An unusual case of giant cardiac fibroelastoma mimicking left atrial myxoma in a patient presenting with syncope

Abstract

Cardiac papillary fibroelastomas are the most common primary valvular tumors. Generally benign, they account only for about 10% of all primary cardiac neoplasms, can occur in normal or diseased hearts, and are associated strongly with open heart surgery and radiotherapy. They are, in most cases, incidental findings, but can be discovered after syncope. We report the case of an elderly female, who was referred for syncope and was found to have a large fibroelastoma at the mitral valve annulus, intermittently obstructing the left ventricular inflow tract, and mimicking the presentation of left atrial myxoma. This case illustrates another potential mechanism of syncope in patients with fibroelastomas.

Papillary fibroelastoma: clinical and echocardiographic features and initial approach in 54 cases

“…Except for special cases PFEs are small tumors, measuring between 1 and 1.5 cm and their mobility depends on the presence of a pedicle that joins the body of the tumor to the endocardial surface. In our series, large fibroelastomas (>1.5 cm in length) were most often valvular (56.8% vs 10.8%, P =.045) in contrast to the description of Sun et al .…”

“…Except for special cases [29][30][31] PFEs are small tumors, measuring between 1 and 1.5 cm and their mobility depends on the presence of a pedicle that joins the body of the tumor to the endocardial surface.…”

Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

“…Most fibroelastomas are benign and asymptomatic (usually found incidentally by echocardiography, with an incidence of 0.019%) [8]. That said, at times, depending on the location and/or dimensions of the tumor, their presence can be signalled by syncope [9–11] and, more rarely, by distal embolisation of the tumor causing transient ischemic attack, stroke, myocardial infarction, or sudden death [7, 8, 12, 13]. For these reasons, whenever such an intracardiac tumor is diagnosed, surgical treatment must be considered, even in asymptomatic cases: the operation is usually a simple excision [14], at times with leaflet repair [12].…”

Papillary Fibroelastoma Found With Transesophageal Echocardiography After a Normal Transthoracic Echocardiography

“…One case report described by Khoueiry et al 17 on a patient presenting with syncopal episodes found a mass, later determined to be a papillary fibroelastoma, on TTE with M-mode, intermittently prolapsing into the left ventricular inflow. High-resolution TEE is able to distinguish papillary fibroelastomas by the bright echocardiographic appearance of the central collagenous core of the tumor compared with the rest of the mass.…”