Papillary fibroelastoma of the mitral valve chordae causing transient ischemic attacks.

Abstract

Cardiac papillary fibroelastoma (CPF) is the most common tumor of the heart valves. Although the tumor generally arises from the valvular endocardium of the mitral or aortic valve, there have been limited numbers of reports on isolated CPF of the mitral valve chordate. This benign tumor may present with systemic embolization. Fragile papillary fronds or fibrin aggregations on the tumor is a cause for systemic embolization. The differential diagnosis includes other heart tumors such as myxoma or lipoma, vegetation, thrombus formation, calcification and Lambl's excrescences. Surgery can be performed with complete resection preserving the mitral valve and its subvalvular apparatus. A 36-year-old woman presented with history of transient ischemic attacks. The patient had experienced several episodes of dysphasia and mental confusion previously. Transthoracic echocardiography revealed a mobile intracardiac mass along the anterior chordae of the mitral valve. To evaluate this lesion in detail, transesophageal echocardiography examination revealed an isolated lesion along the primary chordae of the mitral valve was 15x13 mm in size with an irregular border (Fig. 1, Video. See corresponding video/movie images at ww.anakarder.com). There was no invasion of the papillary muscle, mitral leaflets, or annulus. The tumor was removed from the primary chordae with shave excision