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Ann Thorac Surg 1995;60:234
© 1995 The Society of Thoracic Surgeons

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Correspondence

Cardiac Papillary Fibroelastoma

Anatomical Pathology Laboratory Medicine The University of Ottawa Heart Institute at the Ottawa Civic Hospital 1053 Carling Ave Ottawa On Canada K1Y 4E9

To the Editor:

The report by Shahian and associates [1] was an excellent compilation of previous literature in relation to those interesting endocardial lesions referred to as papillary fibroelastomas (PFEs). We additionally bring to Shahian and associates' attention a report from our group [2] that compared the histology of PFEs and Lambl's excrescences (LEs). In that study we described 10 PFEs (6 aortic valve, 2 pulmonary valve, 1 tricuspid valve, and 1 posterior right atrial wall). These PFEs were compared with 20 LEs (all aortic, with two coexistent on mitral valve).

In our comparison of PFEs and LEs we found most were microscopically indistinguishable, suggesting similar origin. What was distinct about the two groups was the variety of locations over the valve surfaces where the PFEs could be found, whereas the LEs were confined to the closing margins of the valve, and sat particularly in the midline. In 7 cases the LEs were accompanied by valve free edge fibrous tags (illustrated in our report). Papillary fibroelastomas tended to be larger than LEs and to have smaller stalks.

The conclusion from our study, and our review of the literature, was that PFEs and LEs likely represent degenerative lesions of similar origin. Papillary fibroelastomas are unusual grossly, however, in that they tend to be larger (and so are now more frequently diagnosed with various noninvasive imaging techniques) and have variant locations when compared with the much commoner LEs. With improved imaging techniques it seems likely that LEs also will become diagnosable clinically, and whether the separation of the two lesions continues to have merit will be the subject of further debate, we are sure.

References

1. Shahian DM, Labib SB, Chang G. Cardiac papillary fibroelastoma. Ann Thorac Surg 1995;59:538–41.[Abstract/Free Full Text]
2. Boone SA, Campagna M, Walley VM. Lambl's excrescences and papillary fibroelastomas: are they different? Can J Cardiol 1992;8:372–6.[Medline]

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