Abstract Body (Do not enter title and authors here): Papillary fibroelastomas (PFEs) are benign cardiac tumors, most commonly arising on left sided heart valves but have been reported on non-valvular structures. Histologically, PFEs are comprised of throngs of an avascular mucopolysaccharide core with an overlying layer of endothelial cells. While PFEs carry no inherent malignant potential, the risk of embolization poses a unique challenge to clinicians.
Case series exist describing the anatomical characteristics of PFEs, though as echocardiography has become more ubiquitous and imaging quality has dramatically improved, little contemporary data exists on the patient characteristics, management techniques employed, and outcomes. Our objective was to describe a quaternary center’s experience with PFEs.
A single quaternary center, retrospective case review of patients with a diagnosis of cardiac tumor between Janurary 1 2008 and Janurary 30 2024, using ICD codes D15.1 and I42.4, resulted in 410 patients. Using chart review, 80 of the 410 patients had a suspected diagnosis of PFE based on TEE or TTE characteristics. We then performed a retrospective analysis of the 80 patients.
Of the 80 patients, 47 underwent surgical resection, 5 roboticly, with no evidence of PFE on subsequent TTE. The median age at time of diagnosis was 67.7 +/- 13.8 years. 35 patients had a diagnosis of stroke any time prior to PFE identification. The most common indication for the diagnostic echocardiogram was arterial emboli. Valvular PFEs were commonly found on the upstream aspect of valves (55.9%) and most commonly located on the aortic valve (63.8%). Of the 27 patients with a diagnosis of stroke and PFE size data, 20 had a PFE >/= 5 mm. In the non-surgical group 7 were on P2Y12 inhibitor or therapeutic anticoagulation for the indication of PFE. Within 3 years there was 1 mortality in the surgical group and 6 in the non-surgical group. In the non-surgical group 15.2% were hospitalized for bleeding at 3 years verse 6.25% in the surgical group.
While PFEs have been previously characterized in case series, there remains a scarcity of literature on their clinical presentation and management techniques. This single center case series demonstrates an association between PFEs and arterial embolic events with low three-year mortality. There may be a relation to PFE size and stroke as stroke was more common in those with a PFE >/= 5mm. Additional studies evaluating PFE characteristics and treatment strategies are necessary to guide PFE management.