Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas

Abstract

In patients with echocardiographically suspected PFE who do not undergo surgical removal, rates of cerebrovascular accident and mortality are increased.

Imaging and histology in the diagnosis of multiple papillary fibroelastomas in a patient with hypertrophic obstructive cardiomyopathy. Case report

“…TEE, as compared to TTE, is a better technique for detecting and describing the extent and precise attachment of PFEs [1], but sometimes direct inspection during surgery finds supplementary lesions, as was the case of our patient. Unfortunately, at the moment, there are no parameters that can be evaluated in order to classify PFEs into low-or high-risk according to their embolization potential.…”

“…Unfortunately, at the moment, there are no parameters that can be evaluated in order to classify PFEs into low-or high-risk according to their embolization potential. Tumor mobility, as assessed by echocardiogram, did not prove to be a reliable predictor of embolic events [1]. These abnormal structures can be partly responsible for valve insufficiency or hemodynamic conditions similar to stenosis or are simply superimposed on structures whose dysfunction has a distinctive etiology (e.g.…”

“…Papillary fibroelastomas (PFEs) are considered to be the most frequent primary cardiac tumors [1]. Most often they are unique masses in the left cardiac chambers with a propensity for valvular surfaces [2].…”

“…Most often they are unique masses in the left cardiac chambers with a propensity for valvular surfaces [2]. PFEs are associated with an increased risk of neurological events, either stroke or transient ischemic accident (TIA), while rarely being directly responsible for valve dysfunction [1]. There is evidence that they arise more often in patients with hypertrophic cardiomyopathy (HCM) [3].…”

“…This is largely due to the continuous improvement of imaging tools, such as better resolution of transthoracic echocardiography (TTE) [4][5][6] and a wider availability of transesophageal echocardiography (TEE) [7], using both two-and three-dimensional techniques. The only treatment which has shown clear benefits is represented by careful surgical excision of all such tumors, with excellent results, with a low incidence of both valve replacements and recurrence [1,8].…”