared to valvular PFE. We strongly advocate surgical excision in all left-sided PFE.
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Affiliation(s)
- Anthony Alozie
- Rostock Heart Center, Department of Cardiac Surgery, University of Rostock, Rostock, Germany.
| | - Annette Zimpfer
- Institute of Pathology, University Hospital Rostock, Rostock, Germany
| | | | - Catharina Neßelmann
- Rostock Heart Center, Department of Cardiology, University of Rostock, Rostock, Germany
| | - Alper Öner
- Rostock Heart Center, Department of Cardiology, University of Rostock, Rostock, Germany
| | - Pascal M Dohmen
- Rostock Heart Center, Department of Cardiac Surgery, University of Rostock, Rostock, Germany; Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
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11
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Sorour AA, Kurmann RD, El-Am EA, Bois MC, Scott CG, Lee AT, Dearani JA, Maleszewski JJ, Klarich KW. Recurrence of Pathologically Proven Papillary Fibroelastoma. Ann Thorac Surg 2021; 113:1208-1214. [PMID: 34022212 DOI: 10.1016/j.athoracsur.2021.03.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Papillary fibroelastoma (PFE) is the most common primary benign cardiac tumor. Because PFEs have the potential to embolize, they often are surgically excised. Prior studies have suggested that postoperative recurrence of PFE is rare or does not occur. We aimed to determine the rate at which PFEs recurred after surgical removal and to identify any risk factors associated with recurrence. METHODS We retrospectively identified all patients from a single center with pathologically proven PFE, treated from January 1995 through December 2018. Patients were included in the study if they had an echocardiographic examination at least 1 year after surgery. We compared echocardiographic images obtained intraoperatively (after excision) and at dismissal with those of the most recent examination to assess the possibility of PFE recurrence. RESULTS We included 98 patients in the study. The mean (SD) duration of follow-up was 5.4 (3.7) years (range, 1-17 years); the median duration of follow-up was 4.3 years (interquartile range, 1.9-7.7 years). Twelve patients (12.2%) had echocardiographically supported PFE recurrence. Three patients had the recurrent lesion surgically re-excised, and pathologic analysis showed that 2 were recurrent PFEs and 1 was a Lambl excrescence. Initial clinical presentation of stroke or transient ischemic attack was more common for the recurrence group (for the first PFE) than for the nonrecurrence group (83% vs 26%; P<.001). CONCLUSIONS Contrary to findings from previous studies, PFEs do recur after surgical excision. These findings emphasize the importance of postoperative follow-up with transesophageal echocardiography for identifying recurrent masses.
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Affiliation(s)
- Ahmed A Sorour
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reto D Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Alex T Lee
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph J Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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12
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Zhang W, Mu M, Pei F. A Mobile Intracardiac Mass in a Middle-aged Woman. JAMA Cardiol 2020; 5:1299-1300. [PMID: 33052375 DOI: 10.1001/jamacardio.2020.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mingchao Mu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fei Pei
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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13
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Tan YH, Chien CY. Papillary fibroelastoma of the aortic valve. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Kolek M, Dvorackova J, Motyka O, Brat R. Cardiac papillary fibroelastomas: A 10-year single-center surgical experience and long-term echocardiographic follow-up study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:84-91. [PMID: 31748759 DOI: 10.5507/bp.2019.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/18/2019] [Indexed: 12/30/2022] Open
Abstract
AIMS Limited contemporary data are available on the clinical and echocardiographic outcomes after surgery for cardiac papillary fibroelastoma (CPF). The aim of this study was to review the clinical manifestations, pathological characteristics, surgical management, and prognoses of patients with histologically verified CPF, who underwent surgery at our cardiac surgery center from 2008 to 2018. METHODS AND RESULTS Twelve patients of median age 62 years (28 to 77 years) were treated. Embolic stroke or transient ischemic attack (five patients, 42%) were the only CPF clinical manifestations. Eleven (92%) tumors were localized on the valves, with the aortic valve being the most common tumor site (seven patients; 58%). Multiple factor analysis revealed no independent predictor of CPF-related embolization. Simple shave tumor excision was sufficient in most patients (10 patients, 83%). No operative or tumor-related late mortality during the median follow-up period of 4.7 years (1.1 to 10.2 years) was recorded. Asymptomatic metachronous valve tumor recurrence (in a location different from that of the original tumor) was revealed in two patients (17%) by transesophageal echocardiography (TEE), not detected by transthoracic echocardiography (TTE). One of these two patients underwent repeated surgery for CPF but later suffered a recurrent embolic stroke, due to another tumor recurrence. CONCLUSION CPF can be safely and effectively treated surgically. TEE is superior to the TTE option in CPF post-operative recurrence detection. There is a clear need for a prospective study to determine criteria for embolization risk stratification and optimum management in patients with CPF.
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Affiliation(s)
- Martin Kolek
- Department of Clinic Subjects, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | | | | | - Radim Brat
- Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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15
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Guo DC, Yang YH, Liu Y, Sun LL, Zhu WW, Lu XZ, Li YD. Incidental finding of an asymptomatic pulmonary valve papillary fibroelastoma: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:568-571. [PMID: 31392732 DOI: 10.1002/jcu.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.
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Affiliation(s)
- Di-Chen Guo
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan-Hua Yang
- Department of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lan-Lan Sun
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Wei Zhu
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lu
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi-Dan Li
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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16
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Mashicharan M, El-Dean Z, Zlocha V, Khoo J. Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events. Echo Res Pract 2019; 6:K13-K17. [PMID: 31413862 PMCID: PMC6689122 DOI: 10.1530/erp-19-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/18/2019] [Indexed: 11/24/2022] Open
Abstract
Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source.
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Affiliation(s)
- Mary Mashicharan
- Department of Cardiology, University Hospital Leicester, Leicester, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Viktor Zlocha
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Jeffrey Khoo
- Department of Cardiology, University Hospital Leicester, Leicester, UK
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17
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Roberts CS, Carry MM, Choi JW, Grayburn PA, Roberts WC. Papillary fibroelastoma in the left atrium. Proc (Bayl Univ Med Cent) 2019; 32:247-248. [PMID: 31191142 DOI: 10.1080/08998280.2018.1553439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022] Open
Abstract
Described herein is a 71-year-old woman with previous angina pectoris who suddenly developed slurred speech and right-arm weakness. She was found to have significant coronary narrowing, a small mass in the left atrium attached to the endocardium near the orifice of the appendage, and multifocal punctate cerebral lesions in the distribution of the left middle cerebral artery. The left atrial mass was excised and confirmed to be a papillary fibroelastoma. Coronary bypass was also performed. It is believed that fibrin thrombus developed within the fronds of the fibroelastoma and embolized to the brain. Such lesions in the left atrium are exceedingly uncommon. She had no further emboli events.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac and Thoracic Surgery, Baylor University Medical CenterDallasTexas.,Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Melissa M Carry
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - James W Choi
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
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18
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Boyacıoğlu K, Ak A, Dönmez AA, Çayhan B, Aksüt M, Tunçer MA. Outcomes After Surgical Resection of Primary Non-Myxoma Cardiac Tumors. Braz J Cardiovasc Surg 2019; 33:162-168. [PMID: 29898146 PMCID: PMC5985843 DOI: 10.21470/1678-9741-2017-0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023] Open
Abstract
Objective Primary cardiac tumors are rare lesions with different histological type. We
reviewed our 17 years of experience in the surgical treatment and clinical
results of primary non-myxoma cardiac tumors. Methods Between July 2000 and February 2017, 21 patients with primary cardiac tumor
were surgically treated in our institution. The tumors were categorized as
benign non-myxomas and malignants. Data including the demographic
characteristics, details of the tumor histology and grading, cardiac medical
and surgical history, surgical procedure of the patients were obtained from
the hospital database. Results Eleven patients were diagnosed with benign non-myxoma tumor
(male/female:7/4), ranging in age from 10 days to 74 years (mean age
30.9±26.5 years). Papillary fibroelastoma was the most frequent type
(63.6%). There were two early deaths in benign group (all were rhabdomyoma),
and mortality rate was 18%. The mean follow-up period was 69.3±58.7
months (range, 3 to 178 months). All survivals in benign group were free of
tumor-related symptoms and tumor relapses. Ten patients were diagnosed with
malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from
14 years to 73 years (mean age 44.7±18.9 years). Total resection
could be done in only three (30%) patients. The mean follow-up period was
18.7±24.8 months (range, 0-78 months). Six patients died in the first
10 months. Conclusion Complete resection of the cardiac tumors, whenever possible, is the main goal
of surgery. Surgical resection of benign cardiac tumors is safe, usually
curative and provides excellent long-term prognosis. On the contrary,
malignant cardiac tumors still remain highly lethal.
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Affiliation(s)
- Kamil Boyacıoğlu
- Cardiovascular Surgery Department, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Adnan Ak
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Arzu Antal Dönmez
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Burçin Çayhan
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mehmet Aksüt
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mehmet Altuğ Tunçer
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
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19
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Gonçalves M, Tralhão A, Trabulo M, Madeira M. Mitral valve papillary fibroelastoma as a cause of acute coronary syndrome. BMJ Case Rep 2018; 11:11/1/bcr-2018-226930. [PMID: 30567172 DOI: 10.1136/bcr-2018-226930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 37-year-old man presented with acute chest pain, an unremarkable ECG and mildly elevated cardiac troponin. Coronary CT angiography showed a calcium score of 0 together with the absence of atherosclerotic plaques and normal origin and course of the coronary arteries. Transthoracic and transoesophageal echocardiography revealed an infracentimetric round-shaped mobile mass attached to a secondary tendinous chord of the anterior mitral valve leaflet. Cardiac magnetic resonance further evidenced localised contrast uptake supporting vascular irrigation, making thrombus unlikely. After surgical excision, the patient had an uneventful postoperative course. Histopathology disclosed the typical collagenous matrix covered by a single cell layer. Although mostly benign, cardiac tumours are prone to embolisation and can thus mimic an acute coronary syndrome. Multimodality imaging has an important role in unmasking the true mechanism, revealing less common aetiologies and elucidating the possibility of curative surgical resection.
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Affiliation(s)
- Mariana Gonçalves
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - António Tralhão
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Marisa Trabulo
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Márcio Madeira
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
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20
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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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21
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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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22
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Jullian L, Harrogate SR, Harky A, Roberts N. Presentation of papillary fibroelastoma of the aortic valve with atypical symptoms. BMJ Case Rep 2018; 2018:bcr-2018-224367. [PMID: 30030243 DOI: 10.1136/bcr-2018-224367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Papillary fibroelastomas are rare benign tumours arising from the cardiac endothelium. The rationale behind the treatment of fibroelastomas is to eliminate the risk of embolic events and the associated morbidity and mortality. These tumours present predominantly in males during the seventh decade of life and most commonly affect the aortic valve. We report a case of aortic valve papillary fibroelastoma with an atypical clinical presentation, treated with valve-sparing surgical excision. Our case highlights the management of this rare but serious condition and emphasises the need to develop clear guidelines regarding the treatment of asymptomatic patients with a papillary fibroelastoma.
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Affiliation(s)
- Lucas Jullian
- Department of General Surgery, Homerton University Hospital, London, UK
| | | | - Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Neil Roberts
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
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23
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Leekoff ML, Masur JE, Burke AP, Pollock JS, Peters MN, Pham SM, Miller TR, Cole JW. Clinical Reasoning: An unusual cause of adult cryptogenic ischemic stroke. Neurology 2018; 90:386-391. [PMID: 29459447 DOI: 10.1212/wnl.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mark L Leekoff
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Julia E Masur
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Allen P Burke
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Jeremy S Pollock
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Matthew N Peters
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Si M Pham
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - Timothy R Miller
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore
| | - John W Cole
- From the Department of Neurology (M.L.L.), Department of Pathology (A.P.B.), Division of Cardiovascular Medicine (J.S.P., M.P.), Division of Cardiac Surgery (S.M.P.), and Department of Diagnostic Radiology (T.R.M.), University of Maryland School of Medicine (J.E.M.); and Department of Neurology (J.W.C.), Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore.
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24
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Cook AG, Viswanath O, D'Mello J. Papillary Fibroelastoma Found With Transesophageal Echocardiography After a Normal Transthoracic Echocardiography. Semin Cardiothorac Vasc Anesth 2017; 21:217-220. [PMID: 28758563 DOI: 10.1177/1089253217699281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We present the case of a patient with transient ischemic attacks who was being investigated for multiple embolic strokes. Initial workup, including brain computed tomography, computed tomography angiography, and transthoracic echocardiography (TTE) were negative for a source until transesophageal echocardiography (TEE) found a mass in the left atrium. The TEE differentiated the mass as a rare cardiac papillary fibroelastoma on the left atrial free wall confirmed by postsurgical pathology. This case highlights the importance of TEE as a diagnostic tool for its ability to more accurately differentiate and characterize the tumor compared with TTE. This case underscores that a negative TTE does not equate to zero risk of the presence of a cardiac tumor. It is prudent for the clinician to be cognizant that it may be beneficial to perform a TEE even with a negative TTE workup.
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Affiliation(s)
- Andrew G Cook
- 1 University of Miami School of Medicine/Jackson Health Systems, Miami, FL, USA
| | - Omar Viswanath
- 2 Mt Sinai Medical Center Miami Beach, Miami Beach, FL, USA
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25
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Mkalaluh S, Szczechowicz M, Torabi S, Dib B, Sabashnikov A, Mashhour A, Karck M, Weymann A. Surgery for Cardiac Papillary Fibroelastoma: A 12-Year Single Institution Experience. Med Sci Monit Basic Res 2017; 23:258-263. [PMID: 28706178 PMCID: PMC5523956 DOI: 10.12659/msmbr.904881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We reviewed our clinical experience with cardiac papillary fibroelastoma from 2005 to 2017. The objective of this study was to investigate the clinical and operative data, as well as the early survival rate and immediate postoperative complications. MATERIAL AND METHODS We performed a retrospective analysis of 11 patients (eight males and three females) who underwent resection of cardiac papillary fibroelastoma in our institution. RESULTS Mean age at tumor diagnosis was 60±14 years. The mean dimension of the tumor was 14±11 mm. The most common symptoms were dyspnea, palpitation, and angina pectoris, while one patient had recurrent fever attacks and another patient had a transient ischemic attack. Two patients had concomitant malignant tumors (cervical and colon carcinoma) and another two had concomitant benign neoplasms (liver cyst and thyroid adenoma). Bypass and cross clamp times were 77±32 minutes and 54±18 minutes, respectively. The tumors were found predominantly on cardiac valves (n=7). In eight cases, only tumor extirpation was performed, whereas in the other three cases, the valves had to be replaced. The mean intensive care unit length of stay was 1.1±0.3 days and there was no in-hospital mortality. All patients were alive at one-year follow-up and the survival rate was 91% in the mean follow-up period of 4.15 years. CONCLUSIONS The surgical treatment of cardiac papillary fibroelastoma was curative and safe. Thus, potential complications such as embolization or mechanical irritation of the valves can be avoided without high surgical risk.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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26
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Multiple Cardiac Papillary Fibroelastomas. ACTA ACUST UNITED AC 2017; 1:104-106. [PMID: 30062256 PMCID: PMC6058221 DOI: 10.1016/j.case.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We present a case of a patient who presented with symptoms of heart failure and was found to have multiple cardiac masses. The mass attached to the right atrial lead and the mass in the left ventricle were the largest. The patient underwent cardiac surgery and 9 to ten masses were resected with biopsy consistent with papillary fibroelastomas. There was tissue in the right atrium that resembled ectopic spleen.
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27
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Arikan AA, Omay O, Aydın F, Kanko M, Gür S, Derviş E, Yılmaz CE, Müezzinoğlu B. Aortic valve replacement for papillary fibroelastoma. J Card Surg 2017; 32:347-354. [PMID: 28508532 DOI: 10.1111/jocs.13154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve-sparing techniques in patients with PFE.
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Affiliation(s)
- Ali Ahmet Arikan
- Muş State Hospital, Department of Cardiovascular Surgery, Muş, Turkey
| | - Oğuz Omay
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Fatih Aydın
- Eskişehir State Hospital, Departement of Cardiology, Eskişehir, Turkey
| | - Muhip Kanko
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Sibel Gür
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Emir Derviş
- Kocaeli University Medical Faculty, Departement of Cardiology, Kocaeli, Turkey
| | - Cansu Eda Yılmaz
- Kocaeli University Medical Faculty, Departement of Pathology, Kocaeli, Turkey
| | - Bahar Müezzinoğlu
- Kocaeli University Medical Faculty, Departement of Pathology, Kocaeli, Turkey
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28
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Papillary Fibroelastoma as a Cause of Cardiogenic Embolic Stroke in a β-Thalassemia Patient: Case Report and Literature Review. Case Rep Cardiol 2017; 2017:8185601. [PMID: 28458927 PMCID: PMC5385231 DOI: 10.1155/2017/8185601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/19/2017] [Indexed: 11/30/2022] Open
Abstract
We describe a case of a young male without stroke risk factors who presented with a sudden onset of left-sided weakness, left hand numbness, and left eye blurriness. CT scan of the head without contrast and diffusion-weighted MRI of the brain with contrast revealed an ischemic stroke in the right middle cerebral artery distribution. Transesophageal echocardiography (TEE) revealed a mobile pedunculated mass on the posterior surface of the mitral valve. This mass was resected and pathology showed a cardiac papillary fibroelastoma (CPFE), which was determined to be the cause of the patient's cardioembolic stroke. Further workup also found that patient had microcytic anemia secondary to β-thalassemia intermedia, a rare hematologic disorder due to defective hemoglobin synthesis. Recently, another case report suggested β-thalassemia major may underlie the pathogenesis of CPFE. β-Thalassemia major causes a state of chronic inflammation and endothelial damage, which can mediate CPFE formation. Based on literature review, this is the first case report of a CPFE in a patient with β-thalassemia intermedia. This hypothesis-generating case report calls attention to the need for elucidating the relationship between CPFE and β-thalassemia in future studies to better understand the diagnosis and management of a rare cardiac tumor.
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29
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Ruisanchez C, Alonso A, Carballo B, Gil A, Lerena P, Sarralde JA, Ruano FJ. Incidental tricuspid valve fibroelastoma associated with patent foramen ovale in a young female: Straightforward diagnosis but controversial management. Echocardiography 2017; 34:1399-1400. [PMID: 28401594 DOI: 10.1111/echo.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Papillary fibroelastoma is an uncommon primary cardiac tumor, predominantly associated with left-sided valvular endocardium. Affectation of tricuspid valve leaflets is rare, and management in asymptomatic patients remains controversial. We present a 30-year-old female referred for evaluation prior to bariatric surgery. A routine echocardiogram revealed a mobile cardiac mass attached to the tricuspid valve. A patent foramen ovale was also present. Tumor was surgically removed. Histology confirmed the definite diagnosis of a papillary fibroelastoma. In our case, the presence of a patent foramen ovale associated with the right-sided fibroelastoma was decisive in the decision for surgery.
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Affiliation(s)
- Cristina Ruisanchez
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Angela Alonso
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Beatriz Carballo
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Aritz Gil
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Piedad Lerena
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose Aurelio Sarralde
- Cardiovascular Surgery Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Zamolo F, Calvagna C, D'Oria M, Sgorlon G, Zandonà L, Adovasio R. Neoplastic Embolization from Cardiac Papillary Fibroelastoma with Unusual Presentation: A Case Report. Ann Vasc Surg 2017; 38:317.e1-317.e4. [DOI: 10.1016/j.avsg.2016.05.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
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Cianciulli TF, Soumoulou JB, Lax JA, Saccheri MC, Cozzarin A, Beck MA, Ferreiro DE, Prezioso HA. Papillary fibroelastoma: clinical and echocardiographic features and initial approach in 54 cases. Echocardiography 2016; 33:1811-1817. [PMID: 27566126 DOI: 10.1111/echo.13351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Papillary fibroelastoma (PFE) is a benign cardiac tumor that is currently detected more often due to the technological improvements in echocardiography. OBJECTIVES To describe the echocardiographic features of PFE and correlate them with the clinical presentation and initial treatment. MATERIALS AND METHODS A prospective analysis of patients with a diagnosis of PFE was conducted between 2000 and 2015. We assessed the clinical history, symptoms at the time of diagnosis, echocardiographic features, and initial treatment. RESULTS Fifty-four patients with a diagnosis of PFE by echocardiography were included. The incidence was 0.038%. Mean age was 62±16 years; 50% were male. Forty-six percent of patients had symptoms at the time of diagnosis, the most frequent of which was transient ischemic accident (TIA). Embolic episodes occurred in 31% of patients, mainly to the brain. PFEs were valvular in 70.4% of cases and multiple in 13%. Mean maximum length was 1.18±0.58 cm, and 44% were mobile. PFEs >1.5 cm were most often found in the heart valves (56.8% vs 10.8%; P=.045). There was no significant relation between size, mobility, location and number of tumors, and the presence of embolism or symptoms. Most frequent treatment was oral anticoagulation in 48.6%, followed by simple tumor resection in 42.8% of cases. CONCLUSIONS PFE is a small tumor, predominantly valvular and benign, but entails a high incidence of cerebral embolism. The initial approach should be individualized according to clinical manifestations, comorbidities, and the experience of the surgical center.
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Affiliation(s)
- Tomás Francisco Cianciulli
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Juan Bautista Soumoulou
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Jorge Alberto Lax
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - María Cristina Saccheri
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Alberto Cozzarin
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Martín Alejandro Beck
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Daniel Ernesto Ferreiro
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Horacio Alberto Prezioso
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
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Yong MS, Smail H, Saxena P. Management of incidental papillary fibroelastoma: An update. Int J Cardiol 2016; 215:338-9. [PMID: 27128557 DOI: 10.1016/j.ijcard.2016.04.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew S Yong
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Hassiba Smail
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, The Townsville Hospital, James Cook University, Douglas, Australia.
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Sabzi F, Ghasemi F, Asadmobini A. A Tricuspid Valve Mass Attached to Papillary Muscle. Ethiop J Health Sci 2016; 26:293-6. [PMID: 27358551 PMCID: PMC4913198 DOI: 10.4314/ejhs.v26i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiac myxoma is the most common benign heart tumor which can arise in any of the cardiac chambers, valves or related great veins. Diagnosis of a myxoma arising from the tricuspid valve apparatus is exceptional. We present a rare case of myxoma in a tricuspid valve attached to papillary muscle. CASE DETAILS A 45-year-old man was referred to our center for the evaluation dyspnea and chest pain. During work-up by transthoracic echocardiography (TTE), a mass was found on the corda tendinea of the anterior papillary muscle of the tricuspid valve. Coronary angiography revealed normal coronary artery. During open heart surgery, an oval and non-pedunculated mass was detected on tricuspid corda tendinea and resected. Pathological examination revealed the presence of a myxoma. CONCLUSION This experience illustrates a rare case of myxoma which originated from tricuspid corda tendinea, diagnosed by echocardiography, suggesting fibroelastoma. However, the mass was not clear enough but dyspnea and sign and symptom of probably embolization to lung urged us to treat it surgically. No complications attributable to the mass developed in the postoperative course. In the first year of follow-up, non-recurrence of the mass was detected on TEE, and the patient was asymptomatic.
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Affiliation(s)
- Feridoun Sabzi
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fahimeh Ghasemi
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Atefeh Asadmobini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Choi KB, Kim HW, Kim DY, Jo KH, Choi HJ, Hong SB. Tricuspid Papillary Fibroelastoma Mimicking Tricuspid Vegetation in a Patient with Severe Neutropenia. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:195-8. [PMID: 27298798 PMCID: PMC4900863 DOI: 10.5090/kjtcs.2016.49.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
We report a 72-year-old male with known myelodysplastic syndrome who presented to the emergency department with a 7-day history of fever and dyspnea. Echocardiography revealed a round echogenic mass 13×16 mm in size attached to the atrial side of the tricuspid valve. Considering the high risk of infective endocarditis in the patient with a low absolute neutrophil count (130/mm3), emergency surgery was performed. Intraoperatively, a single gelatinous neoplasm was resected, and subsequent reconstruction of the involved leaflet was accomplished using autologous pericardium. The tumor was pathologically confirmed as papillary fibroelastoma with no evidence of infective endocarditis. Papillary fibroelastoma is a rare cardiac neoplasm that occurs in either the mitral or aortic valves. Interestingly, a few cases of tricuspid valve papillary fibroelastoma have been reported so far. Similar echocardiographic findings between vegetation and tricuspid valve neoplasm make it difficult to distinguish these two disease entities.
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Affiliation(s)
- Kuk Bin Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Keon Hyon Jo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Hang Jun Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
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Kammerer I, Besser R, Al-Azani M, Frank C, Bohrer MH, Sack FU. Fibroelastoma Recurrence in Left Ventricle: Rarity of Primary Cardiac Tumor. Surg J (N Y) 2015; 1:e35-e37. [PMID: 28824968 DOI: 10.1055/s-0035-1565244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022] Open
Abstract
Cardiac papillary fibroelastoma (CPF) is a primary cardiac neoplasm usually detected by echocardiography. Left ventricular fibroelastomas are extremely rare. The incidence of CPF is between 0.0017 and 0.33% during autopsy studies. We report a 70-year-old man who had papillary fibroelastoma discovered and resected in 2005 that recurred in 2013. The tumor grew rapidly from 2013 to 2014. A bioprosthetic mitral valve was placed in 2014. Due to the location and nature of the recurrent tumor, mitral valve replacement was the treatment of choice to prevent a third recurrence of the fibroelastoma. The patient was discharged from the hospital on postoperative day 9.
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Affiliation(s)
- Inna Kammerer
- Department of Cardiac Surgery, Hospital of City Ludwigshafen, Ludwigshafen, Germany
| | - Reinhard Besser
- Department of Cardiac Surgery, Hospital of City Ludwigshafen, Ludwigshafen, Germany
| | - Mohammed Al-Azani
- Department of Cardiac Surgery, Hospital of City Ludwigshafen, Ludwigshafen, Germany
| | - Christian Frank
- Department of Cardiac Surgery, Hospital of City Ludwigshafen, Ludwigshafen, Germany
| | - Manfred H Bohrer
- Institute of Pathology, Hospital of City Ludwigshafen, Ludwigshafen, Germany
| | - Falk-Udo Sack
- Department of Cardiac Surgery, Hospital of City Ludwigshafen, Ludwigshafen, Germany
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Ikegami H, Andrei AC, Li Z, McCarthy PM, Malaisrie SC. Papillary fibroelastoma of the aortic valve: analysis of 21 cases, including a presentation with cardiac arrest. Tex Heart Inst J 2015; 42:131-5. [PMID: 25873822 DOI: 10.14503/thij-14-4262] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac papillary fibroelastoma is a rare, benign tumor, arising predominantly from cardiac valves. This tumor can cause a variety of symptoms due to thromboembolism. We describe our single-center surgical experience with papillary fibroelastoma of the aortic valve. From April 2004 through June 2013, 6,530 patients underwent cardiac surgery. Of those, 6,098 patients were included in the final analysis. Twenty-one patients (0.34%) underwent surgical resection of 30 papillary fibroelastomas of the aortic valve. Most patients (67%) were incidentally diagnosed to have cardiac papillary fibroelastoma. The usual symptom was cerebral infarction (in 5 of 7 symptomatic patients). A rare presentation of papillary fibroelastoma in one patient was cardiac arrest caused by left main coronary artery ostial obstruction. Tumor size was not related to patient age (Pearson correlation coefficient, 0.34; P=0.13). Neither the number of tumors (1.43 ± 0.72 vs 1.43 ± 0.62) nor tumor size (8.14 ± 2.42 vs 8.07 ± 3.31 mm) was significantly different between symptomatic and asymptomatic patients. All lesions were resected by means of the simple shave technique. There were no operative or 30-day deaths. Follow-up echocardiograms showed no tumor recurrence (mean follow-up duration, 17 ± 14 mo). We identified no significant relationship among tumor size, number of tumors, symptoms, or patient age. Because simple shave excision of the tumor can be safely achieved without evidence of tumor recurrence, we conclude that surgical resection can be reasonable in asymptomatic patients.
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Taguchi E, Nakao K, Sassa T, Kamio T, Sakanashi M, Miyamoto S, Sakamoto T, Nishigami K, Uesugi H, Hirayama T. Resting angina due to papillary fibroelastoma of the right coronary cusp. Heart Vessels 2014; 31:114-7. [PMID: 25081095 DOI: 10.1007/s00380-014-0561-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
Abstract
A 63-year-old man with chest pain at rest was referred to our hospital. Transthoracic echocardiography showed a mobile ball-like mass at the top of the right coronary cusp. Subsequently, transesophageal echocardiography also showed a mobile mass at the right coronary cusp. Aortic valve replacement with a mechanical valve was performed under general anesthesia. We diagnosed this condition as papillary fibroelastoma based upon the pathological findings with hematoxylin and eosin staining, and Elastica van Gieson staining. Coronary angiography revealed no organic lesions. The operation was successful, and the patient remains asymptomatic. We speculate that the resting chest pain was induced by transient occlusion of the right coronary orifice by the tumor. We describe this rare case in detail including a review of the literature.
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Affiliation(s)
- Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan.
| | - Toshiharu Sassa
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Takihiro Kamio
- Division of Diagnostic Pathology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Mina Sakanashi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Shinzo Miyamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Kazuhiro Nishigami
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Hideyuki Uesugi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Touitsu Hirayama
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
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Velásquez O, Gómez F, Alzate F, Fortich F, Mejía A. Resección de fibroelastoma papilar mitral mediante cirugía mínimamente invasiva en paciente con accidente cerebrovascular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Srivatsa SV, Adhikari P, Chaudhry P, Srivatsa SS. Multimodality imaging of right-sided (tricuspid valve) papillary fibroelastoma: recognition of a surgically remediable disease. Case Rep Oncol 2013; 6:485-9. [PMID: 24163665 PMCID: PMC3806706 DOI: 10.1159/000355419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Presentation of an increasingly recognized right-sided primary valve tumor of clinical importance: the tricuspid valve papillary fibroelastoma (PF). Early recognition and surgical intervention is emphasized for valvular PF, which carries a significant risk of morbidity and mortality. Newer imaging techniques, including CT and MRI, assist in localizing and differentiating PF from alternative cardiac pathology.
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Affiliation(s)
- Shantanu V Srivatsa
- Department of Cardiology and Cardiothoracic Surgery, Community Regional Medical Center, Fresno, Calif., USA
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Sato M, Nagaya K, Hatakeyama M, Komatsu T. Multiple papillary fibroelastoma: report of a case and implications for management. Gen Thorac Cardiovasc Surg 2013; 62:122-4. [PMID: 23609481 DOI: 10.1007/s11748-013-0249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 04/07/2013] [Indexed: 12/01/2022]
Abstract
A 59-year-old woman with chest discomfort was transferred to our hospital. Echocardiography was suggestive of multiple papillary fibroelastoma (PFE). Tumors on both the left and right coronary cusps were confirmed macroscopically and pathologically and a small tumor was noted microscopically on the non-coronary cusp. Aortic valve replacement was successfully performed. The treatment and recurrence rate of PFE is controversial due to its rarity. Given that multiple tumors were seen in the present case and that possible recurrence has been reported elsewhere, valve replacement may be a better choice for surgical repair than valvoplasty in some cases, such as a single PFE in which plasty may be difficult or multiple PFEs regardless of impaired valve function.
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Affiliation(s)
- Mitsuru Sato
- Division of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-tsukurimichi, Aomori, Aomori, 030-0913, Japan,
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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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Multiple papillary fibroelastomas as a cause of recurrent syncope. J Thorac Cardiovasc Surg 2013; 145:e51-2. [PMID: 23398643 DOI: 10.1016/j.jtcvs.2013.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/11/2013] [Indexed: 11/20/2022]
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