A Rare Case of a Cardiac Papillary Fibroelastoma Arising in the Right Atrial Septum and Resected via Minimally Invasive Cardiac Surgery

Papillary fibroelastomas (PFEs) are rare, benign, primary cardiac tumors, typically found on the valve surfaces and more commonly on the left side of the heart, with occurrences in the right atrium even rarer. In this case, a highly mobile tumor was incidentally detected in the right atrium of an 83-year-old woman with advanced right lung cancer during preoperative transthoracic echocardiography and magnetic resonance imaging. Although the patient was asymptomatic and of advanced age, the tumor's high mobility warranted resection. Given her low surgical tolerance, simultaneous cardiac and lung surgery was deemed too risky. Therefore, we decided to prioritize right upper lobectomy for lung cancer, followed by minimally invasive cardiac surgery (MICS) for tumor resection. The postoperative course was uneventful, and pathological examination confirmed the diagnosis of a PFE. Although PFEs are benign and often asymptomatic, especially when located on the right side of the heart, they can lead to fatal complications such as acute myocardial infarction or pulmonary embolism. Therefore, early surgical resection should be considered, particularly for highly mobile tumors. In addition, resection via MICS may be an effective option, depending on the location and morphology of the tumor.