Fibroelastoma of the Mitral Valve As a Cause of Transient Ischemic Stroke (original) (raw)

Cardiac papillary fibroelastoma of the mitral valve chordae

European Journal of Cardio-Thoracic Surgery, 1998

Papillary fibroelastomas are rare, benign, primary cardiac tumors, usually single and small. The neoplasm consists of a leafy, soft excrescence typically located on the cardiac valves. Although papillary fibroelastomas are usually an asymptomatic incidental finding at autopsy, or during cardiac operation, they are occasionally associated with embolic coronary or cerebral symptoms. A case of a patient is reported with papillary fibroelastoma of the mitral valve chordae, who presented several transitory ischemic attacks characterized by loss of conscience, visual bilateral deficit and right emiparesis. Because of their potential systemic embolization, we believe that these lesions should be always excised.

Cardiac Papillary Fibroelastoma and Stroke in a Young Man – Etiology and Treatment

Cerebrovascular Diseases, 2008

Stroke Notes activities, rheumatoid factor, antinuclear antibody, anticardiolipin antibody and serum VDRL was negative. Chest radiography and electrocardiogram showed no remarkable findings. A transthoracic echocardiogram revealed a mobile mass attached to the chordae of the mitral valve. The transesophageal echocardiogram confirmed the presence of a 2 ! 2 mm pedunculated mobile round mass, attached to the chordae of the posterior leaflet of the mitral valve, the appearance of which was consistent with CPF (fig. 2). Heart MRI was then obtained to characterize the tissue tumor. It demonstrated a round tumor with signal intensity similar to the cardiac muscle on T 1-and T 2-weighted sequences consistent with the presumptive diagnosis of CPF rather than a myxoma (fig. 3). There were neither valve abnormality, intracavitary thrombus, septal defects nor mitral regurgitation. Surgical excision of the tumor was initially proposed as firstchoice treatment. However, due to the intimate relationship between tumor and mitral chordae, the possible need of valvar replacement could not be ignored. The patient refused to undergo surgery, and, alternatively, he has received oral anticoagulation therapy with sodium warfarin. Along a 48-month follow-up period, the International Normalized Ratio varied between the therapeutic interval of 2 and 3. Cardiac function remained stable, and neurological deficits improved slowly (current modified Rankin scale and Barthel index scores both 1); the patient has returned to his daily activities. Control brain MRI after 48 months did not reveal any new asymptomatic infarct lesion (fig. 4).

Papillary fibroelastoma of the mitral valve with systemic embolization

…, 2000

Primary tumors of the heart are rare disorders. In autopsy studies, their incidence was reported to be 0.01-0.5%. We present the case of a papillary fibroelastoma of the mitral valve with systemic embolization in a young man. (ECHOCARDIOGWHY, Volume 17, February 2000) papillary fibroelastoma, mitral valve, echocardiography We present the case of a papillary fibroelastoma of the mitral valve with systemic embolization in a young man. Case Report A 21-year-old man who was previously asymptomatic was admitted to our hospital neurology clinic with the complaint of weakness of his left extremities. His physical examination was normal except for weakness of his left extremity muscles. He was hospitalized, and a computed tomography scan of the head was performed, which revealed a n area of infarct in the right portion of the brain. He was referred to the cardiology department. Transthoracic echocardiography was performed to search for a source of systemic embolization echocardiography (Figs. 1 and 2). A mobile mass with a diameter of 1.5 cm was revealed on the atrial aspect of the anterior mitral leaflet. On the apical four-chamber view, the mass appeared to have the shape of a ball. Transesophageal echocardiography was

Cardiac papillary fibroelastoma as a reason of transient ischemic attack for a young patient

International Journal of Cardiology, 2008

Cardiac papillary fibroelastoma is a rare primary cardiac tumor. It occurs mainly in the endothelium of cardiac valves. Although cardiac papillary fibroelastomas are benign tumors, they have potential life threatening complications such as sudden death, stroke, and myocardial infarction. A young man who presented two syncope attacks referred to our hospital for cardiac examination. A mass was found attached to the anterior mitral leaflet, detected by transthoracic echocardiography. We planned an urgent surgery for the patient. During operation, we found out the cauliflower shaped mass on the atrial side of the anterior mitral leaflet. We excised the tumor completely without damage to the mitral valve. We confirmed the diagnosis histopathologically. Intracardiac tumors must be excised urgently due to severe complications. It's so important to protect native valve leaflets during the excision of papillary fibroelastoma with low rates of recurrence.

Mitral valve papillary fibroelastoma as a cause of acute coronary syndrome

BMJ Case Reports, 2018

A 37-year-old man presented with acute chest pain, an unremarkable ECG and mildly elevated cardiac troponin. Coronary CT angiography showed a calcium score of 0 together with the absence of atherosclerotic plaques and normal origin and course of the coronary arteries. Transthoracic and transoesophageal echocardiography revealed an infracentimetric round-shaped mobile mass attached to a secondary tendinous chord of the anterior mitral valve leaflet. Cardiac magnetic resonance further evidenced localised contrast uptake supporting vascular irrigation, making thrombus unlikely. After surgical excision, the patient had an uneventful postoperative course. Histopathology disclosed the typical collagenous matrix covered by a single cell layer. Although mostly benign, cardiac tumours are prone to embolisation and can thus mimic an acute coronary syndrome. Multimodality imaging has an important role in unmasking the true mechanism, revealing less common aetiologies and elucidating the possib...

Tumor Excision Versus Valve Replacement for Papillary Fibroelastoma Involving the Mitral Valve

The American Journal of Cardiology, 2006

We recently encountered a young man who had 3 strokes and a mass found by echocardiography on his mitral valve, which as a consequence was replaced. The tumor both grossly and histologically was a classic papillary fibroelastoma (PF). The patient's condition stimulated a discussion regarding whether excision of the PF or replacement of the valve containing it might be the preferred procedure. In an attempt to answer the question posed, patients previously reported in an English publication since the first mitral valve operation for PF involving an otherwise normal valve were reviewed.

Cardiac papillary fibroelastoma: experience of an institution

2005

Primary intracardiac tumors are rare, with prevalence between 0.0017% and 0.19% from non-selected autopsy studies. Approximately 75% are benign and almost half of them are myxomas. The remaining tumors are divided among rabdomyomas, lipomas and fibroelastomas. Myxomas are the most common intracardiac tumors in adult age and rabdomyomas the most common among pediatric population. Papillary fibroelastoma (PFE) is a relative rare benign heart tumor, corresponding to approximately 8% of intracardiac tumors. They most commonly manifested in cardiac valves 1 . In the past, they either consisted of

Papillary fibroelastoma situated in the subvalvular structure of the mitral valve

Turkish Journal of Thoracic and Cardiovascular Surgery, 2013

Cardiac papillary fibroelastomas (CPFs) are rare tumors. [1] They are the third most common primary cardiac tumor, following myxomas and lipomas, and the most common primary valvular tumor. [2-5] They usually occur on the left side of the heart, especially on the aortic valve. [6] However, involvement of the subvalvular structure of the mitral valve is uncommon. Although CPFs are benign in nature, they can cause severe thromboembolic complications regardless of the tumor size. [1,3,5,7,8] Therefore, surgical treatment is recommended to prevent this from happening. [2,4] Here we report a patient with papillary fibroelastoma of the subvalvular structure of the mitral valve that was treated surgically.

Echocardiographic diagnosis of papillary fibroelastoma of the mitral and tricuspid valve apparatus

Clinical Cardiology, 1997

Papillary fibroelastomas are rare and normally benign cardiac tumors typically attached to cardiac valves. This report describes two patients who were evaluated for intermittent dyspnea in one case and for the source of cerebral embolism in the other. In both patients transthoracic echocardiography revealed a pedunculated mobile mass adjacent to an atrioventricular valve, suggestive of papillary fibroelastoma. Postoperative histology was confirmatory of papillary fibroelastoma with a typical hyalinized hypocellular stroma covered by a single layer of endocardial cells.

Papillary fibroelastoma of the aortic valve- a case report and literature review

Journal of Cardiothoracic Surgery, 2010

The prevalence of primary cardiac tumour ranges from 0.0017-0.28% and papillary fibroelastoma is rare but not uncommon benign cardiac neoplasm. Currently, with the advent of higher-resolution imaging technology especially transoesophageal echocardiography such cases being recognized frequently. The clinical presentation of these tumours varies from asymptomatic to severe ischaemic or embolic complications. We herein, present a 50year-old female patient with a papillary fibroelastoma of the aortic valve arising from the endocardium of the right coronary cusp very close to the commissure between the right and non-coronary cusps. The patient presented with angina-like chest pain and was investigated using echocardiography and CT angiographic modalities in addition to the usual investigations. The differential diagnosis considered was a thrombus, myxoma, Lambl's excrescence and infective vegetation. The surgical management included a prompt resection of the tumour on cardiopulmonary bypass avoiding injury to the aortic valve. The patient recovered well. A review of the literature suggests that the cardiac papillary fibroelastoma is a rare but potentially treatable cause of embolic stroke and other fatal complications, therefore, a strong suspicion; appropriate use of imaging modality, preoperative anticoagulation and urgent surgical resection is warranted. Also, possibility of this diagnosis should be kept in mind while managing cardiac or valvular tumours.