Embolization of multiple papillary fibroelastoma of the aortic valve as cause of a ST-segment elevation myocardial infarction

Alozie, Anthony; Prall, Friedrich; Hendrikson, Christian; Westphal, Bernd; Werner, Dierk

doi:10.1093/ejechocard/jer119

Cited by 10 publications

(6 citation statements)

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“…The noncoronary leaflet of the aortic valve is most often affected. 3,4 Most PFEs are incidentally found on echocardiograms and are clinically silent; however, symptoms can occur after embolization and give rise to a wide variety of presenting features, including neurologic events (such as transient ischemic attack [TIA], stroke, amaurosis fugax, and spinal cord infarction), [5][6][7] acute coronary syndrome, 8,9 and distal thromboembolism. 10 Very few systemic or comprehensive study results have been published to validate a single medical or surgical approach to rarer primary cardiac tumors like PFE, so we reviewed our institution's surgical experience with PFE during a 22-year period.…”

Section: Single-institution Experience With 14 Surgical Patientsmentioning

confidence: 99%

Cardiac Papillary Fibroelastoma: Single-Institution Experience with 14 Surgical Patients

Saleh¹,

Jabbari²,

Ramlawi³

et al. 2016

Texas Heart Institute Journal

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In general, treatment for symptomatic and asymptomatic cardiac papillary fibroelastoma is surgical resection-particularly of left-sided lesions, because of the risk of systemic embolization. However, few institutions have enough experience with these tumors to validate this approach. We present our institutional experience with papillary fibroelastoma and discuss our current approach. We searched our institution's cardiac tumor database, identified all patients diagnosed with cardiac papillary fibroelastoma from 1992 through 2014, and recorded the clinical and pathologic characteristics of each case. We found 14 patients (mean age, 60.5 ± 12.3 yr) who had 18 lesions. Eleven patients (79%) were symptomatic; however, we could not always definitively associate their symptoms with a cardiac tumor. Most lesions were solitary and ≤1.5 cm in diameter; half involved the left side of the heart. All 18 lesions were surgically excised. There were no operative or 30-day deaths, and no patient needed valve replacement postoperatively. There was one late death; at one year, another 3 patients were lost to follow-up, and the others were alive without tumor recurrence. Because of the embolic risk inherent to intracardiac masses and our relatively good postoperative outcomes, we recommend the surgical resection of all left-sided papillary fibroelastomas in surgical candidates, and we discuss with patients the advisability of resecting right-sided lesions.

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Section: Single-institution Experience With 14 Surgical Patientsmentioning

confidence: 99%

Cardiac Papillary Fibroelastoma: Single-Institution Experience with 14 Surgical Patients

Saleh¹,

Jabbari²,

Ramlawi³

et al. 2016

Texas Heart Institute Journal

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“…Papillary fibroelastomas have a predilection for men, with a mean age of 56 years . Although papillary fibroelastomas are usually asymptomatic, they are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization . In the present case, the patient was scheduled for left carotid endarterectomy.…”

Section: Discussionmentioning

confidence: 79%

Double papillary fibroelastoma: Beautiful, innocent flowers in the left heart

Floria

Gerard

Louagie

et al. 2014

J of Clinical Ultrasound

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Papillary fibroelastoma is a rare, benign tumor, and multiple papillary fibroelastomas are even more uncommon. In an asymptomatic patient scheduled for carotid endarterectomy, transthoracic echocardiography discovered a fibroelastoma on the mitral valve. Then, transesophageal echocardiography showed another fibroelastoma on the aortic valve. Because he also needed a right coronary artery bypass, the patient underwent surgical excision of both masses. Fibroelastomas are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization. Transoesophageal echocardiography may improve the diagnosis of multiple papillary fibroelastomas.

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“…Papillary fibroelastoma is a solitary lesion, and multiple fibroelastomas are rarely recognized. 1,2 Alozie et al 2 found multiple masses on the left, right, and non-coronary cusps during surgery, and postoperative histopathological analysis confirmed the diagnosis of multiple cardiac papillary fibroelastomas. Lin et al also reported a case with multiple fibroelastomas.…”

Section: Discussionmentioning

confidence: 96%

“…Like myxomas, they constitute a curable and identifiable cause of strokes and other embolic events. Papillary fibroelastomas usually develop on a left-sided valve leaflet 1,2 and can appear in the right heart. [3][4][5][6] Diagnostic procedures for papillary fibroelastomas include trans-thoracic and trans-esophageal echocardiographic techniques, cardiac magnetic resonance imaging, and computed tomography.…”

Section: Discussionmentioning

confidence: 99%

Multiple papillary fibroelastomas in the right heart

Muraoka

Kurumisawa

Kaminishi

et al. 2015

Cardiovascular and Thoracic Open

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Background: Cardiac multiple papillary fibroelastonas are rare. Methods and Results: A 70-year-old woman presented with an exertional dyspnea. A trans-thoracic echocardiogram showed a moving mass near the inferior vena cava in the right atrium. She underwent an operation for a cardiac tumor. A trans-esophageal echocardiogram during the operation showed a mass in the right ventricle, which had echo properties similar to the mass in the right atrium. The mass in the atrium was resected including the attached intima, and the mass in the ventricle was resected by the shave method. Her postoperative course was uneventful. A pathological examination showed that the two tumors were papillary fibroelastomas. Conclusion: A precise examination should be performed when a cardiac tumor is diagnosed to investigate the possibility of multiple lesions.

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Embolization of multiple papillary fibroelastoma of the aortic valve as cause of a ST-segment elevation myocardial infarction

Cited by 10 publications

References 0 publications

Cardiac Papillary Fibroelastoma: Single-Institution Experience with 14 Surgical Patients

Cardiac Papillary Fibroelastoma: Single-Institution Experience with 14 Surgical Patients

Double papillary fibroelastoma: Beautiful, innocent flowers in the left heart

Multiple papillary fibroelastomas in the right heart

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