Transesophageal echocardiography for detection of a papillary fibroelastoma of the aortic valve.

Papillary fibroelastoma (PF) is a benign cardiac tumor, typically attached to the cardiac valves. It is usually found incidentally at autopsy or surgery. It is rarely symptomatic, but can cause myocardial infarction, cerebral infarction and systemic embolism, even in young patients, and sometimes results in sudden death. We report on a case of a PF attached to the nodulus arantii of the left coronary cusp in a 56-year-old woman. She was referred to our institution due to a non ST-elevation myocardial infarction diagnosed by troponin positive-test. No other embolic source was identified. Diagnosis was obtained by two-dimensional echocardiography and confirmed by transesophageal echocardiography. After complete surgical removal of the tumor, we reconstructed the left coronary cusp with autologous pericardium. The histology revealed the diagnosis of a PF. Intraoperative transesophageal echocardiography confirmed complete restoration of aortic valve cusp coaptation. The clinical course was uneventful.