Fibroelastic papilloma: A not-so-benign cardiac tumor

Six fibroelastic papillomas, ranging in size from 2 to 17 mm, were diagnosed among 106 benign cardiac tumors observed at our institute since 1970. Two were incidental autopsy findings, and involved the pulmonary and aortic semilunar valves, respectively; four were surgically removed specimens from the left side of the heart. Clinical diagnosis was achieved in two young subjects, aged 25 and 31 years, by 2D-echo examination, following an episode of acute myocardial infarction precipitated during a soccer game; the tumor was related to the mitral valve apparatus in both cases, and a coronary embolism, either neoplastic or thrombotic, was the most likely cause of myocardial infarction. Thus, cardiac left-side fibroelastic papilloma should be considered a potentially lifethreatening tumor in hemodynamic terms. Like myxoma, this tumor entails the risk of systemic embolism that may also occur in the coronary arterial tree, precipitating myocardial infarction and sudden cardiac arrest.