Infected Papillary Fibroelastoma Attached to the Atrial Septum.

Abstract

rimary tumors of the heart are rare and are often classified histologically as 'benign'. One-sixth of these are papillary fibroelastomas, which usually originate in the heart valves. 1 A few previous reports have shown papillary fibroelastomas arising from the mural endocardium of the heart chambers, papillary fibroblastomas attached to the atrial septum are extremely rare. 2 Case ReportA 61-year-old woman was in good health until 2 months prior to admission to the Yamamoto General Hospital in June 1998. On admission she complained of progressive fatigue. The week before, she had had intermittent fever peaking at 39.5°C and 2 months prior she had had a tooth extraction.On physical examination, the patient was anxious, but did not appear to be ill. Her body temperature was 39.2°C, pulse rate was 84 beats/min, respiratory rate was 16 breaths/min and her blood pressure was 108/80 mmHg. The first and second heart sounds were normal with no gallop. A grade 2/6 mid-systolic murmur was heard at the apex. The lungs were clear on auscultation. The abdominal examination was unremarkable and the extremities showed no clubbing, edema, arthritis, Osler's nodes, or Janeway lesions. Neurological examination was unremarkable. Two-dimensional echocardiography showed a 5.0×1.5 cm heavy stick-like mass attached to the atrial septum, in the left atrium during ventricular systole and passing freely into the left ventricle in diastole. The head of the mass had a high-density echo that was thought to be vegetation (Fig 1) A 61-year-old woman had intermittent fever of 2 months' duration following a dental extraction. On admission, her body temperature was 39.2°C. A mid-systolic murmur was heard at the apex on ausculation. A 2-dimensional echocardiogram revealed a mobile, heavy stick-like mass with vegetation (5.0×1.5 cm) attached to the left atrial septum. Multiple blood cultures grew Streptococcus constellatus. On diagnosis of an infected left atrial myxoma, antibiotics were administered daily and 4 weeks later, the left atrial tumor was resected. The tumor was 5.3 cm long, 1.5 cm in diameter at the inter-atrial wall and had vegetation on the free edge. On microscopic examination, colonies of Gram-positive cocci were found in the thrombus, on the papillary fibroelastoma. After treatment with antibiotics for a further 4 weeks, the patient was discharged. This is the first report of infected papillary fibroelastoma.

Double Primary Left Ventricular and Aortic Valve Papillary Fibroelastoma

“…2 They can occur anywhere in the heart, but approximately 80% occur on the valvular endocardium 2 and can be associated with mechanical valve thrombus 3 and infection. 4 According to Howard et al, 55% of these tumors are found on the mitral or aortic valves, 1 they are usually singular, and only 7 cases of multiple tumors have been published in the literature. [5][6][7][8][9][10][11] The etiology of these tumors is unknown, but reaction to mechanical trauma, neoplasms, hamartomas or inflammatory nodules has been considered.…”

“…2 The number of patients diagnosed with papillary fibroelastomas has increased since the advent of echocardiography, but cases of recurrence have not been reported and multiple occurrence is rare. [3][4][5][6][7][8][9][10][11] We present a case of double papillary fibroelastoma of the aortic valve with aortic regurgitation and mitral periprosthetic leakage occurring 4 years after resection of an initial left ventricular papillary fibroelastoma with mitral and tricuspid valvular disease. …”

Papillary Fibroelastoma of the Interatrial Septum:. A Case Report

“…They are usually found on the atrial side on the atrioventricular valve and can be found on either side on semilunar valves. Papillary fibroelastomas attached to the atrial septum are rare 4,5 . In our case, the papillary fibroelastoma was attached to the left side of the interatrial septum.…”

“…Additionally, since atrial lipomas are now considered to be atrial fat infiltration and not neoplasms, fibroelastomas are likely the second most common cardiac neoplasm. Ninety percent are found on the valves, most commonly the aortic and mitral valves 4 . They are usually found on the atrial side on the atrioventricular valve and can be found on either side on semilunar valves.…”

Cardiac rhabdomyoma presenting as infective endocarditis: a case report

“…Arrhythmia was reported in 16% of the paediatric patients with cardiac rhabdomyomas 1 ; of these, 6% presented with ventricular tachycardia. 1 Infective endocarditis has frequently been reported in association with cardiac tumours including cardiac myxoma [2][3][4] and fibroelastoma, 5,6 and the diagnosis of infected cardiac tumour was confirmed by histological examination of the surgically resected masses. [4][5][6] Other clinical features in our case are prolonged fever associated with persistent staphylococcus bacteremia after umbilical venous catheterisation.…”