Nonvalvular Papillary Fibroelastoma of the Left Ventricle: A Case Report and Review of the Literature

Papillary fibroelastoma (PFE) is a benign primary cardiac tumor that most commonly arises from valvular endocardium, whereas nonvalvular involvement, particularly within the left ventricle, is rare. Despite benign histology, PFEs are clinically relevant due to mobility and embolic risk. We report a case of a 64-year-old woman in whom a small nonvalvular left ventricular PFE was identified during evaluation for ventricular arrhythmias. Cardiac imaging demonstrated a mobile mass attached to the apical inferior left ventricular wall, which was successfully resected surgically under cardiopulmonary bypass with pathologic confirmation of PFE. We additionally performed a focused review of published cases of nonvalvular left ventricular PFEs, including lesions arising from the subvalvular mitral apparatus. The literature demonstrates heterogeneous clinical presentation, diverse anatomic attachment sites, and a strong preference for surgical management. This case and review highlight the importance of considering PFE in the differential diagnosis of left ventricular masses and support surgical excision for mobile nonvalvular lesions.