Cardiol Young 2007; 17: 678–680 r Cambridge University Press ISSN 1047-9511 doi: 10.1017/S104795110700131X First published online 22 October 2007 Brief Report A papillary fibroelastoma of the tricuspid valve Filipa Parame ´s, 1 Ana Carric ¸o, 2 Fa ´tima F. Pinto 1 1 Paediatric Cardiology Department, Hospital de Santa Marta, Lisbon, 2 Paediatric Cardiology Department, Hospital de Sa˜o Joa˜o, Oporto, Portugal Abstract Primary cardiac tumours are rare in children. Of these, papillary fibroelastomas are unusual but benign, usually being found in adults. There are only sporadic cases reported in children. We diagnosed such a papillary fibroelastoma involving the tricuspid valve in an asymptomatic child during a routine cardiac investigation. Keywords: Cardiac surgery; cardiac mass; paediatric P RIMARY CARDIAC TUMOURS ARE RARE IN children, with Beghetti and colleagues 1 reporting an incidence of 0.32% in a total of 27,640 patients with cardiac disease. The diagnosis has increased in the last decade due to the improvement in non-invasive imaging techniques. Of these tumours, papillary fibroelastomas are rare and benign, accounting for less than one-tenth of all primary cardiac tumours, 2 but still representing the commonest tumour afflicting the cardiac valves. 3 In children, however, there are only sporadic reports. The patients are usually asympto- matic, and the lesions are often diagnosed incidentally in the process of cardiac investigation for an unrelated problem, at necropsy, or during cardiac surgery. 4 We describe here an asymptomatic lesion involving the tricuspid valve, discovered incidentally in the process of cardiac investigation of an otherwise healthy child. Case report A 6-year-old asymptomatic boy was referred to our department for diagnosis and treatment of a mass involving the tricuspid valve. His past medical history was not relevant. One year previously, an echocardiographic evaluation had been performed because of discovery of a heart murmur during a routine examination. The investigation disclosed a dysplastic tricuspid valve, with redundant localized thick tissue, albeit in an otherwise normal heart. A repeat echocardiogram performed one year after the first revealed an echo dense tumour arising from the septal leaflet of the valve, with moderate tricuspid regurgitation. On examination, he had a soft pansystolic heart murmur, graded at 2 from 6, and best heard at the third and fourth left intercostals space at the sternal border. For a more accurate assessment, we performed a transoesophageal echocardiogram, which revealed a very mobile mass with multiple papillary fronds, 18 millimetres in diameter, attached by a stalk to the atrial aspect of the tricuspid valve and projecting into the right outflow tract. The study confirmed the presence of moderate tricuspid valvar regurgitation (Fig. 1). Because of its mobility, and the risk of embolisation, the mass was surgically removed. Histopathologic examination provided the diagnosis of papillary fibroelastoma (Fig. 2). The postopera- tive recovery was uneventful, and after six months of follow up, the child remains asymptomatic, with no recurrence of the tumour. Discussion Cardiac tumours are rare at all ages, and are even less common in infants and children. Cardiac Correspondence to: Filipa Parame ´s, Rua de Campolide, nr. 24 – 98 Dto, 1070-036 Lisbon, Portugal. Tel: 1(351) 91 458 0477; Fax: 1(351) 21 812 7682; E-mail: f_parames@hotmail.com Accepted for publication 4 April 2007