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IN PRESS
Mitral Valve Papillary Fibroelastoma as the Cause of Ischemic Stroke in a Young Patient: A Case Report

Milena Miranda Vasconcelos, Caroline Ferreira da Silva Mazeto Pupo da Silveira, Marcello Laneza Felício, Marcelo Padovani de Toledo Moraes, Renato Teixeira, Stella de Angelis Trivellato, Gabriel Pinheiro Modolo, Rodrigo Bazan, Silméia Garcia Zanati Bazan

Brazil Department of Cardiology, Botucatu Medical School – UNESP, São Paulo State University, Botucatu, SP, Brazil

Am J Case Rep 2021; 22:e930561 :: DOI: 10.12659/AJCR.930561

Available online: 2021-02-03, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication.
The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

#930561

BACKGROUND Primary cardiac tumors represent less than 5% of total cardiac tumors. Fibroelastoma is a rare benign cardiac tumor that is usually asymptomatic but is acknowledged for its emboligenic potential for causing cardiac, neurological, and vascular symptoms and increasing patient morbidity and mortality.
CASE REPORT This report describes the clinical case of a 27-year-old woman who entered the Emergency Department with motor aphasia and hemiparesis in the right dimidium. A brain computed tomography scan was performed at admission, which showed left frontal-parietal hypodensity. The diagnosis of ischemic stroke was made, but cerebral reperfusion therapy with intravenous recombinant tissue plasminogen activator was not instituted due to the time that had passed since ictus (15 h 40 min). On the first day of hospitalization, the patient had a fever, with no apparent infectious cause. She underwent transthoracic echocardiogram that showed a sessile, isoechoic mass adhered to the atrial surface of the anterior mitral valve leaflet, measuring 6.8×5.5 mm. Antibiotic therapy with ceftriaxone and gentamicin was initiated due to the initial diagnosis of infective endocarditis. Three blood culture samples had negative results. Given a differential diagnosis of fibroelastoma, transesophageal echocardiography and cardiac resonance imaging were performed, and the findings were compatible with a diagnosis of mitral valve fibroelastoma. After clinical discussion, the patient was referred to cardiac surgery and underwent tumor resection with anatomopathological diagnosis of papillary fibroelastoma of the heart valve.
CONCLUSIONS Young patients with ischemic stroke must be investigated with transthoracic and transesophageal echocardiograms. Papillary fibroelastoma is potential cause of ischemic stroke in young patients, and surgical resection is curative and has excellent prognosis.

Keywords: Echocardiography, Doppler; Endocardial Fibroelastosis; Stroke

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