| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2005;79:e3-e4
© 2005 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
b Department of Surgery, University of Sydney, Sydney, Australia
Accepted for publication July 14, 2004.
* Address reprint requests to Dr Paterson, Westmead Private Hospital, 14B Mons Rd, Suite 10, Westmead, NSW 2145 Australia; (E-mail: patersonh{at}aol.com).
 |
Abstract |
|---|
 Top Abstract IntroductionCommentReferences |
|---|
|
Introduction |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
A 59-year-old man was admitted to Westmead Hospital after acute myocardial infarction. Coronary angiography showed three-vessel disease. Left ventriculography and transthoracic echocardiography revealed severely impaired left ventricular function with apical dyskinesis and anterolateral hypokinesis. The aortic valve was considered to be normal. He proceeded to coronary artery surgery for unstable angina.
Intraoperative transesophageal echocardiography (TEE) demonstrated anterior left ventricular dyskinesis and an incidental finding of a 6.5 mm x 5.7 mm lesion on the left coronary cusp of the aortic valve without valve dysfunction (Fig 1). Left ventricular aneurysm repair and coronary artery bypass grafting were performed. The aortic valve was inspected and a sessile wart-like lesion was noted on the aortic side of the left coronary cusp. This was largely avulsed with a pair of forceps, but complete excision would have required valve replacement and this was not considered appropriate. Subsequent histologic examination confirmed an incompletely excised papillary fibroelastoma. Postoperative recovery was uneventful, and the patient continued routine aspirin antiplatelet therapy. Follow-up was performed with annual TEE and clinical examination. The TEE demonstrated persistent thickening of the left cusp of the aortic valve, which remained unchanged over the subsequent 6.5 years suggesting no regrowth of the tumor. There were no signs or symptoms to suggest an embolic complication.
|
|
Comment |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
On gross examination, fibroelastomas resemble sea anemones with multiple papillary fronds attached to the endocardium by a short stalk. They are generally solitary and small, measuring < 20 mm [1]. Most have been encountered in adults and occur equally in men and women. They can arise from any endocardial surface but most occur on the valves rather than in the chambers, with the majority reported on the aortic valve [1–3].
The majority of patients with fibroelastomas are asymptomatic. However, it has the potential to result in embolic events including transient ischemic attacks, strokes, angina, and sudden death. In a literature review in 1999 it was noted that 65% of the patients who had undergone excision of fibroelastomas had done so after a presumed embolic event [4].
Surgical excision has been recommended by some authors for both symptomatic and asymptomatic patients [2–5]. Valve replacement has been considered necessary if the lesion is extensive, the resection distorts the valve anatomy, or if there is a pre-existing valve disease. Although the aortic valve is the most common site, the tumors may be pedunculated allowing valve-sparing complete excision [1, 5, 6].
A recent report from the Cleveland Clinic suggested that asymptomatic patients with small, left-sided, nonmobile (no stalk) fibroelastomas noted nonoperatively can be observed without surgical treatment and that the majority of fibroelastomas seen at echocardiography did not have a stalk [1]. There were 45 patients with an echocardiographic diagnosis of fibroelastoma who were followed for a mean of 1.5 years and in whom there were 3 patients with presumed embolic events attributable to their tumors (4.4% per patient year). For small nonmobile fibroelastomas the risk appeared to be less and may compare favorably with that of a mechanical valve prosthesis. Of those patients with pathologically confirmed fibroelastomas after surgical excision, follow-up data extended to 10 years (mean, 630 days) and no recurrence of a fibroelastoma was seen.
There is no information regarding regrowth of fibroelastomas after incomplete surgical excision. Our patient has had follow-ups every year with TEE, and no regrowth of the mass has been detected for 6.5 years.
There are neither data to evaluate the efficacy of anticoagulation or antiplatelet therapy for patients with fibroelastomas nor firm evidenced based guidelines regarding use and duration of anticoagulation, especially in the absence of valve repair or replacement, although it is speculated that deposition of thrombotic material on the tumors may add to the risk of microembolization. If valve repair or replacement is required, standard treatment guidelines for the anticoagulation therapy should apply [4].
In summary, cardiac papillary fibroelastomas are rare benign tumors with the potential for embolic events. Fibroelastomas have been increasingly detected intraoperatively by TEE. The recurrence rate after surgical excision remains unknown but appears low, and this report supports the contention that aggressive resection may not be required.
|
References |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  Y. Okamoto, M. Matsumoto, H. Inoue, and K. Shimura Aortic valve papillary fibroelastoma that developed rapidly after open-heart surgery Interactive CardioVascular and Thoracic Surgery, December 1, 2008; 7(6): 1134 - 1136. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
