The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve

Abstract

A cardiac papillary fibroelastoma (CPFE) is reported to be the second most common cardiac neoplasm after myxoma cordis. CPFEs are histologically benign, frequently asymptomatic, but highly thrombogenic, which could lead to systemic and peripheral embolization. We present a case of a 68-year-old-patient, with a history of angioosteohypertrophy syndrome, who presented at our emergency department (ED) with symptoms of transient ischemic attacks. A thorough investigation, including echocardiography, revealed a neoplasm on the left coronary cusp (LCC) of the aortic valve. The neoplasm was resected via a valve-sparing shave via the right anterior thoracotomy (RAT). The pathological assessment confirmed it to be CPFE. CPFE is a rare but treatable cause of thromboembolism. The removal of CPFEs has classically been performed through a full median sternotomy. We like to present the first case of a valvesparing removal of a CPFE on the aortic valve through a RAT approach.

Minimally invasive resection of heart valve papillary fibroelastoma: two case reports and review of the literature

“…Our observations indicate that the utilization of a minimally invasive approach in managing PFE resulted in favorable outcomes for these two cases. In comparison to other authors, the length of hospitalization observed in our study is nearly equivalent [ 1 , 13 ]. In our experience, we posit that the optimal therapeutic approach for treating PFE in specific patient subpopulations is minimally invasive surgery.…”

“…Among these approaches, the upper hemi-sternotomy method is widely employed and considered effective [ 1 ]. Additionally, the Right Anterior Thoracotomy Approach has been reported as a successful technique for excising PFE located on the aortic valve [ 13 ]. Furthermore, some institutions employ completely endoscopic techniques, whether robotic or non-robotic, to achieve PFE removal from the aortic valve [ 12 , 17 ].…”

Minimally invasive resection of heart valve papillary fibroelastoma: two case reports and review of the literature

“…Our observations suggest that the utilization of the minimally invasive approach in the management of PFE yielded positive outcomes in these two cases. In comparison to other authors, the length of hospitalization observed in our study is nearly equivalent [1,13]. In our experience, we posit that the optimal therapeutic approach for treating PFE in speci c patient subpopulations is minimally invasive surgery.…”

“…While median sternotomy remains the predominant surgical approach, recent evidence suggests that minimally invasive techniques can provide favorable exposure and safe resection, particularly for aortic or tricuspid valve PFE, when there is no co-existing pathology necessitating open cardiac surgical intervention [1,2,6,8,[12][13][14][15]. Minimally invasive surgery offers several potential bene ts, such as improved cosmesis, decreased post-operative pain, reduced blood loss and subsequent need for transfusion, as well as shorter intensive care unit and overall hospital stay [1].…”

Giant and multiple cardiac papillary fibroelastomas masquerading as acute cerebrovascular events

“…Surgical resection has traditionally been performed using cardiopulmonary bypass via median sternotomy. Recently, minimal invasive techniques have been employed to that goal, including thoracoscopic [ 23 , 24 ] or robotic access [ 25 ].…”