Papillary Fibroelastoma in Association With Thrombosis on a Mechanical Valve

Taniyasu, N; Akiyama, K; Iba, Yutaka; Hirota, Jun

doi:10.1253/jcj.64.797

Cited by 9 publications

(10 citation statements)

References 9 publications

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“…Papillary fibroelastomas have been described as neoplasms, hamartomas, organizing thrombi, or posttraumatic tumors. The organizing thrombi hypothesis is supported by the presence of fibrin, hyaluronic acid, and laminated elastic fibers within the fronds [5, 6]. The presence of miniature tendinous chords, as well as the association of congenital PFE with other congenital cardiac anomalies, provides the basis for the hamartoma hypothesis [7, 8].…”

Section: Commentmentioning

confidence: 99%

Surgical Experience With Cardiac Papillary Fibroelastoma Over a 15-Year Period

Anastacio

Moon

Damiano

et al. 2012

The Annals of Thoracic Surgery

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Background Papillary fibroelastomas are rare, benign cardiac tumors. They are predominantly asymptomatic. However, they can lead to serious complications, namely thromboembolic events. Symptomatic lesions can be managed primarily with surgical excision and valvular preservation. Controversy exists as to the management of asymptomatic lesions. Methods All patients diagnosed with cardiac papillary fibroelastoma between 1996 and 2012 at a single institution were queried for clinical and pathologic characteristics. Results Twenty-three patients with 29 lesions were identified. Most lesions were solitary, less than 1.0 cm in diameter, and occurred in patients greater than 60 years of age. The most common presentation was thromboembolic complication. All were managed successfully with surgical excision. One patient developed a recurrence or metachronous lesion within 3 months of initial surgical intervention. Conclusions Papillary fibroelastomas are rare, benign, predominantly asymptomatic cardiac tumors that can cause potentially serious complications. The natural history and etiology of papillary fibroelastomas are largely unknown. Controversy exists over the management of asymptomatic lesions. However, there is consensus that symptomatic lesions should undergo surgical excision with valvular preservation when possible. A unique case of a possible papillary fibroelastoma recurrence is also described.

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Section: Commentmentioning

confidence: 99%

Surgical Experience With Cardiac Papillary Fibroelastoma Over a 15-Year Period

Anastacio

Moon

Damiano

et al. 2012

The Annals of Thoracic Surgery

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“…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. …”

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confidence: 99%

Double Primary Left Ventricular and Aortic Valve Papillary Fibroelastoma

Tanaka

Narisawa

Mori

et al. 2004

Circ J

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apillary fibroelastomas, which are generally found on the valvular endocardium, are relatively uncommon benign tumors and the next most common of the primary cardiac tumors after myxomas and lipomas. 1,2 However, they can cause lethal embolisms resulting in myocardial infarction, cerebral infarction and pulmonary embolism. 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. Case ReportIn 1997, a 52-year-old man presented to hospital with dyspnea and a medical history that included atrial fibrillation in 1993. Cardiac catheterization revealed mild pulmonary hypertension of 45/22 mmHg, elevated wedge pressure of 22 mmHg, and obstruction of the posterior descending artery. Transthoracic echocardiography confirmed the presence of a left ventricular tumor (Fig 1A), and revealed moderate mitral stenosis and regurgitation, tricuspid regurgitation and trivial aortic regurgitation. Mitral valve replacement (29 mm Carbomedics Valve), tricuspid annuloplasty (32 mm Carpentier Ring) and tumor excision without blood transfusion were performed. The tumor, found on the anterior wall of the left ventricle near the apex of the heart, was pale yellow and 7 mm in maximum length. It was excised through the mitral valve (Fig 2A). Pathology showed papillary growth with myxoid stroma and the

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“…In another series of 45 patients, three cerebrovascular accidents were documented 10 . Sporadic reports have also described a PFE occurrence over a period ranging from 6 months to 30 years 17,22,27 . In addition, because PFE commonly arise in the high flow and high pressure systemic outflow tract of the heart, the risk of embolization is comparatively higher than that of the most common myxomas as confirmed by previous published series 8,9,14‐16 .…”

Section: Natural Historymentioning

confidence: 56%

“…The histochemical presence of fibrin, hyaluronic acid, and laminated elastic fibers within the fronds supports the hypothesis that PFEs may be related to organizing thrombi 17‐20 . Conversely, evidence favoring the hamartoma hypothesis includes a histologic appearance suggesting the proliferation of miniature tendinous cords rather than organizing thrombi, as well as apparent congenital PFEs associated with other congenital cardiac anomalies 5,19,21 .…”

Section: Etiologymentioning

confidence: 64%

“…Conversely, evidence favoring the hamartoma hypothesis includes a histologic appearance suggesting the proliferation of miniature tendinous cords rather than organizing thrombi, as well as apparent congenital PFEs associated with other congenital cardiac anomalies 5,19,21 . However, the fact that these tumors are observed rarely in children and more frequently in older patients with longstanding heart disease suggests that PFEs are secondary to mechanical wear and tear, possibly representing a posttraumatic tumor or a degenerative process 7,9 , 13‐17 . A clear correlation with a previous cardiac surgery has been described, especially in those cardiac chambers most closely associated with the site of the old operation 22 .…”

Section: Etiologymentioning

confidence: 99%

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