Papillary fibroelastoma of the tricuspid valve

A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.     

Surgical treatment of a cardiac papillary fibroelastoma developing from the chordae of the tricuspid valve: Report of a case

(Received for publication on Aug. 27, 1996; accepted on May 12, 1997)     

Papillary fibroelastoma of the tricuspid valve chordae

Papillary fibroelastoma (PFE) commonly involves the native valve tissue, especially that of the left side of the heart. PFE originates less commonly from the valve of the right side of the heart and rarely from the valve chordae. A 69-year-old man was admitted to our hospital complaining of chest discomfort in October 2005. Transthoracic echocardiography showed a highly mobile round mass measuring approximately 10 mm in diameter in the right ventricle. He underwent urgent surgery. The tumor was located at the middle of the tricuspid valve chordae and was excised under cardiopulmonary bypass with cardiac arrest. He had an uneventful recovery and was discharged from the hospital 15 days after surgery. The patient has been asymptomatic and remains well without tumor recurrence 7 months after surgery.     

Papillary fibroelastoma of the mitral valve associated with rheumatic mitral valve stenosis

With the advent of echocardiography, diagnosis of papillary fibroelastoma in living patients has been made possible, yet papillary fibroelastoma found in the living remains a very rare cardiac tumor. We report a case of papillary fibroelastoma of the mitral valve with rheumatic mitral valve stenosis. A 68-year-old woman was referred to our hospital with a mitral valve tumor and rheumatic mitral valve stenosis. She underwent anticoagulation therapy with Warfarin for 8 years since having a cerebral embolization. Echocardiography revealed a mass attached to the mitral valve, with severe mitral valve stenosis. Electrocardiography demonstrated a chronic atrial fibrillation. Tumor excision with mitral valve replacement and maze procedure were performed. Both the surgical and histological findings depicted papillary fibroelastoma. The postoperative course was uneventful and the patient has remained symptom-free one year after surgery.     

Right atrial myxoma developing 4 years following patch closure of an atrial septal defect: Report of a case

We report herein the rare case of a 13-year-old boy in whom a right atrial myxoma developed 4 years following patch closure of an ostium secundum atrial septal defect, at which time no other atrial abnormality had been observed. The myxoma arose from the atrial septum in the area between the orifices of the coronary sinus and inferior vena cava. The suture line was not involved. Gross and histopathological findings were characteristic of atrial myxoma. Atrial myxomas are usually considered to be slow-growing neoplasms; however, this case demonstrates that the initial period of growth may be quite rapid in some cases.     

Secundum atrial septal defect associated with mitral valve cleft: Report of a case with chromosomal syndrome of trisomy 3p

A 4-year-old boy was diagnosed as having a chromosomal abnormality with trisomy 3p associated with a secundum atrial septal defect and a cleft of the anterior mitral leaflet. His craniofacial features showed microcephaly, micrognathia, ocular hypertelorism associated with epicanthus, and low-set ears. Moderate mental retardation and hypoplasia of the penis were also noted. A left ventriculogram demonstrated grade 2 mitral regurgitation according to the Sellers' classification with a prolapsing of the mitral leaflets. A cleft of the anterior mitral leaflet was detected at the time of operation. The secundum atrial septal defect was directly closed and the mitral cleft was repaired. This is the first report of trisomy 3p associated with an atrial septal defect and a mitral valve cleft.     

Papillary fibroelastoma of the aortic valve: report of a case

This report describes a case of aortic papillary fibroelastoma causing transient ischemic attack (TIA), and is followed by a review of the relevant literature. A tumor measuring 1.5 × 1.5 cm was located in the right coronary cusp of the aortic valve, which was found to have a "sea anemone-like" configuration due to collagenous or elastic papillary projections. Aortic fibroelastoma can cause cerebrovascular symptoms, and this patient presented with TIA. Moreover, aortic fibroelastoma usually causes chest symptoms and occasionally results in death despite its small size of generally less than 1 cm. According to the literature, all of the patients who died of fibroelastoma had an aortic valve tumor in the right or left coronary cusp, which indicates that the location of the tumor rather than its size may be an important factor contributing to the case of death. Surgical treatment is usually indicated especially for aortic fibroelastoma because of the high associated risk or cerebrovascular and chest diseases. The recent evolution of echocardiography will promote the chance of establishing a preoperative diagnosis of this lesion. However, because it is not possible to differentiate fibroelastoma from other lesions, including malignancies, by echocardiography alone, this may be another reason for performing surgical removal. Received: August 24, 2000 / Accepted: September 11, 2001     

Rapid development of a papillary fibroelastoma in the aortic valve: Report of a case

We report a case of a fast-growing cardiac papillary fibroelastoma (CPF) arising in the aortic valve. A 71-year-old woman was referred to a cardiologist for investigation of palpitations. Cardiac catheterization, coronary angiography, and echocardiography showed no stenosis of the coronary arteries, nor any other cardiovascular abnormalities. However, 12 months later she was referred to our hospital for further investigations when she began experiencing chest discomfort on exertion. This time, echocardiography showed an abnormal mass arising from the aortic valve, floating between the left sinus of Valsalva and the ascending aorta. Considering the risk of an embolic event, we performed semi-emergency surgery to remove the tumor, preserving the aortic valve. The resected tumor was 16 × 7 mm, and sea anemone-like, with many villus projections. It was diagnosed as papillary fibroelastoma. Such rapid development of CPF is rare.     

Isolated tricuspid valve stenosis caused by infective endocarditis in an adult: Report of a case

We report herein the case of a 42-year-old man in whom dyspnea on exertion was found to be caused by isolated tricuspid stenosis. Two-dimensional echocardiogram showed thickening of the tricuspid valve with a markedly enlarged right atrium. A color-flow Doppler examination-revealed severe tricuspid stenosis without regurgitation and a Doppler-derived tricuspid diastolic pressure gradient of 23 mmHg. At the time of surgery, the patient was noted to have a stenotic tricuspid valve with thickened leaflets, fused commissures, and almost normal chorda tendineae. The valve leaflets were teased apart to the scattered specimen, and tricuspid valve replacement was successfully performed. Microscopic examination of the specimen demonstrated infective endocarditis. Isolated acquired tricuspid stenosis is extremely rare and, to our knowledge, this is the first case of infective endocarditis being involved as the primary cause.     

多发性房间隔缺损介入治疗

目的本文报告1998年10月-2006年11月13例多发性ASD介入治疗体会。方法13例中男3例,女10例。年龄4~60岁,平均(26.1±4.2)岁。13例中9例2处缺损,3例3处缺损,1例4处缺损。合并房间隔膨出瘤2例,1例合并心房纤颤和心包积液。结果13例中11例应用一个闭合器功闭合,闭合器型号12~40 mm,2例应用两个闭合器闭合缺损,型号均为18/8 mm,2例术后残余分流。无其它并发症。结论多发性ASD介入治疗,必用TEE监测,确定ASD数目、直径和间距,尽量用1个闭合器闭合多处缺损。     

食管超声在经胸微创继发孔房间隔缺损封堵术中的应用

目的报告经食管超声心动图（TEE）用于58例经胸微创治疗继发孔房间隔缺损（ASD）封堵术的结果。方法术前经胸超声心动图（TTE）初步筛选58例继发孔型ASD患者,观察ASD大小及各残缘,并在术中指导封堵过程,术后评价封堵效果。结果封堵术后随访一个月后,54例完全闭合房间隔;2例残留少量房水平分流;2例封堵失败,行体外循环下修补术。手术并发症1例,无TEE相关并发症。结论TEE可在术前修正TTE诊断,并在选择封堵器、术中全程引导及术后疗效的即刻判断等方面起重要作用。     

Impaired ventilatory efficiency after closure of atrial or ventricular septal defect

Objectives: Atrial and ventricular septal defects are the most common congenital heart defects and the closing procedures share important similarities. Generally, the postoperative outcome is considered benign, but there is growing concern regarding late ventilatory function. Therefore, the aim of this review was to describe the ventilatory function in patients with open as well as percutaneously or surgically closed atrial and ventricular septal defects. Methods: We performed a search protocol based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and cross-checked by the secondary reviewer. Results: We found an increasing evidence of late impairment in ventilatory efficiency, and despite that ventilatory function is commonly normal at rest, abnormalities were disclosed during exercise. There are indices that surgical closure plays an important role. Discussion: Atrial septal defect and ventricular septal defect patients have persisting, long-term impairment in ventilatory efficiency during exercise. Although the pathogenesis behind this finding may be multifactorial, there are indices that the surgical procedure may play an important role. Nevertheless, the literature is this field is sparse, and additional studies are needed.     

An unusual variation of left ventricular-right atrial communication

We herein present a 5-month-old boy with an infravalvular-type left ventricular-right atrial communication without an abnormal tricuspid valve leaflet. The thick chorda of the anterior tricuspid leaflet was inserted into the upper edge of the ventricular septal defect which was placed just under the commissure. The jet from the septal defect pushed this thick chorda and opened the commissure, which thus caused the abnormal pathway from the left ventricle to the right atrium. This mechanism of left ventricular-right atrial communication has not yet been reported elsewhere.     

Atrial septal defect closure in young females by an anterolateral thoracotomy

There are many approaches for closure of atrial septal defects. We used an anterolateral thoracotomy for closure of atrial septal defects in 140 young females for cosmetic considerations. The technique was relatively simple and no extra equipment was needed. The outcome was excellent however breast development will need to be followed up as many of these were pre pubertal children.