背景:心脏乳头状纤维弹性瘤是一种罕见的良性肿瘤,经常被误认为是植被。主要无症状,会导致危及生命的并发症.虽然罕见,在受影响的瓣膜之间移动的乳头状纤维弹性瘤可能会阻碍瓣膜关闭并损坏瓣膜,导致瓣膜返流。内皮损伤增加发生感染性心内膜炎的风险。我们报告了一例罕见的高活动性乳头状纤维弹性瘤,起源于房间隔接触二尖瓣,导致二尖瓣反流,最终,感染性心内膜炎.
方法:一名疑似感染性心内膜炎的26岁女性在经历了一个月的间歇性发热后,从以前的医院转诊给我们。发烧之前,她一直在经历劳力性呼吸困难。此外,她在入院前两周接受了剖宫产手术.经胸超声心动图显示,来自房间隔的活动肿块接触二尖瓣,并伴有严重的二尖瓣反流。计算机断层扫描显示右股深动脉闭塞,有栓子。诊断为与高栓塞风险的移动植被相关的感染性心内膜炎,并进行了紧急手术。手术后,检查显示源自房间隔的乳头状纤维弹性瘤和二尖瓣感染性心内膜炎。组织病理学检查证实,最初被认为是移动植被的肿块是乳头状纤维弹性瘤。除心包炎外,术后病程顺利。感染性心内膜炎或乳头状纤维弹性瘤没有复发。
结论:高流动性乳头状纤维弹性瘤被认为是引起慢性二尖瓣返流和感染性心内膜炎的原因。可移动的乳头状纤维弹性瘤可导致附近瓣膜的内皮损伤,并使患者容易发生感染性心内膜炎。
BACKGROUND: Cardiac papillary fibroelastoma is a rare benign tumor, which is often mistaken for a vegetation. Predominantly asymptomatic, it can cause life-threatening complications. Although rare, mobile papillary fibroelastoma movement between affected valves may hamper valve closure and damage the valve, leading to valvular regurgitation. Endothelial damage increases the risk of developing infective endocarditis. We report a rare case of a highly mobile papillary fibroelastoma originating from the atrial septum touching the mitral valve, leading to mitral regurgitation and, eventually, infective endocarditis.
METHODS: A 26-year-old woman with suspected infective endocarditis was referred to us from a previous hospital after having experienced intermittent fever for a month. Before the fever, she had been experiencing exertional dyspnea. In addition, she had undergone a cesarean section two weeks before this admission. A transthoracic echocardiogram showed a mobile mass originating from the atrial septum touching the mitral valve with severe mitral regurgitation. Computed tomography revealed an occluded right profunda femoris artery with an embolus. Infective endocarditis associated with a mobile vegetation with high embolic risk was diagnosed, and urgent surgery was performed. Following the surgery, examinations revealed papillary fibroelastoma originating from the atrial septum and infective endocarditis of the mitral valve. The histopathological examination confirmed that a mass initially thought to be a mobile vegetation was a papillary fibroelastoma. The postoperative course was uneventful except for pericarditis. There has been no recurrence of infective endocarditis or papillary fibroelastoma.
CONCLUSIONS: The highly mobile papillary fibroelastoma was thought to have caused both chronic mitral regurgitation and infective endocarditis. Mobile papillary fibroelastomas can cause endothelial damage to nearby valves and predispose patients to infective endocarditis.