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J Thorac Cardiovasc Surg 2007;133:849-850
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Papillary fibroelastoma of aortic valve: Early diagnosis and surgical management

Pankaj Saxena, MCh, DNB, Igor E. Konstantinov, MD, PhD, Andrew Lee, MBBS, Mark A.J. Newman, FRACS

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

To the Editor:

We read with great interest the article by Vagefi and associates1Go regarding their experience with papillary fibroelastoma of the aortic valve. We had a similar experience with 2 patients having very small papillary fibroelastomas who were referred to us and had their tumors excised urgently.

A 68-year-old woman presented to her general practitioner with a 3-month history of symptoms including one transient ischemic attack (TIA).2Go The patient subsequently underwent echocardiography, which demonstrated a mobile mass attached by a thin stalk to the aortic valve. A 15-mm long and 2 mm in diameter tumor attached to the noncoronary cusp of the aortic valve was resected with standard cardiopulmonary bypass.

A 67-year-old man was referred with a recent history of multiple TIAs. Various investigations including carotid Doppler and transthoracic echocardiogram were inconclusive. However transesophageal echocardiography (TEE) revealed a 5 x 1-mm pedunculated tumor attached to the aortic valve. At the time of surgery, a small tumor with a thin stalk was found attached to the undersurface of the left coronary cusp (Figure 1). Both patients had an uncomplicated recovery and were discharged home on day 5.


Figure 1
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  		Figure 1. Papillary fibroelastoma excised from aortic valve of patient 2.

 
Our patients were very similar to the case reported by Vagefi and colleagues in that both had an early diagnosis of the tumor made by echocardiography on the basis of neurologic symptoms. Both of our patients had their tumors shaved off the structurally normal aortic valve on an urgent basis. At the conclusion of the procedure, intraoperative TEE demonstrated a competent aortic valve with no evidence of residual tumor or aortic insufficiency.

It seems that an early diagnosis of these tumors is being made with very small masses detected with echocardiography. We emphasize the importance of prompt excision of these tumors owing to the risk of preoperative thromboembolic phenomena.3Go

References

  1. Vagefi PA, Bates NR, Ptaszek LM, Adams MS, Walker JD. Valve-sparing excision of aortic valve papillary fibroelastoma. J Thorac Cardiovasc Surg 2006;131:1177-1178.[Free Full Text]
  2. Saxena P, Lee A, Konstantinov IE, Newman MAJ. Papillary fibroelastoma of aortic valve: diagnosis and surgical management. Heart Lung Circ. In press.
  3. Bossert T, Gummert JF, Mohr F. Papillary fibroelastomas and other cardiac tumors should be resected on an urgent basis. Ann Thorac Surg 2005;79:756.[Free Full Text]




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Mark A.J. Newman
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