From the Guidelines
Surgical excision is recommended for symptomatic aortic valve papillary fibroelastomas and for those that are >1 cm in diameter or appear mobile, even if asymptomatic, due to the risk of embolism. Aortic valve papillary fibroelastoma is a rare, benign cardiac tumor that typically develops on the heart valves, particularly the aortic valve 1. These tumors are composed of fibrous and elastic tissue, appearing as small, frond-like growths resembling sea anemones. Management depends on the size, location, and whether symptoms are present. For symptomatic patients or those with mobile tumors larger than 1 cm, surgical intervention, including removal or occasionally valve replacement, is necessary to prevent embolization that can cause stroke or other thromboembolic events 1.
Key Considerations
- Surgical excision is the treatment of choice for symptomatic patients or those with high-risk features
- Asymptomatic patients with small, non-mobile fibroelastomas may be managed conservatively with regular echocardiographic monitoring
- The risk of embolization is a key consideration in the management of aortic valve papillary fibroelastoma 1
Treatment Approach
- Surgical excision typically involves valve-sparing excision of the tumor, with excellent outcomes and low recurrence rates
- Patients should undergo regular follow-up with echocardiography after diagnosis or treatment
- The exact cause of fibroelastomas remains unclear, but they may develop from organizing microthrombi on valve surfaces, endothelial damage, or as a response to infection or inflammation 1
From the Research
Diagnosis of Aortic Valve Papillary Fibroelastoma
- The diagnosis of aortic valve papillary fibroelastoma can be made using echocardiography, which can reveal a tumor at the aortic valve 2.
- Cardiac computed tomography can also be used to diagnose papillary fibroelastoma, and it can show a sea-anemone-like appearance of the tumor 2.
- Incidental diagnosis of papillary fibroelastoma can also be made during routine intraoperative transesophageal echocardiography 3.
Treatment of Aortic Valve Papillary Fibroelastoma
- Early surgical excision is the treatment of choice for aortic valve papillary fibroelastoma due to the risk of embolism 2, 4.
- Valve-sparing excision is a recommended approach, which can produce good long-term results in most instances 4, 3.
- Anticoagulation therapy may be considered in patients who cannot undergo early surgical excision, and it can successfully prevent thromboembolism 2.
- Nonsurgical management of asymptomatic patients with papillary fibroelastoma may be considered, but further data are needed to support this approach 5.
- Transcatheter aortic valve replacement (TAVR) can be used as a strategy for aortic valve stenosis and papillary fibroelastoma in high-risk patients 6.