Mitral papillary fibroelastoma as a cause of cardiogenic embolic stroke: report of two cases and review of the literature

Papillary fibroelastoma (PFE) is a rare benign tumour that attaches to the endocardial surface, mostly on cardiac valves. Though usually asymptomatic, it can be the source of several complications. To date, 49 cases have been reported of embolic stroke with a PFE as the probable origin. Case reports : (i) a 39-year-old male presented with ischemic embolic stroke; the presen ce of a PFE was assessed by means of transoesophageal echocardiography and confirmed by pathological findings; (ii) a 32-year-old woman presented with sudden onset of left hemiparesis; a cardiogenic embolic stroke was suspect ed, and a diagnosis of PFE was made based on echocardiographic and patholog ical findings. In both cases, surgical excision of the tumours was performe d with no recurrences at follow-up. Two mechanisms can explain the formatio n of emboli in PFE: dislodgement of the tumour leaves or fibrin-platelet ag gregation on the endocardial surface of these leaves. Transthoracic echocar diography may lead to the suspicion of a PFE, but transoesophageal echocard iography is required for confirmation. Prompt surgical excision is indicate d in most cases. Anticoagulation is only recommended in situations of high surgical risk and during the wait for surgery.