Robotic, totally endoscopic excision of mitral valve papillary fibroelastoma

Papillary fibroelastoma is a rare, benign tumor that affects males more frequently than females and that tends to be diagnosed during the fifth or sixth decade of life. It tends to arise on cardiac valves, with the aortic valve being the most frequent location followed by the mitral valve, the tricuspid valve, and the pulmonary valve. We present the case of a robotic-assisted, totally endoscopic excision of a mitral valve papillary fibroelastoma.

Case Report: A Tale of a Cardiac Mass: Looks Like a Papillary Fibroelastoma, Acts Like a Non-bacterial Thromboendocarditis

Introduction: Benign cardiac tumors and tumor like conditions are a heterogeneous collection of mass lesions that vary widely in their characteristics, such as presentation, size, and location. In some instances, these tumors are found incidentally, and therefore a broad differential diagnosis should be considered.Case: An elderly male with significant unintentional weight loss and a high risk for cancer presented with an incidental valvular cardiac mass. The mass was thought to be a non-bacterial thromboendocarditis on initial clinical evaluation. After multiple imaging modalities, the mass was suspected to be a papillary fibroelastoma (PFE), which was resected due to high stroke risk and multiple previous chronic infarcts on brain MRI.Conclusion: This case highlights the need for a comprehensive cardiac evaluation of a valvular tumor to discern the etiology and rule out other underlying pathophysiological processes that may require alternative interventions to cardiac surgery.

Left Ventricular Chord Masquerading As An Aortic Valve Papillary Fibroelastoma

Background Characterization of cardiac masses and anomalies is challenging and usually requires multimodality imaging. Herein, we present the case of a left ventricular chord masquerading as an aortic valve papillary fibroelastoma. Case summary In this case, a 62-year-old woman presented with acute right foot weakness. Brain imaging showed multiple areas of acute infarction concerning for a cardioembolic stroke. Transesophageal echocardiography revealed a mass, which was thought to be a papillary fibroelastoma, attached to the non-coronary cusp of the aortic valve. The patient underwent surgical excision of the mass which turned out to be a left ventricular chord crossing the aortic valve and attaching to the left aortic sinus of Valsalva. Conclusion This case underlines the importance of close examination of the aortic subvalvular apparatus when assessing aortic valve masses.

Cardiac Papillary Fibroelastoma Result in Acute Left Main Coronary Artery Disease: A Case Report

Background: Cardiac papillary fibroelastoma is a rare, benign primary cardiac tumor that remains asymptomatic. Severe complications have been reported in some cases. The only effective therapy is surgical excision. Case presentation: Here, we report a case of cardiac papillary fibroelastoma with the initial symptom of chest pain and a first diagnosis of acute left main coronary artery disease. This patient eventually underwent tumor excision surgery and recovered well. Conclusion: For patients with symptomatic cardiac papillary fibroelastoma, we provide a series of comprehensive data from before, during, and after surgery. This might be helpful for the future diagnosis and treatment of these tumors.

Role of imaging for diagnosis and management of aortic valve papillary fibroelastoma and cardiac AL amyloidosis: A case report

Background We report the case of a patient who presented with concomitant aortic valve papillary fibroelastoma and cardiac amyloidosis. Although histologically benign, papillary fibroelastoma confers an increased thromboembolic risk, and surgical excision is often indicated. However, outcomes of cardiac surgery are poor in patients with cardiac amyloidosis. Case summary A 61-year old man with complaints of dyspnoea and weight loss of 10 kg developing over the past five months was evaluated in the cardiology clinic. Echocardiography revealed sessile aortic valve papillary fibroelastoma and was also highly suggestive of cardiac amyloidosis. The diagnosis of amyloid light chain amyloidosis secondary to indolent multiple myeloma was eventually confirmed. Therapy with daratumumab, bortezomib, cyclophosphamide and dexamethasone allowed full remission over a six month period and resulted in marked improvement in symptoms and cardiac function as evaluated by global longitudinal strain. Further workup with cerebral magnetic resonance revealed multiple vascular sequelae. Surgical removal of the aortic fibroelastoma with bioprosthetic aortic valve replacement was performed successfully and the patient had an uneventful recovery. Discussion Papillary fibroelastoma and cardiac amyloidosis are rare and most likely unrelated entities. Concomitant presentation of both conditions in the same patient presents a unique therapeutic challenge. By allowing cardiac function to be monitored during chemotherapy, speckle tracking echocardiography can prove instrumental in determining the optimal timing of surgical intervention.

Successful interdisciplinary treatment as a rare cause of acute myocardial ischemia by intermittent tumor-associated obstruction of the left main coronary artery– A case report

Background A papillary fibroelastoma of the aortic valve has been reported as a rare cause of myocardial ischemia. An advanced combined interventional and surgical approach leading to sufficient therapy for the patient is presented in this case report. Case summary A 56-year old female patient presented in an emergency room of a hospital with an acute coronary syndrome. Over 1.5 years, recurrent stable angina had been known in the patient and significant coronary artery disease has already been ruled out in a previous coronary angiogram. The patient was immediately transferred to the catheter laboratory due to cardiogenic shock where a drug-eluting stent was implanted to, firstly, recanalize the left main coronary artery and, secondly, to protect the left main ostium from obstruction by an echocardiographic-proven mass. During subsequent deterioration of hemodynamics caused by decreasing left ventricular function and acute severe mitral insufficiency, firstly an intra-aortic balloon pump and secondly a VA-ECMO was established through the femoral vessels. The patient was transferred to our cardiac surgery unit and was successfully operated utilizing a valve-sparing technique by extracting the tumor mass from the left coronary cusp and extracting the stent carefully from the left main coronary artery. Histology revealed a papillary fibroelastoma (Figure 4). Conclusion A papillary fibroelastoma of the aortic valve with intermittent obstruction of the coronary arteries requires surgical therapy. Interventional recanalization and extracorporeal support might be useful strategies to ensure the patient’s safety as a bridge to surgery.