Papillary fibroelastoma are generally small (mean 8 mm; up to 40 mm), usually single (>90%), typically attached to valve surfaces, and may be pedunculated and mobile.
A study from the Cleveland Clinic reported on a series of 162 patients with papillary fibroelastoma. Of these, 45% were on the aortic valve, most often the right coronary cusp, followed by the noncoronary cusp, and least often on the left coronary cusp.
A papillary fibroelastoma is generally round, oval, or irregular but homogeneous with well-demarcated borders (approximately 50% is attached via a stalk and is mobile).
Embolic events secondary to PFE have been described, with resulting stroke, transient ischemic attack (TIA), angina, sudden death, myocardial infarction (MI), pulmonary embolism, and retinal artery occlusion.
Surgical excision may be indicated in patients with large, mobile, left-sided tumors (>1 cm), those who have had embolic events, and those in whom complications are directly related to tumor mobility, such as coronary ostial occlusion.
Patients who are not surgical candidates may be given oral anticoagulants, but there are no randomized controlled data to support this.