Abstract Fibroelastomas are the second most common benign cardiac tumor1. They are small avascular structures with a mean size of 9mm, ranging up to 70mm, usually attached to the heart valves’ surface (aortic and mitral are the most affected, followed by tricuspid and pulmonary valves). Their etiology is unclear, but the hypothesis of coalescence of microthrombus at the coaptation margins of valves is the most widely accepted theory. On echocardiography, they are pedicled, mobile, with a filamentous surface, and usually have a speckled appearance with echolucencies and a stippled pattern near the edges. Clinically, they may be associated with embolic phenomena; however, in most cases, the diagnosis is incidental. We present a series of four clinical cases with an incidental diagnosis of fibroelastomas across the four cardiac valves as assessed by transthoracic echocardiography (Video 1; Figure 1). Video 1 From left to right and top to bottom: fibroelastomas of the anterior leaflet of the tricuspid valve, anterior leaflet of the mitral valve, left cusp of the pulmonary valve and left cuspid of the aortic valve, each corresponding to a different patient. Link: http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp4 Figure 1 From left to right and top to bottom: fibroelastomas of the anterior leaflet of the tricuspid valve, anterior leaflet of the mitral valve, left cusp of the pulmonary valve and left cuspid of the aortic valve, each corresponding to a different patient. tumor1 tumor 9mm mm 70mm affected valves. . valves) unclear theory pedicled mobile edges Clinically phenomena however 1. 1) bottom patient Link http//abccardiol.org/supplementarymaterial/2024/12102/20230222_IM_video01.mp4 httpabccardiolorgsupplementarymaterial20241210220230222IMvideo01mp4 httpabccardiolorgsupplementarymaterialIMvideomp http //abccardiol.org/supplementary material/2024/12102/2023 0222_IM_video01.mp4 abccardiol org supplementary material 2024 12102 2023 0222 IM video01 mp4 video mp http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp supplementarymaterial 20230222 http//abccardiol.org/supplementarymaterial/2024/12102/20230222_IM_video01.mp httpabccardiolorgsupplementarymaterial IMvideo httpabccardiolorgsupplementarymaterial20241210220230222IMvideo01mp abccardiolorgsupplementary material2024121022023 material/2024/12102/202 0222IMvideo01mp4 IMvideomp 0222_IM_video01.mp 202 1210 022 video0 2023022 material202412102202 material/2024/12102/20 0222IMvideo01mp 20 121 02 202302 material20241210220 material/2024/12102/2 2 12 0 20230 material2024121022 material/2024/12102/ material202412102 material/2024/12102 material20241210 material/2024/1210 material2024121 material/2024/121 material202412 material/2024/12 material20241 material/2024/1 material2024 material/2024/ material202 material/2024 material20 material/202 material2 material/20 material/2 material/
Resumo Os fibroelastomas são o segundo tumor cardíaco benigno mais comum. São estruturas pequenas, avasculares, com uma dimensão média de 9mm, podendo atingir até 70mm, habitualmente aderentes à superfície das válvulas cardíacas (válvulas aórtica e mitral são as mais comumente afetadas, seguidas das válvulas tricúspide e pulmonar). A etiologia não é clara, sendo a hipótese de formação de microtrombos nas margens de coaptação das válvulas a mais aceite. Na ecocardiografia apresentam aspeto pediculado, móvel, com superfície filamentosa, tipicamente com uma aparência pontilhada nas margens e ecolucente. Do ponto de vista clínico, podem estar associados a fenómenos embólicos, no entanto, na maioria dos casos o diagnóstico é incidental. Apresentamos de seguida quatro casos de diagnóstico incidental de fibroelastomas nas quatro válvulas cardíacas, diagnosticados por ecocardiograma transtorácico (ETT) (Vídeo 1; Figura 1). Vídeo 1 Da esquerda para a direita, de cima para baixo: fibroelastomas no folheto anterior da válvula tricúspide, folheto anterior da válvula mitral, cúspide esquerda da válvula pulmonar e cúspide esquerda da válvula aórtica, cada um correspondendo a um doente diferente. Em: http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp4 Figura 1 Da esquerda para a direita, de cima para baixo: fibroelastomas no folheto anterior da válvula tricúspide, folheto anterior da válvula mitral, cúspide esquerda da válvula pulmonar e cúspide esquerda da válvula aórtica, cada um correspondendo a um doente diferente. comum pequenas avasculares 9mm mm 70mm afetadas pulmonar. . pulmonar) clara aceite pediculado móvel filamentosa ecolucente clínico embólicos entanto ETT (ETT 1. 1) direita baixo diferente Em http//abccardiol.org/supplementarymaterial/2024/12102/20230222_IM_video01.mp4 httpabccardiolorgsupplementarymaterial20241210220230222IMvideo01mp4 httpabccardiolorgsupplementarymaterialIMvideomp http //abccardiol.org/supplementary material/2024/12102/2023 0222_IM_video01.mp4 abccardiol org supplementary material 2024 12102 2023 0222 IM video01 mp4 video mp http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp supplementarymaterial 20230222 http//abccardiol.org/supplementarymaterial/2024/12102/20230222_IM_video01.mp httpabccardiolorgsupplementarymaterial IMvideo httpabccardiolorgsupplementarymaterial20241210220230222IMvideo01mp abccardiolorgsupplementary material2024121022023 material/2024/12102/202 0222IMvideo01mp4 IMvideomp 0222_IM_video01.mp 202 1210 022 video0 2023022 material202412102202 material/2024/12102/20 0222IMvideo01mp 20 121 02 202302 material20241210220 material/2024/12102/2 2 12 0 20230 material2024121022 material/2024/12102/ material202412102 material/2024/12102 material20241210 material/2024/1210 material2024121 material/2024/121 material202412 material/2024/12 material20241 material/2024/1 material2024 material/2024/ material202 material/2024 material20 material/202 material2 material/20 material/2 material/