A rare location of tricuspid papillary fibroelastoma: a case report

Introduction. Papillary fibroelastoma is the second most common benign cardiac tumor after myxoma. Unlike myxoma; which is mainly located in the fossa ovalis area and is a hamartoma by origin; fibroelastoma originates from endocardial cells and is therefore located on the heart valves; mainly on the aortic one (44%). It is found on the tricuspid valve in 15% of cases. Fibroelastoma may be asymptomatic; but in some cases; it leads to embolism in the form of myocardial infarction or stroke if located on the aortic valve; or pulmonary embolism if located on the tricuspid valve.

Brief description. A case of a rare tricuspid fibroelastoma in a 67-year-old woman is presented. The patient sought help due to frequent blood pressure increase against the background of the therapy she was taking. She was examined in accordance with the current clinical guidelines on hypertension in adults. Echocardiography revealed mass in the right atrium. Intraoperative assessment revealed the mass of 1;6´1;5´1;3 cm with a villous surface and a loose; jellylike consistency; which is attached to the anterior tricuspid leaflet by a pedicle. Histological analysis identified papillary fibroelastoma.

Conclusion. Differential diagnostics of papillary fibroelastoma is extensive and includes benign (myxoma; fibroma); malignant (lymphoma; sarcoma) and metastatic heart tumors. Valvular vegetations; Lambl's excrescences; cysts; thrombus; fenestration and artifacts should be also ruled out. Cardiac ultrasound does not make it possible to determine the mass origin. Only histological analysis revealed that it was papillary fibroelastoma. The clinical example emphasizes the importance of examining each patient in accordance with related clinical guidelines. This allows for timely detection and prevention of severe embolic complications; usually characteristic of fibroelastoma. 

1. Li W, Zheng J, Zhao H, et al. Beating-heart surgical treatment of tricuspid valve papillary fibroelastoma: a case report. Med (Baltim). 2016;95(34):e4690. doi:10.1097/MD.0000000000004690.

2. Nellis JR, Wojnarski CM, Fitch ZW, et al. Minimally invasive pul-monary fibroelastoma resection. Innovations (Phila). 2019; 14(6):577-80. doi:10.1177/1556984519884308.

3. Andreeva AE, Bartosh-Zelenaya SYu, Novikov VI, et al. Formations of the right heart chambers in norm and in pathology. Cardiology: news, opinions, training. 2021;1(26):70-82. (In Russ.) doi:10.33029/2309-1908-2021-9-1-70-82.

4. Fedorov SA, Zhurko SA, Shirokova OR, et al. Surgical Treatment of Aortic Valve Papillary Fibroelastoma in Combination With Coronary Artery Bypass Grafting. Innovative Medicine of Kuban. 2023;(3):80-6. (In Russ.) doi:10.35401/2541-9897-2023-26-3-80-86.

5. Galyautdinova LE, Basek IV, Alekseeva DV, et al. Papillary fibroelastoma as a cause of myocardial ischemia: clinical case. Regional blood circulation and microcirculation. 2024;23(1):70-5. (In Russ.) doi:10.24884/1682-6655-2024-23-1-70-75.

6. Pletnev NE, Antonov IM, Libov IA, et al. Papillary fibroelastoma of the aortic valve as a cause of acute coronary syndrome. Medical alphabet. 2024;(14):21-5. (In Russ.) doi:10.33667/2078-5631-2024-14-21-25.

7. Fonyakin AV, Geraskina LA. Cardioembolic stroke: classification of causes and prevention strategies. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(6):4-13. (In Russ.) doi:10.14412/2074-2711-2021-6-4-13.

8. Nechaenko MA, Kuznetsova LM, Podolyak DG, et al. Diagnostic and surgical tactics in pseudotumorous voluminous heart formations. Russian Journal of Cardiology. 2014;(5):81-7. (In Russ.) doi:10.15829/1560-4071-2014-5-81-87.

9. Rosic M, Zdravkovic R, Komazec N, et al. An unusual case of loca-lization of papillary fibroelastoma on the upstream side of the tricuspid valve. Kardiol Pol. 2023;81(4):405-7. doi:10.33963/KP.a2023.0035.

10. Fang L, Wu W, Wang J, et al. Flail tricuspid valve with torrential regurgitation caused by papillary fibroelastoma. Cardiol J. 2022;29(5):882-3. doi:10.5603/CJ.2022.0085.

11. Ku L, Chen Y, Ma X. A rare case of right-sided papillary fibroelastoma originating from the tricuspid valve. Acta Cardiol. 2024;1-2. doi:10.1080/00015385.2024.2313935.

12. Phan TQ, Pham CTV, Bui VDA, et al. Minimally invasive resection of heart valve papillary fibroelastoma: two case reports and review of the literature. J Cardiothorac Surg. 2023;18(1):320. doi:10.1186/s13019-023-02392-1.

13. Actis Dato GM, Calia C, Lodo V, et al. A rare case of papillary fibroelastoma involving the tricuspid valve. A single center experience over a period of 22 years (1999-2021). Acta Chir Belg. 2023;123(5):563-5. doi:10.1080/00015458.2022.2064625.

14. Volkov DYu, Sakovich VA, Drobot DB, et al. Experience in the application of minimally invasive heart surgery techniques in the conditions of the Federal Center for Cardiovascular Surgery. Moscow Surgical Journal. 2021;(3):15-21. (In Russ.) doi:10.17238/2072-3180-2021-3-15-21.