Transapical Left Ventricular Approach for Cardiac Papillary Fibroelastomas: A Case Report

Abstract

Background/Aim: Cardiac papillary fibroelastomas (CPF) are benign tumors, frequently asymptomatic, characterized by a mobile pedunculated mass that arises from the endocardium. When CPF is located in the left ventricle, it may protrude into the left ventricular outflow tract and affect hemodynamics. They are highly thrombogenic, and can also cause some life-threatening events such as cerebral and peripheral embolization. Case Report: We herein report a case of a 74-year-old female admitted to our center with palpitations and dyspnea on exertion. Her past medical history revealed that she had had a transient ischemic attack 7 months before presentation. Echocardiography and cardiac magnetic resonance imaging revealed an intracardiac mass anchored in the anteroapical interventricular septum without interference with aortic or mitral valve functionality. Surgical resection of the left ventricular mass was performed through the left apical ventriculotomy approach. Histopathological examination of the tumor was suggestive of papillary fibroelastoma. The postoperative course was uneventful. The patient was discharged home on the eighth postoperative day, with no recurrence at 6 months. Conclusion: Although left ventricular papillary fibroelastomas are benign tumors, they carry a high risk for embolic complications and therefore surgery should be proposed, the transapical approach being a safe and effective method.

Very Mobile Left Ventricular Outflow Tract Papillary Fibroelastoma Presenting with Multiple Ischemic Strokes

“…PFs are rare cardiac tumors composed of collagen and elastic fibers, layered with endothelium. [ 4 ] They are mostly located (>80%) on valvular surfaces,[ 5 ] more commonly on left side cardiac valves (44% on the aortic valve and 35% on the mitral valve);[ 6 ] therefore, in the present knowledge, PFs arising from LVOT are rare and mostly anecdotally descripted. [ 6 ]…”