Cardiac Papillary Fibroelastoma:A Rare Cause of Isch emic Stroke in the Young

Abstract

Among etiologies of stroke in young adults, primary cardiac tumors are very rare. We report the case of a 37-year-old woman who was admitted for an ischemic stroke in the right middle cerebral artery region. Etiologic investigations revealed, after transthoracic and transesophageal echocardiography, an aortic valve tumor. Treatment was first medical with anticoagulation, then surgical. Histological examination showed a papillary fibroelastoma. After a review of the literature, the possible mechanisms of the ischemic event are discussed and lead to the conclusion that this tumor must be surgically excised, even if asymptomatic, because of recurrent ischemic complications responsible for myocardial infarction, stroke and sudden death.

Papillary fibroelastoma of mitral papillary chordae in a young patient

“…However, our patient was relatively young and the tumor was localized to the mitral papillary chordae rather than the aortic valve. Although these tumors may serve as a source of embolization, our case was free of any sign and symptom [6,7]. This can be attributed to its well-demarcated and elastic structure.…”

Papillary fibroelastoma of mitral papillary chordae in a young patient

“…However, our patient was relatively young and the tumor was localized to the mitral papillary chordae rather than the aortic valve. Although these tumors may serve as a source of embolization, our case was free of any sign and symptom [6,7]. This can be attributed to its well-demarcated and elastic structure.…”

Nonbacterial Thrombotic Endocarditis of the Mitral Valve With Echocardiographic Appearances Mimicking a Papillary Fibroelastoma in a Middle-Aged Female Patient

“…The size, shape, location, and appearance of the mass as seen on echo in our case were all consistent with the diagnosis of fibroelastoma. In the context of multiple embolic events, surgical intervention was indicated and, as such, elected as the treatment of choice without consideration of further imaging or another diagnostic testing as it was determined that regardless of etiology, given the high-risk features for a future embolic event, the additional information provided by adjunctive tests or imaging would not alter the course of management [ 12 ].…”

Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature

“…In addition, Sun et al recommended that patients undergoing cardiac surgery for other lesions should also be considered for surgical resection 3. However, other authors have suggested that surgery should be performed even in patients who are asymptomatic with non-mobile tumours citing the high risk of embolic events 34–38. Lifelong anticoagulation can be offered to patients who are symptomatic, but are poor surgical candidates.…”

Papillary fibroelastoma of mitral papillary chordae in a young patient

“…However, our patient was relatively young and the tumor was localized to the mitral papillary chordae rather than the aortic valve. Although these tumors may serve as a source of embolization, our case was free of any sign and symptom [6,7]. This can be attributed to its well-demarcated and elastic structure.…”

Nonbacterial Thrombotic Endocarditis of the Mitral Valve With Echocardiographic Appearances Mimicking a Papillary Fibroelastoma in a Middle-Aged Female Patient

“…The size, shape, location, and appearance of the mass as seen on echo in our case were all consistent with the diagnosis of fibroelastoma. In the context of multiple embolic events, surgical intervention was indicated and, as such, elected as the treatment of choice without consideration of further imaging or another diagnostic testing as it was determined that regardless of etiology, given the high-risk features for a future embolic event, the additional information provided by adjunctive tests or imaging would not alter the course of management [ 12 ].…”

Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature

“…In addition, Sun et al recommended that patients undergoing cardiac surgery for other lesions should also be considered for surgical resection 3. However, other authors have suggested that surgery should be performed even in patients who are asymptomatic with non-mobile tumours citing the high risk of embolic events 34–38. Lifelong anticoagulation can be offered to patients who are symptomatic, but are poor surgical candidates.…”

Papillary fibroelastoma of mitral papillary chordae in a young patient

“…However, our patient was relatively young and the tumor was localized to the mitral papillary chordae rather than the aortic valve. Although these tumors may serve as a source of embolization, our case was free of any sign and symptom [6,7]. This can be attributed to its well-demarcated and elastic structure.…”

Nonbacterial Thrombotic Endocarditis of the Mitral Valve With Echocardiographic Appearances Mimicking a Papillary Fibroelastoma in a Middle-Aged Female Patient

“…The size, shape, location, and appearance of the mass as seen on echo in our case were all consistent with the diagnosis of fibroelastoma. In the context of multiple embolic events, surgical intervention was indicated and, as such, elected as the treatment of choice without consideration of further imaging or another diagnostic testing as it was determined that regardless of etiology, given the high-risk features for a future embolic event, the additional information provided by adjunctive tests or imaging would not alter the course of management [ 12 ].…”

Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature

“…In addition, Sun et al recommended that patients undergoing cardiac surgery for other lesions should also be considered for surgical resection 3. However, other authors have suggested that surgery should be performed even in patients who are asymptomatic with non-mobile tumours citing the high risk of embolic events 34–38. Lifelong anticoagulation can be offered to patients who are symptomatic, but are poor surgical candidates.…”