Papillary fibroelastoma of the mitral valve initially suspected as myxoma: a case report of resection via minimally invasive approach.

Abstract

Background: Papillary fibroelastomas typically arise from the cardiac valves, whereas cardiac myxomas rarely originate from the valves. Distinguishing these tumors intraoperatively can be challenging.

Case presentation: An 81-year-old man was referred for evaluation of an incidental cardiac mass. Transesophageal echocardiography revealed a mobile 10-mm mass attached to the P1 segment of the posterior mitral leaflet. Minimally invasive cardiac surgery via a right mini-thoracotomy allowed satisfactory exposure of the mitral valve. Intraoperative findings and frozen section analysis suggested a myxoma, prompting excision with a margin that included the tumor attachment. However, the final histopathological examination revealed papillary fibroelastoma. The postoperative course was uneventful, and the mitral valve function was preserved.

Conclusions: Papillary fibroelastomas and myxomas can be difficult to differentiate intraoperatively. Surgical decision-making should balance adequate tumor resection with preserved valve function when a diagnosis is uncertain.