SHM Converge Scientific Abstract ePoster Gallery-Cardiac Papillary Fibroelastoma: A Case Report Review

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This case report describes a 73-year-old woman who was found unresponsive at home and achieved return of spontaneous circulation after CPR. Her initial evaluation showed a left tension pneumothorax and inferior ST-segment elevations, but cardiac catheterization revealed no coronary artery disease or culprit lesion. An initial transthoracic echocardiogram showed normal left ventricular function with mild aortic valve sclerosis.<br /><br />During her ICU course, she suffered seven additional cardiac arrests. A repeat echocardiogram then identified a 1.5 x 0.9 cm echogenic mass on the anterior coronary cusp of the aortic valve, with severely reduced ejection fraction and wall motion abnormalities. Transesophageal echocardiography could not be performed because of upper esophageal sphincter constriction. Given the concern for an intracardiac tumor, the patient underwent emergent surgical resection of the aortic valve mass with aortic valve repair. Pathology confirmed cardiac papillary fibroelastoma.<br /><br />After surgery, her cardiac function improved dramatically, with ejection fraction returning to 60%, a competent aortic valve, and no residual mass on follow-up echocardiography.<br /><br />The report emphasizes that cardiac papillary fibroelastoma is a rare but clinically important benign cardiac tumor and the second most common primary cardiac tumor after myxoma. Although often asymptomatic and incidentally discovered, it can cause serious embolic or cardiac complications including stroke, myocardial infarction, ventricular fibrillation, and sudden death. Diagnosis typically begins with transthoracic echocardiography, followed by transesophageal echocardiography when possible, and definitive confirmation requires histology. Surgical excision is the preferred treatment, especially for symptomatic patients or lesions on the aortic valve. If surgery is not feasible, anticoagulation and close monitoring may be considered.

Asset Subtitle

Mridula P. Talari

Meta Tag

Author List Alisha Freitas, Camelia Chirculescu, Dakota J. Robertson, Haytham Adada, Mridula P. Talari, Ravi Patel

Category Clinical Vignettes

Concept Papillary Fibroelastoma

Concept Embolism

Concept Transthoracic Echocardiography

Concept Aortic Valve

Concept Surgical Excision

Distinguished Non-Finalist

Presenter Organization Johnston Memorial Hospital

Presenting Author Mridula P. Talari

Track Adult

Keywords

cardiac papillary fibroelastoma

aortic valve mass

cardiac arrest

tension pneumothorax

ST-segment elevation

echocardiography

transesophageal echocardiography

surgical resection

benign cardiac tumor

aortic valve repair

Papillary Fibroelastoma

Embolism

Transthoracic Echocardiography

Aortic Valve

Surgical Excision