An uncommon cause of coronary artery ostial obstruction: papillary fibroelastoma

Cardiac papillary fibroelastoma is a benign tumor that mainly affects cardiac valves. The tumor has the potential to cause angina and myocardial infarction due to embolization of tumor fragments. We describe a rare case of right coronary artery ostial obstruction by a 12 x 19 mm sized papillary fibroelastoma located in the sinus of Valsalva. The report underlies the importance of echocardiography in diagnosis and intraoperative treatment of this type of cardiac mass.

Papillary fibroelastoma of the heart

BACKGROUND: Fibroelastoma is a rare cardiac tumor that was originally described typically from autopsy findings. Thanks to improved imaging modalities, such tumors are today relatively easy to detect and therefore are actively searched for in patients with unclear embolic events. We present the cases of 2 patients recently treated in our clinic and review the recent literature pertaining to fibroelastomas. METHODS AND RESULTS: An electronic PubMed search revealed 186 cases reported between 1994 and 2003. Ninety-seven percent of the reported fibroelastomas were diagnosed in living patients in their fourth and fifth decades of life. The majority (86%) were symptomatic, with stroke, transient ischemic attack, myocardial infarction, and angina pectoris being the most commonly described. Echocardiography was the typical diagnosis modality. Surgical resection was completed in 95% of the cases. CONCLUSIONS: Although cardiac papillary fibroelastomas are rare and benign tumors, they cannot be considered as harmless endothelial lesions, because related embolic events are frequent and primarily involve adults in their active period of life. Echocardiography must therefore consider fibroelastoma in the differential diagnosis of every unclear systemic embolic event, especially because surgical resection can be considered as curative.

Características ultraestruturais do segmento abdominal da aorta de rato albino

The objective of the present research was to investigate the ultrastructural peculiarities of the aortic wall of the rat. Seven young adult rats were used, from which fragments of the infrarenal abdominal aorta were collected. After collection, the vascular segments were fixed and sent for analysis by scanning electron microscope. The elastic lamellae appear interposed with smooth muscular fibers; this pattern was verified mainly at the medial layer structure. Among the mural elements a well defined interrelationship was established through connective lamellae of the arterial wall. The collagen lamellae mainly provided anchoring among the elastic and smooth muscular constituents. The intimal layer showed special ultrastructural features, such as a non-continuous inner elastic lamina presented in certain sites of the vascular wall, followed by endothelial pores. This mural pattern of the abdominal aorta provided support to vascular functions such as shrinkage among the laminar composition of the arterial layers, also acting in mechanical properties of the vascular wall, such as viscoelasticity and contractility - essential actions to blood vessel hemodynamics.

Twenty years experience in oncologic surgery for primary cardiac tumors

Introduction. Primary cardiac tumors are uncommon in cardiac surgery. To investigate the clinical presentation, surgical results and long-term follow-up we retrospectively analyzed our experience in the treatment of primary cardiac tumors. Patients and methods. Ninety-one patients with primary cardiac tumors underwent surgery in our department in the last 20 years. Fifthy-one patients were female, the mean age was 62,2 years. Sixty-three had myxomas, 22 had papillary fibroelastoma, 4 had malignant neoformations and 2 had other benign tumors. Results. All myxomas, fibroelastomas and angiomyolipoma were radically removed. Only a palliative treatment was possible in malignant disease. In-hospital mortality was 1.2%. The mean follow-up time was 78.5 months. Three patients had recurrence of myxoma, all patients with malignant disease dead during the follow-up. Discussion. Primary benign cardiac tumors can be treated with low morbidity and mortality. The follow-up demonstrates that radical surgery is curative in case of benign tumors. The prognosis of malignant tumors is still poor. Palliative procedures have small impact on survival in these patients.