**2.2 Papillary fibroelastoma**

Papillary fibroelastoma is a rare, primary benign cardiac tumor that is most frequently found in the cardiac valves (9). It is the third primary cardiac tumor after myxoma and lipoma. These tumors are mostly found incidentally on post mortem. However, because of high tendency for systemic emboli, prompt diagnosis and management is necessary. Other rare presentations such as sudden death have been reported (10-12).

Papillary fibroelastoma represents 7.9% of benign primary cardiac tumor in adults (9). Approximately 90% of primary fibroelastomas arise from valves on ventricular side of pulmonary and aortic valve and atrial side of mitral and tricuspid valve (13-14). Aortic or mitral valves are mostly affected (15-16). The tricuspid valve is most affected in children; however, mitral and aortic valves are mostly affected in adults (17). Echocardiography remains the main tool for detection of this tumor. Because of involvement of cardiac valves other diagnosis such as infective endocarditis, degenerative changes and 0Lamble's excrescences should be kept in mind. Typical echocardiographic features include round, oval or irregular appearance, with a homogenous texture with small stalk (18). Surgical removal is indicated for large mobile tumors.
