1
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Greeshma S, Palangadan S, Leena devi KR, Vijayaraghavan G. An unusual case of recurrence of papillary fibroelastoma: a case report. Eur Heart J Case Rep 2023; 7:ytad020. [PMID: 36733685 PMCID: PMC9887676 DOI: 10.1093/ehjcr/ytad020] [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] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
Background Papillary fibroelastomas (PFEs) are uncommon primary cardiac tumours and their recurrence after resection is rare. Case summary A 32-year-old woman, who was evaluated for recurrent embolic stroke, was found to have lesions on mitral leaflets on echocardiography. The mitral leaflets were otherwise normal with no clinical or laboratory evidence of infective endocarditis. Transthoracic, as well as transesophageal echocardiography, revealed masses on mitral leaflets, which remained almost the same over 3 years. A tentative diagnosis of PFE on the mitral valve was made. She had undergone intra-cardiac excision of mitral valve mass along with ring annuloplasty in February 2020. In November 2021, during her regular follow-up visit, transthoracic echocardiography revealed the recurrence of the masses on mitral leaflets with severe mitral regurgitation. She underwent mitral valve replacement and excision of tumour masses. Histopathological examination confirmed the diagnosis of recurrent PFE. Discussion Recurrence of PFEs is rare. We report a rare case of histologically proven recurrence of PFE of the mitral valve. This highlights the importance of routine post-operative echocardiographic follow-up in patients with PFE.
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Affiliation(s)
- S Greeshma
- Kerala Institute of Medical Sciences, P.B. No.1, Anayara P.O, Trivandrum 695029, Kerala, India
| | - S Palangadan
- Kerala Institute of Medical Sciences, P.B. No.1, Anayara P.O, Trivandrum 695029, Kerala, India
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2
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Batool S, Patoir A, de Meaux A, Vola M. Totally endoscopic non-robotic excision of aortic valve fibroelastoma: a case report. J Cardiothorac Surg 2022; 17:292. [PMCID: PMC9675282 DOI: 10.1186/s13019-022-02040-0] [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: 07/17/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Papillary fibroelastomas (PFEs) are a rare subtype of benign primary cardiac tumours, which are most commonly found on the aortic valve. Although median sternotomy is still used frequently there has been different attempts to remove the aortic valve PFEs minimally invasively using robotic and Mini sternotomy approach. Case presentation We report herein a case of totally endoscopic non robotic removal of PFE of aortic valve. Conclusions The encouraging intra and post-operative outcomes and fast recovery using totally endoscopic approach for removal of PFE shows the potential benefits of this technique. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-02040-0.
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Affiliation(s)
- Sadia Batool
- grid.413858.3Department of Cardiac Surgery and Lung and Heart Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Arnaud Patoir
- grid.413858.3Department of Thoracic Surgery and Lung Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Amelie de Meaux
- grid.413858.3Echocardiography Unit, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Marco Vola
- grid.413858.3Department of Cardiac Surgery and Lung and Heart Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
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3
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Cardiac papillary fibroelastoma as a cause of acute coronary syndrome. J Cardiol Cases 2022; 26:379-382. [DOI: 10.1016/j.jccase.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/19/2022] Open
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4
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Pupovac SS, Koss E, Albanese J, Saba SG, Hartman AR, Palazzo R. Paucicellular Fibroma of the Ascending Aorta. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:110-112. [PMID: 34638144 PMCID: PMC8598310 DOI: 10.1055/s-0041-1730006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary tumors of the aorta are extremely rare. To the best of our knowledge, herein, we present the first case in the literature of a paucicellular fibroma originating from the aortic wall.
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Affiliation(s)
- Stevan S Pupovac
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - James Albanese
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Shahryar G Saba
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.,Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alan R Hartman
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Robert Palazzo
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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5
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Igarashi W, Wada T, Takagi D, Kadohama T, Kiryu K, Igarashi I, Yamamoto H. Right coronary ostium occlusion by aortic valve tumor during systole. J Card Surg 2021; 36:3393-3395. [PMID: 34196040 DOI: 10.1111/jocs.15777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022]
Abstract
Here, we present a case of acute myocardial infarction caused by an aortic valve tumor. Electrocardiography (ECG)-gated four-dimensional computed tomography revealed obstruction of the right coronary ostium by a mobile mass during systole. To ensure an accurate diagnosis of angina in patients without significant coronary artery disease, ECG-gated four-dimensional computed tomography is useful because it can simultaneously visualize the coronary ostium and arteries, aortic valve leaflets, and mass.
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Affiliation(s)
- Wataru Igarashi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takuya Wada
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Itaru Igarashi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
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6
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Kaplan JG, Kanwal A, Bahoora J, Berquist J, Hunyadi V, Keirn R. Papillary fibroelastoma presenting with multi-organ symptoms. J Community Hosp Intern Med Perspect 2020; 10:597-599. [PMID: 33194138 PMCID: PMC7598949 DOI: 10.1080/20009666.2020.1811067] [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: 10/25/2022] Open
Abstract
Papillary fibroelastomas are a rare cardiac neoplasm typically found on the left side of the heart, and most commonly on the aortic valve, which can present with cardiac or neurologic symptoms. A 51-year-old woman with no cardiac history presented to a resident clinic with complaints of left-sided facial paresthesias and palpitations for 1 month. Echocardiographic imaging showed a mass on the aortic annulus, concerning for a cardiac tumor. Due to the risk of possible embolization, if the tumor was a myxoma, the patient required intrathoracic surgery. During the intrathoracic procedure the mass was confirmed to be a papillary fibroelastoma and the patient had the mass removed without any complications. Papillary fibroelastomas are found in less than 1% of the population but can present clinically with a wide variety of symptoms. Patients with this neoplasm are at risk for severe complications, due to embolization, potentially causing cerebrovascular accidents or myocardial infarctions. We present a case of a papillary fibroelastoma producing both cardiac and neurologic symptoms.
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Affiliation(s)
- Jason G Kaplan
- Department of Internal Medicine, McLaren Oakland/Michigan State University Internal Medicine Residency Program, Pontiac, MI, USA
| | - Arjun Kanwal
- Department of Internal Medicine, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Justin Bahoora
- Department of Internal Medicine, McLaren Oakland/Michigan State University Internal Medicine Residency Program, Pontiac, MI, USA
| | - John Berquist
- Department of Internal Medicine, McLaren Oakland/Michigan State University Internal Medicine Residency Program, Pontiac, MI, USA
| | - Victor Hunyadi
- Department of Cardiology, McLaren Macomb/Michigan State University Cardiology Fellowship Program, Mt Clemens, MI, USA
| | - Richard Keirn
- Department of Internal Medicine, McLaren Oakland/Michigan State University Internal Medicine Residency Program, Pontiac, MI, USA
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7
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Mirić D, Baković Kramarić D, Bulat C, Bukarica K, Tičinović Kurir T, Giunio L. Cardiac papillary fibroelastoma and kidney infarction. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Topal B, Hindori V, Pouwels S, Riezebos R. The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve. Cureus 2020; 12:e7136. [PMID: 32257681 PMCID: PMC7105234 DOI: 10.7759/cureus.7136] [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: 12/02/2022] Open
Abstract
A cardiac papillary fibroelastoma (CPFE) is reported to be the second most common cardiac neoplasm after myxoma cordis. CPFEs are histologically benign, frequently asymptomatic, but highly thrombogenic, which could lead to systemic and peripheral embolization. We present a case of a 68-year-old-patient, with a history of angioosteohypertrophy syndrome, who presented at our emergency department (ED) with symptoms of transient ischemic attacks. A thorough investigation, including echocardiography, revealed a neoplasm on the left coronary cusp (LCC) of the aortic valve. The neoplasm was resected via a valve-sparing shave via the right anterior thoracotomy (RAT). The pathological assessment confirmed it to be CPFE. CPFE is a rare but treatable cause of thromboembolism. The removal of CPFEs has classically been performed through a full median sternotomy. We like to present the first case of a valve-sparing removal of a CPFE on the aortic valve through a RAT approach.
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Affiliation(s)
- Besir Topal
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | - Vikash Hindori
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | | | - Robert Riezebos
- Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
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9
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Giant Tricuspid Valve Fibroelastoma Incidentally Diagnosed During Routine Stress Testing. JACC Case Rep 2019; 1:564-568. [PMID: 34316879 PMCID: PMC8289157 DOI: 10.1016/j.jaccas.2019.08.016] [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] [Received: 04/25/2019] [Revised: 07/11/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022]
Abstract
Papillary fibroelastomas (PFEs) are the most common valvular tumor, typically occurring on left-sided valves. We describe the evaluation and treatment of a giant tricuspid PFE in a healthy 43-year-old police officer who was referred for evaluation of frequent premature ventricular contractions during job-related treadmill stress testing. (Level of Difficulty: Beginner.).
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10
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Logan N, Islam MS, Chughtai JZ, Murphy NF. An atypical cause of myocardial infarction: case report of an obstructing papillary fibroelastoma of the aortic valve. Eur Heart J Case Rep 2019; 3:5485821. [PMID: 31449619 PMCID: PMC6601164 DOI: 10.1093/ehjcr/ytz058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 04/08/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Papillary fibroelastomas are rare primary cardiac tumours with a prevalence of 0.01% at autopsy. They are histologically benign tumours but have been demonstrated through case series to confer an increased risk of thrombo-embolism resulting in: transient ischaemic attack, stroke, myocardial infarction, and pulmonary and systemic embolization. CASE SUMMARY A 54-year-old woman presented with central chest pain radiating to her left arm. At presentation there was a significant troponin rise; initial high-sensitivity troponin-I (hsTn-I) 660 pg/mL increased to 3340 pg/mL at 6 h. Coronary angiogram did not reveal any obstructing coronary artery disease. Echocardiography revealed a rounded, mobile mass on the left coronary cusp of the aortic valve suspicious for papillary fibroelastoma. The patient underwent shave excision of the lesion. Intra-operatively it was noted that the mass intermittently sat within the ostium of the left main resulting in its occlusion. Histology confirmed a papillary fibroelastoma. DISCUSSION Primary cardiac tumours are rare but can cause life-threatening complications such as stroke, myocardial infarction, and cardiac arrest. In the literature, the mechanism of these complications is mainly attributed to thrombo-embolism. This case demonstrates the utility of echocardiogram in investigating and diagnosing a rare cause of myocardial infarction and highlights an unusual mechanism, that is tumour causing obstruction of the coronary ostium.
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Affiliation(s)
- Niamh Logan
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
| | - Mohammad Sirajul Islam
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
| | - Jehan Zeb Chughtai
- Cardiothoracic Department, Mater Misericordiae University Hospital, Eccles St, Dublin, D07 R2WY, Ireland For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
| | - Niamh F Murphy
- Cardiology Department, Our Lady of Lourdes Hospital, Windmill Road, Drogheda, Co Louth, A92 VW28, Ireland
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11
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Anand S, Sydow N, Janardhanan R. Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature. BMJ Case Rep 2017; 2017:bcr-2017-219327. [PMID: 28794051 DOI: 10.1136/bcr-2017-219327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a woman presenting with transient ischaemic attack, who was found to have a papillary fibroelastoma arising from the aortic wall, an extremely rare location. We describe the multimodality imaging techniques used in diagnosing this patient and review the most recent literature on evaluation and management of patients with cardiac papillary fibroelastomas.
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Affiliation(s)
- Senthil Anand
- Cardiology, Sarver Heart Centre, Tucson, Arizona, USA
| | - Nicole Sydow
- Cardiology, Sarver Heart Centre, Tucson, Arizona, USA
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12
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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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13
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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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14
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Shi L, Wu L, Fang H, Han B, Yang J, Ma X, Liu F, Zhang Y, Xiao T, Huang M, Huang M. Identification and clinical course of 166 pediatric cardiac tumors. Eur J Pediatr 2017; 176:253-260. [PMID: 28074279 DOI: 10.1007/s00431-016-2833-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of this study was to investigate the pathological classifications, clinical features, and natural history of pediatric cardiac tumors to provide a basis for the selection of an appropriate therapeutic method. The medical records of in- or outpatients with cardiac tumors at four hospitals were classified to analyze various types of tumor growth locations, clinical manifestations, surgical indications, and long-term follow-up results. There were 166 patients, including 158 with primary cardiac tumors, six with metastatic cardiac tumors, and two with unclassified cardiac tumors. Among the 158 cases of primary cardiac tumor, 150 were benign and eight were malignant. The rhabdomyoma, fibroma, and myxoma are the most common types of benign cardiac tumors. The major clinical manifestations of cardiac tumors include outflow tract obstruction, arrhythmia, dyspnea, pericardial effusion, heart failure, and seizures. Among the 59 patients who underwent surgery, 49 had primary benign cardiac tumors, eight had primary malignant tumors, and two had malignant metastatic tumors. Post-surgery, nine of the patients had residual tumor tissues that did not significantly affect their hemodynamics. Following surgery, there were two cases of recurrence and nine deaths, including four of benign and five of malignant tumors with mortality rates of 8.2 and 50.0 %, respectively. Of the remaining 107 cases of patients who did not undergo surgery, five (4.7 %) died. CONCLUSION The primary benign cardiac tumors are the predominant pediatric cardiac tumors, of which rhabdomyoma, fibroma, and myxoma are the most common types. If severe symptoms are nonexistent and the hemodynamics is unaffected, most of the patients can survive in the long term despite the tumors. What is known: • Pediatric cardiac tumors are rare and are predominantly primary and benign. • The symptoms of heart failure, arrhythmia, and outflow obstruction are the most severe complications of cardiac tumors. What is new: • The rhabdomyoma, fibroma, and myxoma are the most common types of primary benign cardiac tumors. • If severe symptoms are not present and the hemodynamics are unaffected, most of the patients can survive in the long term despite the tumors.
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Affiliation(s)
- Lin Shi
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Lanping Wu
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Huijuan Fang
- , Shandong Provincial Hospital, Jinan, People's Republic of China
| | - Bo Han
- , Shandong Provincial Hospital, Jinan, People's Republic of China
| | - Jialun Yang
- Children's Hospital, Fudan University, Shanghai, China
| | - Xiaojin Ma
- Children's Hospital, Fudan University, Shanghai, China
| | - Fang Liu
- Children's Hospital, Fudan University, Shanghai, China
| | - Yongwei Zhang
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Tingting Xiao
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Min Huang
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Meirong Huang
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China. .,Department of Pediatric Cardiology, Shanghai Children's Medical Center, Medical Institute, Shanghai Jiao Tong University, 1678, Dongfang Road, Shanghai, 200127, China.
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15
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Zhang F, Zhu Z, Upadhya GK, Tong J, Gotlieb V, Khan A, Gupta RP. Papillary fibroelastoma of the aortic valve presenting with chronic angina and acute stroke: a case report. J Med Case Rep 2017; 11:17. [PMID: 28095921 PMCID: PMC5241950 DOI: 10.1186/s13256-016-1179-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary fibroelastomas are rare, benign cardiac tumors that are often found on cardiac valvular surfaces. Most are incidental discoveries during surgery or autopsy. The clinical presentation of fibroelastoma varies widely, ranging from clinically asymptomatic to severe thromboembolic events. CASE PRESENTATION We report a case of 65-year-old white man diagnosed with scattered, bilateral acute cerebral hemisphere infarcts with a history of chronic angina. Transesophageal echocardiography identified a fibroelastoma on the right coronary cusp of the aortic leaflet. Cardiac catheterization revealed mild non-obstructive stenosis. We postulate that the etiology of his angina is related to the dynamic occlusion of his right coronary ostium by the fibroelastoma. CONCLUSIONS To the best of our knowledge, this is the first case report describing a patient with a cardiac papillary fibroelastoma who presented with both chronic angina and acute stroke.
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Affiliation(s)
- Fan Zhang
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Ziqiang Zhu
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Gautham K Upadhya
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Jiankun Tong
- Department of Pathology, New York-Presbyterian/Queens, Flushing, NY, 11355, USA
| | - Vlad Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Abdullah Khan
- Division of Cardiology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Rakesh P Gupta
- Division of Cardiology, New York-Presbyterian/Queens, Flushing, NY, 11355, USA
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16
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Cardiac Fibroelastoma versus Thrombus: Echocardiographic Evidence Can Be Misleading. Case Rep Cardiol 2016; 2016:2896056. [PMID: 27547468 PMCID: PMC4983359 DOI: 10.1155/2016/2896056] [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: 04/18/2016] [Accepted: 07/10/2016] [Indexed: 11/18/2022] Open
Abstract
We present a case of a young female with stroke symptoms who underwent valve sparing resection of a presumed fibroelastoma based on echocardiographic findings. After confirming embolic stroke, she underwent excision of the lesion, which on pathology revealed a nonbacterial thrombus. Ultimately, this led to a more extensive work-up leading to the discovery of a papillary serous ovarian carcinoma, the underlying cause of her hypercoagulable state. The initial echocardiographic findings painted the clear picture of a papillary tumor on the aortic valve which was likely the source of the emboli resulting in ischemic stroke. This unique case presentation illustrates that imaging, including echocardiography, may not always coincide with the clinical diagnosis. Thus, understanding the differential diagnoses of cardiac masses is of vital clinical significance. The distinction of fibroelastoma versus the much less common finding of aortic thrombus may lead to early diagnosis of malignancy and prevention of life threatening events due to stroke or undiagnosed disease.
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Matsukuma S, Koga A, Takeo H, Kato K, Mori K, Sato K. Non-exophytic Lambl excrescences of aortic valves: a morphological study. Histopathology 2016; 69:307-14. [PMID: 26825675 DOI: 10.1111/his.12938] [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] [Received: 08/04/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
AIMS To elucidate the histopathological findings of classical Lambl excrescences (LEs) and non-exophytic LEs (non-ex LEs) without excrescent papillary features. METHODS AND RESULTS We examined 126 aortic valves (AVs) and revealed LEs (non-ex and/or classical), non-ex LEs and classical LEs in 106, 78 and 88 AVs, respectively. The detection of non-ex LEs was challenging, but elastica van Gieson stain highlighted their presence. Non-ex and classical LEs chiefly involved the ventricular regions, favoured posterior cusps and coexisted in the same areas of 31 AVs. A possible transformation of classical LEs into non-ex LEs was suggested histologically in 39 AVs. Non-ex LEs were associated with age of >70 years (P < 0.001) and marked deformity (P = 0.007). Classical LEs were associated inversely with marked deformity (P < 0.001), but not with age of >70 years. Compared with age- and sex-matched control AVs, non-ex LEs and marked deformity in dysfunctional AVs were more common (P = 0.037 and P < 0.001, respectively), but classical LEs were less common (P = 0.021). CONCLUSIONS Non-ex LEs have subtle features but are a common form of LEs, and seem to develop from classical LEs. AV dysfunction-related marked deformity can promote non-ex LEs.
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Affiliation(s)
- Susumu Matsukuma
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan.,Health Care Center, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Ayano Koga
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Hiroaki Takeo
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Kimi Kato
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Kazuma Mori
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Kimiya Sato
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
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Shi J, Bai ZX, Zhang BG, Guo YQ. Papillary fibroelastoma of the aortic valve in association with rheumatic heart disease: a case report. J Cardiothorac Surg 2016; 11:6. [PMID: 26772603 PMCID: PMC4715320 DOI: 10.1186/s13019-016-0410-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/12/2016] [Indexed: 02/05/2023] Open
Abstract
Background Papillary fibroelastoma (PFE) is a rare primary cardiac neoplasm that is usually discovered incidentally at autopsy or during cardiac surgery. PFE combined with rheumatic heart disease (RHD) is extremely rare, and only a few cases have been reported. Additionally, the growth rate of the tumor is unknown. Case Presentation Here, we present a very rare case of PFE of the aortic valve combined with RHD, which were identified in a female patient who survived for 5 years without surgical intervention, and who subsequently underwent successful surgical treatment. Conclusions PFEs may be generally slow-growing tumors, however, the better treatment of choice may be surgery because it produces good curative effects with very low risk of complications, while preventing serious disease consequences.
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Affiliation(s)
- Jun Shi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St, Chengdu, Sichuan, China.
| | - Zhi-xuan Bai
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St, Chengdu, Sichuan, China.
| | - Ben-gui Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St, Chengdu, Sichuan, China.
| | - Ying-qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St, Chengdu, Sichuan, China.
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Chiba N, Matsuzaki M, Furuya S, Iida K, Wakui S, Akiyama K, Kinoshita K. Complete occlusion of the left main trunk coronary artery by a cardiac papillary fibroelastoma in a hemodynamically unstable patient. J Cardiol Cases 2015; 13:97-100. [PMID: 30546617 DOI: 10.1016/j.jccase.2015.11.002] [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] [Received: 06/15/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022] Open
Abstract
Papillary fibroelastomas are benign cardiac tumors with high embolic potential. The majority of cases of complete obstruction of the left main trunk (LMT) of the coronary artery are diagnosed via autopsy following sudden death; survival is rare in this setting. We present the case of a 60-year-old woman who underwent stent placement in the LMT three years prior to developing chest pain and cold sweats. On coronary arteriography, the catheter could not be advanced into the LMT due to resistance in the ostium. Insertion of the catheter was achieved after the resolution of resistance via catheterization of the LMT by means of an intra-aortic balloon pump drive system. The LMT was normal, and the patient's circulatory failure improved. The cause of the LMT embolism was a cardiac papillary fibroelastoma. Primary surgical excision is the recommended therapy for symptomatic cardiac papillary fibroelastoma. If the patient is hemodynamically stable, it may be possible to delay surgery. However, the patient in question developed cardiogenic shock secondary to two-vessel obstruction by the tumor. Therefore, even if the tumor had been removed using an intra-aortic balloon pump, the patient may not have survived until surgery. <Learning objective: Primary surgical excision is the recommended therapy for symptomatic cardiac papillary fibroelastoma. If the patient is hemodynamically stable, it may be possible to delay surgery. However, hemodynamically unstable patients may not survive until surgery. Therefore, emergent therapy is a useful stop-gap measure until surgery is feasible.>.
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Affiliation(s)
- Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Masakazu Matsuzaki
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Shingo Furuya
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Kiyoshi Iida
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Shinji Wakui
- Department of Cardiovascular Surgery, Nihon University Hospital, Nihon University Hospital, Tokyo, Japan
| | - Kenji Akiyama
- Department of Cardiovascular Surgery, Nihon University Hospital, Nihon University Hospital, Tokyo, Japan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
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Giambruno V, Karangelis D, Cucchietti C. Aortic Valve Papillary Fibroelastoma: An Insidious and Unusual Cause of Angina. J Cardiothorac Vasc Anesth 2015; 29:e61-3. [PMID: 26275520 DOI: 10.1053/j.jvca.2015.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Vincenzo Giambruno
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Dimos Karangelis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Cristina Cucchietti
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
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Chan DCS, D'Silva A, Grosser K. Unexplained acute coronary occlusion causing anterior myocardial infarction. Oxf Med Case Reports 2015; 2014:26-8. [PMID: 25988015 PMCID: PMC4369982 DOI: 10.1093/omcr/omu011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/31/2014] [Accepted: 04/07/2014] [Indexed: 12/04/2022] Open
Abstract
We present a diagnostic conundrum with a case of a young woman presenting with an acute myocardial infarction in cardiogenic shock who was found to have an occluded left main stem (LMS). Despite ballooning the LMS, multiple re-occlusions in the same area warranted stent deployment. There was a filling defect in the left aortic sinus which was evaluated further with a CT scan and transoesophageal echocardiogram, confirming a mass consistent with a papillary fibroelastoma. The patient went on to have an left ventricular assist device and died while awaiting a heart transplant, but the mass was never found at surgery.
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Affiliation(s)
- Daniel C S Chan
- Department of Cardiology , Kettering General Hospital , Kettering NN16 8UZ , UK
| | - Andrew D'Silva
- Department of Cardiology , Queen Elizabeth the Queen Mother Hospital , Margate CT9 4AN , UK
| | - Konrad Grosser
- Department of Cardiology , Queen Elizabeth the Queen Mother Hospital , Margate CT9 4AN , UK
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22
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CT of Cardiac Valves. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Papillary fibroelastoma of the right ventricular free wall. Case Rep Surg 2014; 2014:654641. [PMID: 25258692 PMCID: PMC4166618 DOI: 10.1155/2014/654641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/27/2014] [Indexed: 11/17/2022] Open
Abstract
Papillary fibroelastoma is a rare benign cardiac tumor that usually arises from the valvular endocardium and its development in the cardiac chambers is extremely rare. A 52-year-old woman complained of palpitations and echocardiography revealed a cardiac tumor. Resection was performed via the right ventricle and main pulmonary artery under cardiopulmonary bypass. Histological examination of the resected tumor showed that it was a papillary fibroelastoma. The patient's postoperative course was unremarkable and no complications have been detected on followup.
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Singhal P, Luk A, Rao V, Butany J. Molecular basis of cardiac myxomas. Int J Mol Sci 2014; 15:1315-37. [PMID: 24447924 PMCID: PMC3907871 DOI: 10.3390/ijms15011315] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis.
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Affiliation(s)
- Pooja Singhal
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON M5G2C4, Canada.
| | - Adriana Luk
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON M5G2C4, Canada.
| | - Vivek Rao
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON M5G2C4, Canada.
| | - Jagdish Butany
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON M5G2C4, Canada.
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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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26
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Thrombotic thrombocytopenic purpura and cardiac papillary fibroelastoma: a 'unique coexistence'. Blood Coagul Fibrinolysis 2013; 24:881-3. [PMID: 24077148 DOI: 10.1097/mbc.0b013e32836466ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP), a complex thrombotic microangiopathy, remains an evolving enigma. A 49-year-old African-American woman presented with acute left hemiplegia, an ischemic cerebrovascular accident involving the right middle cerebral artery. Sequential appearance of thrombocytopenia and evidence of microangiopathic haemolysis led to the diagnosis of acquired idiopathic autoimmune TTP. This was managed with plasma exchange (PEX) and steroids. Early haematologic relapse within a month was managed with the addition of rituximab attaining sustained remission. The patient presented 3 years later with acute confusion and expressive aphasia due to multiple infarcts involving the left parieto-occipital cortex. Transoesophageal echocardiography demonstrated a pedunculated 6 mm mitral valvular mass consistent with a papillary fibroelastoma. Anticoagulation was instituted and the patient was continued on therapeutic oral warfarin. A haematologic relapse of TTP eventually emerged and was managed with PEX, steroids and rituximab. This vignette demonstrates several dilemmas in the clinical presentation, diagnosis and management of TTP in current day practice. Rituximab has adjuvant benefits to PEX and is being investigated as potential first-line therapy. Monitoring ADAMTS13 activity and inhibitor titre, as in our case, prove to have prognostic significance. Cardiac fibroelastomas are rare benign cardiac tumours usually arising from valvular endocardium with thromboembolic potential. One of the proposed mechanisms of origin of these masses is organizing thrombi in the setting of endocardial injury and inflammation questioning a possible link to thrombotic microangiopathy. To the best of our knowledge, this is the first report of this unique coexistence.
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Tejada J, Galiana A, Balboa Ó, Clavera B, Redondo-Robles L, Alonso N, Magadán V. Mechanical endovascular procedure for the treatment of acute ischemic stroke caused by total detachment of a papillary fibroelastoma. J Neurointerv Surg 2013; 6:e37. [DOI: 10.1136/neurintsurg-2013-010800.rep] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Tejada J, Galiana A, Balboa O, Clavera B, Redondo-Robles L, Alonso N, Magadán V. Mechanical endovascular procedure for the treatment of acute ischemic stroke caused by total detachment of a papillary fibroelastoma. BMJ Case Rep 2013; 2013:bcr-2013-010800. [PMID: 24000210 DOI: 10.1136/bcr-2013-010800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Papillary fibroelastomas (PFEs) are rare cardiac tumors. Despite their benign nature, they are associated with a high risk of embolic complications including stroke. Endovascular treatment has been reported as a safe procedure in patients with myxoma, the most common type of primary cardiac tumor. A case of ischemic stroke due to embolization of a PFE successfully treated with a single pass of a retrievable stent is described. A 64-year-old patient with a right middle cerebral artery syndrome was treated with an intravenous and endovascular protocol as a revascularization procedure. Mechanical thrombectomy resulted in total recanalization with clinical improvement. Histological examination of the clot showed pathological features of a typical PFE. The endovascular treatment was safe and effective. With mechanical embolectomy it is possible to obtain and analyze pathological specimens, enabling the diagnosis of uncommon strokes.
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Affiliation(s)
- Javier Tejada
- Department of Neurology, Hospital de León, León, Spain.
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29
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González-Santos JM, Arnáiz-García ME, Vargas-Fajardo MDC, Arribas-Jiménez A. Aortic wall papillary fibroelastoma. J Thorac Cardiovasc Surg 2013; 146:e1-3. [PMID: 23664692 DOI: 10.1016/j.jtcvs.2013.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
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Aryal MR, Badal M, Mainali NR, Jalota L, Pradhan R. Papillary fibroelastoma of the aortic valve: An unusual cause of angina. World J Cardiol 2013; 5:102-105. [PMID: 23675556 PMCID: PMC3653009 DOI: 10.4330/wjc.v5.i4.102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 01/24/2013] [Accepted: 03/29/2013] [Indexed: 02/06/2023] Open
Abstract
Papillary fibroelastoma of the aortic valve is an uncommon benign tumor of the heart that can present with embolic events. We report a case of 54-year-old lady with exertional chest pain and prior history of ST segment elevation myocardial infarction who was subsequently found to have a fibroelastoma of the aortic valve. The absence of angiographically significant coronary artery disease and resolution of anginal symptoms post-surgery in our patient points to the possibility of fibroelastoma causing these anginal symptoms. Although uncommon, fibroelastoma are being recognized more frequently with the help of transesophageal echocardiography. Hence, in the absence of significant coronary artery disease, we emphasize the importance of consideration of papillary fibroelastoma of the aortic valve as a cause of angina. We also discuss the key aspects of the fibroelastoma including presentation, diagnostic modalities and treatment options.
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Zhang M, Liu X, Song Z, Zou L, Xiang B. Cardiac papillary fibroelastoma: a retrospect of four cases. J Cardiothorac Surg 2013; 8:65. [PMID: 23561320 PMCID: PMC3639082 DOI: 10.1186/1749-8090-8-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We have reviewed the medical histories of 4 patients who underwent operations between November 2004 and February 2011 at Changhai Hospital for cardiac papillary fibroelastoma. METHODS Diagnosis was demonstrably suggested by echocardiography. Tumor locations were mitral valve (1), left atrium (1), and aortic valve (2). Indications for operation were previous cerebrovascular accident for the mitral tumor, incidental apopsychia and giant mobile mass for the left atrium, ingravescent chest tightness and palpitations for the first aortic tumor, and severe regurgitation of aortic valve for the second aortic tumor. The study was approved by the Changhai Hospital Ethics Committee, and the consent from the patients or their immediate family was obtained. RESULTS Surgical excision with necessary valve replacement operations was performed 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 removed because of potential embolic complications.
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Affiliation(s)
- Mi Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, No168, Changhai Road, Yangpu District, Shanghai 200433, China
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Vanichakarn P, Beaver TA, Costa SP, Czum JM, Palac RT. An unusual left atrial mass in hypertrophic cardiomyopathy: the role of multimodality imaging. Echocardiography 2013; 30:E111-3. [PMID: 23305199 DOI: 10.1111/echo.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pantila Vanichakarn
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Her AY, Kim YH, Heo JW, Yie K, Lee S. Papillary fibroelastoma of the aortic valve with atypical chest pain: late presentation with acute myocardial infarction and cardiac arrest. J Card Surg 2012; 27:327-30. [PMID: 22321193 DOI: 10.1111/j.1540-8191.2011.01385.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of a 54-year-old female with papillary fibroelastoma of the aortic valve who presented with ST-elevation myocardial infarction and cardiac arrest. Though her initial symptom was only atypical chest pain, life-threatening complications such as acute myocardial infarction and cardiac arrest developed. After cardiopulmonary resuscitation, we promptly resected the fibroelastoma on cardiopulmonary bypass, and the patient was discharged without any other complications.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
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Kim EK, Park SJ, Park PW, Byun KM, Lee SC, Park SW, Choe YH. Popcorn-Like Appearance of Papillary Fibroelastoma of the Aortic Valve. Circ J 2012; 76:758-60. [DOI: 10.1253/circj.cj-11-0716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kyung Min Byun
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yeon Hyeon Choe
- Department of Radiology and Center for Imaging Science, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Unusual cause of stroke - papillary fibroelastoma - and its surgical management. COR ET VASA 2011. [DOI: 10.33678/cor.2011.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, Anastasiou-Nana M. Cardiac tumors. ISRN ONCOLOGY 2011; 2011:208929. [PMID: 22091416 PMCID: PMC3195386 DOI: 10.5402/2011/208929] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/20/2011] [Indexed: 11/23/2022]
Abstract
Cardiac tumors represent a relatively rare, yet challenging diagnosis. Secondary tumors are far more frequent than primary tumors of the heart. The majority of primary cardiac tumors is benign in origin, with primary malignant tumors accounting for 25% of cases. Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas. Clinical manifestations of cardiac tumors depend on the size and location of the mass and the infiltration of adjacent tissues rather than the type of the tumor itself. Echocardiography is the main diagnostic tool for the detection of a cardiac mass. Other imaging modalities (C-MRI, C-CT, 3D Echo) may offer further diagnostic information and the establishment of the diagnosis is made with histological examination. Management depends on the type of the tumor and the symptomatology of the patient.
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Affiliation(s)
- Ioannis A Paraskevaidis
- Second Department of Cardiology, Athens University Medical School, Attikon University Hospital, 1 Rimini St, 12462 Athens, Greece
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