Dynamic obstruction of the left main coronary artery ostium by a papillary fibroelastoma

Cardiovasc Pathol. 2014 Jan-Feb;23(1):57-8. doi: 10.1016/j.carpath.2013.05.004. Epub 2013 Jul 15.

Abstract

Background: Benign tumours of the heart are usually detected as incidental findings during echocardiography. Most cases are intracardiac tumours, with myxoma being the most frequent entity. We present images of a patient with acute myocardial infarction and a concomitant extracardiac benign tumour in the aortic root.

Methods: Transesophageal echocardiography, coronary computed tomography angiography, cardiac surgery and histology of the excised tumour were performed.

Results: A mobile mass was found in the aortic root obstructing the left main coronary artery ostium during diastole. Coronary CT angiography indicated severe coronary artery disease and the patient underwent bypass surgery and excision of the tumour. The excised tumour was identified as papillary fibroelastoma.

Conclusions: Papillary fibroelastoma is the second most benign tumour of the heart. More than other tumours it is prone to embolization. Extracardiac location as in our case is very rare but dangerous since embolization may occur spontaneously or associated with catheterization.

Keywords: Acute coronary syndrome; Myocardial infarction; Papillary fibroelastoma; Sinus of valsalva; Transesophageal echocardiography.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Biopsy
  • Coronary Angiography / methods
  • Coronary Artery Bypass
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / etiology*
  • Coronary Stenosis / surgery
  • Echocardiography, Transesophageal
  • Fibroma / complications*
  • Fibroma / diagnosis
  • Fibroma / surgery
  • Heart Neoplasms / complications*
  • Heart Neoplasms / diagnosis
  • Heart Neoplasms / surgery
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Tomography, X-Ray Computed
  • Treatment Outcome