Discussion CPF predominate in adults and are particularly frequent between the 4th and 8th decades of life. Most cases are probably acquired, however the etiology is unknown.5) CPF are more frequently located on the aortic valve (40%), tricuspid valve (17%), mitral valve (14%), pulmonary valve (13%), left atrium (7%), right atrium (2%), right ventricle (2%), and left ventricle papillary muscle (1%).6) Inhibitors,research,lifescience,medical Left ventricular CPF is rare, only reported via case reports.7) Although it is found incidentally, it can result in life-threatening complications, such as coronary and cerebral embolism, acute valvular dysfunction and sudden

death.8) The most common clinical presentations are stroke, syncope, mesenteric ischemia, pulmonary emboli and sudden death.5) The clinical presentation is determined by location, size, and mobility of the tumor and when they arise from the left sided heart, systemic embolism is frequent. The treatment of choice of CPF is surgical excision, which is safe without Inhibitors,research,lifescience,medical causing significant morbidity or mortality. When valvular involvement is present, excision with valve repair or replacement is curative. Asymptomatic non-mobile or right side CPF could be followed-up closely.4),5) The diagnostic method of choice for CPF is TTE or transesophageal

Inhibitors,research,lifescience,medical echocardiography (TEE), although the ultimate diagnosis of CPF is based on histopathology. The most characteristic echocardiographic features that identify a tumor as a CPF are small size (usually Inhibitors,research,lifescience,medical < 1.5 cm), pedical or stalk attachment to endocardium, with high mobility, and refractive appearance and areas of echolucency within the tumor.2) Although no extensive studies have yet quantified the diagnostic

yield of TEE for CPF http://www.selleckchem.com/products/SB-202190.html compared with TTE, TEE is considered to be more accurate in diagnosing CPF. For tumors with a diameter < 0.2 cm, the sensitivity of TTE was only 61.9% and of TEE was 76.6%. In contrast, the sensitivity and specificity of TTE for CPF with a diameter > 0.2 cm are 88.9% and 87.8%, respectively.9) However, it is impossible to differentiate CPF Inhibitors,research,lifescience,medical from myxomas or thrombi, using TTE or TEE alone. Magnetic resonance imaging (MRI) may be more helpful than TEE in detecting the extent of the lesion invading the myocardium. MRI typically demonstrates a CPF mass on a valve leaflet or on the endocardial surface below of the affected cardiac chamber and increase accuracy of diagnosis by showing the differential enhacement with respect to the surrounding normal cardiac structures.10) Histopathologically, CPF are composed of a central stalk with radiating villus-like projections. The papillae are avascular structures, which contains a core of dense collagen fibers admixed with varying amounts of reticulin and elastin fibers. The cells lining the elongated papillae are hyperplastic endothelial cells, occasionally bulging from the surface.11) The lining epithelium is contiguous with the rest of endocardium.