Key result
Conservative surveillance maintains clinical and morphological stability for an incidental mitral papillary fibroelastoma in HCM.
Case Report (n=1)
This case highlights the rare occurrence of an echocardiographic mass suggestive of a papillary fibroelastoma on the mitral valve in an HCM patient, challenging the theory that such tumors strictly arise from high hemodynamic trauma, and supports individualized conservative management in asymptomatic patients.
May support conservative surveillance in select asymptomatic HCM cases; challenges hemodynamic trauma theory and leaves open prospective validation.
BACKGROUND: Papillary fibroelastoma (PFE) is a benign cardiac tumor typically found on valves and is often asymptomatic. However, embolic complications are known. CASE SUMMARY: A patient with hypertrophic cardiomyopathy (HCM) was found to have an echocardiographic mass on the mitral valve. Despite no histologic confirmation, the imaging characteristics were consistent with PFE. The patient was managed conservatively and has remained asymptomatic under clinical and echocardiographic surveillance. DISCUSSION: Although PFEs have been reported on the aortic valve and left ventricular outflow tract in HCM patients, mitral valve involvement is rare. This case challenges the theory that PFEs arise from hemodynamic trauma in high-flow regions. It also supports the individualized approach to managing incidental valvular masses and contributes to the evolving understanding of PFE pathogenesis. TAKE-HOME MESSAGES: Hemodynamic flow may not fully explain PFE development in HCM. Individualized management is key for asymptomatic patients with incidental valvular mass suggestive of PFE.
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Le et al. (2025) conducted a case report in Hypertrophic cardiomyopathy and suspected papillary fibroelastoma (n=1). Conservative management was evaluated. An incidental suspected papillary fibroelastoma on the mitral valve in a patient with hypertrophic cardiomyopathy remained clinically silent and morphologically stable under conservative management.
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