Cardiac papillary fibroelastoma originating from the coumadin ridge and review of literature

Abstract

Papillary fibroelastomas represent the second most common benign cardiac tumour, secondary only to cardiac myxoma. A majority of patients are asymptomatic on presentation. The most common clinical manifestations include stroke, transient ischaemic attack, myocardial infarction and angina. Echocardiography remains the primary imaging modality for identification of these tumours. The majority of papillary fibroelastomas arise from the valves. Simple surgical excision is the mainstay of treatment, carrying an excellent prognosis. We present an unusual case of cardiac papillary fibroelastoma originating from the coumadin ridge (CR) in a 70-year-old woman. The patient exhibited increasing paroxysms of her atrial fibrillation and was pursuing a MAZE procedure. Preoperatively, a transesophageal echocardiogram revealed a 0.7×1 cm intracardiac mass that had echocardiographic appearance of a fibroelastoma. Surgical resection and MAZE procedures were performed. The gross specimen and histopathology findings were consistent with papillary fibroelastoma. This case reports the seventh documented case of fibroelastoma originating from the CR.

Papillary fibroelastoma originating from the left ventricular outflow tract

“…The majority of primary cardiac tumors is benign and papillary fi broelastomas are the most common primary cardiac tumors after cardiac myxomas. 1 Papillary fi broelastoma is attached especially to cardiac valves while the aortic valve is affected predominantly (29.4%). Although mitral valve attachment is seen relatively uncommon compared to aortic valve, the studies state that the concurrent valvular disease is represented in 41.7 % of patients.…”

“…2 Unlike valvular disease, nonvalvular fi broelastomas are mostly originated from left ventricle. 1 In addition to that, neoplasms occur sporadically and most of them are detected incidentally during routine echocardiographic examination.…”

“…Primary cardiac tumors are usually benign, relatively uncommon masses compared to metastatic tumors of heart. 1 Papillary fi broelastomas, which are benign avascular endocardial papillomas, are one of the most common benign cardiac tumors that arise predominantly from the cardiac valves. 2 Despite predominance of male gender, there are no other signifi cant risk factors or pathophysiologic mechanism proven.…”

“…2 Despite predominance of male gender, there are no other signifi cant risk factors or pathophysiologic mechanism proven. 1 Clinical manifestations of tumors depend on their size and location such as originating from the endocardium, heart valves, or myocardium. 2 While the majority of patients is asymptomatic on presentation, the clinical presentation of papillary fi broelastoma varies from asymptomatic to sudden cardiac death because of severe embolic complications such as stroke or myocardial infarction.…”

Ascending Aortic Wall Fibroelastoma in an Elderly Woman with Dyspnea

“…These pathologic tissues tend to be found incidentally on routine clinical imaging, with most patients asymptomatic at the time of diagnosis. 1 , 2 However, individuals with FE on occasion may be predisposed to an increased risk of embolization with significant morbidity and mortality, hence diagnosis and management of this clinical condition remains of noteworthy interest. Whereas most cases tend to be attached to the aortic and mitral valves, nonvalvular locations have been described in a handful of case studies.…”