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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Left atrial papillary fibroelastoma: a rare cause of multiple cerebral emboli

Siamak Mohammadi1, Andre Martineau, Pierre Voisine

  • 1Department of Cardiac Surgery, Laval Hospital, Québec City, Québec, Canada.

The Annals of Thoracic Surgery
|September 25, 2007
PubMed

Insights

Papillary fibroelastomas, often found incidentally via echocardiography, can cause cerebral ischemic attacks. This case highlights an unusual left atrial appendage location requiring surgical excision during bypass surgery.

Area of Science:

  • Cardiology
  • Neurology
  • Pathology

Background:

  • Papillary fibroelastomas (PFEs) are increasingly diagnosed due to advances in cardiac imaging, particularly echocardiography.
  • These benign cardiac tumors commonly affect the aortic valve but can embolize, leading to neurological events like ischemic attacks.
  • The left ventricle is the most frequent nonvalvular site for PFEs.

Observation:

  • A 59-year-old male presented with recurrent cerebral ischemic attacks, necessitating coronary artery bypass surgery.
  • Initial neurological workup and transthoracic echocardiography were unremarkable.
  • Intraoperative transesophageal echocardiography revealed a 5x5 mm pedunculated, mobile mass in the left atrial appendage.

Findings:

  • The mass was surgically excised via the left atrial appendage during the coronary artery bypass grafting procedure.
  • Microscopic examination confirmed the diagnosis of papillary fibroelastoma.
  • This case represents an unusual localization of a PFE.

Implications:

  • The findings underscore the importance of considering PFEs in patients with unexplained embolic events, even with initially normal cardiac imaging.
  • Surgical management, including excision during other cardiac procedures like bypass surgery, can be effective for PFEs in atypical locations.
  • Further research into the optimal diagnostic and management strategies for PFEs in non-traditional sites is warranted.

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