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Stiru O, Geana RC, Dragulescu PR, Tulin A, Raducu L, Bacalbasa N, Balescu I, Cretoiu D, Diaconu C, Iliescu L, Savu C, Iliescu VA. Transapical Left Ventricular Approach for Cardiac Papillary Fibroelastomas: A Case Report. In Vivo 2021; 34:3681-3685. [PMID: 33144485 DOI: 10.21873/invivo.12216] [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: 08/16/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- Ovidiu Stiru
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Carmen Geana
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | | | - Adrian Tulin
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Prof. Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Laura Raducu
- Department of Plastic and Reconstructive Microsurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, Prof Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania .,Department of Obstetrics and Gynecology, I. Cantacuzino Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | - Dragos Cretoiu
- Department of Cellular, Molecular and Histology Biology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Scientific researcher, Alessandrescu-Rusescu National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Laura Iliescu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Cornel Savu
- Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Thoracic Surgery, Marius Nasta Institute of Pneumonology, Bucharest, Romania
| | - Vlad Anton Iliescu
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Arikan AA, Omay O, Aydın F, Kanko M, Gür S, Derviş E, Yılmaz CE, Müezzinoğlu B. Aortic valve replacement for papillary fibroelastoma. J Card Surg 2017; 32:347-354. [PMID: 28508532 DOI: 10.1111/jocs.13154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve-sparing techniques in patients with PFE.
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Affiliation(s)
- Ali Ahmet Arikan
- Muş State Hospital, Department of Cardiovascular Surgery, Muş, Turkey
| | - Oğuz Omay
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Fatih Aydın
- Eskişehir State Hospital, Departement of Cardiology, Eskişehir, Turkey
| | - Muhip Kanko
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Sibel Gür
- Kocaeli University Medical Faculty, Department of Cardiovascular Surgery, Kocaeli, Turkey
| | - Emir Derviş
- Kocaeli University Medical Faculty, Departement of Cardiology, Kocaeli, Turkey
| | - Cansu Eda Yılmaz
- Kocaeli University Medical Faculty, Departement of Pathology, Kocaeli, Turkey
| | - Bahar Müezzinoğlu
- Kocaeli University Medical Faculty, Departement of Pathology, Kocaeli, Turkey
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Sato M, Nagaya K, Hatakeyama M, Komatsu T. Multiple papillary fibroelastoma: report of a case and implications for management. Gen Thorac Cardiovasc Surg 2013; 62:122-4. [PMID: 23609481 DOI: 10.1007/s11748-013-0249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 04/07/2013] [Indexed: 12/01/2022]
Abstract
A 59-year-old woman with chest discomfort was transferred to our hospital. Echocardiography was suggestive of multiple papillary fibroelastoma (PFE). Tumors on both the left and right coronary cusps were confirmed macroscopically and pathologically and a small tumor was noted microscopically on the non-coronary cusp. Aortic valve replacement was successfully performed. The treatment and recurrence rate of PFE is controversial due to its rarity. Given that multiple tumors were seen in the present case and that possible recurrence has been reported elsewhere, valve replacement may be a better choice for surgical repair than valvoplasty in some cases, such as a single PFE in which plasty may be difficult or multiple PFEs regardless of impaired valve function.
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Affiliation(s)
- Mitsuru Sato
- Division of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-tsukurimichi, Aomori, Aomori, 030-0913, Japan,
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Kim SY, Park TH, Lee DY, Lee DH, Cho YR, Kim MH, Kim YD, Hong SH. Papillary fibroelastoma mimicking vegetation of the mitral valve. J Cardiovasc Ultrasound 2013; 20:213-5. [PMID: 23346294 PMCID: PMC3542518 DOI: 10.4250/jcu.2012.20.4.213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/17/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022] Open
Abstract
Although cardiac papillary fibroelastoma is rare, it is the most common primary tumor of cardiac valves. The clinical presentation of these tumors varies from asymptomatic to embolic complications. We report an asymptomatic case of papillary fibroelastoma of mitral valve which was diagnosed by transthoracic echocardiography. The tumor was successfully resected by surgery.
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Affiliation(s)
- Su Young Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Le Tourneau T, Betto M, Richardson M, Juthier F, Ennezat PV, Polge AS, Bauters C, Vincentelli A, Deklunder G. Prospective assessment of multiple cardiac papillary fibroelastomas. Int J Cardiol 2010; 145:319-320. [DOI: 10.1016/j.ijcard.2009.11.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/29/2009] [Indexed: 11/24/2022]
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Vizzardi E, Faggiano P, Antonioli E, Zanini G, Chiari E, Nodari S, Cas LD. Thrombus or tumor? a case of fibroelastoma as indicated during the submission process. CASES JOURNAL 2009; 2:31. [PMID: 19133150 PMCID: PMC2647911 DOI: 10.1186/1757-1626-2-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 01/08/2009] [Indexed: 11/10/2022]
Abstract
We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 x 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.
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Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Disease, Department of Applied Experimental Medicine, Brescia University, Brescia, Italy.
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Hino H, Miyairi T, Kitamura T, Miura S, Kigawa I, Fukuda S. Papillary fibroelastoma of the left ventricle: report of two cases. Asian Cardiovasc Thorac Ann 2007; 15:e72-4. [PMID: 18042764 DOI: 10.1177/021849230701500628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Papillary fibroelastoma is a relatively rare cardiac tumor. We report two cases of papillary fibroelastoma. The first case involved a 45-year-old woman who presented with rheumatic valves and three tumors developing from the papillary muscle and left ventricle. The second case involved a 68-year-old man who was asymptomatic and whose tumor was detected incidentally on echocardiogram. Both cases were treated surgically. An additional 71 cases of papillary fibroelastoma reported in the medical literature in Japan are reviewed.
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Affiliation(s)
- Haruaki Hino
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
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Sugiyama H, Naito H, Tsukano S, Echigo S, Kamiya T. Evaluation of Cardiac Tumors in Children by Electron-Beam Computed Tomography Rhabdomyoma and Fibroma. Circ J 2005; 69:1352-6. [PMID: 16247210 DOI: 10.1253/circj.69.1352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The most common cardiac tumors in young children are rhabdomyoma and fibroma, and prognosis depends on the tumor's characteristics. In the present study electron-beam computed tomography (EBT) was used to evaluate tumor characteristics and myocardial perfusion in 6 children with cardiac tumors. METHODS AND RESULTS Five children had rhabdomyomas and 1 had a fibroma. In the precontrast study, the computed tomography numbers of rhabdomyomas were higher and those of the fibroma were slightly lower than those of the normal myocardium. In the early postcontrast study, the size, location, shape and number of the tumor were clearly detected, and in the late postcontrast study, the fibrous characteristics of the tumor were seen. The fibroma contained calcification and 2 rhabdomyomas contained a fat density spot. In the cine-mode study, both the tumor and ventricular wall motion could be simultaneously evaluated. There was a filling defect of the left ventricular myocardium on the early postcontrast scan of 1 child with a rhabdomyoma and dyskinetic wall motion at the same region in the cine-mode study. CONCLUSION EBT was useful for evaluating tumor characteristics in children.
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Affiliation(s)
- Hisashi Sugiyama
- Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.
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