Cardiac papillary fibroelastoma

Papillary fibroelastoma(PFE)is a primary,histologically benign endocardial neoplasm.Though PFE has long been reported as the second most common primary cardiac neoplasm,it has since pulled ahead of cardiac myxomas,largely due to evolving cardiac imaging modalities.While PFEs are benign histologically,they have the potential for devastating clinical consequences,transient ischemic attack,stroke,myocardial infarction,syncope,pulmonary,and peripheral embolism.Despite increased detection rate,there remains uncertainty regarding etiology,exact prevalence,and clinical management of PFEs.This paucity of information is reflected by the lack of official guidelines on this matter.In this article,we aim to summarize the current state of understanding regarding PFE and discuss areas of ongoing controversy.

A valve-in-valve approach to manage severe bioprosthetic tricuspid valve stenosis

severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe tricuspid valve(TV)disease.[1]However,a redo sternotomy is rarely performed for isolated TV disease due to very high perioperative mortality.[2]Evolving percutaneous technology presents new frontiers in treatment,with the valveinvalve procedure emerging as an alternative.We present a case of a 65year woman with progressive symptoms due to failure of a bioprosthetic valve in the tricuspid position who was not a surgical candidate but underwent percutaneous intervention with significant clinical improvement.

Transcatheter interventions for severe tricuspid regurgitation:a literature review

The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.