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Almeida FS, Canevazzi GJ, Rocha PB, Sobral ACCM, Sobral MLP. Tumoration in Anterior Leaflet of the Mitral Valve. Braz J Cardiovasc Surg 2021; 36:116-119. [PMID: 33594865 PMCID: PMC7918378 DOI: 10.21470/1678-9741-2020-0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Priscila Barão Rocha
- Faculdade de Medicina, Centro Universitário das Américas, São Paulo, São Paulo, Brazil
| | | | - Marcelo Luiz Peixoto Sobral
- Faculdade de Medicina, Centro Universitário das Américas, São Paulo, São Paulo, Brazil.,Departament of Cardiovascular Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil.,Post Graduate Department of Cardiovascular and Thoracic Surgery, Universidade de São Paulo, Instituto do Coração, São Paulo, São Paulo, Brazil
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2
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Spiliopoulos S, Gürsoy D, Serrano M, Koerfer R, Tenderich G. Zwei atypisch lokalisierte papilläre Fibroelastome. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-012-0926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Sisu RC, Lanzillo G, Benea DC, Cerin G, Vinereanu D. A rare association between mitral valve fibroelastoma and myxomatous disease with severe mitral regurgitation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:179-181. [PMID: 21387331 DOI: 10.1002/jcu.20758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 08/30/2010] [Indexed: 05/30/2023]
Abstract
We report a rare case of association between mitral valve fibroelastoma and myxomatous disease in a patient with long history of asymptomatic myxomatous disease and progressive severe mitral regurgitation. The tumor was an intraoperative transesophageal echocardiographic finding and was confirmed during surgery. The differential diagnosis of the echocardiographic image was infective endocarditis.
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4
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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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5
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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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6
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Yavuz Balci A, Kayacioglu I, Vural U, Alkan P, Ates M, Tuygun AK, Yekeler I. Cardiac papillary fibroelastoma as a reason of transient ischemic attack for a young patient. Int J Cardiol 2008; 127:e86-8. [PMID: 17706802 DOI: 10.1016/j.ijcard.2007.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
Abstract
Cardiac papillary fibroelastoma is a rare primary cardiac tumor. It occurs mainly in the endothelium of cardiac valves. Although cardiac papillary fibroelastomas are benign tumors, they have potential life threatening complications such as sudden death, stroke, and myocardial infarction. A young man who presented two syncope attacks referred to our hospital for cardiac examination. A mass was found attached to the anterior mitral leaflet, detected by transthoracic echocardiography. We planned an urgent surgery for the patient. During operation, we found out the cauliflower shaped mass on the atrial side of the anterior mitral leaflet. We excised the tumor completely without damage to the mitral valve. We confirmed the diagnosis histopathologically. Intracardiac tumors must be excised urgently due to severe complications. It's so important to protect native valve leaflets during the excision of papillary fibroelastoma with low rates of recurrence.
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7
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Liebeskind DS, Buljubasic N, Saver JL. Cardioembolic stroke due to papillary fibroelastoma. J Stroke Cerebrovasc Dis 2007; 10:94-5. [PMID: 17903807 DOI: 10.1053/jscd.2001.24654] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2000] [Indexed: 11/11/2022] Open
Abstract
Papillary fibroelastoma (PFE) is a rare primary benign cardiac tumor with significant embolic potential. Diagnosis and requisite surgical treatment may be neglected unless transesophageal echocardiography (TEE) is performed. A 72-year-old man with hypertension and diabetes had a right middle cerebral artery stroke of unclear cause after standard work-up. Subsequent TEE indicated an aortic valve PFE. The TEE may be the only diagnostic modality to identify embolic lesions such as PFE and must be strongly considered in cryptogenic large vessel stroke.
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Affiliation(s)
- D S Liebeskind
- University of California Los Angeles Medical Center, Los Angeles, CA, USA
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8
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Yuan SM, Shinfeld A, Kostiuk O, Nass D, Raanani E. Cardiac papillary fibroelastoma of the mitral chorda. Heart Lung Circ 2007; 17:428-32. [PMID: 17723320 DOI: 10.1016/j.hlc.2007.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 05/18/2007] [Accepted: 05/24/2007] [Indexed: 11/29/2022]
Abstract
We describe a case of cardiac papillary fibroelastoma in a 33-year-old man. The diagnosis was established by echocardiography. Computerised tomographic angiography gave no evidence of coronary stenosis, but illustrated a radiopaque filling defect in the left ventricle. The papillary fibroelastoma was removed together with the involved chorda, and an artificial chord was implanted under cardiopulmonary bypass. Histological study confirmed the diagnosis of papillary fibroelastoma. Due to the potentials of cerebral and coronary embolisation, surgical management to the patients with a papillary fibroelastoma is highly recommended.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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9
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Outomuro D, del Riego H, Grana DR, Milei J. Unusual location in the left ventricular outflow tract and atypical symptoms of cardiac papillary fibroelastoma. J Cardiovasc Med (Hagerstown) 2006; 7:768-70. [PMID: 17001239 DOI: 10.2459/01.jcm.0000247325.03278.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac papillary fibroelastoma, though potentially fatal, are rare benign tumours. Therefore, high index of suspicion is needed in order to identify these lesions and to limit complications at surgery or during long-term oral anticoagulation if the patient is not a surgical candidate. We present a case report of unusual location and presentation, highlighting the pathological findings. A 55-year-old white male, without risk factors for ischaemic cardiomyopathy, presented several episodes of chest pain. Nine years previously, the patient had had a convulsive attack without any organic neurological finding and was treated with different anticonvulsive drugs for five years. Echocardiography showed a mobile mass in the left ventricular outflow tract. The patient underwent surgical excision of the mass, which was later identified as cardiac papillary fibroelastoma.
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Affiliation(s)
- Delia Outomuro
- Instituto de Investigaciones Cardiológicas Prof. Dr Alberto C. Taquini, CONICET, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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10
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Nonvalvular cardiac papillary fibroelastoma. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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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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12
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Taniguchi I, Morimoto K, Miyasaka S, Marumoto A. Papillary fibroelastoma of the mitral valve associated with rheumatic mitral valve stenosis. ACTA ACUST UNITED AC 2005; 53:143-6. [PMID: 15828294 DOI: 10.1007/s11748-005-0020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
With the advent of echocardiography, diagnosis of papillary fibroelastoma in living patients has been made possible, yet papillary fibroelastoma found in the living remains a very rare cardiac tumor. We report a case of papillary fibroelastoma of the mitral valve with rheumatic mitral valve stenosis. A 68-year-old woman was referred to our hospital with a mitral valve tumor and rheumatic mitral valve stenosis. She underwent anticoagulation therapy with Warfarin for 8 years since having a cerebral embolization. Echocardiography revealed a mass attached to the mitral valve, with severe mitral valve stenosis. Electrocardiography demonstrated a chronic atrial fibrillation. Tumor excision with mitral valve replacement and maze procedure were performed. Both the surgical and histological findings depicted papillary fibroelastoma. The postoperative course was uneventful and the patient has remained symptom-free one year after surgery.
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Affiliation(s)
- Iwao Taniguchi
- Department of Thoracic Cardiovascular Surgery, Tottori Prefectural Central Hospital, Tottori, Japan
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13
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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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Meng Q, Lai H, Lima J, Tong W, Qian Y, Lai S. Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases. Int J Cardiol 2002; 84:69-75. [PMID: 12104067 DOI: 10.1016/s0167-5273(02)00136-5] [Citation(s) in RCA: 200] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To investigate the characteristics and pathological features of primary cardiac tumors and to evaluate the diagnostic sensitivity of echocardiography in primary cardiac tumors, all pathologic and echocardiographic records at the Chinese PLA general hospital and its satellite hospitals between January 1st, 1990 and January 1st, 2000 were reviewed to identify patients with a confirmed diagnosis of primary cardiac tumors. A total of 149 patients who had complete echocardiographic records and who were diagnosed with primary cardiac tumors were included in the study. Pathologic and echocardiographic records were reviewed retrospectively to evaluate the presence, location and histologic type of the tumors. The majority (n=118, 79.2%) of cases had been diagnosed with benign tumors. Myxoma was the most common histologic type accounting for 50.0% of total cardiac tumors. Lipoma was the second most common type of benign tumor. Among cases with malignant tumors (n=31, 20.8%), unclassified sarcoma (n=7), angiosarcoma (n=6) and rhabdomyosarcoma (n=6) were the common histologic types of primary malignant tumor. Non-myxomatous benign tumors were more likely to have occurred in the ventricle than myxomas (17/43, 39.5% vs. 7/75, 9.3%; P=0.00). The proportion of pericardium involvement in the malignant tumors (8/31, 25.8%) was significantly higher than that in the myxomas (0/75, 0%; P=0.00) and non-myxomas (2/43, 4.7%; P=0.01). The diagnostic sensitivity of transthoracic and transesophageal echocardiography was 93.3% (139/149) and 96.8% (30/31), respectively. The study, using a relatively large sample, confirms that myxoma was the most common primary cardiac tumor. The locations of tumor involvement varied by types of tumor. Echocardiography may be a useful tool for early diagnosis of primary cardiac tumors.
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Affiliation(s)
- Qingyi Meng
- Department of Emergency Medicine, Chinese PLA General Hospital, Beijing, PR China
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15
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Abstract
A 43-year-old woman presented with an ischemic stroke in the right middle cerebral artery territory. Cardiac echography disclosed a tumor of a primary chordae of the anterior leaflet of the mitral valve. After neurologic recovery, the patient was referred to surgery for excision of the tumor and plastic reconstruction using a chordal transfer technique. Histological examination of the tumor showed a typical papillary fibroelastoma. Papillary fibroelastoma is the third most frequent cardiac benign tumor. The high embolic potential of this tumor is in favor of an aggressive surgical attitude.
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Affiliation(s)
- J M Marnette
- Department of Cardiac Surgery, Namur General Hospital, 185 avenue Albert 1st, 5000 Namur, Belgium.
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16
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Abstract
Transesophageal echocardiography has assisted the detection of intracardiac masses and, in certain cases, aided our ability to define the specific type of mass. This technique, when coupled with three-dimensional imaging, may help to define infiltration of the wall. TEE aids in the intraoperative management of cardiac tumors.
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Affiliation(s)
- J H Goldman
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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17
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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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