Right Atrial Non-Valvular Papillary Fibroelastoma Causing Paradoxical Embolic Stroke Through an Ostium Secundum...

Area of Science:

• Cardiology
• Neurology
• Pathology

Background:

• Papillary fibroelastomas (PFEs) are rare cardiac tumors, typically left-sided and valvular.
• Right-sided, non-valvular PFEs are uncommon, and systemic embolization is rare, usually requiring an interatrial shunt.

Purpose of the Study:

• To report a case of a right-atrial, non-valvular PFE causing paradoxical embolic stroke.
• To highlight an unusual mechanism of embolism and diagnostic/therapeutic implications.

Main Methods:

• Case report of a 72-year-old woman with recurrent ischemic events and stroke.
• Diagnostic imaging included transthoracic and transesophageal echocardiography.
• Surgical resection of the right atrial mass and closure of an atrial septal defect (ASD).

Main Results:

• Transesophageal echocardiography identified a right atrial mass and an ostium secundum ASD with bidirectional shunting.
• Histopathology confirmed the mass as a papillary fibroelastoma (PFE).
• Surgical resection and ASD closure were performed, with an uneventful recovery and no further embolic events.

Conclusions:

• This case demonstrates paradoxical embolism from a right-sided PFE through an ASD.
• Transesophageal echocardiography is crucial for diagnosing atypical PFEs.
• Surgical intervention is recommended for symptomatic PFEs or those causing embolism, especially with coexisting shunts.