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Butt N, Gulab A, Yook JH, Alsaray IAF, Chhabra L. Ascending Aortic Wall Fibroelastoma in an Elderly Woman with Dyspnea. Methodist Debakey Cardiovasc J 2022; 18:23-28. [PMID: 35855402 PMCID: PMC9248980 DOI: 10.14797/mdcvj.1081] [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] [Received: 01/06/2022] [Accepted: 03/30/2022] [Indexed: 11/08/2022] Open
Abstract
Aortic fibroelastoma is an uncommon pathology that is often found incidentally on routine cardiac imaging. The use of multimodality imaging including computerized tomography and magnetic resonance imaging has led to discovery of further distinguishing features of these lesions that may allow improved differentiation from aortic thrombi. Although most are located on cardiac valves, nonvalvular fibroelastomas have been seen on occasion. Optimal diagnosis and management of incidental aortic fibroelastomas remains debated. We describe a case of nonvalvular aortic fibroelastoma and review current diagnostic and management approaches.
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Affiliation(s)
| | - Asma Gulab
- Einstein Medical Center, Philadelphia, Pennsylvania, US
| | - Ji Hyun Yook
- Shanghai Medical College of Fudan University, Shanghai, CN
| | | | - Lovely Chhabra
- Mid-Hudson Regional Hospital, Poughkeepsie, New York, US
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Lak HM, Kerndt CC, Unai S, Maroo A. Cardiac papillary fibroelastoma originating from the coumadin ridge and review of literature. BMJ Case Rep 2020; 13:13/8/e235361. [PMID: 32847879 DOI: 10.1136/bcr-2020-235361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Papillary fibroelastomas represent the second most common benign cardiac tumour, secondary only to cardiac myxoma. A majority of patients are asymptomatic on presentation. The most common clinical manifestations include stroke, transient ischaemic attack, myocardial infarction and angina. Echocardiography remains the primary imaging modality for identification of these tumours. The majority of papillary fibroelastomas arise from the valves. Simple surgical excision is the mainstay of treatment, carrying an excellent prognosis. We present an unusual case of cardiac papillary fibroelastoma originating from the coumadin ridge (CR) in a 70-year-old woman. The patient exhibited increasing paroxysms of her atrial fibrillation and was pursuing a MAZE procedure. Preoperatively, a transesophageal echocardiogram revealed a 0.7×1 cm intracardiac mass that had echocardiographic appearance of a fibroelastoma. Surgical resection and MAZE procedures were performed. The gross specimen and histopathology findings were consistent with papillary fibroelastoma. This case reports the seventh documented case of fibroelastoma originating from the CR.
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Affiliation(s)
| | | | - Shinya Unai
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anjli Maroo
- Cardiovascular Medicine, Fairview Hospital, Cleveland, Ohio, USA
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de Klerk S, Dogon C, Grossman M, Adler JE, McFalls J, Furukawa S, Goldberg S. Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion. ACTA ACUST UNITED AC 2020; 4:278-282. [PMID: 32875195 PMCID: PMC7451855 DOI: 10.1016/j.case.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A patient presented with reduced effort tolerance and abnormal stress test. He was subsequently found to have a left ventricular mass. Multimodal imaging was utilized; however, diagnostic certainty remained limited. Cardiac surgery was pursued, wherein a single left ventricular mass was resected. Biopsy was consistent with cardiac papillary fibroelastoma. On follow-up, the patient reported a return to prior functioning.
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Affiliation(s)
- Storm de Klerk
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Calli Dogon
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Moshe Grossman
- Department of Radiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy E Adler
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeanne McFalls
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Satoshi Furukawa
- Cardiovascular Surgery, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Sheldon Goldberg
- Cardiovascular Education, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Casavecchia G, Gravina M, Zicchino S, Moranti E, Cuculo A, Macarini L, Di Biase M, Brunetti ND. Tricuspid Papillary Fibroelastoma at Multimodal Imaging. J Cardiovasc Echogr 2019; 28:236-238. [PMID: 30746328 PMCID: PMC6341851 DOI: 10.4103/jcecho.jcecho_48_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Papillary fibroelastoma is a rare benign cardiac tumor, second after cardiac myxoma as more frequent cardiac valvular tumor. The therapy is usually based on surgery according to size, mobility, symptoms, and risks of surgery. We report the case of a 67-year old female with transient ischemic attack. Echocardiography showed the presence of a round mobile formation localized on the atrial side of septal leaflets of tricuspid valve, first identified as an endocarditis vegetation. Cardiac magnetic resonance (cMRI) confirmed the presence of the mass and showed an isointense signal in T1-turbo spin echo sequences, hypointense in cine steady-state free precession and in first-pass sequences, and hyperintense in T2 and phase-sensitive inversion recovery with central hypointense core, with a suspected diagnosis of fibroelastoma. The patient underwent cardiac surgery and histology confirmed the presence of fibroelastic tissue with papillary extroflexions compatible with diagnosis of fibroelastoma. The use of cMRI may be useful in the evaluation of the exact position, dimensions, and nature of cardiac masses and fibroelastomas, diagnostic workup, and preliminary assessment before surgery.
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Affiliation(s)
- Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Gravina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Zicchino
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Luca Macarini
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Sousa-Uva M, Cardim N. Cardiac papillary fibroelastoma: So small and yet so dangerous. Rev Port Cardiol 2018; 37:987-989. [PMID: 30545746 DOI: 10.1016/j.repc.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Carnaxide, Portugal; Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Nuno Cardim
- Serviço de Cardiologia, Departamento de Imagiologia Cardíaca Hospital da Luz, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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Cardiac papillary fibroelastoma: So small and yet so dangerous. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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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Aortic root fibroelastoma causing cardiac ischemia. J Cardiovasc Comput Tomogr 2017; 12:90-91. [PMID: 28917492 DOI: 10.1016/j.jcct.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 09/09/2017] [Indexed: 11/22/2022]
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Hilker FM, Paliaga M, Venturino E. Diseased Social Predators. Bull Math Biol 2017; 79:2175-2196. [PMID: 28795325 DOI: 10.1007/s11538-017-0325-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
Social predators benefit from cooperation in the form of increased hunting success, but may be at higher risk of disease infection due to living in groups. Here, we use mathematical modeling to investigate the impact of disease transmission on the population dynamics benefits provided by group hunting. We consider a predator-prey model with foraging facilitation that can induce strong Allee effects in the predators. We extend this model by an infectious disease spreading horizontally and vertically in the predator population. The model is a system of three nonlinear differential equations. We analyze the equilibrium points and their stability as well as one- and two-parameter bifurcations. Our results show that weakly cooperating predators go unconditionally extinct for highly transmissible diseases. By contrast, if cooperation is strong enough, the social behavior mediates conditional predator persistence. The system is bistable, such that small predator populations are driven extinct by the disease or a lack of prey, and large predator populations survive because of their cooperation even though they would be doomed to extinction in the absence of group hunting. We identify a critical cooperation level that is needed to avoid the possibility of unconditional predator extinction. We also investigate how transmissibility and cooperation affect the stability of predator-prey dynamics. The introduction of parasites may be fatal for small populations of social predators that decline for other reasons. For invasive predators that cooperate strongly, biocontrol by releasing parasites alone may not be sufficient.
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Affiliation(s)
- Frank M Hilker
- Institute of Environmental Systems Research, School of Mathematics/Computer Science, Osnabrück University, Osnabrück, Germany.
| | - Marta Paliaga
- Scuola Politecnica, DIID, University of Palermo, Palermo, Italy
| | - Ezio Venturino
- Department of Mathematics, "Giuseppe Peano", University of Torino, Turin, Italy
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