Fibroelastomas
Are fibroelastomas dangerous? Get all the information about these tumors: causes, symptoms, and treatments.
Symptoms and Causes
A cardiac fibroelastoma, papillary fibroelastoma, or fibroelastic papilloma is a rare benign tumor that originates in the heart valves or, in some cases, in the ventricular endocardium. Among cardiac fibroelastomas, the most common types are mitral fibroelastoma (which arises in the mitral valve) and aortic fibroelastoma (which occurs in the aortic valve).
These tumors consist of mesenchymal cells, composed of a central core of dense connective tissue surrounded by a layer of hyperplastic endocardial cells. Fibroelastomas have a frond-like or villous shape, typically present as solitary masses, and are attached to the cardiac surface by a small stalk.
Since these tumors are benign, the prognosis for fibroelastomas is positive once the necessary treatment is performed.
Symptoms
Most fibroelastomas remain asymptomatic and are discovered incidentally. Symptoms only occur if the tumor interferes with valve function or if emboli form (fragments that break off and travel through the bloodstream). In such cases, symptoms may include:
- Chest pain.
- Shortness of breath with exertion.
- Fatigue.
- Wheezing.
- Arrhythmias.
- Syncope.
Causes
Fibroelastoma results from DNA mutations that cause abnormal cell proliferation, leading to the formation of tumor masses. Although the exact cause of this genetic alteration is unknown, several theories have been proposed:
- Cytomegalovirus infections.
- Chronic viral endocarditis.
- Initially thrombotic masses that are replaced by fibroblasts (cells that form connective tissue).
- Congenital origin.
- Previous radiotherapy treatment.
Risk Factors
The following risk factors are associated with the development of fibroelastoma:
- Radiotherapy in the thoracic area.
- Previous open-heart surgery.
Complications
Despite being a benign neoplasm, fibroelastomas carry a high risk of embolization, meaning that fragments of the tumor can break off and travel through the bloodstream, potentially blocking an artery or vein. Depending on the affected blood vessel and the organ it supplies, embolism may lead to:
- Stroke.
- Heart attack.
- Pulmonary embolism.
- Peripheral embolism (affecting arteries in the arms, legs, and abdomen).
- Sudden blindness.
- Sudden death.
Additionally, fibroelastomas can impair heart valve function, leading to leaks (regurgitation) or obstructions (stenosis) in blood flow. Both conditions severely impact the heart’s ability to pump blood, potentially causing heart failure.
Prevention
Since the exact cause of fibroelastomas is unknown, there are no specific preventive measures to avoid their formation.
Which Specialist Treats Fibroelastomas?
Fibroelastomas are diagnosed and treated by specialists in cardiology and cardiovascular surgery.
Diagnosis
The presence of a fibroelastoma is confirmed through imaging diagnostic tests:
- Transesophageal echocardiography: A specialized ultrasound probe is inserted through the esophagus to capture moving images of the heart, allowing detection of the tumor’s location and size.
- Magnetic resonance imaging (MRI): Using magnetic fields and radiofrequency waves, MRI provides highly detailed views of soft tissues, which can help assess the tumor mass if echocardiography results are inconclusive.
- Computed tomography (CT): This imaging technique, which uses X-rays to generate high-resolution images, can be used as an alternative to MRI.
Treatment
Depending on the size of the fibroelastoma and the presence of symptoms, several treatment options are available:
- Conservative management: For small, asymptomatic fibroelastomas with no apparent risk of embolization, periodic imaging studies are conducted to monitor their progression.
- Surgical resection: If the tumor is larger than one centimeter, symptomatic, or poses an embolic risk, complete surgical removal is performed.
- Follow-up: Fibroelastomas have a high recurrence rate, making regular check-ups necessary after surgery.
