**Introduction/Hypothesis:**
Nearly one third of all strokes in the United States can be classified as cryptogenic and are associated with high rates of recurrence. Cardioembolic etiology is thought to be a common cause. Echocardiography has an essential role in evaluating patients with cryptogenic stroke for cardiac risk factors. Papillary fibroelastoma (PFE) and left atrial septal pouch (LASP) are less common risk factors that can be identified. We present a patient diagnosed with cryptogenic stroke and imaging findings suggestive of PFE and LASP.

**Methods**
Initial Evaluation: A 44-year-old female presented with a two-week history of ongoing dizziness, right facial numbness, and right forearm numbness.  MRI of the head demonstrated evidence of a left medial cerebellar stroke.  Initial workup included intracranial and extracranial vascular imaging as well as laboratory analysis for thrombophilia which returned negative.  Transesophageal echocardiogram demonstrated a fingerlike mass on the mitral valve concerning for PFE. A septal defect was concerning for PFO versus LASP.

**Results**
Management: Cardiology was consulted to close the PFO but a wire was unable to be passed through the septum.  On further radiologic reveiw, LASP was suspected.  Robotic assisted mitral valve debridement and left atrial septal pouch excision with peripheral bypass was performed.  Pathology demonstrated the mass to be benign fibromembranous tissue.  The patient was discharged on postoperative day 3.  No recurrent stroke or surgical complications were observed in the 30-day postoperative period.

**Conclusion**
Patients with cryptogenic stroke merit a thorough cardiovascular evaluation for possible risk factors of embolic sources. PFE and LASP are less common causes of emboli that can be identified with echocardiogram. New surgical modalities such as robotic cardiac surgery reduce the morbidity of heart surgery and may allow for improved evaluation and treatment of these sources of emboli.



Papillary Fibroelastoma and Left Atrial Septal Pouch- Identifiable Risk Factors in Cryptogenic Stroke Treatable with a Robotic Surgical Approach:  A Case Report