Papillary fibroelastoma of the aortic valve--a case report and literature review.
The prevalence of primary cardiac tumour ranges from 0.0017-0.28% and papillary fibroelastoma is rare but not uncommon benign cardiac neoplasm. Currently, with the advent of higher-resolution imaging technology especially transoesophageal echocardiography such cases being recognized frequently. The clinical presentation of these tumours varies from asymptomatic to severe ischaemic or embolic complications. We herein, present a 50-year-old female patient with a papillary fibroelastoma of the aortic valve arising from the endocardium of the right coronary cusp very close to the commissure between the right and non-coronary cusps. The patient presented with angina-like chest pain and was investigated using echocardiography and CT angiographic modalities in addition to the usual investigations. The differential diagnosis considered was a thrombus, myxoma, Lambl's excrescence and infective vegetation. The surgical management included a prompt resection of the tumour on cardiopulmonary bypass avoiding injury to the aortic valve. The patient recovered well. A review of the literature suggests that the cardiac papillary fibroelastoma is a rare but potentially treatable cause of embolic stroke and other fatal complications, therefore, a strong suspicion; appropriate use of imaging modality, preoperative anticoagulation and urgent surgical resection is warranted. Also, possibility of this diagnosis should be kept in mind while managing cardiac or valvular tumours.
Jha
Neerod K
NK
Division of Adult Cardiac Surgery, Institute of Cardiac Sciences, Sheikh Khalifa Medical City Managed by Cleveland Clinic, PO Box-51900, Abu Dhabi-UAE. nk_jha@hotmail.com
Khouri
Michael
M
Murphy
Donogh M
DM
Salustri
Alessandro
A
Khan
Javed A
JA
Saleh
Moataz A
MA
Von Canal
Friederike
F
Augustin
Norbert
N
D001021:Aortic Valve; D003937:Diagnosis, Differential; D005260:Female; D005350:Fibroma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged