A papillary fibroelastoma is a non-cancerous growth that originates within the heart. While these tumors can appear on various surfaces inside the heart, they most frequently develop on the heart valves, with the aortic valve being a common site. Although benign, the presence of a papillary fibroelastoma on a heart valve can still lead to complications due to its location. This type of tumor is considered the most common growth found directly on the heart’s valves.
Potential Complications and Symptoms
The primary concern with a papillary fibroelastoma, particularly when located on the aortic valve, is the risk of systemic embolism. This occurs when a fragment of the tumor itself, or a small blood clot that has formed on its surface, detaches and travels through the bloodstream. Once dislodged, these emboli can block blood flow to other parts of the body.
Embolic events can manifest in various ways depending on where the fragment travels. If it reaches the brain, it can cause a stroke, characterized by sudden weakness or numbness on one side of the body, difficulty speaking, or vision changes. A transient ischemic attack (TIA), a “mini-stroke” with similar but temporary symptoms, may also occur. Should the embolus obstruct a coronary artery, it can result in a myocardial infarction, commonly known as a heart attack, presenting with symptoms like chest pain, shortness of breath, or discomfort in the arm or jaw.
Despite these potential complications, many individuals with a papillary fibroelastoma are asymptomatic. The tumor is often discovered incidentally during medical imaging. Even in symptomatic patients, the symptoms are often related to the embolic event rather than the tumor itself directly interfering with valve function.
Diagnosis and Imaging Techniques
Discovering a papillary fibroelastoma typically involves specialized medical imaging of the heart. The primary diagnostic tool used to identify these tumors is an echocardiogram, which uses sound waves to create moving pictures of the heart and its structures. This imaging allows medical professionals to visualize the heart’s chambers, valves, and the flow of blood.
Two main types of echocardiograms are commonly employed. A transthoracic echocardiogram (TTE) is a non-invasive procedure where a transducer is placed on the chest, providing a general view of the heart. For a more detailed assessment, particularly of the heart valves, a transesophageal echocardiogram (TEE) is often used. This procedure involves a small probe being passed down the esophagus, positioning it closer to the heart and providing clearer, more precise images of the valve structures and any attached growths.
The TEE is particularly effective for confirming the presence of a papillary fibroelastoma and evaluating its specific characteristics, such as its size, mobility, and exact attachment point on the valve. These tumors often appear as small, mobile masses with a distinctive “sea anemone” like appearance due to their papillary projections.
Medical Management and Surgical Options
Once a papillary fibroelastoma is diagnosed, the approach to management depends largely on whether the patient is experiencing symptoms or if the tumor possesses features associated with a higher risk of complications. For individuals who are asymptomatic and whose tumors do not exhibit high-risk characteristics, a “watchful waiting” approach is often adopted. This involves regular monitoring with follow-up echocardiograms to observe any changes in the tumor’s size or mobility.
In some asymptomatic cases, healthcare providers might consider prescribing antiplatelet medications, such as aspirin, or anticoagulant therapy, like warfarin, to help reduce the risk of blood clot formation on the tumor’s surface and subsequent embolism. However, the routine use of these medications for asymptomatic fibroelastomas is still a topic of discussion among medical professionals and depends on an individual patient’s overall risk profile.
Conversely, for patients who have experienced an embolic event, such as a stroke or TIA, or for those with tumors displaying high-risk features like larger size or increased mobility, surgical excision is generally the recommended treatment. The surgeon typically performs a “valve-sparing” procedure, carefully shaving the tumor off the valve leaflet while preserving the valve’s integrity and function. In rare instances where the valve has sustained significant damage from the tumor or the removal process, valve repair or, rarely, valve replacement might be necessary.