A Case of Cardiac Papillary Fibroelastoma in a Tricuspid Valve

Abstract

Cardiac papillary fibroelastoma (CPFE) is a rare tumor, and is usually located in the atrioventricular or ventriculoarterial valves. It is occasionally identified by echocardiography or surgery. It can also be an unexpected finding at autopsy. As this tumor often occurs in left-sided cardiac chambers, early aggressive surgical resection is required in order to prevent severe systemic embolic complications. However, the operative indications of tumors on the right cardiac chamber are controversial. The patient was a 73 year-old man. He had had cerebral infarction at age 58. Before the currently reported operation, we found CPFE on the tricuspid valve but we could not find a patent foramen ovale (PFO) by the usual examinations. During surgery, we found a CPFE on the tricuspid valve that had a short stalk and PFO. We cut the short stalk of the CPFE easily, and closed the PFO directly. This patient did not need complicated valve repair. We speculated that this cerebral infarction was caused by a CPFE on the tricuspid valve and patent foramen ovale. Echocardiography is very useful in diagnosing CPFE. However, we should not neglect the possibility of PFO before surgery. The postoperative course was uneventful. We concluded that early surgical resection of CPFE, even in right-sided cardiac chambers, should be performed in order to prevent severe embolic complications, even without PFO diagnosis.