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Phan TQ, Pham CTV, Bui VDA, Ho TD, Le TN, Nguyen TVT, Nguyen D, Vuong MN, Nguyen DH. Minimally invasive resection of heart valve papillary fibroelastoma: two case reports and review of the literature. J Cardiothorac Surg 2023; 18:320. [PMID: 37957673 PMCID: PMC10641953 DOI: 10.1186/s13019-023-02392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cardiac papillary fibroelastomas are rare, accounting for approximately 10% of all cardiac tumors, with 44% of cases located on the aortic valve and only 15% of cases located on the tricuspid valve. However, the optimal management of papillary fibroelastomas remains varied. CASE PRESENTATION We present two successful instances of treating heart valve papillary fibroelastomas through minimally invasive surgery. These cases involved heart valve papillary fibroelastomas located in two common sites: the aortic valve on the left heart, which was accessed via an upper hemi-sternotomy, and the tricuspid valve on the right heart, which was accessed via beating heart total thoracoscopy. CONCLUSION The article consistently demonstrates the effectiveness of a minimally invasive surgical approach in managing heart valve papillary fibroelastomas. This study provides further evidence by presenting two cases of heart valve papillary fibroelastomas - one on the aortic valve and the other on the tricuspid valve - that were successfully treated using this approach, resulting in favorable outcomes.
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Affiliation(s)
- Thuan Q Phan
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chuong T V Pham
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vinh D A Bui
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Chi Minh City, Vietnam
| | - Thang D Ho
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thao N Le
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh V T Nguyen
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, MA, USA
| | - Minh N Vuong
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dinh H Nguyen
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Chi Minh City, Vietnam.
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2
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Mitchell KG, Podgorsek B, Fiorito DE, Abreu JA, Ramzy D. Robot-Assisted Resection of Left Ventricular Papillary Fibroelastoma Arising From the Mitral Chordal Apparatus. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:100-102. [PMID: 36782085 PMCID: PMC10119374 DOI: 10.1177/15569845231152891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The application of robot-assisted thoracoscopy to cardiac surgery affords an opportunity to leverage the exceptional intraoperative exposure, visualization, and dexterity of the robotic platform. Here, we report the case of a 72-year-old woman who presented to our institution for evaluation of a left ventricular mass that was identified following workup for an embolic event. We present an intraoperative video that provides technical details of the robot-assisted resection of the lesion, which was found to be a left ventricular papillary fibroelastoma arising from the mitral chordal apparatus. This case highlights the advantages provided by the robotic platform, which permitted complete, minimally invasive surgical excision of the lesion while minimizing the burden of surgical trauma.
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Affiliation(s)
- Kyle G Mitchell
- Department of Cardiothoracic and Vascular Surgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Blaz Podgorsek
- Department of Cardiothoracic and Vascular Surgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Diego E Fiorito
- Department of Pathology, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Juan A Abreu
- Department of Cardiothoracic and Vascular Surgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Danny Ramzy
- Department of Cardiothoracic and Vascular Surgery, University of Texas McGovern Medical School, Houston, TX, USA
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3
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Batool S, Patoir A, de Meaux A, Vola M. Totally endoscopic non-robotic excision of aortic valve fibroelastoma: a case report. J Cardiothorac Surg 2022; 17:292. [PMCID: PMC9675282 DOI: 10.1186/s13019-022-02040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Papillary fibroelastomas (PFEs) are a rare subtype of benign primary cardiac tumours, which are most commonly found on the aortic valve. Although median sternotomy is still used frequently there has been different attempts to remove the aortic valve PFEs minimally invasively using robotic and Mini sternotomy approach. Case presentation We report herein a case of totally endoscopic non robotic removal of PFE of aortic valve. Conclusions The encouraging intra and post-operative outcomes and fast recovery using totally endoscopic approach for removal of PFE shows the potential benefits of this technique. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-02040-0.
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Affiliation(s)
- Sadia Batool
- grid.413858.3Department of Cardiac Surgery and Lung and Heart Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Arnaud Patoir
- grid.413858.3Department of Thoracic Surgery and Lung Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Amelie de Meaux
- grid.413858.3Echocardiography Unit, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Marco Vola
- grid.413858.3Department of Cardiac Surgery and Lung and Heart Transplantation, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
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Abdallah H, El Boghdadi S, Ibrahim A, Moursi I, Alkhamees K. Uncommon Location of a Papillary Fbroelastoma: Case Report. CJC Open 2020; 3:121-123. [PMID: 33458640 PMCID: PMC7801223 DOI: 10.1016/j.cjco.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/30/2020] [Indexed: 11/24/2022] Open
Abstract
An elderly man, with a history of diabetes and hypertension presented to our hospital complaining of attack of syncope and palpitations. Echocardiogram revealed the presence of a pedunculated mass attached to the interventricular septum. Sternotomy was performed and ascending aorta was opened transversely, aortic valve leafets were retracted, and a tumour was resected. The postoperative course was uneventful; the patient was discharged after 1 week from the operation. This case demonstrates atypical location for fibroelastoma on the interventricular septum, thus underpinning the need for proper assessment of all patients with a history of systemic embolization to rule out any unusual intracardiac causes.
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Affiliation(s)
- Hassane Abdallah
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Sherif El Boghdadi
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ahmed Ibrahim
- Department of Research and Biostatistics, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ihab Moursi
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
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Hirota M, Ito F, Watanabe M, Isomura T, Endo M. Minimally invasive approach for an adult patient with papillary fibroelastoma: reversed C-shaped partial sternotomy. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Topal B, Hindori V, Pouwels S, Riezebos R. The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve. Cureus 2020; 12:e7136. [PMID: 32257681 PMCID: PMC7105234 DOI: 10.7759/cureus.7136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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 valve-sparing removal of a CPFE on the aortic valve through a RAT approach.
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Affiliation(s)
- Besir Topal
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | - Vikash Hindori
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | | | - Robert Riezebos
- Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
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Dénes S, Daron B, Behaeghe M, Seghaye MC. Cardiac papillary fibroelastoma of a bicuspid aortic valve in an adolescent: A case report. Clin Pract 2019; 9:1135. [PMID: 31579491 PMCID: PMC6766684 DOI: 10.4081/cp.2019.1135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023] Open
Abstract
Cardiac papillary fibroelastomas (CPFE) are exceptional primary benign cardiac tumours affecting the heart valves. We report here the case of a 15-year-old boy in whom echocardiography performed for non-specific chest pain during follow-up for bicuspid aortic valve showed as accidental finding the presence of a round mobile mass without stalk attached on the inferior side of the aortic valve. The mass did not cause any outflow tract obstruction or aortic insufficiency. Electrocardiogram-gated cardiac computed tomography and magnetic resonance imaging allowed to suspect CPFE. Although the patient was asymptomatic, open cardiac surgery with elective surgical resection of the tumour was performed to avoid systematic emboli. Histology confirmed the diagnosis of CPFE. This is an exceptional case of acquired CPFE in a young patient with bicuspid aortic valve. Due to the risk of systemic embolization, aortic or coronary ostium obstruction, elective excision of such lesions is recommended.
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Affiliation(s)
- Sarah Dénes
- Pediatric Cardiology, Department of Pediatrics, University Hospital of Liège
| | - Benoît Daron
- Department of Pediatrics, Regional Hospital Verviers
| | - Marie Behaeghe
- Department of Anatomic Pathology, University Hospital of Leuven, Belgium
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Gonçalves M, Tralhão A, Trabulo M, Madeira M. Mitral valve papillary fibroelastoma as a cause of acute coronary syndrome. BMJ Case Rep 2018; 11:11/1/bcr-2018-226930. [PMID: 30567172 DOI: 10.1136/bcr-2018-226930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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 possibility of curative surgical resection.
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Affiliation(s)
- Mariana Gonçalves
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - António Tralhão
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Marisa Trabulo
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Márcio Madeira
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
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Souaf-Khalafi S, Narváez-Muñoz AF, Duran-Muñoz D, Fernández-García A. Un caso infrecuente de fibroelastoma papilar. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Sharma R, Golian M, Shah P, Jassal DS, Shaikh N. Multimodality cardiac imaging of a left ventricular papillary fibroelastoma: a case report. BMC Res Notes 2017; 10:25. [PMID: 28061883 PMCID: PMC5219654 DOI: 10.1186/s13104-016-2323-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/07/2016] [Indexed: 11/11/2022] Open
Abstract
Background In the setting of an acute myocardial infarction (AMI), although the most common etiology of a left ventricular (LV) mass identified on multimodality cardiovascular imaging is a thrombus, other possibilities including a vegetation or tumor should be entertained within the differential diagnosis. Case presentation We describe a case of a 43-year-old Caucasian female post AMI diagnosed with a mid-cavitary mass within the LV. Although echocardiography and cardiovascular MRI (CMR) suggested that the mass was a thrombus, given the context of the recent AMI, exploration and surgical excision was completed by the surgeon due to the potential for the mass to embolize. Conclusion The final diagnosis of a papillary fibroelastoma was unique due to its unusual location and large size within the LV cavity. This unique case demonstrates shortcomings of multimodality cardiac imaging in the diagnosis of an atypical mass and the importance of obtaining tissue when clinically safe and feasible.
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Affiliation(s)
- Rajat Sharma
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6
| | - Mehrdad Golian
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6
| | - Pallav Shah
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6. .,Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6. .,Institute of Cardiovascular Sciences, St. Boniface Albrechtsen Research Centre, University of Manitoba, 351 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6.
| | - Nasir Shaikh
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6
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11
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Papillary fibroelastoma of the right ventricular free wall. Case Rep Surg 2014; 2014:654641. [PMID: 25258692 PMCID: PMC4166618 DOI: 10.1155/2014/654641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/27/2014] [Indexed: 11/17/2022] Open
Abstract
Papillary fibroelastoma is a rare benign cardiac tumor that usually arises from the valvular endocardium and its development in the cardiac chambers is extremely rare. A 52-year-old woman complained of palpitations and echocardiography revealed a cardiac tumor. Resection was performed via the right ventricle and main pulmonary artery under cardiopulmonary bypass. Histological examination of the resected tumor showed that it was a papillary fibroelastoma. The patient's postoperative course was unremarkable and no complications have been detected on followup.
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