Mitral Papillary Muscle Papillary Fibroelastoma in Obstructive Hypertrophic Cardiomyopathy: A Surgically Treated Embolic Source.
4 affiliations
- 1Division of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada.
- 2Division of Pathology, Toronto General Hospital, Toronto, Ontario, Canada.
- 3Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
- 4Division of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: [email protected].
Abstract
Background
Papillary fibroelastoma, an uncommon cardiac tumor, can cause systemic embolization and raise unique diagnostic and therapeutic challenges when superimposed on a hypertrophic cardiomyopathy.Case summary
A 71-year-old woman with obstructive HCM, prior unilateral retinal artery occlusion (RAO), and progressive exertional dyspnea was referred for Mavacamten therapy. An incidental mitral chordal mass was found on baseline transthoracic echocardiography, suspicious for papillary fibroelastoma. Given the prior unilateral RAO and symptomatic LVOT obstruction, septal myectomy and mass excision were performed. Histopathology confirmed papillary fibroelastoma, and her symptoms and LVOT gradients improved significantly.Discussion
This case underscores the importance of comprehensive imaging to identify rare valvular tumors as potential embolic sources in patients with obstructive HCM and prior embolic events, with important management implications.Take-home message
Mitral papillary fibroelastoma in obstructive HCM, even if "incidental," can be a surgically correctable embolic source beyond atrial fibrillation and may warrant combined resection and myectomy.
Related
- Managing a mavacamten non-responder in obstructive hypertrophic cardiomyopathy: A case report
- Percutaneous endomyocardial ablation as a septal reduction strategy in symptomatic obstructive hypertrophic cardiomyopathy: A 20-year single-center observational experience.
- Hypertrophic obstructive cardiomyopathy complicated by severe midventricular obstruction treated with percutaneous transluminal septal myocardial ablation using simultaneous contrast imaging with left ventriculography and coronary angiography: a case report
- GLP-1 Receptor Agonist Use and Long-Term Outcomes in Hypertrophic Cardiomyopathy With Obstructive Sleep Apnea
- Life-long management of atrial fibrillation in a patient with hypertrophic obstructive cardiomyopathy following alcohol septal ablation: A10-year follow-up case report
BibTeX
@article{rashidi2026mitral,
title = {{Mitral Papillary Muscle Papillary Fibroelastoma in Obstructive Hypertrophic Cardiomyopathy: A Surgically Treated Embolic Source.}},
author = {Negin Rashidi and Mahdi Montazeri and Cathy Cao and Michael Seidman and Anthony Ralph-Edwards and Harry Rakowski},
journal = {JACC. Case reports},
year = {2026},
month = oct,
doi = {10.1016/j.jaccas.2026.110553},
url = {https://europepmc.org/article/MED/42847571},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Mitral Papillary Muscle Papillary Fibroelastoma in Obstructive Hypertrophic Cardiomyopathy: A Surgically Treated Embolic Source.
AU - Negin Rashidi
AU - Mahdi Montazeri
AU - Cathy Cao
AU - Michael Seidman
AU - Anthony Ralph-Edwards
AU - Harry Rakowski
PY - 2026
DA - 2026/10/01
JO - JACC. Case reports
DO - 10.1016/j.jaccas.2026.110553
UR - https://europepmc.org/article/MED/42847571
AB - Background Papillary fibroelastoma, an uncommon cardiac tumor, can cause systemic embolization and raise unique diagnostic and therapeutic challenges when superimposed on a hypertrophic cardiomyopathy.Case summary A 71-year-old woman with obstructive HCM, prior unilateral retinal artery occlusion (RAO), and progressive exertional dyspnea was referred for Mavacamten therapy. An incidental mitral chordal mass was found on baseline transthoracic echocardiography, suspicious for papillary fibroelastoma. Given the prior unilateral RAO and symptomatic LVOT obstruction, septal myectomy and mass excision were performed. Histopathology confirmed papillary fibroelastoma, and her symptoms and LVOT gradients improved significantly.Discussion This case underscores the importance of comprehensive imaging to identify rare valvular tumors as potential embolic sources in patients with obstructive HCM and prior embolic events, with important management implications.Take-home message Mitral papillary fibroelastoma in obstructive HCM, even if "incidental," can be a surgically correctable embolic source beyond atrial fibrillation and may warrant combined resection and myectomy.
SN - 2666-0849
ER -