Aortic Valve Papillary Fibroelastoma Associated with Acute Cerebral Infarction: A Case Report

Abstract

An 80-year-old woman with a history of congestive heart failure, atrial fibrillation, and hypertension was transferred to our institution with hematemesis. Her drug regimen included 2 mg warfarin potassium/day to prevent thromboembolic events. Transthoracic echocardiography (TTE) performed at 78 years of age revealed a mass attached to the noncoronary cusp and a cardiac tumor was suspected. The patient declined surgery and was meticulously followed up with periodic TTE. Upper gastroendoscopy revealed a gastric ulcer with an exposed blood vessel; anticoagulant therapy was ceased. On day 15 of admission, acute cerebral infarction occurred. Heparin sodium and warfarin potassium were administered rapidly, and her symptoms improved. TTE revealed no alteration of the mobile, string-like mass attached to the noncoronary cusp. Cardiac tumor was considered the cause of cerebral infarction, and the patient consented to surgical therapy. Pathological examination of the resected tumor suggested papillary fibroelastoma (PFE). Although no guidelines exist for PFE management, a mobile, cardiac tumor necessitates surgical resection to prevent thromboembolic events, even when small in size.

Native Aortic Valve Thrombus Complicating Intermittent Occlusion of a Left Main Coronary Artery

“…However, the antiphospholipid antibody titer may be transiently elevated as an epiphenomenon, and to meet the diagnostic criteria for APS, the titer must be consistently positive at evaluations 12 months apart ( 7 ). Other causes of NAVT, such as protein C or S deficiency ( 5 ), undetected cancer ( 8 , 9 ), the calcific valve itself, and other autoimmune disease, such as systemic lupus erythematosus (SLE) ( 6 ), could not be excluded because these tests were not able to be performed in this case.…”

Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet

“…Some authors have speculated that PFE is a virus-induced local growth 3 or that it might be caused by prior cardiac surgery. 4,5 Although PFE is a slow-growing, benign neoplasm, there is a risk of embolization leading to myocardial or cerebral infarction. There are no guidelines on PFE management beyond a seeming consensus that symptomatic patients should be treated surgically.…”