Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas

Area of Science:

• Cardiovascular Pathology
• Cardiac Oncology
• Neoplastic Disease

Background:

• Papillary fibroelastomas (PFE) are the most common primary cardiac tumors, typically benign.
• Limited data exists regarding the clinical course and outcomes of PFE, particularly for unoperated cases.
• Understanding PFE behavior is crucial for guiding management strategies and patient prognostication.

Purpose of the Study:

• To determine the frequency and clinical outcomes of surgically treated PFE.
• To describe the clinical course of patients with echocardiographically suspected PFE who did not undergo surgery.
• To compare the risks of stroke and mortality between operated and unoperated PFE cohorts.

Main Methods:

• Retrospective analysis of 511 patients from Mayo Clinic databases (1995-2010).
• Group 1: 185 patients with surgically removed and pathologically confirmed PFE.
• Group 2: 326 patients with echocardiographic evidence of PFE but no surgical intervention.

Main Results:

• PFE most commonly occurred on cardiac valves (78%).
• In surgically treated patients (Group 1), stroke was the presenting symptom in 32%, with valve preservation in 98% and recurrence in 1.6%.
• Unoperated patients (Group 2) had higher 5-year risks of cerebrovascular accident (13%) compared to operated patients (8%).

Conclusions:

• Surgical removal of PFE is safe and effective, with low recurrence and high rates of valve preservation.
• Patients with suspected PFE who do not undergo surgical removal face increased risks of cerebrovascular accident and mortality.
• Timely surgical intervention for PFE is recommended to improve patient outcomes and reduce long-term complications.