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Published on: February 11, 2022
Simultaneous surgery for patent ductus arteriosus associated with papillary fibroelastoma
Atsushi Morishita1, Hideyuki Tomioka, Seiichiro Katahira
1The Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, Numata, Gunma, Japan.
Insights
This case report details a rare association between patent ductus arteriosus (PDA) and papillary fibroelastoma (PFE) in an elderly woman. Surgical intervention successfully treated both conditions, highlighting the diagnostic utility of transesophageal echocardiography.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Background:
- Patent ductus arteriosus (PDA) is a congenital heart defect, and papillary fibroelastoma (PFE) is the most common primary cardiac tumor.
- Co-occurrence of PDA and PFE is exceptionally rare, with no prior documented cases.
Observation:
- A 76-year-old female patient presented with a history of stroke, atrial fibrillation, and COPD.
- Preoperative cranial diffusion-weighted imaging (DWI) revealed a cerebellar lesion, prompting further cardiac evaluation.
- Transesophageal echocardiography (TEE) identified two mobile masses on the aortic valve and confirmed PDA.
Findings:
- Surgical management involved transpulmonary patch closure of PDA and excision of the aortic valve masses under hypothermic circulatory arrest.
- Pathological examination confirmed the masses as papillary fibroelastomas (PFEs).
- This represents the first reported instance of PDA associated with PFE.
Implications:
- This case underscores the importance of comprehensive cardiac evaluation in patients with embolic events.
- Transesophageal echocardiography (TEE) is a crucial diagnostic tool for managing cardiovascular conditions, particularly in suspected cardiogenic embolism.
- The successful surgical outcome demonstrates the feasibility of managing combined PDA and PFE.
Abstract:
We describe a case of patent ductus arteriosus (PDA) in a 76-year-old woman with a history of stroke, atrial fibrillation, and chronic obstructive pulmonary disease. Cranial diffusion-weighted imaging (DWI) performed for preoperative assessment showed a hyperintense lesion in the left cerebellum. Preoperative transesophageal echocardiography (TEE) demonstrated two highly mobile masses approximately 5 mm in diameter adherent to the left and non-coronary cusps of the aortic valve. We performed transpulmonary patch closure of PDA under hypothermic circulatory arrest. Subsequently, two frond-like masses were completely shaved off the cusps, preserving the native aortic leaflets. Pathological examination confirmed the diagnosis of papillary fibroelastoma (PFE). To our knowledge, this is the first report of PDA associated with PFE. Perioperative use of TEE is an effective tool for management of cardiovascular patients with suspected cardiogenic embolism.
