CARDIAC PAPILLARY FIBROELASTOMA - A TREATABLE CAUSE OF TRANSIENT ISCHEMIC ATTACK AND ISCHEMIC STROKE DETECTED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Transesophageal echocardiography (TEE) is used frequently in patients with cerebrovascular ischemia. On TEE, a typical appearance of a cardi ac fibroelastoma is that of a pedunculated, mobile mass attached to a leaflet of a valve. Surgical excision of the lesion may lead to resolu tion of the symptoms and prevent further cerebrovascular ischemic even ts; valve replacement is seldom necessary. Herein we describe three pa tients with cerebral or ocular ischemia in whom histologic study confi rmed a cardiac papillary fibroelastoma after initial detection by TEE, Cardiac papillary fibroelastomas should be considered in the differen tial diagnosis of transient ischemic attack and stroke, even in cases of recurrent events in the same vascular distribution. Although the us e of echocardiography in the evaluation of stroke and transient ischem ic attack is controversial, TEE must be considered in patients in whom the cause of cerebrovascular ischemia is unclear after noninvasive ne urovascular studies or transthoracic echocardiography, even if the pat ient's cardiac history and the findings on physical examination are no rmal.