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Central retinal artery occlusion in a patient with aortic valve papillary fibroelastoma: a case report
Fabian Kerwagen1,2, Antony William3, Nodir Madrahimov4
1Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.
Insights
Papillary fibroelastomas, rare heart tumors, can cause stroke-like events. A small aortic valve tumor led to vision loss, emphasizing the need for early detection and surgical removal to prevent serious embolic complications.
Area of Science:
- Cardiology
- Ophthalmology
- Oncology
Background:
- Cardiac papillary fibroelastomas are rare endocardial tumors, frequently originating from heart valves.
- Despite benign histology, they possess significant embolic potential, leading to ischemic events.
- Ocular embolization, such as central retinal artery occlusion, is an uncommon initial presentation.
Background:
Cardiac papillary fibroelastoma are rare benign tumours of the endocardium, often arising from heart valves. Despite their benign histology, papillary fibroelastoma carry high embolic potential and can lead to ischaemic events. In contrast to stroke, ocular embolization including central retinal artery occlusion is a rather rare first manifestation.
Case Summary:
We report a 61-year-old female with sudden painless monocular vision loss due to central retinal artery occlusion. Initial stroke and cardiovascular work-up revealed a very small floating mass (0.6 × 0.4 × 0.2 cm) on the aortic valve by transesophageal echocardiography. The patient underwent successful surgical excision, with histopathology confirming papillary fibroelastoma.
Discussion:
Central retinal artery occlusion as a primary manifestation of papillary fibroelastoma highlights the embolic potential of these tumours. Multimodality imaging, especially transesophageal echocardiography, is crucial in diagnosis. Even very small papillary fibroelastoma may cause devastating embolic events such as irreversible monocular blindness. Surgical excision is the treatment of choice to prevent recurrence.
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