WHEN AN INCIDENTAL HEART MURMUR BECOMES ISCHEMIC BOWEL: A CASE OF AORTIC VALVE PAPILLARY FIBROELASTOMA
Aujla S, and Patel V. WHEN AN INCIDENTAL HEART MURMUR BECOMES ISCHEMIC BOWEL: A CASE OF AORTIC VALVE PAPILLARY FIBROELASTOMA. J Am Coll Cardiol 2023; 81(8):3760.
J Am Coll Cardiol
Background: Papillary fibroelastomas have a prevalence of up to 0.28%. These benign endocardial tumors can result in embolic phenomena, myocardial infarction, and sudden cardiac death.
Case: A 59 year-old woman with depression, hypertension, and hypothyroidism was found to have an incidental murmur at a routine office visit. TTE revealed a mobile mass on the aortic valve non-coronary cusp. She was scheduled for TEE but presented to the emergency department for abdominal pain. Troponin levels and EKG were normal. TEE showed an aortic valve mass 1 × 1 cm on the ventricular surface of the noncoronary cusp with mild aortic valve insufficiency. The mass was resected and biopsy revealed papillary fibroelastoma. She was found to have ischemic bowel and underwent subtotal colectomy. CT abdomen showed bilateral renal cortical infarcts. She was discharged home on apixaban 5 mg twice daily.
Decision-making: Our patient developed bowel and renal infarcts, likely embolic phenomena due to the fibroelastoma. There are no evidence-based guidelines regarding anticoagulation choice, duration, or initiation. She was placed on apixaban 5 mg twice daily due to her extensive thrombotic complications. There may be a possible benefit to starting anticoagulation at suspicion of diagnosis.
Conclusion: This case highlights the importance of prompt diagnosis of papillary fibroelastoma in order to prevent critical complications. We hope that our patient has reduced risk of thromboembolic events compromising quality of life.