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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 December;26(6):425-8
Avoiding the risk of complications: when is surgical management of papillary fibroelastoma of the aortic valve in asymptomatic patients indicated?
Zientara A. 1, Dzemali O. 1, Odavic D. 1, Homburg K. 2, Pellegrini-Ochsner D. 3, Genoni M. 1
1 Department of Cardiac Surgery, City Hospital Triemli Zurich, Zurich, Switzerland;
2 Department of Anesthesiology, City Hospital Triemli Zurich, Zurich, Switzerland;
3 Institute of Pathology, City Hospital Triemli Zurich, Zurich, Switzerland
The papillary fibroelastoma (PFE) is a benign tumor of the endocardium with a high embolic potential. We discuss the resection of the tumor in open-heart surgery, this being the current standard therapy, and define alternative strategies for asymptomatic patients. A 60-year-old female presented herself to our hospital for a resection of a pedunculated moving mass on the leftcoronary leaflet of the aortic valve. Except for sclerosis and a slight mitral valve insufficiency the aortic valve and other cardiac structures and parameters were normal. A therapy with Phenprocoumon was started in order to avoid embolism. The patient was taken for elective operation under standard cardiopulmonary bypass. A transverse aortotomy for access to the tumor was performed giving the option of valve replacement in case the native valve could not be preserved. The mass could be easily removed. Intraoperative TEE showed a normal function of the aortic valve after the resection. Macroscopically, the tumor had the morphologic character of a solid mass and resembled a sea anemone in saline solution. Histopathological findings revealed a typical fibroelastoma. Small risk of surgery and high rate of preservation of the valve integrity in comparison to the high embolic potential and the likelihood of recurrence for cardioembolic events speak for the surgical resection of the tumor. Nevertheless, since open cardiac surgery is the only established method for complete resection, an individual therapy should be considered in asymptomatic patients including the morphology of the tumor, secondary diagnoses, operability and adverse drug reaction of anticoagulation.