title: Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas.
abstract: BACKGROUND
  Papillary fibroelastomas (PFE) are benign neoplasms with little available outcome data.
  
  
  OBJECTIVE
  This study sought to describe the frequency and clinical course of patients with surgically removed PFE and echocardiographically suspected, but unoperated, PFE.
  
  
  METHODS
  Mayo Clinic pathology and echocardiography databases (January 1, 1995, to December 31, 2010) were queried, resulting in 511 patients: group 1 (n = 185), including patients with surgically removed, histopathologically confirmed PFE; group 1a (n = 94; 51%) with PFE removed at primary surgery; and group 1b (n = 91; 49%) with PFE removal at time of another cardiac surgery. Group 2 (n = 326) patients had echocardiographic evidence of PFE but no cardiac surgery to remove PFE.
  
  
  RESULTS
  Group 1 had mean age of 63 ± 14 years (116 women [63%]). During the study period, we identified 112 cardiac myxomas in the pathology database and 142 in the echocardiographic database. Mean age in group 2 was 67 ± 14 years (162 women [50%]). PFE occurred most commonly on cardiac valves (n = 400 [78%]). In group 1, transient ischemic attack or stroke was the presenting symptom in 58 patients (32%). With surgical removal of valvular PFE, the valve was preserved in 92 (98%). Recurrence was documented in 3 patients (1.6%). Follow-up stroke risk in groups 1, 1a, and 1b at 1 year was 2%, 0%, and 4%; at 5 years, 8%, 5%, and 11%, respectively. Cerebrovascular accident risk in group 2 at 1 and 5 years was 6% and 13%.
  
  
  CONCLUSIONS
  In patients with echocardiographically suspected PFE who do not undergo surgical removal, rates of cerebrovascular accident and mortality are increased.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Syahidah S
authors.initials: SS
authors.lastname: Tamin
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: S K
authors.initials: SK
authors.lastname: Khan
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bruce
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: klarich.kyle@mayo.edu.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Klarich
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D004452:Echocardiography; D005260:Female; D005350:Fibroma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006351:Heart Valves; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies
keywords: cardiac tumor; neoplasm; source of embolism; valve mass