Papillary fibroelastomas: innocent bystanders or ignored culprits?

Area of Science:

• Cardiology
• Oncology

Background:

• Cardiac papillary fibroelastomas (PFEs) are the most common tumors affecting heart valves and the third most frequent cardiac tumor overall.
• While often incidentally discovered via echocardiography, PFEs pose a significant risk of embolic events, including stroke and myocardial infarction.

Purpose of the Study:

• To review the current understanding of cardiac papillary fibroelastomas, encompassing their epidemiology, pathology, pathophysiology, clinical presentation, diagnostic approaches, and management strategies.
• To emphasize the critical need for large-scale randomized clinical trials to establish evidence-based guidelines for PFE treatment, particularly concerning anticoagulation.

Main Methods:

• This review synthesizes existing literature on cardiac papillary fibroelastomas.
• Information was gathered on diagnosis, including echocardiography, MRI, and CT, and treatment options such as surgical resection and anticoagulation.

Main Results:

• Echocardiography is the primary diagnostic tool for PFEs.
• Surgical resection is the recommended treatment for PFEs with high embolic risk.
• Anticoagulation is an option for non-surgical candidates, but its efficacy and optimal use remain uncertain.

Conclusions:

• Current management of PFEs is largely empirical due to a lack of robust clinical trial data.
• Further research, including randomized trials, is essential to refine treatment guidelines for PFEs, especially regarding anticoagulation therapy.