Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 5, November 2005, Pages 1712-1718
The Annals of Thoracic Surgery

Original article
Cardiovascular
Surgical Treatment of Cardiac Papillary Fibroelastoma: A Single Center Experience With Eighty-Eight Patients

Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
https://doi.org/10.1016/j.athoracsur.2005.04.030Get rights and content

Background

Cardiac papillary fibroelastoma is a rare benign tumor that can cause thromboembolism. We have found no large surgical series describing its treatment and outcome.

Methods

A retrospective review of all patients treated surgically for this tumor from 1985 to 2002.

Results

There were 88 patients with a mean age of 62 ± 16 years. Sixty-two (71%) were male. Cardiac papillary fibroelastoma was a primary indication for surgery in 47 (group 1, 53%) and an incidental finding in 41 (group 2, 47%). The common clinical symptoms were neurologic (group 1) and cardiac (group 2). Cardiac valves were predominantly involved (77%); the aortic valve was the most affected (52%). Other common sites were the left ventricular outflow tract (18%) and anterior mitral leaflet (11%). All heart valves were involved in one patient. Seventy-three patients (83%) had shave excision and 8 (9%) excision with valve repair. Of 5 (6%) valve replacements, 2 were for concurrent degenerative valve disease. Concomitant procedures included repair or replacement of another valve (32 %), CABG (28%), and septal myectomy (19%). Surgical mortality occurred in 1 patient (2.1%) in group 1 who had concomitant lung resection for bronchiolitis obliterans. There was no tumor recurrence, and no tumor-related late morbidity or mortality at a mean follow-up of 3 years.

Conclusions

Cardiac papillary fibroelastoma has a propensity to affect the anatomically contiguous structures of the aortic valve, left ventricular outflow tract, and anterior mitral leaflet. Surgical treatment by simple shave excision is low risk and can achieve good results.

Section snippets

Patients and Methods

All patients who underwent surgical treatment for cardiac papillary fibroelastoma at our institution between 1985 and 2002 were identified from the cardiovascular surgery and pathology databases. Institutional Review Board approval was obtained for this study on August 31, 2004. Clinical histories, echocardiographic reports, operative notes, and histopathologic findings were reviewed. Demographic characteristics such as age and gender, and clinical data including presenting symptoms, concurrent

Patient Characteristics

There were 88 patients with a mean age of 62 ± 16 (range, 23 to 86) years. Sixty-two (71%) were male. Cardiac papillary fibroelastoma was a primary indication for surgery in 47 patients (group 1, 53%) and was an incidental echocardiographic or surgical and/or histologic finding in 41 patients undergoing cardiac surgery primarily for other conditions (group 2, 47%). The most common clinical symptom in group 1 patients was neurologic (53%); cerebral embolism in 38%, retinal embolism in 9%, and

Comment

This retrospective cohort study describes the surgical treatment of cardiac papillary fibroelastoma from a single cardiac surgical center. Even though improved clinical diagnosis has transformed cardiac papillary fibroelastoma from a postmortem to an antemortem diagnosis, there is still a significant incidence of underdiagnosis. In this study cardiac papillary fibroelastoma was discovered incidentally in 47% of patients. Edwards and colleagues [9] investigated primary cardiac tumors and

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