Papillary fibroelastomas: innocent bystanders or ignored culprits?
Cardiac papillary fibroelastomas (PFEs) are the most common tumors of the cardiac valves and the third most common cardiac tumor. They are usually detected accidentally on echocardiography, but have the potential to manifest with catastrophic embolic phenomena, resulting in stroke and myocardial infarction. Echocardiography is currently the preferred diagnostic modality, while magnetic resonance imaging and computed tomography are helpful in the differential diagnosis of cardiac tumors. The management of PFEs is empiric, as no large randomized trials have been conducted to support specific treatment guidelines. The treatment of choice for PFEs with high-risk features for peripheral embolization is surgical resection. Anticoagulation is recommended in patients who are poor surgical candidates or who refuse surgery, although its duration and intensity are debatable. This review summarizes current knowledge on the epidemiology, pathology, pathophysiology, clinical manifestations, diagnosis, and treatment of PFEs. It also highlights the need for large randomized clinical trials that would delineate more specific guidelines for managing PFEs with anticoagulation.
Saloura
Vassiliki
V
Department of Internal Medicine, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, USA.
Grivas
Petros D
PD
Sarwar
A Bilal
AB
Gorodin
Paulina
P
Ledley
Gary S
GS
D006348:Cardiac Surgical Procedures / Q000379:methods; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D004695:Endocardial Fibroelastosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D010212:Papilloma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods