Abstract 18173: Medical Management of Papillary Fibroelastoma is Associated With Low Risk of Embolization in Selected Cases
Introduction: Papillary fibroelastoma (PFE) is a rare primary cardiac tumor with a variable clinical spectrum. Surgical excision is recommended in symptomatic patients, but the optimal management of asymptomatic patients is quite controversial.
Hypothesis and Method: We hypothesized that non-surgical cases would have excess embolic events, and performed a retrospective and prospective observational study to evaluate the course of patients diagnosed with PFE at our institution. We queried our echo database from 2006 to 2014 for patients age 18 years or older with a mass suggestive of PFE on a cardiac valve by TTE or TEE; significant valvular calcifications, endocarditis, or serial echos with contradictory interpretations were excluded. Electronic health records were reviewed, and those with available outcomes data comprised the final study cohort. Outcomes were collected prospectively from time of identification through May 1st, 2015.
Results: We identified 60 cohort patients aged 29 to 89 years (mean 67 +-12); 60% were women, and 85% of PFE were on the aortic valve, with the largest reported dimension 0.2 cm to 1.4 cm. Follow-up data were available for 3 to 126 months (median 40). Surgical excision was performed on 22 patients (38%), mean age 66 +-11 years. Among the remaining 38 patients who did not undergo initial excision, mean age 67 +- 12 years, frailty was cited as the justification in 50%. In the initial non-surgical cohort, 12 received coumadin for unrelated indications such as atrial fibrillation, and 22 received daily Aspirin. In the initial non-surgical cohort, 15 underwent surgical valve repair with resection of the PFE and 7 underwent valve replacement. No post-surgical recurrences were found by TTE. None of the patients in the entire cohort had clinically evident embolic events during follow-up.
Conclusion: This is the first reported study to include prospective outcomes data for PFE. Our data suggest that watchful waiting may be a reasonable strategy in selected patients. The optimal medical therapy remains unknown, and larger randomized trials are needed to establish practice guidelines.
Author Disclosures: T. Bauch: None. W. Htun: None.
- © 2015 by American Heart Association, Inc.