Nonsurgical management of a left ventricular pedunculated papillary fibroelastoma: a case report

Papillary fibroelastoma (PFE) is a benign cardiac tumor that has the potential to cause life-threatening embolic events. Surgical excision of the tumor is recommended for all patients who develop symptoms, but the treatment of asymptomatic patients with an echocardiographically identified PFE is still controversial. Our case report describes a 63-year-old patient with the incidental finding of a probable left ventricular PFE. The patient was not a candidate for surgical excision of this tumor because of comorbidities and refusal to undergo surgery. The patient was followed up during a period of 4 years and was kept on anticoagulation with warfarin. During this follow-up period, the patient developed no symptoms or complications attributable to the cardiac tumor. This is the first case reported in the literature with left ventricular mobile PFE conservatively managed for a duration of more than 4 years. Randomized controlled trials regarding the best management for such incidental PFEs may be needed.