Author + information
- Received June 4, 2012
- Accepted June 12, 2012
- Published online December 11, 2012.
- Saranya Buppajarntham, MD⁎,†,
- Sudarat Satitthummanid, MD⁎,†,
- Poonchavist Chantranuwatana, MD‡,
- Kittichai Luengtaviboon, MD†,§,
- Pairoj Chattranukulchai, MD⁎,†,
- Smonporn Boonyaratavej, MD⁎,† and
- Sarinya Puwanant, MD⁎,†
A 56-year-old man with a history of ischemic stroke presented with progressive dyspnea. He denied any history of fever. On the exam, he had a wide pulse pressure and a grade 3/6 diastolic blowing murmur. Two- and 3-dimensional transesophageal echocardiography demonstrated a pedunculated mass (A1 to A3, arrows;Online Videos A1, A2, and A3) with a thin stalk consistent with papillary fibroelastoma attached to the noncoronary cusp (NCC) and another small mobile echodensity (B1 and B2, arrowheads;Online Videos B1 and B2) on the left coronary cusp (LCC) of the aortic valve. Severe aortic regurgitation (A4, arrowheads;Online Video A4) caused by traction of the NCC by the tumor, and hence malcoaptation of the aortic valve, was noted. The patient underwent aortic valve replacement. Gross pathology revealed an 8-mm gelatinous tumor with multiple fronds (C, arrowheads) on the NCC and stromal destruction of the LCC. Histopathological exam revealed multiple papillary projections (D) composed of hyalinized central cores lined by a single layer of endothelium (E), typical of papillary fibroelastoma. Tissue and hemoculture were negative for bacterial growth. AO = aorta; LA = left atrium; LV = left ventricle; RCC= right coronary cusp.
- Received June 4, 2012.
- Accepted June 12, 2012.
- American College of Cardiology Foundation