Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1995;22(4):327–331.

Papillary fibroelastoma of the mitral valve. A rare cause of embolic events.

V Colucci 1, A Alberti 1, E Bonacina 1, V Gordini 1
PMCID: PMC325283  PMID: 8605435

Abstract

A 66-year-old woman was admitted to our department with an 11-month history of multiple transient ischemic attacks and strokes. A 2-dimensional echocardiographic study revealed an intracardiac tumor attached both to the chordae and to the anterolateral papillary muscle of the mitral valve. The patient underwent excision of the tumor, which necessitated concomitant mitral valve replacement. She remains free of symptoms 1 year postoperatively, with no echocardiographic evidence of recurrence of the tumor. To date, 19 cases of surgically treated papillary fibroelastomas of the mitral valve have been reported in the English-language literature. We add the description of our case to emphasize the importance of this tumor as an identifiable and curable cause of cerebral and coronary embolization. The frequent occurrence of cardiac valve tumors suggests the use of 2-dimensional echocardiography in patients who are experiencing transient ischemic attacks or strokes, as well as in those who sustain a myocardial infarction despite normal coronary arteries at angiography. When papillary fibroelastoma is diagnosed, surgical treatment must be considered because of the high risk of embolization.

Full text

PDF
327

Images in this article

328Image
on p.328
328Image
on p.328

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akagawa H., Kawara T., Hirano A., Sugiwara S., Ogata M., Aoyagi S., Kosuga K., Ohishi K., Koga M. Excision of papillary endocardial tumor. J Cardiovasc Surg (Torino) 1989 Jan-Feb;30(1):47–49. [PubMed] [Google Scholar]
  2. Braile D. M., Rossi M. A., Jacob J. L., Thevenard R. S., Suzigan S., Ramos S. G. Cystic fibroelastoma of the mitral valve: report of a case. J Thorac Cardiovasc Surg. 1993 Dec;106(6):1228–1230. [PubMed] [Google Scholar]
  3. Butterworth J. S., Poindexter C. A. Papilloma of cusp of the aortic valve. Report of a patient with sudden death. Circulation. 1973 Jul;48(1):213–215. doi: 10.1161/01.cir.48.1.213. [DOI] [PubMed] [Google Scholar]
  4. Edwards F. H., Hale D., Cohen A., Thompson L., Pezzella A. T., Virmani R. Primary cardiac valve tumors. Ann Thorac Surg. 1991 Nov;52(5):1127–1131. doi: 10.1016/0003-4975(91)91293-5. [DOI] [PubMed] [Google Scholar]
  5. Etienne Y., Jobic Y., Houel J. F., Barra J. A., Boschat J., Meunier M., Penther P. Papillary fibroelastoma of the aortic valve with myocardial infarction: echocardiographic diagnosis and surgical excision. Am Heart J. 1994 Feb;127(2):443–445. doi: 10.1016/0002-8703(94)90138-4. [DOI] [PubMed] [Google Scholar]
  6. Flotte T., Pinar H., Feiner H. Papillary elastofibroma of the left ventricular septum. Am J Surg Pathol. 1980 Dec;4(6):585–588. doi: 10.1097/00000478-198012000-00009. [DOI] [PubMed] [Google Scholar]
  7. Fowles R. E., Miller D. C., Egbert B. M., Fitzgerald J. W., Popp R. L. Systemic embolization from a mitral valve papillary endocardial fibroma detected by two-dimensional echocardiography. Am Heart J. 1981 Jul;102(1):128–130. doi: 10.1016/0002-8703(81)90424-5. [DOI] [PubMed] [Google Scholar]
  8. Frumin H., O'Donnell L., Kerin N. Z., Levine F., Nathan L. E., Jr, Klein S. P. Two-dimensional echocardiographic detection and diagnostic features of tricuspid papillary fibroelastoma. J Am Coll Cardiol. 1983 Nov;2(5):1016–1018. doi: 10.1016/s0735-1097(83)80253-8. [DOI] [PubMed] [Google Scholar]
  9. Gallas M. T., Reardon M. J., Reardon P. R., DeFelice C. A., Raizner A. E., Mody D. R. Papillary fibroelastoma. A right atrial presentation. Tex Heart Inst J. 1993;20(4):293–295. [PMC free article] [PubMed] [Google Scholar]
  10. Gallo R., Kumar N., Prabhakar G., Awada A., Maalouf Y., Duran C. M. Papillary fibroelastoma of mitral valve chorda. Ann Thorac Surg. 1993 Jun;55(6):1576–1577. doi: 10.1016/0003-4975(93)91118-7. [DOI] [PubMed] [Google Scholar]
  11. Gorton M. E., Soltanzadeh H. Mitral valve fibroelastoma. Ann Thorac Surg. 1989 Apr;47(4):605–607. doi: 10.1016/0003-4975(89)90444-x. [DOI] [PubMed] [Google Scholar]
  12. Grande A. M., Ragni T., Viganò M. Primary cardiac tumors. A clinical experience of 12 years. Tex Heart Inst J. 1993;20(3):223–230. [PMC free article] [PubMed] [Google Scholar]
  13. Israel D. H., Sherman W., Ambrose J. A., Sharma S., Harpaz N., Robbins M. Dynamic coronary ostial obstruction due to papillary fibroelastoma leading to myocardial ischemia and infarction. Am J Cardiol. 1991 Jan 1;67(1):104–105. doi: 10.1016/0002-9149(91)90113-y. [DOI] [PubMed] [Google Scholar]
  14. Kasarskis E. J., O'Connor W., Earle G. Embolic stroke from cardiac papillary fibroelastomas. Stroke. 1988 Sep;19(9):1171–1173. doi: 10.1161/01.str.19.9.1171. [DOI] [PubMed] [Google Scholar]
  15. Lee K. S., Topol E. J., Stewart W. J. Atypical presentation of papillary fibroelastoma mimicking multiple vegetations in suspected subacute bacterial endocarditis. Am Heart J. 1993 May;125(5 Pt 1):1443–1445. doi: 10.1016/0002-8703(93)91025-a. [DOI] [PubMed] [Google Scholar]
  16. Levinsky L., Srinivasan V., Gingell R. L., Fisher J. E., Pieroni D. R., Choh J. H., Subramanian S. Papillary fibroelastoma of aortic and mitral valves following myectomy for idiopathic hypertrophic subaortic stenosis. Thorac Cardiovasc Surg. 1981 Jun;29(3):187–191. doi: 10.1055/s-2007-1023474. [DOI] [PubMed] [Google Scholar]
  17. Mann J., Parker D. J. Papillary fibroelastoma of the mitral valve: a rare cause of transient neurological deficits. Br Heart J. 1994 Jan;71(1):6–6. doi: 10.1136/hrt.71.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Marvasti M. A., Obeid A. I., Cohen P. S., Giambartolomei A., Parker F. B. Successful removal of papillary endocardial fibroma. Thorac Cardiovasc Surg. 1983 Aug;31(4):254–255. doi: 10.1055/s-2007-1021991. [DOI] [PubMed] [Google Scholar]
  19. Mazzucco A., Bortolotti U., Thiene G., Dan M., Stritoni P., Scutari M., Stellin G. Left ventricular papillary fibroelastoma with coronary embolization. Eur J Cardiothorac Surg. 1989;3(5):471–473. doi: 10.1016/1010-7940(89)90061-4. [DOI] [PubMed] [Google Scholar]
  20. McFadden P. M., Lacy J. R. Intracardiac papillary fibroelastoma: an occult cause of embolic neurologic deficit. Ann Thorac Surg. 1987 Jun;43(6):667–669. doi: 10.1016/s0003-4975(10)60248-2. [DOI] [PubMed] [Google Scholar]
  21. Nakao T., Hollinger I., Attai L., Oka Y. Incidental finding of papillary fibroelastoma on the atrial septum. Cardiovasc Surg. 1994 Jun;2(3):423–424. [PubMed] [Google Scholar]
  22. Ong L. S., Nanda N. C., Barold S. S. Two-dimensional echocardiographic detection and diagnostic features of left ventricular papillary fibroelastoma. Am Heart J. 1982 May;103(5):917–918. doi: 10.1016/0002-8703(82)90410-0. [DOI] [PubMed] [Google Scholar]
  23. Richard J., Castello R., Dressler F. A., Willman V. L., Nashed A., Lewis B., Labovitz A. J. Diagnosis of papillary fibroelastoma of the mitral valve complicated by non-Q-wave infarction with apical thrombus: transesophageal and transthoracic echocardiographic study. Am Heart J. 1993 Sep;126(3 Pt 1):710–712. [PubMed] [Google Scholar]
  24. Schwinger M. E., Katz E., Rotterdam H., Slater J., Weiss E. C., Kronzon I. Right atrial papillary fibroelastoma: diagnosis by transthoracic and transesophageal echocardiography and percutaneous transvenous biopsy. Am Heart J. 1989 Nov;118(5 Pt 1):1047–1050. doi: 10.1016/0002-8703(89)90243-3. [DOI] [PubMed] [Google Scholar]
  25. Shapira O. M., Williamson W. A., Dugan J. M. Papillary fibroelastoma of the mitral valve. Cardiovasc Surg. 1993 Oct;1(5):599–601. [PubMed] [Google Scholar]
  26. Shub C., Tajik A. J., Seward J. B., Edwards W. D., Pruitt R. D., Orszulak T. A., Pluth J. R. Cardiac papillary fibroelastomas. Two-dimensional echocardiographic recognition. Mayo Clin Proc. 1981 Oct;56(10):629–633. [PubMed] [Google Scholar]
  27. Topol E. J., Biern R. O., Reitz B. A. Cardiac papillary fibroelastoma and stroke. Echocardiographic diagnosis and guide to excision. Am J Med. 1986 Jan;80(1):129–132. doi: 10.1016/0002-9343(86)90063-x. [DOI] [PubMed] [Google Scholar]
  28. Wolfe J. T., 3rd, Finck S. J., Safford R. E., Persellin S. T. Tricuspid valve papillary fibroelastoma: echocardiographic characterization. Ann Thorac Surg. 1991 Jan;51(1):116–118. doi: 10.1016/0003-4975(91)90464-2. [DOI] [PubMed] [Google Scholar]
  29. de Virgilio C., Dubrow T. J., Robertson J. M., Siegel S., Ginzton L., Nussmeier M., Nelson R. J. Detection of multiple cardiac papillary fibroelastomas using transesophageal echocardiography. Ann Thorac Surg. 1989 Jul;48(1):119–121. doi: 10.1016/0003-4975(89)90195-1. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES