Figure - available from: Frontiers in Cardiovascular Medicine
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Biplanar transesophageal echocardiography of the aortic valve during systole with the mid-esophageal aortic valve long axis (left) and short-axis (right).
Source publication
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 signif...
Citations
... P apillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. [1][2][3][4][5] PFEs are commonly located on the cardiac valves, but can also be present on nonvalvular endocardial surfaces. Involvement of the left-sided valves is the most common. ...
Papillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. Surgical excision is the definitive treatment of symptomatic PFE and is conventionally performed through a median sternotomy. In this study, we report a series of 12 patients, who underwent robotic-assisted PFE removal at the Mayo Clinic. PFE involved the mitral valve, left atrium, and tricuspid valve. No major complications occurred after the procedure, and most patients were discharged 4 days after the surgery. On follow-up, 1 patient demonstrated pericarditis.
... Endocarditis infects patients with recent fever or cerebral infarction, or with elevated leukocyte count, erythrocyte sedimentation rate (ESR), ASO, and C-reactive protein levels. PFE is particularly difficult to distinguish from LE because they are histologically similar; however, they have some important features that can be distinguished on echocardiography: they are usually solitary when they occur, arising from the center of the valve, away from the closed valve line [31,32]. Our patient had no history of recent fever or cerebral infarction, and leukocyte count, ESR, ASO, and C-reactive protein levels were normal. ...
Background: Lambl's excrescence (LE) presents challenges due to its small size and elusive nature. Methods: We present a case of an asymptomatic LE patient in which the patient recovered well and a literature review of LE involving the aortic valve (AV). Results: Transthoracic echocardiography revealed 10 × 4 mm strips of highly echoic attachment on the AV, swinging on the aortic side with high motion. The pathological analysis confirmed LE. The patient underwent surgical management, and the excrescence was successfully removed without damaging the AV. No complications were reported during the 18-month follow-up period. Of the 53 patients with LE (including the one in our report) aged 8–80, 18 were female, and 35 were male. The lengths of the LEs ranged from 1 to 32 mm. There were 6 asymptomatic cases, 25 ischemic stroke cases, 1 myocardial infarction case, 15 cases underwent surgical treatment, and 8 cases underwent simple surgical excision of the LE. The commonly used anticoagulants included warfarin, aspirin, clopidogrel, and rivaroxaban. The 27 patients were followed up with good results. Conclusion: For smaller LE, anticoagulants should be taken for a long time and monitored closely. We recommend surgical resection for large LE (longer than 2 cm), patients who have had more than one stroke, or those undergoing other simultaneous intracardiac operations.
Background
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac tumors most commonly found on left-sided cardiac valves. Right atrial CPFs are extremely rare, accounting for only 2% of all CPFs. Median sternotomy is a typical approach for surgical excision of CPFs in most cases. Herein, we report an extremely rare case of multifocal CPFs involving the right atrium and aortic valve that were surgically excised via minimally invasive right anterolateral thoracotomy.
Case Summary
A 59-year-old Chinese man was admitted because of an incidental finding of a right atrial mass on transthoracic echocardiography during a routine check-up. The mass was initially diagnosed as a myxoma, and the patient was scheduled for minimally invasive excision via right anterolateral thoracotomy. An additional mass on the non-coronary cusp of the aortic valve was identified using intraoperative transesophageal echocardiography. The patient still underwent complete tumor excision via right anterolateral thoracotomy. Both neoplasms were pathologically diagnosed as CPFs.
Conclusions
This case highlights the need for a comprehensive cardiac evaluation of cardiac tumors because CPFs can manifest as multifocal lesions. Moreover, minimally invasive surgery is highly feasible as the CPF can be easily excised, and the valve can usually be preserved.
