Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases

Gowda, Ramesh M.; Khan, Ijaz A.; Nair, Chandra K.; Mehta, Nirav; Vasavada, Balendu C.; Sacchi, Terrence J.

doi:10.1016/s0002-8703(03)00249-7

Cited by 617 publications

(965 citation statements)

References 129 publications

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“…In one study of 725 patients with PFE, 425 were treated surgically: 81% underwent simple shave excision; 10%, valve replacement; and 9%, valve repair. 7 Had our patient's tumor been definitively diagnosed as PFE, we would have performed valve-sparing surgery; however, the gross appearance and the intraoperative frozen section were consistent with myxoma, not PFE. Resection of myxoma with inadequate margins leads to recurrence in approximately 5% of patients, 8 so patients with myxoma need valve repair or replacement to enable complete resection of the tumor and its attachment.…”

Section: Discussionmentioning

confidence: 96%

“…Ngaage and colleagues 6 further suggested that asymptomatic patients with a mobile PFE >10 mm in the left-sided heart chambers should undergo cardiac surgery, to prevent thromboembolic events or sudden death. Gowda and co-authors 7 reported that 12 of 25 medically treated patients died of tumor-related causes. Therefore, even though our patient's tumor was only 9 mm in diameter, we chose surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Sakata¹,

Nakaya²,

Otsu³

et al. 2017

Texas Heart Institute Journal

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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-

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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

Sakata¹,

Nakaya²,

Otsu³

et al. 2017

Texas Heart Institute Journal

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“…2 Definite diagnosis is based on histopathological features. 1 Because of its rarity, there are few data regarding safety and efficacy of thrombolytic therapy in acute ischemic strokes caused by CPF. Only 3 previous reports presented patients with acute ischemic stroke and associated CPF treated with thrombolytic therapy-1 received alteplase intravenously 3 and 2 intra-arterially 4,5 -in one of them intra-arterially thrombolysis was combined with mechanical clot disruption.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 We describe a patient in whom emboli originating from CPF caused cerebral infarction; he was submitted to intravenous (IV) recombinant tissue plasminogen activator and mechanical thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

Stroke and Cardiac Papillary Fibroelastoma: Mechanical Thrombectomy after Thrombolytic Therapy

Santos

Pinho

Ramos

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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We describe a case of a 34-year-old man with a sudden development of right hemiparesis and aphasia because of infarction of the left middle cerebral artery that was submitted to intravenous (IV) recombinant tissue plasminogen activator and mechanical thrombectomy. Transesophageal echocardiogram showed a small mass on the anterior leaflet of the mitral valve. Cardiac surgery was performed, and histological examination of the removed material was consistent with cardiac papillary fibroelastoma (CPF). Experience in using IV thrombolysis for the treatment of embolic stroke because of CPF is limited. To the best of our knowledge, only 3 patients are reported in literature in whom acute ischemic stroke and associated CPF were treated with thrombolytic therapy. A discussion of the efficacy of IV thrombolysis and the possible superiority of mechanical thrombectomy is included.

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“…3 Oral anticoagulation can be offered to patients who are not candidates for surgery due to their clinical condition. 4 ■…”

mentioning

confidence: 99%

Asymptomatic papillary fibroelastoma of the aortic valve

Hordijktrion¹,

Bol-Raap²,

Kofflard³

2008

NHJL

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Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases

Cited by 617 publications

References 129 publications

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

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

Stroke and Cardiac Papillary Fibroelastoma: Mechanical Thrombectomy after Thrombolytic Therapy

Asymptomatic papillary fibroelastoma of the aortic valve

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