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Demirel M, Acar E, Toprak C, İzci S, Öcal L. Papillary Fibroelastoma of the Mitral Valve: an Unusual Cause of Mitral Valve Obstruction. Korean Circ J 2017; 47:286-287. [PMID: 28382087 PMCID: PMC5378038 DOI: 10.4070/kcj.2016.0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Muhittin Demirel
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Emrah Acar
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Cüneyt Toprak
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Servet İzci
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Umraniye Research and Training Hospital, Kartal, Istanbul, Turkey
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Dumaswala B, Dumaswala K, Hsiung MC, Quiroz LDM, Sungur A, Escanuela MGA, Mehta K, Oz TK, Bhagatwala K, Karia NM, Nanda NC. Incremental Value of Three-Dimensional Transesophageal Echocardiography over Two-Dimensional Transesophageal Echocardiography in the Assessment of Lambl's Excrescences and Nodules of Arantius on the Aortic Valve. Echocardiography 2013; 30:967-75. [DOI: 10.1111/echo.12310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bhavin Dumaswala
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Komal Dumaswala
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ming Chon Hsiung
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan; Republic of China
| | | | - Aylin Sungur
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | | | - Kruti Mehta
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Tugba Kemaloglu Oz
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Kunal Bhagatwala
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Nidhi M. Karia
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
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Anastacio MM, Moon MR, Damiano RJ, Pasque MK, Maniar HS, Lawton JS. Surgical experience with cardiac papillary fibroelastoma over a 15-year period. Ann Thorac Surg 2012; 94:537-41. [PMID: 22626753 DOI: 10.1016/j.athoracsur.2012.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/29/2012] [Accepted: 04/02/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Papillary fibroelastomas are rare, benign cardiac tumors. They are predominantly asymptomatic. However, they can lead to serious complications, namely thromboembolic events. Symptomatic lesions can be managed primarily with surgical excision and valvular preservation. Controversy exists as to the management of asymptomatic lesions. METHODS All patients diagnosed with cardiac papillary fibroelastoma between 1996 and 2012 at a single institution were queried for clinical and pathologic characteristics. RESULTS Twenty-three patients with 29 lesions were identified. Most lesions were solitary, less than 1.0 cm in diameter, and occurred in patients greater than 60 years of age. The most common presentation was thromboembolic complication. All were managed successfully with surgical excision. One patient developed a recurrence or metachronous lesion within 3 months of initial surgical intervention. CONCLUSIONS Papillary fibroelastomas are rare, benign, predominantly asymptomatic cardiac tumors that can cause potentially serious complications. The natural history and etiology of papillary fibroelastomas are largely unknown. Controversy exists over the management of asymptomatic lesions. However, there is consensus that symptomatic lesions should undergo surgical excision with valvular preservation when possible. A unique case of a possible papillary fibroelastoma recurrence is also described.
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Affiliation(s)
- Melissa M Anastacio
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Luo GH, Ma WG, Sun HS, Pan SW, Huang ZX, Wang HY, Zhu XD. Surgical treatment for primary mitral valve tumor: a 25-year single-center experience. Cardiology 2011; 119:81-7. [PMID: 21912119 DOI: 10.1159/000329918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 06/03/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Primary mitral valve (MV) tumor is a rare lesion, and to date, there have been few larger surgical series of MV tumors. We retrospectively analyzed 11 cases of primary MV tumors regarding clinical and pathological features, surgical procedure and long-term outcomes. METHODS From November 1983 to December 2008, we operated on 11 patients (age 36.3 ± 17.7 years, weight 55.4 ± 11.2 kg) with primary MV tumors. Symptoms were cardiac in 8 cases (72.7%) and neurologic in 3 (26.3%). Surgical procedures included en bloc excision and MV repair in 8 cases and tumor resection and MV replacement in 3. No radiotherapy or chemotherapy was given to patients with malignant tumors. RESULTS Pathological diagnosis was papillary fibroelastoma in 3 cases, myxoma in 3, lymphangioma in 1, lipoma in 1, hemangioma in 1 and sarcoma in 2. No early deaths or complications occurred. Late death occurred in 2 patients with sarcoma 1 year postoperatively. At the latest follow-up, with a maximum of 25 years (mean 10.6 ± 8.8), the 9 survivors were in New York Heart Association functional class I with normal MV function and no echocardiographic evidence of local recurrence. CONCLUSIONS The majority of primary MV tumors are benign. They can cause cardiac or neurologic symptoms and should be excised as soon as a diagnosis is made. For benign tumors, valve-sparing resection and valve repair are often possible with excellent long-term outcomes. The prognosis of malignant MV tumors is poor.
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Affiliation(s)
- Guo-Hua Luo
- Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China
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5
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Eftekhari H, Islam A, Slawsky M. Aortic valve fibroelastoma presenting with myocardial infarction. Catheter Cardiovasc Interv 2011; 77:716-9. [PMID: 21061251 DOI: 10.1002/ccd.22879] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/17/2010] [Indexed: 11/09/2022]
Abstract
Fibroelastoma is a rare, benign cardiac tumor. It is the second most common primary cardiac tumor and the most common primary cardiac valvular tumor. Nonvalvular endocardial location is rare and may be difficult to differentiate from thrombus and myxoma. Fibroelastoma consists of a small, highly papillary, pedunculated, and avascular tumor which is covered by a single layer of endothelium. It contains fine elastic fibrils arranged in whorls in a hyaline stroma. Fibroelastoma is mostly found incidentally at the time of echocardiography, cardiac catheterization, surgery, or autopsy. Symptomatic patients present with various clinical presentations, mainly cardiovascular in nature.
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Affiliation(s)
- Hossein Eftekhari
- Department of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA.
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6
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Mariscalco G, Bruno VD, Borsani P, Dominici C, Sala A. Papillary Fibroelastoma: Insight to a Primary Cardiac Valve Tumor. J Card Surg 2010; 25:198-205. [DOI: 10.1111/j.1540-8191.2009.00993.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Berne JP, Bouchot O, Jazayeri S, Tatou E, Gomez-Bielfeld MC, Martin L, Brenot R, David M. [Cardiac papillary fibroelastoma, a rare valvular source of cerebral embolism: report of two cases]. Ann Cardiol Angeiol (Paris) 2009; 58:61-63. [PMID: 18980749 DOI: 10.1016/j.ancard.2008.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 09/07/2008] [Indexed: 05/27/2023]
Abstract
Cardiac papillary fibroelastomas are very rare and benign tumors, usually involving heart valves. They are sometimes asymptomatic. However, they become serious illnesses when associated with clinical events, as systemic embolism. Diagnosis is evoked by echocardiography and confirmed by histopathological examination. The only curative treatment consists of the excision of the tumor under cardiopulmonary bypass. This approach is safe and prevents the risk of embolism recurrence. We report the cases of two patients suffering from acute cerebral embolism. Transthoracic and transoesophageal echocardiography detected tumors of the mitral and aortic valve in the first and second patients, respectively. Preserving the valve integrity, both masses were surgically excised and pathological findings confirmed the diagnosis. As surgical management is curative, we believe that these lesions should be always removed.
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Affiliation(s)
- J-P Berne
- Service de chirurgie cardiovasculaire, hôpital du Bocage, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21034 Dijon cedex, France.
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8
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Wolf RC, Spiess J, Vasic N, Huber R. Valvular strands and ischemic stroke. Eur Neurol 2007; 57:227-31. [PMID: 17312371 DOI: 10.1159/000100016] [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] [Received: 08/18/2006] [Accepted: 11/26/2006] [Indexed: 11/19/2022]
Abstract
We report the case of a previously healthy 47-year-old woman suffering an acute embolic stroke in the left middle cerebral artery distribution. A filiform structure along the line of the aortic valve was first identified by transesophageal echocardiography, leading to the diagnosis of a valvular strand. These masses are thought to represent giant Lambl's excrescences, although differential diagnoses include several benign cardiac tumors, e.g. papillary fibroelastoma. Valvular strands have previously been associated with embolic events including stroke, although exact pathogenetic mechanisms and further patient management have not yet been fully established. This case report additionally provides a short overview of the currently existing literature. As a conclusion, standard recommendations for patient management and treatment cannot be derived from currently available evidence.
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9
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Fox E, Brunson C, Campbell W, Aru G. Cardiac papillary fibroelastoma presents as an acute embolic stroke in a 35-year-old African American male. Am J Med Sci 2006; 331:91-4. [PMID: 16479182 DOI: 10.1097/00000441-200602000-00016] [Citation(s) in RCA: 10] [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
This is an interesting case of a young patient suffering an acute embolic stroke in the middle cerebral artery distribution, who was later found to have a papillary fibroelastoma on the mitral valve. The mass was first recognized by transesophageal echocardiography and eventually resected surgically. The retrieved specimen had classic histologic findings of a papillary fibroelastoma. A thrombus was noted on the tip of the specimen, supporting the theory that these masses are risks for strokes secondary to damage along the endothelial lining predisposing to subsequent fibrin deposition and mural thrombus formation.
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Affiliation(s)
- Ervin Fox
- Department of Medicine, the University of Mississippi Medical Center, Jackson, Mississippi, USA.
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10
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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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11
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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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12
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Batur MK, Yildirir A, Kabakci G, Aksöyek S. A huge mitral valve tumor and its vascularity--a case report. Angiology 2001; 52:77-81. [PMID: 11205937 DOI: 10.1177/000331970105200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary cardiac tumors of the mitral valve are extremely rare; however, they present a major risk of embolization. Therefore, prompt diagnosis and urgent treatment is obligatory. The authors report the case of a 60-year-old man with a huge mitral valve mass and its vascularity, which was diagnosed by transthoracic echocardiography and selective coronary arteriography. Our patient's mitral valve tumor had a size of 5.9 x 2.9 cm, which was the largest size reported up to this time in this location. The patient died from a major cerebrovascular event before surgical excision could be performed.
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Affiliation(s)
- M K Batur
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
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Abstract
Papillary fibroelastomas are rare benign neoplasms, predominantly involving cardiac valves, that have been discovered with increasing frequency through the use of echocardiography. Most are papillary lesions, less than 1 cm in size, connected to the valve or mural endocardium by a small stalk. Although often asymptomatic, embolization from the lesion or attached thrombus may cause serious neurological or cardiac events. All symptomatic papillary fibroelastomas should be removed unless there are compelling contraindications, in which case anticoagulation is an acceptable but unreliable alternative. Surgical removal is safe, simple, effective, and permanent. Asymptomatic lesions of the left side of the heart should be removed because of their potentially serious or fatal consequences, whereas those arising from the right side of the heart may be observed.
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Affiliation(s)
- D M Shahian
- Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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14
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Voros S, Nanda NC, Thakur AC, Winokur TS, Samal AK. Lambl's Excrescences (Valvular Strands). Echocardiography 1999; 16:399-414. [PMID: 11175169 DOI: 10.1111/j.1540-8175.1999.tb00833.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We review the literature on Lambl's excrescences (valvular strands). With the widespread use of cardiac imaging modalities, most importantly, with transesophageal echocardiography, abnormal valvular structures are frequently identified on both native and prosthetic heart valves. However, there is no consensus in the literature on the correct terminology of these structures. The relationship between valvular strands (the so-called Lambl's excrescences) and papillary fibroelastomas has not been well established. In this review, we attempt to summarize the available echocardiographic descriptors and the gross macroscopic and histological features of Lambl's excrescences (valvular strands). In addition, we review the etiology, pathogenesis, and clinical implications of these cardiac excrescences. Also, we describe features that help to distinguish between Lambl's excrescences and papillary fibroelastomas. Because valvular strands (Lambl's excrescences) have been implicated in systemic thromboembolism, we also review the available management principles for patients with valvular strands; unfortunately, no specific therapeutic guidelines can be proposed at the present time.
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Affiliation(s)
- Szilard Voros
- University of Alabama at Birmingham, Heart Station SW/S102, Birmingham, AL 35233
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Voros S, Nanda NC, Thakur AC, Narayan VK, Samal AK. Lambl's Excrescences Involving the Pulmonary Valve Detected by Transesophageal Echocardiography. Echocardiography 1999; 16:35-39. [PMID: 11175120 DOI: 10.1111/j.1540-8175.1999.tb00783.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report the first case of echocardiographically detected Lambl's excrescences on the pulmonary valve in a 72-year-old man who was referred for transesophageal echocardiography as a part of an evaluation for ischemic stroke. A total of four excrescences were noted on the arterial aspect of the pulmonary valve; two of them were on the anterior cusp, one was on the left cusp, and one was on the right cusp. The excrescence on the left cusp was the largest, measuring 5 mm in length. These valvular strands (Lambl's excrescences) represented an incidental finding and were not associated with any disease process.
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Affiliation(s)
- Szilard Voros
- University of Alabama at Birmingham, Heart Station SW/S102, Birmingham, AL 35233
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Di Mattia DG, Assaghi A, Mangini A, Ravagnan S, Bonetto S, Fundarò P. Mitral valve repair for anterior leaflet papillary fibroelastoma: two case descriptions and a literature review. Eur J Cardiothorac Surg 1999; 15:103-7. [PMID: 10077384 DOI: 10.1016/s1010-7940(98)00271-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiac papillary fibroelastomas are rare cardiac tumors and have been considered a 'benign' incidental finding that may have significant clinical manifestations. In this paper we report two cases of mitral valve fibroelastoma: one was discovered by chance with transthoracic echocardiography in a young healthy man, the other was an intraoperative incidental finding in a middle aged man with a recent history of acute myocardial infarction. The mitral valve was repaired in both cases after excising the tumor. The patients did well and remain asymptomatic. A literature review was compiled which comprises previous case reports of 34 patients with mitral valve papillary fibroelastomas. Most were asymptomatic, but when symptoms occurred, they could be disabling, such as stroke, cardiac heart failure, myocardial infarction, and sudden death. Papillary fibroelastoma is amenable to simple surgical excision or in addition to mitral valve repair or replacement. Recurrence has not been reported.
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Affiliation(s)
- D G Di Mattia
- Department of Thoracic and Cardiovascular Surgery, Luigi Sacco Hospital, Milan, Italy
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17
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Caballero J, Calle G, Arana R, Sancho M, Caballero FJ, Piñero C, Daroca T, Jiménez JM. [Cardiac papillary fibroelastoma. Different forms of the clinical presentation]. Rev Esp Cardiol 1997; 50:815-7. [PMID: 9424708 DOI: 10.1016/s0300-8932(97)74687-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Papillary fibroelastoma is an uncommon cardiac tumor rarely diagnosed during life. Although most fibroelastomas are incidental findings at autopsy, a few cases have been associated with cardiac symptoms that include angina, arterial embolism and sudden death. We report the case of two patients, a 35-year-old male with an acute myocardial infarction and ventricular fibrillation and a 53-year-old asymptomatic female, with cardiac masses first detected by transthoracic echocardiography. A more detailed morphological study was provided by transesophageal echocardiography. After cardiac surgery, the anatomical study demonstrated that both tumors were papillary fibroelastomas. The literature concerning papillary fibroelastoma is reviewed.
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Affiliation(s)
- J Caballero
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz
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Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB. Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation. J Am Coll Cardiol 1997; 30:784-90. [PMID: 9283541 DOI: 10.1016/s0735-1097(97)00211-8] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We sought to determine the clinical and echocardiographic characteristics of papillary fibroelastoma (PFE). BACKGROUND PFE is a rarely encountered cardiac tumor about which relatively little is known. METHODS Institutional records were reviewed for the years 1980 to 1995 for patients with pathologic or echocardiographic diagnosis of PFE. Group 1 included 17 patients with the pathologic diagnosis of PFE who also underwent echocardiography. Echocardiographic features of PFE were established in group 1. Group 2 included 37 patients with only echocardiographic evidence of PFE. RESULTS In group 1, 7 (41.2%) of 17 patients had symptoms related to PFE. Neurologic events occurred in 5 (29.4%) of 17 patients. All patients had the tumor surgically removed. During follow-up, no new embolic events occurred. Echocardiographic characteristics of PFE included a small tumor (12.1 +/- 6.5 x 9.0 +/- 4.3 mm), usually pedunculated (14 [94%] of 17 patients) and mobile, with a homogeneous speckled pattern and a characteristic stippling along the edges. PFEs were most common on valvular surfaces (12 [60%] of 20 PFEs) but were not uncommon on other endocardial surfaces (8 [40%] of 20 PFEs). The tumor did not cause valvular dysfunction. In group 2, 16 (43%) of 37 patients were asymptomatic. Five patients (13.5%) had a previous neurologic event. During follow-up (mean 31 months, range 1 to 77), nine neurologic events occurred. CONCLUSIONS PFEs are associated with embolism, can be diagnosed with echocardiography, are often an incidental clinical finding and do not cause valvular dysfunction.
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Affiliation(s)
- K W Klarich
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Hicks KA, Kovach JA, Frishberg DP, Wiley TM, Gurczak PB, Vernalis MN. Echocardiographic evaluation of papillary fibroelastoma: a case report and review of the literature. J Am Soc Echocardiogr 1996; 9:353-60. [PMID: 8736022 DOI: 10.1016/s0894-7317(96)90152-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Papillary fibroelastomas comprise approximately 7.9% of benign primary cardiac tumors. Although papillary fibroelastomas were at first discovered incidentally at autopsy or during heart surgery, these tumors are increasingly being identified by echocardiography. This article reviews those papillary fibroelastomas detected by transthoracic or transesophageal echocardiography and discusses the echocardiographic features of these tumors, associated symptoms, and management. Echocardiography is important in influencing management decisions regarding excision, valve replacement, and valve repair.
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Affiliation(s)
- K A Hicks
- Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA
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