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Stiru O, Geana RC, Dragulescu PR, Tulin A, Raducu L, Bacalbasa N, Balescu I, Cretoiu D, Diaconu C, Iliescu L, Savu C, Iliescu VA. Transapical Left Ventricular Approach for Cardiac Papillary Fibroelastomas: A Case Report. In Vivo 2021; 34:3681-3685. [PMID: 33144485 DOI: 10.21873/invivo.12216] [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: 08/16/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cardiac papillary fibroelastomas (CPF) are benign tumors, frequently asymptomatic, characterized by a mobile pedunculated mass that arises from the endocardium. When CPF is located in the left ventricle, it may protrude into the left ventricular outflow tract and affect hemodynamics. They are highly thrombogenic, and can also cause some life-threatening events such as cerebral and peripheral embolization. CASE REPORT We herein report a case of a 74-year-old female admitted to our center with palpitations and dyspnea on exertion. Her past medical history revealed that she had had a transient ischemic attack 7 months before presentation. Echocardiography and cardiac magnetic resonance imaging revealed an intracardiac mass anchored in the anteroapical interventricular septum without interference with aortic or mitral valve functionality. Surgical resection of the left ventricular mass was performed through the left apical ventriculotomy approach. Histopathological examination of the tumor was suggestive of papillary fibroelastoma. The postoperative course was uneventful. The patient was discharged home on the eighth postoperative day, with no recurrence at 6 months. CONCLUSION Although left ventricular papillary fibroelastomas are benign tumors, they carry a high risk for embolic complications and therefore surgery should be proposed, the transapical approach being a safe and effective method.
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Affiliation(s)
- Ovidiu Stiru
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Carmen Geana
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | | | - Adrian Tulin
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Prof. Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Laura Raducu
- Department of Plastic and Reconstructive Microsurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, Prof Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania .,Department of Obstetrics and Gynecology, I. Cantacuzino Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | - Dragos Cretoiu
- Department of Cellular, Molecular and Histology Biology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Scientific researcher, Alessandrescu-Rusescu National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Laura Iliescu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Cornel Savu
- Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Thoracic Surgery, Marius Nasta Institute of Pneumonology, Bucharest, Romania
| | - Vlad Anton Iliescu
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Karacorlu M, Ozdemir H, Arf Karacorlu S. Optical Coherence Tomography Findings in Branch Retinal Artery Occlusion. Eur J Ophthalmol 2018; 16:352-3. [PMID: 16703561 DOI: 10.1177/112067210601600228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the optical coherence tomography (OCT) findings in a 35-year-old man with acute inferior branch retinal artery occlusion. METHODS OCT findings in acute branch retinal artery occlusion were evaluated. RESULTS OCT disclosed diffuse thickening of the neurosensory retina in the inferior perifoveolar area. Increased reflectivity was noted in the inner retinal layers rom the surface of the retina to the photoreceptor layers. Decreased reflectivity was observed from the photoreceptor layers and the retinal pigment epithelium secondary to the shadowing effect. Foveolar depression, photoreceptor layer in the fovae, and retinal pigment epithelium underneath the fovea were normal. OCT findings in the superior perifoveolar area were also normal. CONCLUSIONS In the retinal artery occlusion, denaturation and breakdown of the normally transparent intracellular protein and an increase in the intracellular fluid cause ischemic whitening of the retina. Otherwise there is no retinal thickening secondary to the accumulation of serous fluid escaping from retinal capillaries into the extracellular space. The OCT findings support these descriptions.
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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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4
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Affiliation(s)
- Fanxia Meng
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Jing Ping Sun
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Ming Chen
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Min Xu
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Nan Xu
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Alex Pui-Wai Lee
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Xing Sheng Yang
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.)
| | - Cheuk-Man Yu
- From the Department of Noninvasive Cardiac Function, Heart Center (F.M., M.C., M.X.), and Department of Radiology (N.X.), East Hospital, Tongji University School of Medicine, Shanghai, China; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong (J.P.S., A.P.L., X.S.Y., C.Y.).
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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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Ergun K, Golbasi Z, Cagli K, Altinsoy A, Mustafa Ulas M, Temucin T, Arat N, Topaloglu S, Deveci B, Ertan A. A Rare Cause of Sudden Vision Loss in a Young Male: Papillary Fibroelastoma of the Aortic Valve. Echocardiography 2007; 24:425-9. [PMID: 17381654 DOI: 10.1111/j.1540-8175.2006.00410.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiac papillary fibroelastoma (CPF) is a rare cardiac neoplasm predominantly affecting the cardiac valves. Although it is most commonly an incidental finding, it can result in life-threatening complications, such as coronary and cerebral embolism, acute valvular dysfunction, and sudden death. In this report, we describe a case of a patient with aortic valve papillary fibroelastoma, which presented with sudden vision loss due to branch retinal artery occlusion. To the best of our knowledge, this is the third case of CPF-related retinal artery embolism in English literature.
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Affiliation(s)
- Kumral Ergun
- Türkiye Yüksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
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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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8
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Nawaz MZ, Lander AR, Schussler JM, Grayburn PA, Hamman BL, Roberts WC. Tumor excision versus valve replacement for papillary fibroelastoma involving the mitral valve. Am J Cardiol 2006; 97:759-64. [PMID: 16490452 DOI: 10.1016/j.amjcard.2005.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 11/15/2005] [Accepted: 11/15/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Mohammad Zaim Nawaz
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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9
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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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10
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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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Lopez-Sanchez E, Muñoz EF, Aviño Martinez JA, Menezo Rozalen JL. Central retinal artery occlusion as the initial sign of aortic valve papillary fibroelastoma. Am J Ophthalmol 2001; 131:667-9. [PMID: 11336952 DOI: 10.1016/s0002-9394(00)00846-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We describe a central retinal artery occlusion in a young man who was subsequently found to have an aortic valve papillary fibroelastoma. METHODS Case report with clinical, echocardiographic, and histopathologic observations. RESULTS The aortic valve papillary fibroelastoma was successfully treated with tumor resection. CONCLUSION Appropriate investigations in young patients with central retinal artery occlusion should therefore be conducted, including transthoracic and transesophageal echocardiography, to diagnose and treat this tumor, because failure to diagnose this tumor may result in further embolic events, including stroke and sudden death.
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12
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Wen F, Chen X, Liao R. Branch retinal artery occlusion after thyroid artery interventional embolization. Am J Ophthalmol 2000; 129:690-1. [PMID: 10844076 DOI: 10.1016/s0002-9394(99)00471-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a case of branch retinal artery occlusion after thyroid artery interventional embolization. METHODS A 33-year-old man with hyperthyroidism complained of visual loss and scotoma in the left eye after thyroid artery interventional embolization. He underwent a full ophthalmologic examination, including fluorescein angiography. RESULTS Visual acuity was 20/25, with inferior and superior scotomas present in the left eye. Fluorescein angiography of the left eye revealed delayed filling of a superotemporal branch retinal artery and nonfilling of an inferotemporal branch retinal artery. CONCLUSION A small, but definite risk of retinal artery occlusion after thyroid artery interventional embolization should be considered.
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Affiliation(s)
- F Wen
- Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou, China.
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Küçükoğlu S, Arat A, Mutlu H, Okçün B, Bakay C, Oz B, Uner S. A cardiac papillary fibroelastoma with chordal location. J Am Soc Echocardiogr 1999; 12:1001-4. [PMID: 10552364 DOI: 10.1016/s0894-7317(99)70156-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Papillary fibroelastomas, which were initially incidental findings at autopsy and surgery, are now being recognized with increasing frequency with the widespread use of echocardiography. Because of their embolic potential, an aggressive treatment approach is generally accepted. We report a papillary fibroelastoma located at the chorda of the anterior mitral leaflet that underwent conservative follow-up for 8 years without any complications. Because most of the cardiac papillary fibroelastoma cases reported are incidental findings, the question of whether symptomless fibroelastomas must be removed or other factors contribute to the embolic nature of the selected cases remains a challenge for the future.
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Affiliation(s)
- S Küçükoğlu
- Istanbul University, Institute of Cardiology, Turkey
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14
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Grinda JM, Couetil JP, Chauvaud S, D'Attellis N, Berrebi A, Fabiani JN, Deloche A, Carpentier A. Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization. J Thorac Cardiovasc Surg 1999; 117:106-10. [PMID: 9869763 DOI: 10.1016/s0022-5223(99)70474-5] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We have reviewed the case histories of 4 patients who underwent operations between September 1994 and November 1997 at Broussais Hospital for cardiac valvular papillary fibroelastoma. METHODS Diagnosis was strongly suggested by echocardiography. Tumor locations were mitral (1), tricuspid (1), and aortic (2). Indications for operation were previous stroke for the mitral tumor, prophylaxis for the tricuspid tumor, syncopal episodes for the first aortic tumor, and transient ischemic attack and mesenteric ischemia for the second aortic tumor. RESULTS Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, aortic valve reconstruction was achieved with part of a cryopreserved aortic homograft cusp. Intraoperative transesophageal echocardiography showed no evidence of valvular regurgitation after excision in all cases. All patients had uneventful postoperative recoveries. No evidence of regurgitation or recurrence was seen on echocardiography at follow-up. CONCLUSIONS Despite their histologically benign aspect, cardiac papillary fibroelastomas should be excised because of potential embolic complications. A conservative, valve-sparing approach is recommended, however, because of the absence of recurrence after total excision.
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Affiliation(s)
- J M Grinda
- Department of Cardiovascular Surgery of Broussais Hospital [1], Paris, France
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15
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Bailbé M, Coisne D, Babin P, Corbi P, Menu P, Rosier MP, Couderq C, Pouget Abadie JF, Gil R, Neau JP. [Papillary fibroelastoma. A rare etiology of strokes in young patients]. Rev Med Interne 1998; 19:119-22. [PMID: 9775126 DOI: 10.1016/s0248-8663(97)83421-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The papillary fibroelastomas are cardiac lesions, which typically occur on the cardiac valves, but rarely on the endocardium. The incidence of these benign primitive tumors varies from 0.002 to 0.33% and increases with advancing age. METHODS We report two cases of stroke, one in a 31-year-old man and the other in a 48-year-old woman, both admitted to the same stroke center. RESULTS The diagnostic studies were normal in these two patients, except for the echocardiography. The first showed an echogenic mass on the mitral valve on transthoracic echocardiography (TTE), confirmed by the transesophageal echocardiography (TEE). The second demonstrated a mass on the sigmoid aortic valve on TEE, but the TTE was normal. For these two patients, a surgical excision was carried out and pathologic examination concluded to a papillary fibroelastoma. After surgery, no recurrence was observed. CONCLUSIONS The papillary fibroelastomas are usually asymptomatic and easily detected by TEE. However, it can be revealed by stroke, myocardial infarction and lower limbs ischemia. These cardiac tumors should be surgically removed, since their complete excision remains the only means of avoiding a recurrence of embolism.
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Affiliation(s)
- M Bailbé
- Service de neurologie, hôpital Jean-Bernard, CHU La Milétrie, Poitiers
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Shirani J, Bradlow JA, Metveyeva P, Losada M, Factor SM, Strom JA, Sisto D. Transient Loss of Vision as the Presenting Symptom of Papillary Fibroelastoma of Aortic Valve. Cardiovasc Pathol 1997; 6:237-40. [DOI: 10.1016/s1054-8807(96)00137-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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