Left atrial papillary fibroelastoma: a rare cause of multiple cerebral emboli.

Papillary fibroelastomas have been increasingly described since the widespread use of cardiac echocardiography. Most often diagnosed incidentally, papillary fibroelastomas may embolize, mainly to the cerebral circulation. The aortic valve is predominantly affected. The left ventricle is the most frequent nonvalvular location. We present a case of a 59-year-old man who had recurrent episodes of cerebral ischemic attacks and required coronary artery bypass surgery. The overall neurologic investigation was normal, including a transthoracic echocardiography. A 5 x 5 mm pedunculated, mobile mass was described on the intraoperative transesophageal echocardiography. The excision was performed through the left atrial appendage during the coronary artery bypass surgery. The microscopic examination demonstrated a papillary fibroelastoma. The unusual localization and management of papillary fibroelastomas are discussed.