Papillary fibroelastoma:Accurate localization but low sensitivity of echo in 84 cases

Cardiac papillary fibroelastoma, the third most common benign cardiac neoplasm, may present with systemic embolus, sudden death, stroke, or acute myocardial infarction, but is most commonly encountered by routine echocardiography. Methods: Between 1983 and 1995, 116 patients (male 46%, Age: 59±14 yrs) with 133 fibroelastomas were confirmed by surgical pathology in our institution. Of these, 94 pts had pre-operative two dimensional echocardiograms (TTE 56, TTE+TEE 28, TEE 10). The pre-operative echo tapes were retrospectively reviewed, and the size, location and mobility of masses compared with surgical pathology. Results: Retrospective review of the 94 preoperative echocardiograms detected fibroelastomas in 84 pts (89%). Of these, only 23% had been noted on the initial echo interpretation. All masses were solid, measuring 3 to 28 mm. Tumors in cardiac chambers were larger than valvular lesions (1.24 cm vs 0.87 cm, p<0.01). Mobility was seen in 55% of aortic valvular lesions, 51% of mitral lesions, and 100% of intracavity lesions (100%); and 30% had stalks of 1-3 mm in length. The location of masses by echo(see table) matched the findings of surgical pathology in 100% of pts (some pts had multiple masses, n=94). Aortic Valve Mitral valve LV RV LA 42(44.6%) 37(39.4%) 11(12%) 3(3%) 1(1%) NCC RCC LCC AMVL PMVL 22% 52% 26% 62% 38% Of 61 pts with postop echo, mean 651 days postop, no recurrence of lesions was seen. Conclusion: Cardiac fibroelastomas, most commonly attached to the aortic or mitral valves, may be diagnosed accurately by echocardiography, provided the examination is done carefully with a high index of suspicion, without which, many fibroelastomas are commonly missed.