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Surgical Management
Published in Takahiro Shiota, 3D Echocardiography, 2020
Another commonly seen cardiac mass is papillary fibroelastoma. Figure 13.4A () shows an example. 3D TEE can show its shape, size, and motion. In this case, we could not tell its nature until pathological evaluation was done after its surgical removal. After surgery, no more mass is seen above the tricuspid valve (Figure 13.4B, ).
Cardiac masses
Published in Andrew R. Houghton, MAKING SENSE of Echocardiography, 2013
Papillary fibroelastoma is a small (<1.5 cm) benign tumour and is most commonly found attached to the aortic or mitral valve. They account for 10 per cent of primary cardiac tumours. They are usually found incidentally during echo, cardiac surgery or post mortem, and their similarity to vegetations can lead to a mistaken diagnosis of infective endocarditis. They are usually highly mobile and have been described as having a ‘shimmering’ appearance around the edges on echo. The tumours can be a source of thrombotic emboli, or fragments of the fibroelastoma itself can embolize, and surgical resection should therefore be considered, particularly if they are large (>1.0 cm), mobile and present in the left heart.
Tumors of Heart
Published in P. Chopra, R. Ray, A. Saxena, Illustrated Textbook of Cardiovascular Pathology, 2013
Papillary fibroelastoma is a papilloma of the endocardium over valves. This has several synonyms namely giant Lambl's excrescences, myxofibroma, myxoma of valves, fibroma of valves, fibroelastic papilloma, etc. There is a great deal of similarity between Lambl's excrescences and papillary fibroelastomas, however, latter are larger and more gelatinous than Lambl's excrescences and are present on valves away from the line of closure. This is generally an incidental finding and may assume clinical significance when they embolise. Grossly, it has papillary or finger like appearance and is often gelatinous to feel. Microscopically the papillae are lined by endothelial cells. The supporting matrix is loose and myxoid with elastic fibers and occasional smooth muscle cells and fibroblasts. Both papillary fibroelastoma and Lambl's excrescences are believed to be organising thrombi.
Cardiac Valves and Primary Tumors
Published in Structural Heart, 2019
Maria Ascaso Arbona, Eduard Quintana, Daniel Pereda, Alejandro Fernandez Cisneros, Jesus Ruíz, Manel Castella, Ramón Cartaña, Elena Sandoval
Results: Fifteen patients (13.5%) were diagnosed with a cardiac mass arising from the cardiac valves. Clinical presentation at the time of diagnosis was varied, but stroke was the most common symptom (46.7%), higher than in the total database. Only 20% of the patients were asymptomatic at the time of diagnosis. A total of 17 valves were involved. The aortic valve was the most frequent location, being affected in 8 cases (47%). Mitral valve was the origin in 5 cases (29.4%) while the tricuspid and pulmonary valve were affected in 2 cases (11.8%), respectively. Papillary fibroelastoma was the most common diagnosis (53%). “Valve malformation” was the definite report in 4 patients (23.5%). There were also 2 myxomas and one malignant sarcoma. Nine tumors could be resected without damaging functionality of the valve (64.7%). However, in the cases with significant valve dysfunction due to the mass invasion, a valve repair was performed in 3 patients and valve replacement in an other 3 (17.6% each). Perioperative mortality was 0%. Mean follow up was 73.7 months. The malignant mass was the only tumoral relapse at follow up (24 months).
A rare emboligenic origin of ischaemic stroke
Published in Acta Cardiologica, 2018
F. Staels, F. Van Durme, F. Casselman, A. Heyse
Cardiac evaluation with transthoracic echocardiography showed a pedunculated mass (white arrow) on the atrial side of the mitral valve (panel B). Transesophageal echocardiography demonstrated a mobile polyglobular mass (white arrow) with the largest diameter of 9 mm, close to the anterior leaflet but attached to the posterior leaflet of the mitral valve (panel C, D). The valvular localisation is most consistent with a fibroelastoma. A thrombus on that location is unlikely. The echocardiographic appearance of the left atrial appendage was completely normal. We referred the patient for resection of the tumour. Surgery is usually indicated after embolic events and also in case of large (>1 cm) or highly mobile masses. She underwent a port-access operation with resection of the mass from the posterior leaflet without complications. The macroscopic appearance was suggestive for a myxoma. However, pathological specimen demonstrated a papillary fibroelastoma (panel E). Recurrence of papillary fibroelastoma has not been described.
Papillary fibroelastoma in the left atrium
Published in Baylor University Medical Center Proceedings, 2019
Charles S. Roberts, Melissa M. Carry, James W. Choi, Paul A. Grayburn, William C. Roberts
Papillary fibroelastoma in the left atrium is rare. Gowda et al2 reviewed 611 previously reported cases of papillary fibroelastoma in which the location of the tumor was described: 84% were located on one or more valvular cusps and 16% had a nonvalvular location. Of the latter, 12 (2%) overall were in the left atrial wall. Anastacio et al3 described 23 patients with cardiac papillary fibroma. None occurred in the left atrium. The most common clinical consequence of a left-sided papillary fibroelastoma is transient ischemic attack or stroke, as occurred in the patient described who also had concomitant coronary bypass.