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We present a case of a 75-year-old woman with typical myocardial infarction, however coronary angiogram was negative. Echocardiography identified the rare cause of chest pain, as a mobile mass of aortic valve was found to obstruct the coronary ostium. histopathology revealed a papillary fibroelastoma (PFE). Chest pain was relieved after surgical resection of the mass.

Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.

We present a case of a 70-year-old woman with exertional shortness of breath. A transthoracic echocardiogram showed a large mass on the ventricular side of the pulmonary valve. The anatomy of the mass was additionally investigated with a transesophageal echocardiogram, which delineated the anatomical details of the structure. The mass was surgically excised, and histopathology confirmed a cardiac papillary fibroelastoma.

Primary cardiac tumours are rare and mostly benign lesions. Recent publications report that cardiac papillary fibroelastomas are the most common benign primary heart tumour, outnumbering myxomas. However, there is no consensus about their aetiology. We investigated the molecular profile of these tumours using next generation sequencing in a cohort of 16 cases. Eleven of 14 (79%) analysable tumours showed mutations of the KRAS oncogene. Our results provide unambiguous evidence that a significant proportion of these lesions are genuine neoplastic tumours caused by an oncogenic driver mutation.

Introduction Papillary fibroelastoma (PFE) is a benign cardiac tumor that is currently detected more often due to the technological improvements in echocardiography. Objectives To describe the echocardiographic features of PFE and correlate them with the clinical presentation and initial treatment. Materials and Methods A prospective analysis of patients with a diagnosis of PFE was conducted between 2000 and 2015. We assessed the clinical history, symptoms at the time of diagnosis, echocardiographic features, and initial treatment. Results Fifty-four patients with a diagnosis of PFE by echocardiography were included. The incidence was 0.038%. Mean age was 62±16 years; 50% were male. Forty-six percent of patients had symptoms at the time of diagnosis, the most frequent of which was transient ischemic accident (TIA). Embolic episodes occurred in 31% of patients, mainly to the brain. PFEs were valvular in 70.4% of cases and multiple in 13%. Mean maximum length was 1.18±0.58 cm, and 44% were mobile. PFEs >1.5 cm were most often found in the heart valves (56.8% vs 10.8%; P=.045). There was no significant relation between size, mobility, location and number of tumors, and the presence of embolism or symptoms. Most frequent treatment was oral anticoagulation in 48.6%, followed by simple tumor resection in 42.8% of cases. Conclusions PFE is a small tumor, predominantly valvular and benign, but entails a high incidence of cerebral embolism. The initial approach should be individualized according to clinical manifestations, comorbidities, and the experience of the surgical center.

A 70‐year‐old woman developed acute cerebral infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium, suggesting cardiac myxoma as the most likely diagnosis. Surgical exploration revealed a papillary fibroelastoma originating from the coumadin ridge, which is fairly rare but important as a source of cerebral embolization.

Papillary fibroelastoma is a rare, benign cardiac tumor. Surgical resection is indicated to prevent embolization. We herein report a case of a 78-year-old asymptomatic man who was found to have a mobile left ventricular papillary fibroelastoma anchoring deep in the left ventricle by incidental transthoracic echocardiography. The tumor was resected under visualization by a video-assisted rigid endoscope with a flexible head inserted through the aortic valve into the left ventricle. Intraoperative frozen section analysis provided a pathological diagnosis of papillary fibroelastoma. The postoperative course was uneventful. This technique is recommended for the observation and resection of a tumor anchoring deep in the left ventricle and is helpful for avoiding the adverse effects of left ventriculotomy.

The pulmonary valve is the least affected site for valvular papillary fibroelastoma. With increasing use of routine echocardiography and other modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE) are being recognized more frequently. PVPFE is more often an incidental diagnosis and symptomatic patients usually present with shortness of breath. Embolic phenomena and right ventricular outflow tract obstruction are the most serious complications of PVPFE. Since PVPFE is rare, the purpose of this systematic review is to address demographic characteristics, the clinical presentation, management, and outcome of this benign tumor of the pulmonary valve.

Papillary fibroelastoma is an uncommon primary cardiac tumor, predominantly associated with left-sided valvular endocardium. Affectation of tricuspid valve leaflets is rare, and management in asymptomatic patients remains controversial. We present a 30-year-old female referred for evaluation prior to bariatric surgery. A routine echocardiogram revealed a mobile cardiac mass attached to the tricuspid valve. A patent foramen ovale was also present. Tumor was surgically removed. Histology confirmed the definite diagnosis of a papillary fibroelastoma. In our case, the presence of a patent foramen ovale associated with the right-sided fibroelastoma was decisive in the decision for surgery.

Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature.

Robotic cardiac surgery was FDA-approved in 2002 and since then several different procedures have been performed to facilitate a truly minimally invasive approach. The use of robotics in aortic valve surgery, however, is still in its infancy. In this article, we report our clinical experience and chronological development with robot-assisted aortic valve surgery. This includes a description of how robotic assistance was gradually integrated during right mini-thoracotomy aortic valve replacement, a series of cases in which the robot was docked for parts of the procedure, a single case of a totally endoscopic robot-assisted aortic valve replacement with a stentless valve, and three cases of aortic valve papillary fibroelastoma resections. All of these were performed safely with early postoperative recovery and excellent clinical results. Additionally, we review the latest literature describing robot-assisted aortic valve surgery. Finally, we describe current issues, and challenges for robot-assisted aortic valve surgery.

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambl's excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017-0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three-dimensional transthoracic echocardiography.

Cardiac papillary fibroelastoma is an uncommon nonmalignant tumor. It is usually found in adults, arising from endocardium within the left side of the heart. We present a case of an asymptomatic pediatric patient with sickle cell disease, in whom a relatively rapidly growing papillary fibroelastoma emanating from the aortic valve was detected on routine echocardiogram (Philips iE33, Philips Ultrasound, Bothell, WA, USA). The tumor was surgically removed without compromising the aortic valve. A mechanism is suggested for the development of this tumor in a patient with sickle cell disease. A 15-year old female with sickle cell disease (homozygous SS) and splenectomy was seen in cardiology clinic. As part of our protocol for following patients with SS-disease, we obtained an echocardiogram to assess left ventricular size and function. The study demonstrated a (9.1 mm 9 8.4 mm) mobile, echo dense mass, attached by a thin stalk to the aortic surface of the right coronary cusp of the aortic valve, close to the commissure between the right and left coronary cusps (Fig. 1). There was no aortic outflow obstruction or aortic valve insufficiency. An echocardiogram performed 17 months earlier showed no mass within the heart (Fig. 2). The patient had no recent fever, infection, headache, or neurologic deficit. A transesophageal echocardiogram (TEE) (Philips iE33), performed just prior to surgery, confirmed our preoperative findings (Fig. 3). There were no additional intracardiac masses seen. The operation was conducted under conditions of normothermia with the hemoglobin S level maintained

UNLABELLED Papillary fibroelastoma (PFE) is a rare benign tumour that attaches to the endocardial surface, mostly on cardiac valves. Though usually asymptomatic, it can be the source of several complications. To date, 49 cases have been reported of embolic stroke with a PFE as the probable origin. CASE REPORTS (i) a 39-year-old male presented with ischemic embolic stroke; the presence of a PFE was assessed by means of transoesophageal echocardiography and confirmed by pathological findings; (ii) a 32-year-old woman presented with sudden onset of left hemiparesis; a cardiogenic embolic stroke was suspected, and a diagnosis of PFE was made based on echocardiographic and pathological findings. In both cases, surgical excision of the tumours was performed with no recurrences at follow-up. Two mechanisms can explain the formation of emboli in PFE: dislodgement of the tumour leaves or fibrin-platelet aggregation on the endocardial surface of these leaves. Transthoracic echocardiography may lead to the suspicion of a PFE, but transoesophageal echocardiography is required for confirmation. Prompt surgical excision is indicated in most cases. Anticoagulation is only recommended in situations of high surgical risk and during the wait for surgery.

Papillary fibroelastomas are small, histologically benign neoplasms that are typically found on the valvular endocardium. We report a patient with a papillary fibroelastoma in an unusual location: the left atrial appendage. Although the mass was visualized both by computed tomography (CT) and transesophageal echocardiography, the diagnosis was histologically confirmed after surgical excision.

Primary cardiac tumors are very rare findings. Papillary fibroelastomas are benign tumors comprising less than 10% of all primary cardiac neoplasms. They are almost always attached to valve surfaces; their location along the ventricular and atrial walls is exceptional. Affected patients are mostly asymptomatic, however peripheral or central embolic events are not rare. We describe an interesting case of papillary fibroelastoma with nonspecific systemic symptoms, arising directly from the left ventricular apex. So far, only four such cases were reported in current literature.

A 76-year-old male was admitted with increasing fatigue and shortness of breath. Transesophageal echocardiogram revealed moderate-to-severe mitral regurgitation and an oscillating mass on the pulmonic valve that was confirmed by magnetic resonance imaging. The patient underwent repair of the mitral valve and excision of the pulmonic valve mass, which was confirmed as a papillary fibroelastoma by histology.

We report the first case of echocardiographically detected Lambl's excrescences on the pulmonary valve in a 72-year-old man who was referred for transesophageal echocardiography as a part of an evaluation for ischemic stroke. A total of four excrescences were noted on the arterial aspect of the pulmonary valve; two of them were on the anterior cusp, one was on the left cusp, and one was on the right cusp. The excrescence on the left cusp was the largest, measuring 5 mm in length. These valvular strands (Lambl's excrescences) represented an incidental finding and were not associated with any disease process.

UNLABELLED Papillary fibroelastoma is a benign tumour of the cardiac valve apparatus. We present an unusual case of life-threatening pulmonary haemorrhage and disseminated intravascular coagulation in a neonate associated with this benign cardiac tumour. Papillary fibroelastoma of the tricuspid valve rarely presents in children and, to our knowledge, this is only the second reported case in a neonate. The patient was successfully managed by anticoagulation therapy followed by surgical excision of the tumour. This case illustrates the potentially fatal presentation of this benign cardiac tumour among neonates. CONCLUSION Pulmonary haemorrhage of this degree is unusual in an otherwise healthy term neonate and needs careful investigation for unusual pathology including potential sources of pulmonary emboli in the heart. We emphasize the value of echocardiography in the evaluation of unexpected pulmonary haemorrhage in the newborn.

Papillary fibroelastoma is a rare, benign tumor, and multiple papillary fibroelastomas are even more uncommon. In an asymptomatic patient scheduled for carotid endarterectomy, transthoracic echocardiography discovered a fibroelastoma on the mitral valve. Then, transesophageal echocardiography showed another fibroelastoma on the aortic valve. Because he also needed a right coronary artery bypass, the patient underwent surgical excision of both masses. Fibroelastomas are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization. Transoesophageal echocardiography may improve the diagnosis of multiple papillary fibroelastomas. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014