Key result
Surgical excision remains the primary management for rare nonvalvular LV papillary fibroelastomas to mitigate embolic risk.
Why the study?
Papillary fibroelastoma most commonly arises from valvular endocardium, whereas nonvalvular involvement within the left ventricle is rare but clinically relevant due to mobility and embolic risk.
This review highlights the diverse anatomic attachment sites and clinical presentations of nonvalvular left ventricular papillary fibroelastomas, supporting surgical excision for mobile lesions.
Supports excision of mobile nonvalvular left ventricular papillary fibroelastomas to reduce embolic risk; extends case literature but remains hypothesis-generating.
Papillary fibroelastoma (PFE) is a benign primary cardiac tumor that most commonly arises from valvular endocardium, whereas nonvalvular involvement, particularly within the left ventricle, is rare. Despite benign histology, PFEs are clinically relevant due to mobility and embolic risk. We report a case of a 64-year-old woman in whom a small nonvalvular left ventricular PFE was identified during evaluation for ventricular arrhythmias. Cardiac imaging demonstrated a mobile mass attached to the apical inferior left ventricular wall, which was successfully resected surgically under cardiopulmonary bypass with pathologic confirmation of PFE. We additionally performed a focused review of published cases of nonvalvular left ventricular PFEs, including lesions arising from the subvalvular mitral apparatus. The literature demonstrates heterogeneous clinical presentation, diverse anatomic attachment sites, and a strong preference for surgical management. This case and review highlight the importance of considering PFE in the differential diagnosis of left ventricular masses and support surgical excision for mobile nonvalvular lesions.
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Aibek E. Mirrakhimov (2026) conducted a review in Nonvalvular left ventricular papillary fibroelastoma (n=91). Surgical excision was evaluated. Nonvalvular left ventricular papillary fibroelastomas are rare, present heterogeneously, and are predominantly managed with surgical excision due to embolic risk.
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