Papillary fibroelastoma of the aortic valve presenting with chronic angina and acute stroke: a case report

Abstract

BackgroundPapillary fibroelastomas are rare, benign cardiac tumors that are often found on cardiac valvular surfaces. Most are incidental discoveries during surgery or autopsy. The clinical presentation of fibroelastoma varies widely, ranging from clinically asymptomatic to severe thromboembolic events.Case presentationWe report a case of 65-year-old white man diagnosed with scattered, bilateral acute cerebral hemisphere infarcts with a history of chronic angina. Transesophageal echocardiography identified a fibroelastoma on the right coronary cusp of the aortic leaflet. Cardiac catheterization revealed mild non-obstructive stenosis. We postulate that the etiology of his angina is related to the dynamic occlusion of his right coronary ostium by the fibroelastoma.ConclusionsTo the best of our knowledge, this is the first case report describing a patient with a cardiac papillary fibroelastoma who presented with both chronic angina and acute stroke.

Rheumatic Mitral Valvopathy and Papillary Fibroelastoma An Unusual Association

“…2018;31(4):272-274 Surgical treatment can be performed conservatively, with excision of the tumor, sparing the valve, or in a non-conservative way, by performing a plastic surgery or valve replacement with a prosthesis implant. 10 Valve preservation surgery is usually safe and curative. 10 However, in some cases, especially when there is significant impairment of the valve, one can choose the exchange.…”

“…10 Valve preservation surgery is usually safe and curative. 10 However, in some cases, especially when there is significant impairment of the valve, one can choose the exchange. 10 Among the patients affected, an 83% rate of exclusive tumor resection has been reported, without valve surgery.…”

“…10 However, in some cases, especially when there is significant impairment of the valve, one can choose the exchange. 10 Among the patients affected, an 83% rate of exclusive tumor resection has been reported, without valve surgery. In the other cases, which are the minority, tumor excision can be performed with concomitant valve repair or valve replacement with a prosthesis implant.…”

Established and potential echocardiographic markers of embolism and their therapeutic implications in patients with ischemic stroke

“…Most cases (90%) of atrial myxoma are sporadic with no known cause. In the remaining (10%), a familial pattern occurs having an autosomal dominant pattern known as Carney complex which is characterized by multiple tumors, including atrial and extracardiac myxomas, cutaneous spotty pigmentation, non-myxomatous extracardiac tumors, schwannomas and various endocrine tumors, through a causative mutation of the PRKAR1α gene located on the long arm of chromosome 17 [25]. Cardiac myxomas produce interleukin (IL)-6, leading to constitutional manifestations such as recurrent fever, anemia, arthralgia, and weight loss which disappear after removal of the tumor [26,27].…”

“…A clear surgical margin is necessary for excision of a myxoma due to its high rate of recurrence. On the other hand, fibroelastomas rarely recur after resection, thus it is recommended to preserve valvular function by shaving off the tumor [25].…”