Author + information
- Received March 4, 2013
- Accepted March 12, 2013
- Published online September 24, 2013.
- Ahmed Bashir, MB BS∗,
- Adrian T. Warfield, MB, ChB†,
- David Quinn, BSc, MD‡ and
- Richard P. Steeds, MA, MD∗
A 69-year-old man presented following a collapse. A computed tomography head scan confirmed multifocal cerebral emboli. Subsequent transesophageal echocardiography showed moderate mixed aortic valve disease and a large (1.8 × 1.4 cm), mobile, cauliflower-like mass with a broad-based attachment to the ridge at the mouth of the left atrial appendage (A and B, Online Videos 1 and 2). Color Doppler demonstrated flow into the recesses. Cardiac magnetic resonance imaging confirmed the location and broad-based attachment (arrow, C). This was excised via a superior transseptal approach to the left atrium, and macroscopically, the mass appeared to be multiple, delicately fronded papilliform tissue. These presented a “sea anemone”-like appearance when immersed in formalin (D). Microscopically, sections confirmed complex papillae composed of variably edematous, paucicelluar, hypovascular, hyalosclerotic and fibroelastotic stroma surmounted by an attenuated monolayer of bland, endothelial cells (E). Benign papillary fibroelastoma accounts for 10% of all cardiac tumors. A nonvalvular location is rare, and hemodynamic consequences are rarely seen, with presentation due to embolization more frequent. MV = mitral valve.
- Received March 4, 2013.
- Accepted March 12, 2013.
- American College of Cardiology Foundation