Beyond Tradition: AngioVac-Assisted Extraction of a Right-Sided Papillary Fibroelastoma

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Papillary fibroelastoma is an uncommon benign tumor, usually left-sided. Tricuspid involvement is rare and may mimic endocarditis, creating diagnostic and therapeutic challenges. CASE An 80-year-old woman with hypertension, diabetes, and hyperlipidemia presented with fever, altered mentation, and MSSA bacteremia from a plantar ulcer. Transthoracic echocardiography was nondiagnostic, but transesophageal imaging showed a 2.2 × 2.0 cm mobile mass on the anterior tricuspid leaflet. Although suspected to be vegetation in the setting of bacteremia, her frailty and prohibitive surgical risk prompted reconsideration of the approach. DECISION-MAKING A multidisciplinary team weighed embolic risk against surgical morbidity. Given her comorbidities, AngioVac-assisted percutaneous debulking was chosen. The mass was extracted, gelatinous in appearance, and histopathology confirmed papillary fibroelastoma. Recovery was uneventful, and she was discharged on postoperative day three with intravenous antibiotics. This case illustrates how advanced imaging and collaborative decision-making can guide individualized management when surgery is not feasible. CONCLUSION Right-sided papillary fibroelastoma is rare and may be mistaken for endocarditis. In selected high-risk patients, AngioVac provides a safe, minimally invasive alternative to surgery, offering both therapeutic benefit and tissue diagnosis.

Volume

87

Issue

13 Suppl

First Page

A1921

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1921

DOI

10.1016/j.jacc.2026.02.4784

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