Surgical Treatment of Cardiac Papillary Fibroelastoma: A Single Center Experience With Eighty-Eight Patients

Ngaage, Dumbor L.; Mullany, Charles J.; Daly, Richard C.; Dearani, Joseph A.; Edwards, William D.; Tazelaar, Henry D.; McGregor, Christopher G.A.; Orszulak, Thomas A.; Puga, Francisco J.; Schaff, Hartzell V.; Sundt, Thoralf M.; Zehr, Kenton J.

doi:10.1016/j.athoracsur.2005.04.030

Cited by 190 publications

(215 citation statements)

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“…Per sis tent tur bu lent flow in the he art or en dot he li al cell di sor der du e to a par ti cu lar ca u se is ge ne rally thought to in du ce en dot he li al cell hyperp la si a and le ad to de ve lop ment of pa pil lary fib ro e las to ma. 5,6 Si milarly, Ku rup et al 7 ha ve sug ges ted that open he art sur gery and tho ra cic ra di a ti on may ca u se fib ro e lasto ma. Ot hers cla im that fib ro e las to ma may rep re sent a ne op lasm, ha mar to ma or a inf lam ma tory no dule.…”

Section: Discussionmentioning

confidence: 99%

“…The most fe a red comp li ca ti on is syste mic em bo li za ti on, es pe ci ally to the ce reb ral or co ro nary cir cu la ti on. [1][2][3][4][5][6] The most com mon cli ni cal pre sen ta ti on des cri bed is stro ke or a tran sient isc he mic at tack. Ot her des cri bed ma ni fes ta ti ons are an gi na, myo car di al in farc ti on, sud den de ath, he art fa i lu re, synco pe, pul mo nary em bo lism, blind ness and pe rip he ral em bo lism with re nal in farc ti on.…”

Section: Fi Gu Rementioning

confidence: 99%

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Aortic Valve Fibroelastoma: Case Report

Durmaz¹,

Keleş²,

Bayram³

et al. 2011

Turkiye Klinikleri J Med Sci

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ncidence of primary cardiac tumors in necropsy series ranges between 0.0017% and 0.33%, and the echocardiographic incidence is reported as 0.019%.1 Papillary fibroelastoma is the third most common primary cardiac tumor (accounting for approximately 7% of all primary cardiac tumors) after myxoma and lipoma. It is the most frequent cardiac valvular tumor (70-80%).1,2 Although this tumor can be found anywhere in the heart, it is mostly located at the valvular endocardium (80%). Before the echocardiography era, papillary fibroelastomas were detected coincidentally at autopsies. However, several advancements in transthoracic (TTE) and transesophageal (TEE) echocardiography enable us to diagnose this entity Case Report A AB BS S T TR RA AC CT T Fib ro e las to mas are the most com mon be nign car di ac tu mo rs in vol ving the car di ac valves. Alt ho ugh this tu mo r can be fo und any whe re in the he art, mostly it is lo ca ted at the val vu lar en do car di um. Alt ho ugh pa pil lary fib ro e las to mas are de tec ted co in ci den tally as an au topsy fin ding, se ve ral ad van ce ments and in cre a sed ava i li a bi lity in ec ho car di og raphy enab le us to di ag no se this en tity ear li er. Fib ro e las to mas may re sult in se ve ral cli ni cal con di ti ons es pe ci ally such as em bo li zati on (isc he a mic stro ke, myo car di al in farc ti on). We re port a 68-ye ar-old ma le pa ti ent ad mit ted with chest pa in and di ag no sed by ec ho car di og rap hic eva lu a ti on to ha ve a lar ge mo bi le mass with a pedic le ad he red to the aor tic si de of right co ro nary cusp. The tumor was sur gi cally re mo ved to avo id an em bo lic event and his to pat ho lo gi cal exa mi na ti on con fir med the di ag no sis to be a car di ac pa pil lary fib ro e las to ma, which is the most com mon be nign val vu lar ne op lasm of the he art.K Ke ey y W Wo or rd ds s: : He art ne op lasms; aor tic val ve Ö ÖZ ZE ET T Fib ro e las tom lar kalp ka pak çık la rı nı tu tan en yay gın iyi huy lu kar di yak tü mör ler dir. Her ne ka dar bu tü mör kal bin her ye rin de gö rü le bil se de, ge nel lik le en yay gın lo ka li zas yo nu val vu lar endo kar di yum dur. Bu nun la be ra ber, her ne ka dar pa pil ler fib ro e las tom lar otop si sı ra sın da te sa dü fen bu lun sa da, eko kar di yog ra fi nin yay gın ola rak kul la nıl ma sı bu ol gu la rı er ken dö nem de teş his et memi ze ola nak sağ la mak ta dır. Fib ro e las tom lar em bo li zas yon baş ta ol mak üze re ba zı has ta lık la ra yol aça rak kar şı mı za çı ka bi lir (is ke mik in me, mi yo kard en fark tü sü). Bu ra da, kli ni ği mi ze gö ğüs ağ rı sı şika ye ti ile baş vu ran 68 ya şın da ki bir er kek has ta yı su nu yo ruz. Has ta nın eko kar di yog ra fik in ce lenme sin de sağ ko ro ner ka pak çı ğın aor tik ta ra fı na ya pı şık bü yük mo bil pe di kü ler kit le tes pit edil di. Ola sı bir em bo li yi ön le mek ama cıy la, kit le cer ra hi ope ras yon la alın dı. Kit le nin his to pa to lo jik in celen me si en yay gın kalp ka pak çı ğı tü mö rü olan kar di y...

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Section: Discussionmentioning

confidence: 99%

Section: Fi Gu Rementioning

confidence: 99%

Aortic Valve Fibroelastoma: Case Report

Durmaz¹,

Keleş²,

Bayram³

et al. 2011

Turkiye Klinikleri J Med Sci

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“…There are no guidelines on PFE management beyond a seeming consensus that symptomatic patients should be treated surgically. Ngaage and colleagues 6 further suggested that asymptomatic patients with a mobile PFE >10 mm in the left-sided heart chambers should undergo cardiac surgery, to prevent thromboembolic events or sudden death. Gowda and co-authors 7 reported that 12 of 25 medically treated patients died of tumor-related causes.…”

Section: Discussionmentioning

confidence: 99%

Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet

Sakata¹,

Nakaya²,

Otsu³

et al. 2017

Texas Heart Institute Journal

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P apillary fibroelastoma (PFE), a benign endocardial papilloma, is the second most prevalent primary cardiac tumor and the most prevalent cardiac valvular tumor. 1 A PFE contains many papillary fragments, has frond-like projections, and is attached to the endocardium. It can resemble myxoma, making it difficult to distinguish one from the other intraoperatively. We report our experience with an aortic valve PFE that was diagnosed as myxoma intraoperatively. After excision, aortic valve repair was performed. We discuss lessons for surgeons and pathologists that can be learned from this case. Case ReportIn March 2014, a 50-year-old asymptomatic man with no relevant medical history was referred to our hospital after inverted T waves were seen on his routine electrocardiogram. Echocardiograms and coronary computed tomograms (CT) revealed a 9-mm-diameter mobile mass on the underside of the aortic valve, apparently on the right coronary cusp. A coronary CT revealed no stenosis. We could not determine whether the mass was thrombus or tumor; in either case, there was risk of embolization. Therefore, surgical treatment was planned. Transthoracic echocardiograms showed no asynergy, morphologic abnormalities, or valvular disease, including aortic regurgitation. Laboratory data revealed no abnormalities.To perform mass resection, we established cardiopulmonary bypass between ascending aorta cannulation and right atrial drainage. After aortic cross-clamping, cardiac arrest was obtained with use of antegrade cardioplegia. The aortic valve tumor was stalkless and attached to the underside of the right coronary cusp. Its surface was smooth, indicative of myxoma (Fig. 1). Intraoperative frozen-section examination yielded spindle cells in edematous interstitial tissue, also consistent with myxoma.We decided to resect the tumor and its attachment, with sufficient margins. Resection created a large trapezoidal defect, including the free margin of the aortic valve leaflet. We repaired the defect with use of a glutaraldehyde-treated autologous pericardial patch and 6-0 Prolene running sutures (Fig. 2). To test for regurgitation, we filled the aortic root with water and confirmed that the water level did not drop. In-

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“…Fortunately, surgical resection of the mass could be accomplished easily via a left atrial appendage approach in this case. Since PFs can rarely be multiple, at the same or different locations within the heart, 7) valve repair or replacement may be necessary to correct the valvular defects in some cases. 7) Therefore, other approaches such as right-sided left atriotomy or a superior trans-septal approach, and so on, should be considered after observing the left chamber surface carefully.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Papillary Fibroelastoma Accidentally Diagnosed with Gastric Cancer

Saitoh

Soeda

Setozaki

et al. 2013

ATCS

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Papillary fibroelastoma is a rare but benign cardiac tumor and usually originates from the cardiac valve. We describe a 78-year-old woman who was initially diagnosed with gastric cancer, and was incidentally found to have a mass in the free wall of her left atrium between the left atrial appendage and the left superior pulmonary vein. An excision was performed through the left atrial appendage under cardiopulmonary bypass. The histopathologic examination of the resected tissue revealed a papillary fibroelastoma. The unusual localization of this papillary fibroelastoma was discussed.Keywords: papillary fibroelastoma, left atrium tion. Since her histological diagnosis revealed the necessity for additional surgical resection, a further examination for the gastrectomy was started. A preoperative CT scan revealed a left atrial mass near the left atrial appendage incidentally (Fig. 1), and transthoracic and transesophageal echocardiography showed a 17 × 10 mm swinging pediculated mass in the left atrial free wall between the left atrial appendage and the left superior pulmonary vein (Fig. 2). The mass resembled a myxoma or thrombus. The remainder of the workup for metastasis, including a whole body CT scan and brain magnetic resonance imaging, was negative. The patient had no prior history of arrhythmia or other cardiac or neurologic symptoms. The electrocardiogram showed a sinus rhythm. Coronary arteriography showed that the coronary arteries were normal. Since it was difficult to determine whether the lesion was a tumor or a thrombus, she was referred to our hospital for surgery to remove the mass before the gastric cancer surgery. Under cardiopulmonary bypass and cardioplegic arrest, the left atrial appendage was opened from the tip of the appendage toward the left superior pulmonary vein, and the mass was directly visualized at this time (Fig. 3). A yellow-white and soft tumor with a short, broad stalk was attached to the ridge between the left superior pulmonary vein and the base of the left atrial appendage. Complete excision of the tumor with part of the left atrial wall was performed,

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Surgical Treatment of Cardiac Papillary Fibroelastoma: A Single Center Experience With Eighty-Eight Patients

Cited by 190 publications

References 12 publications

Aortic Valve Fibroelastoma: Case Report

Aortic Valve Fibroelastoma: Case Report

Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet

Left Atrial Papillary Fibroelastoma Accidentally Diagnosed with Gastric Cancer

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