The Clinical Dilemma of Cardiac Fibroelastic Papilloma

Cardiac papillary fibroelastomas (CPFEs) are one of the most challenging cardiovascular abnormalities that can be encountered. Although uncommon, some studies have reported them to be more prevalent than myxomas. Despite being frequently asymptomatic, they are capable of resulting in systemic emboli, particularly cerebrovascular accidents. They are often found incidentally in asymptomatic individuals or in patients in whom other risk factors for systemic emboli are present. At present there are virtually no prospective or controlled data available regarding their risk for subsequent events, benefit from surgical intervention or response to antiplatelet or anticoagulant medications. Absent firm guidance for management, clinical judgment on a case-by-case basis is paramount. CPFE are lesions that can present that most difficult decision of whether or not to perform cardiac surgery in a perfectly asymptomatic individual. In this article, we will discuss the morphology and pathology, clinical manifestations, diagnosis, treatment, and prognosis of cardiac papillary fibroelastoma.