Thread by @iamritu

1/#Tweetorial #papillary #fibroelastoma for
#ASEchoJC 10/23

🐙= #PFE 1975 named #papillary #fibroelastoma by #armed #forces #institute of #pathology

#papilloma 1973

#Collagen core with elastic fibers & matrix covered by endothelium sheath
Attached by stalk
multiple fronds

2/ What is the incidence of #PFE 🐙 compared to #myxoma (diagnosed in same time period)?

#PFE 511 vs. #myxoma 112

#PFE incidence ~1/1000

common “benign”primary ❤️tumor #modern #EchoFirst (Most common @MayoClinicCV)

#myxoma (autopsy based prevalence)

bit.ly/2Am05Y9

3/How to tell if a #PFE🐙by #echofirst ?
(Vs.Atypical myxoma,SBE,
Llambl’s)
small mobile mass attached #endocardial surface frondlike extensions #independent motion stippled border
Usually on atrial surface of AV valves or either side of semilunar valves,🚫interfere valve Fxn

4/what is risk of #PFE 🐙?

largest single series of #PFE > 500 cases over 16 yrs

Group 1: 185 pts Surgery 1a)primary excision 51%
1b)add on to surgery 49%

Group 2: 326 #echo 👀like #PFE & no #surgery or #pathology
had ⬆️ CVA risk 6% at 1 yr & 13% at 5 yrs

5/ any echo criteria to exclude risk of emboli? No

#PFEs 👀speckled with echolucencies

characteristic stippled edge, with shimmer or vibration at tumor–blood interface notable in larger tumors & finger-like projections = fronds #pathology ➡️ “sea anemone”

6/ #PFE 🐙location?

Aortic most common
bit.ly/2CvSEzf

routine #TTE for other indications likely misses a sizeable proportion of asymptomatic #PFE 🐙 not linked to neurological/embolic events

Also 👀 company it keeps...

7/To ✂️ or not to ✂️?

patients who are surgical candidates ➡️”expert surgical center” for ✂️

Patients who not surgical candidates/ increased risks treated with antiplatelet agents 💊

#data has #bias #selection #referral #verification

no randomized multicenter trials

8/What is #PFE rate of #recurrence post ✂️?

median f/u 1.6 years, ~2/3 of ✂️ patients had f/u #echofirst & evidence of recurrent #PFE🐙 in 3 patients 1.6%
bit.ly/2Am05Y9

0 % prior series bit.ly/2CvSEzf
@mirvatalasnag @joemaleszewski 📸

9/ Size matters?

Pts treated ✂️ had larger #PFE than those treated 💊 (9.76 mm vs. 7.57 mm)@MayoClinicCV

~1/5 of ✂️pt had #PFE unexpectedly dx during #intraop #TEE (2 small 2 👀by #TTE)

Recommend ✂️ if >1 cm but case-by-case basis, ✂️when benefit–risk ratio appears favorable

🐙clinical presentation- ie symptoms (~1/3 cases incidental finding) #FITSurvivalGuide

☄️Embolization: either tumor or thrombus causing
– Stroke/TIA
– MI
– Sudden death
– Syncope
– Peripheral ischemia
Pulmonary embolism
Endocarditis

Follow #ASEchoJC for cases tomorrow 8pm