Robotic-assisted surgery successfully and safely resected a 5-mm papillary fibroelastoma on the coumadin ridge with no complications and no recurrence at six months.
Case Report (n=1)
No
Multimodality imaging is essential for detecting small, highly mobile papillary fibroelastomas in echocardiographic blind spots like the coumadin ridge, and early robotic resection offers a safe strategy to prevent embolic complications.
Papillary fibroelastomas (PFEs) are rare, benign cardiac tumors that carry a significant risk of cardioembolism. While transthoracic echocardiography (TTE) is the standard initial screening tool, certain anatomical locations, such as the coumadin ridge, can present diagnostic challenges. We report the case of a PFE located in an echocardiographic "blind spot" that required a multimodality imaging approach for diagnosis and surgical planning. A 61-year-old woman was referred to our hospital after a 5-mm mass near the left atrial appendage was incidentally detected on cardiac computed tomography angiography (CCTA). The patient had no history of embolic events. Notably, standard TTE failed to visualize the mass. A comprehensive multimodality assessment was performed: transesophageal echocardiography (TEE) revealed a highly mobile mass attached to the coumadin ridge with moderate mitral regurgitation; CCTA clarified the anatomical relationship; and cardiac magnetic resonance imaging findings were more consistent with a tumor than a thrombus. Given the high embolic risk posed by the tumor's mobility, a robotic minimally invasive resection and mitral repair was performed. The tumor was successfully excised without complications, and histopathology confirmed a PFE. This case highlights the limitations of TTE in evaluating the coumadin ridge and underscores the indispensability of multimodality imaging for characterizing small, mobile cardiac tumors located in anatomical blind spots. Robotic surgery offers a safe and effective minimally invasive treatment option for preventing embolic complications in such cases.
Yoshiyama et al. (Fri,) conducted a case report in 61-year-old woman with a 5-mm papillary fibroelastoma located on the coumadin ridge (echocardiographic blind spot), with moderate mitral regurgitation and no prior embolic events (n=1). Robotic-assisted minimally invasive surgical resection of papillary fibroelastoma and mitral valve repair was evaluated on Successful complete tumor resection without complications and no recurrence at six months. Robotic-assisted surgery successfully and safely resected a 5-mm papillary fibroelastoma on the coumadin ridge with no complications and no recurrence at six months.