Incidental Detection and Surgical Management of a Papillary Fibroelastoma

Abstract

Background: Papillary fibroelastoma (PFE) is a rare but potentially embolic primary cardiac tumor, most often found on the valvular endocardium. Its detection is usually incidental, but its clinical consequences can be severe, especially in left-sided locations. Increasing access to echocardiographic imaging has improved the identification of asymptomatic valvular masses. Case Presentation: We report the case of a 69-year-old woman with no significant medical history except for well-controlled hypertension, scheduled for total knee replacement. As part of her routine preoperative cardiac assessment, transthoracic and transesophageal echocardiography revealed a 11 × 7 mm mobile, pedunculated mass on the non-coronary cusp of the tricuspid aortic valve, suggestive of a papillary fibroelastoma. The mass was non-stenotic and associated with only minimal aortic regurgitation. Coronary angiography was unremarkable. After multidisciplinary discussion, the patient underwent surgical resection of the mass with preservation of the native valve. Postoperative echocardiography confirmed intact valve function. Histopathological analysis confirmed the diagnosis of papillary fibroelastoma. The patient had an uneventful recovery and was discharged in stable condition. Conclusion: This case highlights the importance of thorough cardiovascular assessment prior to non-cardiac surgery, as it may uncover rare but clinically relevant conditions. Early detection and timely surgical intervention prevented embolic complications and preserved valvular integrity. Papillary fibroelastomas, although benign, require individualized management strategies based on size, location, and mobility.