There are no prospective randomized trials of management of patients diagnosed with car- diac tumors after stroke or TIA; however, surgical exci- sion of papillary fibroelastoma has been associated with decreased risk of stroke compared with control subjects in 1 single-center study.592 For patients with metastatic disease to the heart or with right-sided tumors, paradoxical embolism of tumor or venous thrombus through a PFO could occur. Recommendation-Specific Supportive Text 1. Retrospective studies have shown increased risk of stroke with left-sided cardiac myxoma and papil- Atrial myxomas can occur in any cardiac chamber but are noted most frequently in the left atrium adherent to the interatrial septum. Broad morphological variation of atrial myxomas has been described, and more villous tumors are felt to have greater embolic and thromboembolic potential. Papillary fibroelastomas are fibrinous mobile tumors occurring most frequently adher- ent to a cardiac valve with nearly equal distribu- tion across the cardiac valves.587 In a single-center study of 323 patients after excision of a cardiac tumor, the OR of embolism associated with left atrial tumors was 1.95 and higher (4.17) with aortic In another series of 725 patients with papillary fibroelastoma, tumor mobility and aor- tic valve location were independent predictors of Less common tumors and metastatic lesions in the heart have been anecdotally associ- ated with stroke; however, there is not enough evi- dence to make a consistent recommendation for those circumstances. For patients with stroke or TIA whose evaluation reveals a left-sided cardiac tumor, consideration should be given to tumor exci- sion to reduce the risk of recurrent stroke. Knowledge Gaps and Future Research Cardiac tumors are rare, and systematic research has been limited to case series, leaving gaps in our under- standing and opportunities for future research. 