Left Atrium Cardiac Papillary Fibroelastoma in Patient With Atrial Fibrillation

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Imaging

Background:

• Cardiac papillary fibroelastoma (CPFE) are rare cardiac masses.
• They are associated with serious cardiovascular events including myocardial infarction, syncope, arterial embolism, and sudden death.
• Left atrial CPFE is an uncommon presentation.

Purpose of the Study:

• To report a case of left atrial CPFE in an elderly patient undergoing evaluation for Watchman device implantation and Cox-Maze procedure.
• To discuss the implications of combined CPFE excision and atrial fibrillation surgery.

Main Methods:

• Transthoracic echocardiogram to identify the left atrial mass.
• Combined surgical excision of the left atrial CPFE and Cox-Maze procedure for atrial fibrillation.
• Postoperative monitoring for complications.

Main Results:

• A 1.2-cm CPFE was identified in the left atrium of an 87-year-old woman.
• The patient developed cardiogenic shock and atrial fibrillation recurrence postoperatively.
• The combined procedure carried significant risks.

Conclusions:

• Left atrial CPFE is rare and requires careful consideration for combined surgical procedures.
• Manipulation of the left atrium during CPFE excision may increase the risk of postoperative atrial fibrillation.
• Staged procedures might be a safer alternative to reduce the risk of atrial fibrillation recurrence.