Papillary Fibroelastomas: Innocent Bystanders or Ignored Culprits?

Cardiac papillary fibroelastomas (PFEs) are the most common tumors of the cardiac valves and the third most common cardiac tumor. They are usually detected accidentally on echocardiography, but have the potential to manifest with catastrophic embolic phenomena, resulting in stroke and myocardial inf...

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Bibliographic Details
Published in:Postgraduate medicine 2009-05, Vol.121 (3), p.131-138
Main Authors: Saloura, Vassiliki, Grivas, Petros D., Sarwar, A. Bilal, Gorodin, Paulina, Ledley, Gary S.
Format: Article
Language:English
Subjects:
Cardiac Surgical Procedures - methods
cardiac tumors
cardiac valves
Diagnosis, Differential
echocardiography
Echocardiography - methods
embolic phenomena
Embolization, Therapeutic - methods
Endocardial Fibroelastosis - diagnosis
Endocardial Fibroelastosis - epidemiology
Endocardial Fibroelastosis - therapy
Female
Heart Neoplasms - diagnosis
Heart Neoplasms - epidemiology
Heart Neoplasms - therapy
Humans
Incidence
Magnetic Resonance Imaging - methods
papillary fibroelastomas
Papilloma - diagnosis
Papilloma - epidemiology
Papilloma - therapy
Practice Guidelines as Topic
Prognosis
Tomography, X-Ray Computed - methods
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Summary:Cardiac papillary fibroelastomas (PFEs) are the most common tumors of the cardiac valves and the third most common cardiac tumor. They are usually detected accidentally on echocardiography, but have the potential to manifest with catastrophic embolic phenomena, resulting in stroke and myocardial infarction. Echocardiography is currently the preferred diagnostic modality, while magnetic resonance imaging and computed tomography are helpful in the differential diagnosis of cardiac tumors. The management of PFEs is empiric, as no large randomized trials have been conducted to support specific treatment guidelines. The treatment of choice for PFEs with high-risk features for peripheral embolization is surgical resection. Anticoagulation is recommended in patients who are poor surgical candidates or who refuse surgery, although its duration and intensity are debatable. This review summarizes current knowledge on the epidemiology, pathology, pathophysiology, clinical manifestations, diagnosis, and treatment of PFEs. It also highlights the need for large randomized clinical trials that would delineate more specific guidelines for managing PFEs with anticoagulation.
ISSN:0032-5481
1941-9260
DOI:10.3810/pgm.2009.05.2013