CASE REPORT
Papillary fibroelastoma of the mitral valve
E.C.W. Cloin, E.S. Zegers, L. Noyez, F.W.A. Verheugt, R.M.H.J. Brouwer
We present a case of a 69-year-old woman with a history of stroke five years previously and an abnormal ECG prior to eye surgery. There were no signs of cardiac disease. Echocardiography disdosed a tumour of the papillary muscle. Surgical excision was performed and histological examination confirmed the diagnosis of a llary fibroelastoma. (Net/HeartJ2003;11:221-2.)
excision ofthe tumour was planned. On inspection of the left ventricle a weak mass was seen just apical to the posteromedial papillary muscle with a 2 cm diameter, stalked to the ventricular wall. The stalk was cut and the process removed. No mitral valve insufficiency was seen, and postoperative recovery was uneveniful. On histopathological examination the mass proved to be a papillary fibroelastoma.
Keywords: mitral valve, papillary fiboelastoma
Dlscussion The first surgical excision of a cardiac papillary fibroelastoma was reported by Lichtenstein and associates in 1976.3 Cardiac fibroelastomas are rare benign tumours; their prevalence varies from 7 to 16%.1'2 Fibroelastomas are usually small and solitary, they have a characteristic frond-like appearance and look like sea anemones when placed in saline. They can arise from virtually any endocardial surface, but they usually originate from the valvular endocardium. According to a literature review by Grinda, 17% of cardiac papillary fibroelastomas originate from the tricuspid valve, 25% from the mitral valve, 13% from the pulmonary valve, 29% from the aortic valve and 16% have a nonvalvular location.3 Histologically the tumour is covered by endothelium that surrounds a layer ofacid mucopolysaccharide and an inner vascular core of connective tissue. The amount of collagen, smooth muscle cells and elastic fibres is variable.1 The majority ofpatients with cardiac fibroelastoma are asymptomatic. Possible clinical features, however, include signs of valvular disease, chest pain, TIA and stroke.' The last two are caused by surface thrombus formation and embolisation, which is common with these tumours.5 This might explain our patient's 'stroke', which could just have well have been an embolism originating from the papillary fronds or a platelet fibrin aggregate on the tumour.4 Our patient did not have mitral valve insufficiency, but some patients do, and in the worst case the entire mitral valve has to be replaced.5 Echocardiography, either transthoracic or transoesophageal, is the most direct, reliable and least invasive method to establish the presence of an intracardiac tumour. The fibroelastoma is described
fardiac papillary fibroelastoma (CPF) is a rare Wcardiac neoplasm.' In the past it has occasionally been identified at autopsy or as an incidental finding during cardiac surgery.2 Today, with the availability of transthoracic and transoesophageal echocardiography, the diagnosis ofthis lesion is now possible, thus allowing treatment to prevent embolisation. Cas report A 69-year-old woman was seen by a cardiologist because of an abnormal routine ECG before ophialmic surgery. Her medical history revealed a stroke five years earlier and was not otherwise relevant. There was no history ofcardiac disease and physical examination was normal. The electrocardiogram showed an incomplete left bundle branch block configuration. The transthoracic and transoesophageal echocardiograms showed no abnormalities except a 2 cm2 echodense mass of heterogenous consistency, which moved like the mitral valve and was suggestive of a myxoma (figure 1). Coronary angiography was normal. The patient was referred to the cardiothoracic surgical team and E.C.W. Cloin. E.S. Zeges. L Noyez. F.W.A. Verhot. R.M.H.J. Brouwer. Heartcenter, UMC St Radboud, PO Box 9101, 6500 HB Nymegen. Address for correspondence: L. Noyez. E-mail: [email protected]
Nethrlands Heart Journal, Vohmc 11, Number 5, May 2003
221
Papillary fibroelastoma of the mitral valve
echocardographically as a small (
Papillary fibroelastoma of the mitral valve
E.C.W. Cloin, E.S. Zegers, L. Noyez, F.W.A. Verheugt, R.M.H.J. Brouwer
We present a case of a 69-year-old woman with a history of stroke five years previously and an abnormal ECG prior to eye surgery. There were no signs of cardiac disease. Echocardiography disdosed a tumour of the papillary muscle. Surgical excision was performed and histological examination confirmed the diagnosis of a llary fibroelastoma. (Net/HeartJ2003;11:221-2.)
excision ofthe tumour was planned. On inspection of the left ventricle a weak mass was seen just apical to the posteromedial papillary muscle with a 2 cm diameter, stalked to the ventricular wall. The stalk was cut and the process removed. No mitral valve insufficiency was seen, and postoperative recovery was uneveniful. On histopathological examination the mass proved to be a papillary fibroelastoma.
Keywords: mitral valve, papillary fiboelastoma
Dlscussion The first surgical excision of a cardiac papillary fibroelastoma was reported by Lichtenstein and associates in 1976.3 Cardiac fibroelastomas are rare benign tumours; their prevalence varies from 7 to 16%.1'2 Fibroelastomas are usually small and solitary, they have a characteristic frond-like appearance and look like sea anemones when placed in saline. They can arise from virtually any endocardial surface, but they usually originate from the valvular endocardium. According to a literature review by Grinda, 17% of cardiac papillary fibroelastomas originate from the tricuspid valve, 25% from the mitral valve, 13% from the pulmonary valve, 29% from the aortic valve and 16% have a nonvalvular location.3 Histologically the tumour is covered by endothelium that surrounds a layer ofacid mucopolysaccharide and an inner vascular core of connective tissue. The amount of collagen, smooth muscle cells and elastic fibres is variable.1 The majority ofpatients with cardiac fibroelastoma are asymptomatic. Possible clinical features, however, include signs of valvular disease, chest pain, TIA and stroke.' The last two are caused by surface thrombus formation and embolisation, which is common with these tumours.5 This might explain our patient's 'stroke', which could just have well have been an embolism originating from the papillary fronds or a platelet fibrin aggregate on the tumour.4 Our patient did not have mitral valve insufficiency, but some patients do, and in the worst case the entire mitral valve has to be replaced.5 Echocardiography, either transthoracic or transoesophageal, is the most direct, reliable and least invasive method to establish the presence of an intracardiac tumour. The fibroelastoma is described
fardiac papillary fibroelastoma (CPF) is a rare Wcardiac neoplasm.' In the past it has occasionally been identified at autopsy or as an incidental finding during cardiac surgery.2 Today, with the availability of transthoracic and transoesophageal echocardiography, the diagnosis ofthis lesion is now possible, thus allowing treatment to prevent embolisation. Cas report A 69-year-old woman was seen by a cardiologist because of an abnormal routine ECG before ophialmic surgery. Her medical history revealed a stroke five years earlier and was not otherwise relevant. There was no history ofcardiac disease and physical examination was normal. The electrocardiogram showed an incomplete left bundle branch block configuration. The transthoracic and transoesophageal echocardiograms showed no abnormalities except a 2 cm2 echodense mass of heterogenous consistency, which moved like the mitral valve and was suggestive of a myxoma (figure 1). Coronary angiography was normal. The patient was referred to the cardiothoracic surgical team and E.C.W. Cloin. E.S. Zeges. L Noyez. F.W.A. Verhot. R.M.H.J. Brouwer. Heartcenter, UMC St Radboud, PO Box 9101, 6500 HB Nymegen. Address for correspondence: L. Noyez. E-mail: [email protected]
Nethrlands Heart Journal, Vohmc 11, Number 5, May 2003
221
Papillary fibroelastoma of the mitral valve
echocardographically as a small (
