**Author details**

conduction abnormalities, and cardiomyopathies due to myocardial fibrosis or coronary disease have also been described. International guidelines on cancer management recommend aggressive management of cardiovascular risk factors and performing perfusion exams or echocardiograms at baseline and 10 years after radiation therapy to detect coronary disease

In terms of the additional incidental finding of a PFE on the papillary muscle, it should be noted that PFEs are the second most common primary benign cardiac tumor after myxoma, and it most often affects the heart valves, as opposed to myxomas, which are most often found

A cardiac MRI with gadolinium showed that the solid mass on the papillary muscle exhibited late enhancement, suggesting that the mass was consistent with a primary cardiac tumor rather than a metastatic lesion. The characteristic irregular surface with mobile papillae

The valves most frequently affected by PFEs are the mitral and aortic valves. In our experience with a total of 54 papillary fibroelastomas [5], in 29.6% (16/54) of patients, they were located in the endocardium of the left ventricle (LV), as in this case. The most common symptoms are due to a peripheral embolism, and the following symptoms have been described: stroke, acute myocardial infarction, and sudden death due to an embolism or obstruction of the coronary ostium. This type of cardiac tumor is not associated with valvular regurgitation. Several authors have reported that this type of tumor is more often seen in elderly patients with longstanding heart disease; therefore, this suggests that they occur due to mechanical damage and involve a degenerative process [6]. In accordance with this theory, in a series of 17 patients with a diagnosis of fibroelastoma, echocardiography was shown to correlate well with pathological findings, and these tumors were usually found in areas of cardiac irritation, such as the aortic and mitral valves [5]. This information proved to be very important in our case, since the damage caused by radiotherapy might have affected the valvular and subvalvular mitral apparatus, thus enhancing the potential development

We report the case of a patient with radiotherapy-induced symptomatic severe mitral regurgitation and an asymptomatic papillary fibroelastoma, which is a rare complication of thoracic radiotherapy that required valve replacement and resection of the tumor. The latent period between radiotherapy and these complications was 10 years and was related to the dose of radiation received. The increase in survival seen in cancer patients has resulted in an increased frequency of these types of complications. This unusual mechanism of formation of an actinic papillary fibroelastoma should be disseminated among cardiologists. In patients who have survived for long periods of time after radiotherapy, it is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for

and valvular lesions in these patients [4].

observed on the TEE suggested that the tumor was a PFE.

in the atria.

128 Cancer Survivorship

of this type of tumor.

**4. Conclusion**

detecting them.

Tomás Francisco Cianciulli1,2\* and María Cristina Saccheri1

\*Address all correspondence to: tcianciulli@gmail.com

1 Department of Cardiology, Echocardiography Laboratory, Hospital "Dr. Cosme Argerich", Buenos Aires, Argentina

2 Researcher of the Ministry of Health of the Government, Buenos Aires, Argentina
