Papillary fibroelastomas are cardiac tumors, usually 9 millimeters to 12 millimeters in diameter. They often affect the aortic valve, ventricular outflow and anterior mitral leaflet, where one or more lesions may appear. The fibroelesatomas have an outer, hyperplastic endothelial layer and a dense central core. Because these tumors are easily mobile, surgery often is recommended to remove them before any find their way into the circulatory system or coronary vessels, causing an embolism.
Often these tumors are detected during imaging before cardiac surgery, or even during another cardiac procedure.
It is thought that papillary fibroelastomas are acquired, not congenital.
Though they are usually benign, fibroelesatomas can cause life-threatening complications such as stroke, acute valvular dysfunction, embolism, ventricular fibrillation and even sudden death. Most of them are located in the left side of the heart, so the risk of systemic embolism is increased, and can lead to myocardial infarction, atypical angina or ventricular tachycardia.
Any coronary artery angiography should be performed with extreme caution, in case a fibroelastoma is present.
Transesophageal echocardiography (TEE) will evaluate the structure and functionality of the heart and should be conducted before any procedure.
Valve-sparing resection surgery for pedunculated tumors usually achieves good long-term results. It is especially recommended if the tumor is mobile, or if the patient has a history of symptoms or complications related to the tumor. For example, patients who have cardiovascular or neurologic embolic occurrences should undergo surgical resection.