Papillary fibroelastoma: an uncommon cause for a transient ischemic attack.

269 THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2005 VOL. 14 NO. 5 S is the leading cause of morbidity in the elderly and the third leading cause of mortality in the United States. Cardioembolic causes may account for approximately 15%–20% of all strokes.1 The potential sources of cardiogenic embolism include atrial fibrillation, left ventricular dysfunction, rheumatic heart disease, prosthetic heart valves, and less commonly, intracardiac tumors. The frequency of primary cardiac tumors is approximately 0.02%, corresponding to 200 tumors in one million autopsies.2 Cardiac papillary fibroelastoma (PFE) is the second most common primary cardiac tumor (myxoma being the most frequent). These benign endocardial tumors predominantly affect the cardiac valves, and account for 75% of all cardiac valvular tumors. This case illustrates detection and surgical removal of the PFE in a patient who presented with a transient ischemic attack. A 64-year-old woman with a history of treated systemic hypertension presented to the emergency department complaining of a new right facial droop and difficulty speaking, which she noticed upon arising from sleep. She denied any prior neurologic events. Cardiac exam revealed a decrescendo grade II/IV diastolic murmur along the left sternal border with no radiation. Computed tomography of the head and bilateral carotid ultrasound exams were unremarkable. A two-dimensional transthoracic echocardiogram and a subsequent transesophageal echocardiogram (Figure 1) showed trace aortic regurgitation and a 1.3 × 0.8 cm rounded mobile mass on the Images in Geriatric Cardiology