Gowda Ramesh M, Khan Ijaz A, Nair Chandra K, Mehta Nirav J, Vasavada Balendu C, Sacchi Terrence J
Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA.
Am Heart J. 2003 Sep;146(3):404-10. doi: 10.1016/S0002-8703(03)00249-7.
With the advent of echocardiography, cardiac papillary fibroelastoma (CPF) is being increasingly reported. The demographics, clinical characteristics, pathological features, treatment, and prognosis of CPF are examined.
Cases, case series and related articles on the subject in all languages were identified through a comprehensive literature search.
Seven hundred twenty-five cases of CPF were identified. Males comprised 55% of patients. Highest prevalence was in the 8th decade of life. The valvular surface was the predominant locations of tumor. The most commonly involved valve was the aortic valve, followed by the mitral valve. The left ventricle was the predominant nonvalvular site involved. No clear risk factor for development of CPF has been reported. Size of the tumor varied from 2 mm to 70 mm. Clinically, CPFs have presented with transient ischemic attack, stroke, myocardial infarction, sudden death, heart failure, presyncope, syncope, pulmonary embolism, blindness, and peripheral embolism. Tumor mobility was the only independent predictor of CPF-related death or nonfatal embolization. Symptomatic patients should be treated surgically because the successful complete resection of CPF is curative and the long-term postoperative prognosis is excellent. The symptomatic patients who are not surgical candidates could be offered long-term oral anticoagulation, although no randomized controlled data are available on its efficacy. Asymptomatic patients could be treated surgically if the tumor is mobile, as the tumor mobility is the independent predictor of death or nonfatal embolization. Asymptomatic patients with nonmobile CPF could be followed-up closely with periodic clinical evaluation and echocardiography, and receive surgical intervention when symptoms develop or the tumor becomes mobile.
随着超声心动图技术的出现，心脏乳头肌纤维弹性瘤（CPF）的报道日益增多。本文对CPF的人口统计学、临床特征、病理特征、治疗方法及预后进行了研究。
通过全面的文献检索，确定了所有语言关于该主题的病例、病例系列及相关文章。
共识别出725例CPF患者。男性占患者总数的55%。发病高峰在80岁左右。肿瘤主要位于瓣膜表面。最常受累的瓣膜是主动脉瓣，其次是二尖瓣。左心室是主要的非瓣膜受累部位。目前尚未报道CPF发生的明确危险因素。肿瘤大小从2毫米到70毫米不等。临床上，CPF可表现为短暂性脑缺血发作、中风、心肌梗死、猝死、心力衰竭、先兆晕厥、晕厥、肺栓塞、失明及外周栓塞。肿瘤活动度是CPF相关死亡或非致死性栓塞的唯一独立预测因素。有症状的患者应接受手术治疗，因为成功完整切除CPF可治愈疾病，且术后长期预后良好。对于不适合手术的有症状患者，可给予长期口服抗凝治疗，尽管尚无关于其疗效的随机对照数据。无症状患者若肿瘤活动，也可接受手术治疗，因为肿瘤活动度是死亡或非致死性栓塞的独立预测因素。无症状且肿瘤不活动的CPF患者可定期进行临床评估和超声心动图检查密切随访，一旦出现症状或肿瘤活动则接受手术干预。
