Cardiac papillary fibroelastoma presenting with acute coronary syndrome and syncope

Abstract

A 70-year-old female was admitted for syncope preceded by chest pain. On admission ECG showed signs of myocardial ischaemia and cardiac troponin I (cTnI) was mildly elevated. Acute coronary syndrome without ST elevation was diagnosed. During hospitalization transthoracic echocardiography (TTE) revealed the presence of a round echogenic pedunculated mass adherent to the aortic valve. Cardiac catheterization revealed normal coronary arteries. According to the hypothesis that the lesion could be responsible for both acute coronary syndrome and syncope, surgical intervention was scheduled. The mass was removed and the histological examination revealed a cardiac papillary fibroelastoma (CPF). CPF is the most common tumour of the cardiac valves, it is often found incidentally but it can cause myocardial infarction, sudden death, syncope and stroke; its embolization is the most common complication. For symptomatic patients surgical excision is curative.

Cardiac Papillary Fibroelastoma as a Cause of Embolic Stroke: Ultrasound and Histopathological Characteristics

“…Although the mass in the present patient did not have a peduncle, other pathological findings were compatible with those previously reported (4,9,10,14,15). CPF presents with various clinical events, including ischemic stroke, transient ischemic attack, ischemic heart disease, heart failure, sudden death, syncope, blindness, and pulmonary embolism (4)(5)(6)(15)(16)(17). It can also be found incidentally on autopsy or during cardiac surgery (4,9).…”

“…In contrast, TEE helps to differentiate CPF from other intracardiac tumors, in particular myxoma and the vegetation of endocarditis (19). When the CPF is large, TEE can delineate a clear surface with a bright echoic core of collagen fibers or fibrous tissue and a stippled edge with vibration at the tumor-blood interface (11,15,20 (4,21,22), as well as the CPF itself (4,7,8) (4,5). The previous reports have provided no firm evidence-based guidelines regarding the use and duration of anticoagulation post excision of CPF (4,16).…”

Two Rare Manifestations of Cardiac Papillary Fibroelastoma Presenting with Dyspnea

“…The association of CPF with coronary embolism is well documented. 9 However, physical obstruction of the right coronary ostium is reported in only a few previous cases. 10 During two-dimensional TTE, the mass was missed because of suboptimal imaging.…”

Accessory Tricuspid Valve Leaflet in an Asymptomatic Adult

“…The diagnosissurface [8]. Although PF is usually asymptomatic, it can present with syncope, chest pain, heart attack, and even sudden cardiac death [9][10][11][12]. The presence of mobility predicts death and nonfatal embolization, and the surgical resection is recommended in the presence of mobility and after any embolization [12].…”