Case of a cardiac papillary fibroelastoma attached to the anterior mitral valve leaflet

Primary cardiac tumors occur very rarely. According to the findings of autopsy studies, the incidence of primary cardiac tumors is between 0.001% to 0.28%. One of the primary cardiac tumors is papillary fibroelastoma (PFE), which represents approximately 7% of all primary cardiac tumors. After myxoma and lipoma, it is the third most common primary cardiac tumor. However, PFE is the most common valvular tumor, affecting mainly the aortic valve. Often, they do not cause any symptoms, but they represent a risk for systemic emboli, myocardial infarction, stroke, and sudden death. Surgical excision is important to prevent cerebrovascular and, rarely, cardiovascular complications. In most cases, the tumor is diagnosed by transesophageal echocardiography. Histologically, PFE consists of papillary frond-like projections with an avascular core of dense connective tissue, surrounded by tissue rich in acid mucopolysaccharides, collagen and elastic fibers, and spindle-shaped cells resembling smooth muscle cells or fibroblasts. The surface of the projections is covered with endothelial cells. In our study, we present a 47-year-old male patient with PFE located in the primary chorda tendinea of the anterior mitral valve leaflet causing cardioembolic cerebral events. This location is the second most common for fibroelastoma growth. The tumor was successfully surgically treated.