“…Surgical excision is the recommended treatment unless there is a contraindication. In fact, a study analysis of the resection of CPF over the years 1998-2020 showed a low operative mortality (0-2.5%), low recurrence rate (15.8%), and a high estimated survival (78.4%) at 10 years [ 12 ]. The indication for operation is determined by the patient’s overall characteristics and comorbidities/risk factors, presence or absence of symptoms, the type of tumor, size, location, and operative and long-term outcomes.…”
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac neoplasms that carry a high risk of embolization if not diagnosed and managed in a timely manner. As most patients are asymptomatic, CPF may be incidentally detected on transthoracic echocardiography (TTE) when performed for other indications. Management of incidental CPF in asymptomatic patients is debatable. We report an unusual case of an incidental CPF in an asymptomatic patient admitted to the hospital for presumed infective endocarditis (IE). Two weeks following laser resection of laryngeal cancer (LC), a new pansystolic murmur was audible during a routine cardiology visit. Outpatient TTE revealed a "vegetation-like" lesion on the mitral valve (MV). Blood cultures (BC) with Gram-positive cocci in clusters (GPC) were reported within 24 hours. This prompted hospital admission for empiric antibiotics. A transesophageal echocardiogram (TEE) confirmed the lesion to be an echogenic mass attached to the MV consistent with CPF. Repeat BC, prior to empiric antibiotic initiation, were all negative. In the absence of all other signs and symptoms of IE, it was determined that the initial BC was false positive and IE was ruled out. Surgical resection was performed due to the potential risk of embolization. The pathology confirmed the diagnosis of CPF with negative tissue cultures.
“…Surgical excision is the recommended treatment unless there is a contraindication. In fact, a study analysis of the resection of CPF over the years 1998-2020 showed a low operative mortality (0-2.5%), low recurrence rate (15.8%), and a high estimated survival (78.4%) at 10 years [ 12 ]. The indication for operation is determined by the patient’s overall characteristics and comorbidities/risk factors, presence or absence of symptoms, the type of tumor, size, location, and operative and long-term outcomes.…”
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac neoplasms that carry a high risk of embolization if not diagnosed and managed in a timely manner. As most patients are asymptomatic, CPF may be incidentally detected on transthoracic echocardiography (TTE) when performed for other indications. Management of incidental CPF in asymptomatic patients is debatable. We report an unusual case of an incidental CPF in an asymptomatic patient admitted to the hospital for presumed infective endocarditis (IE). Two weeks following laser resection of laryngeal cancer (LC), a new pansystolic murmur was audible during a routine cardiology visit. Outpatient TTE revealed a "vegetation-like" lesion on the mitral valve (MV). Blood cultures (BC) with Gram-positive cocci in clusters (GPC) were reported within 24 hours. This prompted hospital admission for empiric antibiotics. A transesophageal echocardiogram (TEE) confirmed the lesion to be an echogenic mass attached to the MV consistent with CPF. Repeat BC, prior to empiric antibiotic initiation, were all negative. In the absence of all other signs and symptoms of IE, it was determined that the initial BC was false positive and IE was ruled out. Surgical resection was performed due to the potential risk of embolization. The pathology confirmed the diagnosis of CPF with negative tissue cultures.
“… 8 Another longitudinal study found that papillary fibroelastoma resection is associated with low operative mortality and excellent long-term outcomes, reinforcing a surgical strategy. 9 However, other authors suggest that small (<1 cm), nonmobile, right-sided and/or asymptomatic papillary fibroelastomas can be managed conservatively with careful observation, and surgical intervention may actually be deferred. 10 …”
“…PFEs are specifically distinguished from simple strands, fenestrations or Lambl excrescences (LEs), which are single or maybe a few linear echocardiographic densities that do not demonstrate a bulky portion sometimes referred to as the ‘head’ of a PFE ( Figure 4 , Supplemental Videos 4 and 5 ). It should be noted that up to 20% of patients can have 2 or more PFE; therefore, careful imaging with meticulous search for other coexisting PFE is warranted 12 , 18 ( Supplemental Video 6 ). Figure 4 PFE in a left atrial appendage.…”
Section: Valvular Massesmentioning
confidence: 99%
“…Surgical intervention, in expert hands, has been shown to bring patients back to background risk of embolism. 12 , 18 , 21 In a single-center study of 294 patients undergoing surgical PFE removal, operative mortality was 0%, the native valve was preserved in 96%, and postoperative stroke occurred in 3 patients (2%). 18 In select cases, a robotic approach is possible especially with PFE located on the MV.…”
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