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

Abstract

P apillary fibroelastoma (PFE), a benign endocardial papilloma, is the second most prevalent primary cardiac tumor and the most prevalent cardiac valvular tumor. 1 A PFE contains many papillary fragments, has frond-like projections, and is attached to the endocardium. It can resemble myxoma, making it difficult to distinguish one from the other intraoperatively. We report our experience with an aortic valve PFE that was diagnosed as myxoma intraoperatively. After excision, aortic valve repair was performed. We discuss lessons for surgeons and pathologists that can be learned from this case. Case ReportIn March 2014, a 50-year-old asymptomatic man with no relevant medical history was referred to our hospital after inverted T waves were seen on his routine electrocardiogram. Echocardiograms and coronary computed tomograms (CT) revealed a 9-mm-diameter mobile mass on the underside of the aortic valve, apparently on the right coronary cusp. A coronary CT revealed no stenosis. We could not determine whether the mass was thrombus or tumor; in either case, there was risk of embolization. Therefore, surgical treatment was planned. Transthoracic echocardiograms showed no asynergy, morphologic abnormalities, or valvular disease, including aortic regurgitation. Laboratory data revealed no abnormalities.To perform mass resection, we established cardiopulmonary bypass between ascending aorta cannulation and right atrial drainage. After aortic cross-clamping, cardiac arrest was obtained with use of antegrade cardioplegia. The aortic valve tumor was stalkless and attached to the underside of the right coronary cusp. Its surface was smooth, indicative of myxoma (Fig. 1). Intraoperative frozen-section examination yielded spindle cells in edematous interstitial tissue, also consistent with myxoma.We decided to resect the tumor and its attachment, with sufficient margins. Resection created a large trapezoidal defect, including the free margin of the aortic valve leaflet. We repaired the defect with use of a glutaraldehyde-treated autologous pericardial patch and 6-0 Prolene running sutures (Fig. 2). To test for regurgitation, we filled the aortic root with water and confirmed that the water level did not drop. In-

Aortic Valve Papillary Fibroelastoma: A Sea Anemone in the Heart, A Case Report

“…However, there is general agreement on treating symptomatic patients with surgery. If surgical excision is delayed, anticoagulation therapy may be considered [6]. Surgical excision should be recommended for not only symptomatic patients but also for asymptomatic patients with high risk CPF to guard against serious and lethal complications.…”

Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart Diseases—A Comprehensive Review

“…76 Excision of benign cardiac tumors may also require the use of pericardium; in one patient with papillary fibroelastoma of the aortic valve, excision of the mass caused perforation of one cusp which was repaired with a patch of glutaraldehyde-fixed autologous pericardium. 77…”