Papillary Fibroblastoma of Tricuspid Valve with Pulmonary Embolization

Abstract

A 53-year-old man was diagnosed with a papillary fibroelastoma of the tricuspid valve with pulmonary embolization and associated coronary artery disease. He underwent excision of the tumor and coronary bypass grafting. Due to potential embolization, it is recommended that all such fibroelastomas be excised.

Multimodality Imaging of Right-Sided (Tricuspid Valve) Papillary Fibroelastoma: Recognition of a Surgically Remediable Disease

“…Surgical excision appears safe, potentially curative (however, good long-term follow-up data for recurrence is lacking), and is advised where symptoms or large PF tumor size or significant tumor mobility is present [4, 5, 6, 7]. There are documented cases of TV-PF with PE [2, 3]. Pleuritic chest pain and dyspnea symptoms are common, and may reflect recurrent distal pulmonary circulation embolization, despite overtly negative CT and V/Q scan findings for proximal PE.…”

“…Right-sided PFs are an important potentially fatal cause of sudden cardiac death, syncope, chest pain, and dyspnea. While PFs are slow growing, their propensity to accumulate superficial thrombus and fragment, embolizing tumor or thrombus fragments into the distal pulmonary circulation or paradoxically embolizing to the left-sided circulation, is significant [2, 3]. Clinical recognition of these tumors is therefore important [4, 5, 6].…”

Successful Biopsy and Removal of a Tricuspid Valve Papillary Fibroelastoma in Cardiac Catheterization Laboratory: A Case Report

“…PFEs, especially the pedunculated tumors, have been suggested as source of thromboembolization or embolization of the tumor itself due to its friability 1,2 . Intermittent right ventricular outflow tract obstruction 3 and pulmonary embolism 4 have been attributed to pedunculated TV PFEs. Management is individualized, with surgical removal recommended for large mobile tumors, even those without symptoms, due to increased risk of embolization and in symptomatic PFEs 1,2 .…”

Papillary Fibroelastoma: Insight to a Primary Cardiac Valve Tumor

“…In case of right side PFE, clinically evident embolic events are rare. Nevertheless, embolic involvement of the pulmonary vessels may lead to pulmonary hypertension or lethal pulmonary embolism 39,40 . In addition, a right heart PFE may pose the risk of systemic embolization in the presence of a patent foramen ovale 41…”

“…Nevertheless, embolic involvement of the pulmonary vessels may lead to pulmonary hypertension or lethal pulmonary embolism. 39,40 In addition, a right heart PFE may pose the risk of systemic embolization in the presence of a patent foramen ovale. 41 Obstruction to blood flow and interference with valve function depend on size, mobility and location of PFE.…”